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Weekend births pose higher risk for mothers, newborns
Mothers admitted to hospitals for a delivery on a weekend and children born on a weekend were at greater risk for adverse outcomes, including perinatal death, according to recent research in BMJ.
“This study highlights an association between day of delivery and aspects of performance; in particular, babies born at the weekend had an increased risk of being stillborn or dying in hospital within the first 7 days,” William L. Palmer, MA, MSc, an honorary research fellow in the department of primary care and public health at Imperial College London, and colleagues wrote. “Moreover, the results also suggest increases in the rates of other complications for both women admitted and babies born at weekends, with higher rates of puerperal infection, injury to neonate, and 3-day neonatal emergency readmissions.”
In the observational study, Palmer and colleagues analyzed medical records from 1,332,835 deliveries and 1,349,599 births from April 2010 to March 2012 across all hospitals that reported data to the English National Health Service dataset. Study groups were defined by admission and delivery date, not the date of any complications. The researchers examined records for perinatal mortality, infections, emergency readmissions or injuries. Outcomes related to staffing were determined by comparing outcomes to the amount of staff available.
The research wrote that the most common day for birth and delivery was Thursday; the least common was Sunday. On weekends, there were 21% fewer maternities compared with the average number on weekdays.
Study results showed that babies and mothers were at a higher risk for four of the seven adverse outcomes measured when admitted or born on the weekend. The outcomes with the highest rate of risk for weekend births were perinatal mortality (adjusted OR = 1.07; 95% CI, 1.02-1.13), puerperal infections (aOR = 1.06; 95% CI, 1.01-1.11) and neonatal injury (aOR = 1.06; 95% CI, 1.02-1.09).
The researchers estimated that the “weekend effect” would result in 770 additional perinatal deaths and 470 maternal infections per year compared with Tuesday births.
No association between staffing and adverse outcomes was found.
“Further work is needed to understand what organizational factors might influence the weekend effect and to investigate centers that have reduced the disparities in access and outcome in out of hours care,” Palmer and colleagues wrote. “Unless managers and practitioners work to better understand and tackle the problems raised in this paper, health outcomes for mothers and babies are likely to continue to be influenced by the day of delivery.”
In a related editorial, Jonathan M. Snowden, PhD, assistant professor, and Aaron B. Caughey, MD, PhD, professor and chair for the department of obstetrics and gynecology at Oregon Health and Science University, elaborated on some of the potential causes of the weekend phenomenon.
“The weekend effect in obstetrics fits within the broad concept of ‘capacity strain’ in health care systems — the process by which performance of a clinical unit can deteriorate above a certain threshold of patient volume, complexity (acuity), or both,” Snowden and Caughey wrote. “Given the decreased levels of staffing and availability of resources that characterize most hospitals at the weekend, a lower threshold above which capacity strain threatens patients’ outcomes is likely.
“Solutions will require extra resources, systems thinking, and all our creativity, to determine what explains the apparent protective effect of weekday delivery and how to extend these benefits to women who deliver at the weekend, and their babies.” – by David Costill
Disclosure: Palmer reports funding from the National Audit Office.
