Role of nurses and midwives in improving patient safety during childbirth: Evidence from obstetric trauma in OECD countries

Abstract

Objectives: To measure the role of nurses and midwives in reducing obstetric trauma as a proxy for safety failures during childbirth in member countries of Organization for Economic Co-operation and Development (OECD).

Methods: The number of practicing nurses' and midwives' density per 1000 population and the proportion of third- and fourth-degree obstetric trauma during vaginal delivery with instrument (OT₁) and without instrument (OT₂) in crude rates per 100 vaginal deliveries for patients aged 15 and over collected from World Development Indicators and OECD Health Statistics in 17 OECD countries during 2010-2017 period. The statistical technique of panel data analysis was applied to estimate the impact of nurses and midwives on improving patient safety during childbirth. The number of physicians per 1000 population, health care expenditure (HCE) per capita and total number of hospital beds per 1000 population were added in data analysis as control variables.

Results: The results of panel co-integration test and dynamic long-run models confirm that there were meaningful relationships from the level of nursing and midwifery staff to reducing OECD's obstetric trauma indicators with long-run magnitudes of -15.8614 for OT₁ and -0.0519 for OT₂. In addition, the results of panel error-correction model argue that if the long-run relationships between nursing and midwifery staff and obstetric trauma indicators are disturbed by the shortage in the needed nurses and midwives, then it takes at least 25 years for OT₁ and 18 years for OT₂ to reduce and restore back to equilibrium; that is quite a long time.

Conclusion: A higher proportion of nursing and midwifery staff is associated with higher patient safety during childbirth in OECD countries. Overall, our findings alert policy makers to consider the deleterious impacts of shortage in the level of nursing and midwifery staff on declining patient safety during childbirth as well as quality of acute care in OECD.

Keywords: Acute care; Childbirth; Midwifery staff; Nursing staff; OECD; Obstetric trauma; Panel data analysis; Patient safety.