REVIEW
Prioritisation on the
labour suite
Joanne Ai Looi Lee
Lucy Kean
Abstract
The ability to successfully prioritise the workload on a labour suite is
an essential skill for a trainee obstetrician to develop. It requires a
trainee to develop effective leadership skills which encompass the
ability to work and communicate well in a multidisciplinary team of ob-
stetricians, anaesthetists and midwives who are all vital members of
the labour suite team. In addition, the trainee needs to be organised,
able to delegate work appropriately, and have a high level of situa-
tional awareness to anticipate issues arising on the labour suite.
Keywords labour suite; obstetrics; pregnancy; prioritisation; triage
General principles
The workload on a labour suite varies little over the course of 24
hours with the exception of elective work such as planned
caesarean sections and inductions of labour. The work carried
out is varied in nature and may include caring for women
requiring high dependency care through to supporting natural
birth. Similarly the experience levels of healthcare professionals
involved in intrapartum care will vary from newly qualified
midwives and foundation trainees through to Band 7 midwives
and consultant obstetricians. The working day is structured
around formal handovers and regular ward and board rounds
which should enable current and potential future problems to be
identified.
Handover
It is recommended that a period of time is allowed for a formal
handover between staff at the shift change over. The handover
should be multidisciplinary and involve the midwife co-
ordinating the labour suite, the incoming and outgoing obstet-
ric and anaesthetic teams and, where possible, the senior
obstetrician and anaesthetist covering the labour suite. A hand-
over that is supported by written documentation has been shown
to improve the retention of information minimising the risk of
important patient information becoming lost.
Structuring the handover using the SBAR (situation, back-
ground, assessment and recommendation) tool keeps the process
Joanne Ai Looi Lee BMBS MRCOG is an ST7 in Obstetrics and
Gynaecology at Nottingham University Hospitals NHS Trust, City
Hospital Campus, Nottingham, UK. Conflicts of interest: none
declared.
Lucy Kean BM BCh DM FRCOG is a Consultant in Fetal and Maternal
Medicine at Nottingham University Hospitals NHS Trust, City
Hospital Campus, Nottingham, UK. Conflicts of interest: none
declared.
OBSTETRICS, GYNAECOLOGY AND REPRODUCTIVE MEDICINE 27:3
of giving information efficient and succinct and allows all
members of the team to contribute to handover in an organised
way. All consultant led cases should be discussed along with new
referrals to the unit and midwifery led cases as required. The
handover for each patient should include the current manage-
ment plan and detail any outstanding investigations or jobs that
need to be completed. Any woman who is pregnant on a non-
obstetric ward should also be discussed so that care can be co-
ordinated.
Ward rounds
At the start of each shift there should be a ward round involving
the obstetric team, the co-ordinating midwife and, where
possible, the anaesthetist covering the labour suite. The safer
childbirth report recommends that when there is no consultant
presence on the labour ward there should be two ward rounds in
the day with a further round in the evening.
The complexity of individual cases and the workload on the
labour suite should determine the frequency of additional board
or ward rounds. Women receiving high dependency care on the
labour suite should be reviewed at least four-hourly. The ward
round is the time to identify any current problems and develop a
management plan. It is also an opportunity to identify potential
future problems and put in place plans to reduce the risk of
complications arising.
Balancing planned and emergency work
A large proportion of the workload on a labour suite is emer-
gency cases and the degree to which they are predictable will
vary. The planned work on a labour suite takes place on most
days and includes elective caesarean sections and inductions of
labour. In most units the planned workload will need to be fitted
in amongst the emergency work. In recent years, a gradual rise in
elective caesarean section and inductions of labour had increased
the workload on labour suite. Therefore, as part of the skill of
prioritisation, it is vital that a trainee develops an understanding
of balancing an increase workload of elective and emergency
work.
Non-technical skills
Originally adapted from the aviation industry, non-technical
skills are the cognitive, social and personal resource skills that
complement clinical and technical skills. Non-technical skills
such as effective leadership, high levels of situational awareness,
good decision making, workload management and communica-
tion can improve patient safety. Such skills are of particular
relevance in our specialty, where multiple tasks are often
required simultaneously.
The link between poor teamwork, communication and poor
maternity care has been highlighted in previous CMACE reports
and the Kings Fund safer birth enquiry with the outcomes being
increased maternal mortality and also significant morbidity and
economic losses, with obstetrics and gynaecology malpractice
claims representing half of the UK NHS litigation bill over the last
10 years. Therefore, there had been a more recent emphasis on
developing non-technical skills in medicine through leadership
and patient safety initiatives. The non-technical skills for sur-
geons (NOTSS) tool is a behavioural marker system initially
developed by the royal college of surgeons of Edinburgh to aid
71 Crown Copyright Ó 2017 Published by Elsevier Ltd. All rights reserved.
 REVIEW
trainers in providing feedback to trainees on non-technical as-
pects of their management. This has been adapted for use on
labour ward and gynaecological theatres and is gradually being
introduced into the curriculum.
Situational (or situation) awareness: situational awareness is
the ability to understand the workload and the resources
available to you and how you can best use this information to
prioritise tasks, anticipate future problems and take effective
actions. This concept is crucial to prioritising the workload on a
labour suite, where multiple tasks may present themselves
simultaneously, task interruption is common, and delegation is
often required. Situational awareness can occur at three levels,
namely the procedure, the patient and the relationship between
the team and environment. For example, whilst performing a
procedure such as a complex caesarean section, surgical com-
plications such as haemorrhage and injury to internal organs
need to be anticipated. Situational awareness whilst commu-
nicating to patients involves being aware of their concerns and
how our position as doctors and the way we communicate can
influence the dynamic with the patient. Situational awareness
of the workload on labour suite can be aided by regular board
rounds with the labour suite co-ordinator, anaesthetist and
junior colleagues in order to maintain a shared mental model
and in doing so any future events can be anticipated and
workload delegated appropriately and in a timely manner.
Decision making: decision making requires an assessment of
the situation and choosing a course of action. The woman
should be involved in the decision making process with the
benefit of clear, accurate information so that she can make an
informed choice. It is also necessary to review the result of a
chosen plan of action, check that the desired outcome has been
achieved and default to a ‘Plan B’ if necessary. Decision making
may be influenced by fatigue, time pressures, the feasibility of
available options, task demands, experience and the levels of
support available to you.
Communication: effective communication with the multidisci-
plinary team and the women is crucial to ensure optimal birth
outcomes. The ability to communicate effectively with the
mother and her partner is essential in order to gain their confi-
dence, provide reassurance in a stressful situation and to avoid
complaints. In emergency situations, once a crisis has been
recognised, verbalise the crisis clearly and use close loop
communication (task clearly and loudly delegated to specific
individuals and task accepted, performed and completion of task
acknowledged by the individuals) to ensure clear communica-
tion which will produce efficient team working. Staff should be
encouraged to use the SBAR format (situation, background,
assessment and response) in transmitting critical information
during handovers, advice telephone calls and referrals. Although
poor communication does not always lead to harm, it may lead
to an increase in frustration, complaints and litigations, and
delay in treatment.
Dissemination of information and mobilising the necessary
staff can be streamlined by making certain that the bleep
numbers of all relevant medical staff including on-call consul-
tants and a list of the extension numbers that may be required
OBSTETRICS, GYNAECOLOGY AND REPRODUCTIVE MEDICINE 27:3
(ward, laboratories, porters) are clearly displayed and up to
date.
Leadership: good leadership skills are essential to the smooth
running of the labour suite. This involves motivating, directing
and organising the medical and midwifery team, encouraging
individuals to work together, appropriately triaging and dele-
gating the workload, assessing performance and generating a
positive environment. One of the keys to good leadership is to
make decisions at the appropriate times so that clear plans exist
for all women, meaning that both patients and staff understand
what is happening and what will happen going forward.
Teaching
Labour suite is an excellent place for learning opportunity and
senior trainees are expected to engage with teaching medical
students and supervising more junior doctors and midwives
when labour suite activity allows. By supervising midwives with
suturing and cannulation, this will help empower the midwives
to be able to cannulate their own patients when access is
required prior to commencing Syntocinon or in a post-partum
haemorrhage. This in turn will provide greater flexibility to
delegate tasks during busy periods and help reduce any unnec-
essary delays. However, supervision of trainees should be
balanced against the trainee’s own educational needs and they
should only be supervising procedures to a level that is appro-
priate for their stage of training and competency level. Quiet
periods on the labour suite can be used to complete workplace
based assessments such as mini CEX, OSATS, NOTTS and to
provide constructive feedback.
Consultant presence on labour suite
Currently most maternity units in the UK have consultant
presence on the labour suite during daytime working hours.
Larger units may have a consultant presence out of hours as
well. The aim of this is to improve patient care and safety and
also to provide support and supervision to trainees to maxi-
mise their learning opportunities. Trainees should be encour-
aged to take this opportunity to complete workplace base
assessments requiring direct observation of a patient encounter
or clinical skill such as mini CEX, OSATS and labour ward
assessment tools. Situational awareness on labour ward can
also be assessed using the non-technical skills for surgeons
(NOTTS).
Simulation training
With the implementation of the European Working Time
Directive, specialty trainees are spending fewer hours on the
labour suite leading to a reduction in their experience of man-
aging obstetric emergencies. Successive confidential enquiries
have consistently identified problems such as poor communi-
cation and poor or non-existent team-working as obstacles to
the provision of care. Simulation based training provides an
opportunity to develop and practice the technical and non-
technical skills necessary to successfully manage obstetric
emergencies.
Senior specialty trainees should aim to become involved in
the running of these drills as this will help to fulfil the
72 Crown Copyright Ó 2017 Published by Elsevier Ltd. All rights reserved.
 REVIEW
requirements of the Advanced Labour Ward Practice and Labour
Ward Lead ATSM and will help with preparation for their future
role as a Consultant.
Prioritising (triage) the workload
The principles of triage are particularly important when the
workload on the labour suite is greater than the number of staff
or resources available. The aim of triage is to deliver the right
care, to the right person at the right time. It was initially devel-
oped for use by the military to aid the prioritisation of casualties.
Four categories are assigned to patients: immediate, urgent,
delayed and expectant. Immediate are those requiring lifesaving
treatment. Urgent patients require treatment within 6 hours.
Patients assigned to the ‘delayed’ category have less serious
problems that require management but not within a set time
period. Expectant are those that cannot survive treatment and
will rarely apply in obstetrics. In obstetrics, triage can be
simplified into a traffic-light system with ‘red’ for woman
requiring immediate attention, ‘amber’ for semi urgent cases and
‘green’ for elective cases which should be dealt with after man-
aging the more urgent cases.
Triage in obstetrics is determined primarily by threats to
maternal health and then by the presence of threats to the fetus.
Threats to maternal life are the immediate priority and in gen-
eral optimising the mother’s condition will improve the situa-
tion for the fetus. Women with immediately life threatening
problems should be assessed using a structured ABCDE
approach beginning with an assessment of the woman’s airway,
breathing and circulation, followed by an assessment of fetal
wellbeing. Any intervention identified alongside the assessment
should be implemented such as giving oxygen, gaining intra-
venous access and giving intravenous fluids. Triage should be
informed by the Obstetric Early Warning Score (OEWS); this
will aid early recognition of the sick woman by highlighting
small changes in a woman’s observations before a marked
deterioration is noted in any one system or in the woman’s
clinical condition.
Prioritisation of care on labour suite, and patient safety issues
have previously been assessed in the OSCE of the MRCOG part 2
examination and are now assessed in the part 3 exam. Trainees
should be encouraged to use the non-technical skills for surgeons
(NOTTS) tool to assess their prioritisation skills by a consultant
or senior midwife present on that shift alongside their reflective
diary to gain insight into their approach of the labour suite.
Use of resources and managing challenging situations
One of the skills required when learning to manage a labour suite
is making the best use of the resources available to you. This
includes making the best use of your time and the staff available
as well as physical resources such as equipment, rooms and
obstetric theatres.
Time management
Effective time management requires that problems are addressed
in a timely manner. Avoid deferring decision-making as the sit-
uation may become more difficult to manage. If there is uncer-
tainly in managing a case, discuss the case, seek advice early or
have the patient reviewed by a more senior colleague. It is also
OBSTETRICS, GYNAECOLOGY AND REPRODUCTIVE MEDICINE 27:3
important to try and anticipate situations where problems could
occur at the same time. For example, it would be sensible to
delay taking an elective case to theatre if there are twins in active
second stage, which will require obstetric input and may require
theatre urgently if there are complications. Equally, it might be
wise to continue induction of labour of twins or in a patient with
a high BMI during the day in order to aim for delivery during day
time when more staff are available.
Learning to delegate comes with experience and knowing the
competencies of your medical and midwifery staff. Appropriate
delegation will allow you to triage work more efficiently and will
result in a smoother running of the labour suite. Once tasks are
appropriately delegated, the workload may not be as unman-
ageable as you had initially thought.
Delegate a team member to review admissions with minor
problems so that they can be discharged or transferred to the
ward in a timely manner. This will allow midwifery staff to care
for women in labour and free-up rooms. All admissions to the
ward should have their medication prescribed and investigations
requested prior to transfer.
Theatre occupied
In many maternity units, elective caesarean sections take place
alongside emergency work on the labour suite. However in some
units, only a single team will be available. In this case, obstetric
staff should not engage in routine work if there are potential
emergency cases that may require transfer to theatre. However,
keeping the obstetric theatre vacant in anticipation of potential
problems that may arise is not justified as it will only delay
elective work. Consequently, situations will arise when theatre is
occupied and another emergency arises. In many units, there is
provision for a second theatre with a team that can be assembled
at relatively short notice. However if another theatre is not
available, various strategies can be adopted even in real emer-
gencies to buy extra time or make better use of the staff and
space available.
Strategies that may inform your decision making include tri-
aging cases using the Obstetric Early Warning Scores. This
strategy provides early evidence of maternal compromise and
can be particularly useful for cases that may be delayed such as
the repair of a third degree tear or a manual removal of placenta.
Similarly fetal blood sampling can be used to triage cases when a
delivery may need to be delayed and there are concerns
regarding fetal wellbeing.
Strategies that may buy extra time include the use of tocol-
ysis in situations where there are concerns regarding fetal
compromise in a woman who is contracting and filling the
maternal bladder in a cord prolapse may dislodge the presenting
part sufficiently to reduce cord compression improving the CTG
and fetal wellbeing whilst delivery is organised. Some problems
can be managed in the labour suite room. Third degree tear
repairs can be carried out in the labour suite room with an
epidural if the lighting and equipment are adequate. Under
exceptional circumstances, a manual removal of placenta could
be considered if the woman has an effective epidural. The
consultant should be informed if there is any deviation from
standard practice and this should be clearly documented in the
medical records along with the reasons for deviation from the
guideline.
73 Crown Copyright Ó 2017 Published by Elsevier Ltd. All rights reserved.
 REVIEW

Potential closure of the labour suite

The labour suite can occasionally be overwhelmed with ad- Example of labour suite board
missions, leading to resources being stretched and potential Room Parity Gestation
closure of the unit. Before considering closing the unit, it is
important to ensure that all the women on the labour suite need 1 P0 38 Admitted with pre-eclampsia and
to be there. The labour suite should be for women who are in headache, BP 180/100
labour or for those who require high dependency care that 2 P0 32 Admitted with tightenings for the last 6
cannot be provided on the antenatal or postnatal wards. A hours
board round, and if necessary award round with the labour 3 P0 39 Midwife led care, in 2nd stage and pushing
suite co-ordinator, to decide whether there are women who can for an hour
be discharged home or moved to the ward to free up rooms 4 P2 39 Induction of labour for gestational
should be carried out. Many maternity units also have a sepa- diabetes, diet control. Had propess for 24
rate 24-hour assessment unit to review non-labouring women hours. Awaiting an ARM for continuation of
presenting with minor ailments which will relieve workload on induction
the labour suite. Good team work is imperative. Discussion with 5 P2 Postnatal Normal delivery, Awaiting suturing e not
the co-ordinating midwife, supervisor of midwives and man- bleeding
agement is important when the level of work exceeds the unit 6 P0 40 Delayed 1st stage of labour, 5 cm with in
ability to provide safe care. coordinated contractions, no meconium
In this situation unit closure may be considered, though it is and normal CTG
recognised that this can then create ongoing problems when 7 P2 41 Retained placenta, trickling, EBL 400 ml
women have care provided in a different hospital, sometimes far good working epidural
from home. 8 P0 41 8 cm with Pathological CTG. No meconium
present
Staffing 9 P1 39 Undiagnosed breech, low risk pregnancy, 3
The limiting factor on many labour suites is the number of staff cm dilated membranes intact. Normal CTG
rather than the availability of resources such as rooms or theatre. 10 P2 Postnatal Day 1 post Emergency caesarean section
The labour ward manager or supervisor of midwives should be for failure to progress. EBL 2.5 L due to
informed if the workload on the labour suite exceeds the number atonic PPH. Bakri balloon in situ. Delivered
of midwives available as each labour suite has processes in place 6 hours ago
to increase staffing or to reduce workload. If the workload ex-
ceeds the medical staff available then the consultant obstetrician Table 1
and anaesthetist covering the labour suite should be asked to
attend if they are not already present and a plan made to manage <160/100. She needs fluid restriction of 85 ml/hour and her fluid
the cases. balance monitored to reduce the risk of pulmonary odema.
Magnesium may be required. Once her blood pressure has been
Example of a labour suite board (Table 1) stabilised the timing of delivery needs to be considered.
You are the ST6 obstetrics and gynaecology specialty trainee on The woman in room 2 needs a full assessment including
call for labour suite arriving for handover at 08.30 pm. The day abdominal and vaginal (speculum) examination to diagnose or
shift has been busy and all the rooms on the labour suite are exclude preterm labour. If threatened preterm labour is
occupied. The staff members available include an ST1 obstetrics confirmed, she will need steroids for fetal lung maturity and
and gynaecology specialty trainee who has been in the depart- tocolysis should be considered. One will also need to liaise with
ment for 9 months, and an anaesthetic ST5 specialty trainee. The the neonatal unit regarding cot availability and potential transfer
midwifery staff members include the co-ordinator, who can if safe and needed.
cannulate and suture. The consultant is on-call from home. In room 3, an update of the woman’s progress is required. She
may not need intervention at present if there is evidence of
What tasks are required in each room? progress in second stage and no suspicion of fetal compromise.
The woman in room 1 has severe pre-eclampsia that had just As a primiparous woman, she can continue pushing as a 2 hour
been diagnosed. She needs assessment of her symptoms of active second stage is reasonable before a medical review is
headache, abdominal pain visual disturbance and significant required. Amniotomy should be encouraged if her membranes
facial or leg odema. Structured clinical examination using ABCDE remain intact after 60 minutes of active stage.
approach is required including assessment of reflexes, clonus The continuation of the induction of labour in room 4 should
and fetal size using symphysis fundal height. She requires an be delayed until the ward activity settles down.
Obstetric Early Warning Score, fluid balance chart and fetal The woman in room 5 requires suturing of a second degree
assessment in the form of a CTG. Further investigation such as tear.
full blood count, urea and electrolytes, liver function test, protein The woman in room 6 needs a review of her progress in la-
creatinine ratio, clotting studies, group and save are also bour including assessing the frequency and strength of contrac-
required. The key management at present is to stabilise her blood tions and ensuring the fetal CTG remains normal. She may likely
pressure with antihypertensive medication aiming for a BP of require augmentation with Syntocinon.

OBSTETRICS, GYNAECOLOGY AND REPRODUCTIVE MEDICINE 27:3 74 Crown Copyright Ó 2017 Published by Elsevier Ltd. All rights reserved.
 REVIEW
The woman in room 7 has a retained placenta and delivered
30 minutes ago with active management of her 3rd stage. She
has trickled since delivery and her measured blood loss is 400
ml. Her bladder has been emptied. She needs intravenous ac-
cess with at least one wide bore cannula, a full blood count and
group and save should be taken. She should be started on an
OEWS if this has not already been done. She needs a vaginal
examination to ensure there are no significant ongoing bleeding
and to ensure the placenta is not just sitting at the cervix or
vagina. If the oxytocin is not successful within 30 minutes or if
there is evidence of ongoing bleeding then the woman should
be re-examined and a manual removal of placenta should be
organised (assuming the placenta cannot be delivered). Intra-
venous oxytocic agents should not be routinely used to deliver a
retained placenta. However, if the placenta is retained and the
woman is bleeding excessively, give intravenous oxytocic
agents whilst organising transfer to theatre for manual removal
of placenta.
The woman in room 8 needs a fetal blood sample. If it is
normal then labour can carry on but if a category 1 caesarean
section is required, the consultant may need to come in due to
the ward activity.
There needs to be a discussion with the woman in room 9
with regards to her ongoing management. If the pregnancy has
been uncomplicated and there are no contraindications to
external cephalic version (ECV) this may be discussed as an
option. If there are contraindications to ECV the mode of delivery
by either caesarean section or vaginal breech delivery needs to be
discussed.
The woman in room 10 needs to be reviewed to ensure she
remains stable over night by assessing her blood loss, recent
haemoglobin level, urine output and observations.
Who should review each room and is the staffing on
the labour suite adequate?
All the rooms on the labour suite are occupied and there is more
work to be carried out than members of staff available. Further
staff members may be needed. Much depends on how rapidly
events unfold and how efficiently the team available can be
utilised. Do not hesitate to ask for extra help if you believe this is
needed.
The woman in room 1 should be receiving one to one care
from a midwife with experience of high dependency care. She
will require a review by the most senior obstetrician and
anaesthetic registrar. The woman in room 2 should be reviewed
by an ST1. The Band 7 midwife can review the woman’s progress
in room 3 and in room 4 she can provide explanation for the
situation on labour ward and apologise for the delay. Room 5 will
need a review by a midwife who can suture or by a member of
the obstetric team. The woman in room 6 should be reviewed by
the obstetric ST6. The initial assessment of the woman in room 7
can be carried out by either the Band 7 midwife of obstetric ST1.
Room 8 requires a fetal blood sample which can be performed by
the obstetric ST1. Room 9 can initially be reviewed by the ob-
stetric ST1 however she will needs a full discussion of options
with the obstetric ST5. Room 10 can be reviewed the anaesthetic
ST5 or obstetric ST1.
If the fetal blood sample from room 8 is abnormal and re-
quires immediate delivery in theatre, then there will be
OBSTETRICS, GYNAECOLOGY AND REPRODUCTIVE MEDICINE 27:3
inadequate obstetric staffing on labour suite given the workload
on labour ward. Therefore the obstetric consultant needs to be
informed and asked to attend.
In which order should the problems be addressed?
The first priority is the woman in room 1 who has the potential of
developing an eclamptic fit. She should be reviewed by the most
senior obstetrician and anaesthetic registrar with the aim of
stabilising her blood pressure with intravenous antihypertensive
medication and sending off investigations urgently.
The urgent cases are room 7, room 8 and room 9. The woman
in room 7 is at risk of a postpartum haemorrhage and must be
proactively managed to prevent deterioration. She should be on
an OEWS chart and any evidence of haemodynamic instability or
increased vaginal bleeding warrants an urgent manual removal
of placenta. This can even be performed in the room if needed as
she has an effective epidural. The Band 7 midwife or obstetric
ST1 should review her initially. Room 8 requires an urgent fetal
blood sample which should be performed by the obstetric ST1. If
the results are normal, labour can be allowed to progress but
regular CTG review is required. If the FBS is abnormal immediate
delivery is required. The woman in room 9 with undiagnosed
breech could be establishing in labour. In view she is a multip-
arous, she could potentially progress quickly in labour. There-
fore, once the obstetric registrar is available, she should be
reviewed to assess progress and discuss options or vaginal
breech or caesarean section. ECV is more difficult once labour
establishes.
The cases requiring attention once the other problems have
been dealt with are room 2, room 3, room 4, room 5, room 6
and room 10. The woman in room 2 requires a review by a
member of the obstetric team for potential preterm labour. The
woman in room 3 will require a full assessment, but could
continue pushing if progress is still being made. Amniotomy
should be carried out if the membranes are still intact and she
will need continuous electronic fetal monitoring. A senior
midwife could assess this situation. The continuation of in-
duction in room 4 should be delayed. In room 5, hopefully a
midwife can assess and suture the perineal tear. The woman in
room 6 will require a full assessment with a consideration of
commencing a Syntocinon infusion. Finally in room 10, the
woman could be initially assessed by the anaesthetic ST5 or
obstetric ST1 to ensure there is no ongoing bleeding and her
coagulation studies, haemoglobin levels and observations are
stable. A
FURTHER READING
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2006e08. The eighth report on confidential enquiries into
maternal deaths in the United Kingdom. BJOG 2011; 118(suppl
1): 1e203.
Crofts J, Winter C, Sowter M. Practical simulation training for maternity
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OBSTETRICS, GYNAECOLOGY AND REPRODUCTIVE MEDICINE 27:3
Practice points
C Safe prioritisation of the labour suite workload begins with a
good handover at the beginning of the shift. Make notes and ask
questions.
C Non-technical skills such as good communication and effective
leadership are essential for maintaining safe performance in the
workplace and maintaining morale.
C Do not hesitate to ask for senior help if you do not know what the
best course of action is.
C Aim to anticipate potential problems instead of firefighting.
C Remember that maternal wellbeing takes priority over fetal well-
being. Improving the maternal condition will, in general, improve
the fetal condition.
C Use the Obstetric Early Warning score and structured ABCDE
approach to identify sick women and prioritize the workload.
C Good documentation is essential, particularly in circumstances
where you have deviated from standard practice.
C Use reflective practice to consider your approach to prioritization
and task delegation on the labour suite.
76 Crown Copyright Ó 2017 Published by Elsevier Ltd. All rights reserved.