In Swiss maternity care, midwifery and nursing staff are scheduled in fixed rosters by unit and shift. The amount of staffing and the skill-mix are referred to as care supply. Care demand consists of the number of mothers and newborns combined with their complexities. Due to the unpredictable timing of natural birth, care demand cannot be scheduled while respecting the natural processes associated with pregnancy and childbirth. The critical issue that arises when the dynamic care demand exceeds the scheduled care supply is understaffing, ultimately affecting care quality. The challenge for staff planning is the alignment between care demand and care supply. In Swiss maternity care, however, neither staffing recommendations nor monitoring systems are in place. The “MaNtiS – Maternal and Neonatal Outcomes in Association with Midwifery Staffing” project of Luisa Eggenschwiler aimed to explore the effect of midwifery staffing on mothers and newborns to support clinical practice, management and policy.

In a first step, Luisa Eggenschwiler’s dissertation closes the knowledge gap regarding perinatal midwifery care demand variation in Switzerland, describing it for one tertiary hospital on unit- and on shift-level. Furthermore, the care demand was combined with care supply and their match was reviewed. In the labour ward, a mismatch between care demand and care supply was observed more often than in the prenatal and postnatal units. The labour ward had in almost every third shift understaffing of at least one midwife.

This understaffing on shift-level was then assessed upon its causal effect on maternal outcomes. The question of how international gold-standard midwifery staffing influences the rates of spontaneous vaginal births and the use of labour pain medication, was answered. In a target trial emulation using routine hospital data, women receiving one-to-one midwifery care throughout labour and birth were compared to women receiving less than one-to-one care. Women receiving one-to-once care experienced fewer interventions (more spontaneous vaginal births and less epidural anaesthesia), confirming that gold-standard midwifery staffing promotes physiological childbirth.

In the postnatal unit, such gold standards do not appear to exist, although few associations have formulated recommendations. In a third step, recommended shift-level staffing in the postnatal unit was assessed upon its causal effect on maternal and neonatal outcomes. In a target trial emulation, exclusive breastfeeding in mother–baby dyads that experienced 1-to-4 care during their hospital stays was compared with exclusive breastfeeding in dyads that received less care. Dyads receiving 1-to-4 care did more often exclusively breastfeed compared to those not receiving 1-to-4 care. Therefore, this staffing-ratio seems favourable for exclusive breastfeeding and could be considered in the Swiss context for implementation. For the outcome of healthy newborns, the data did not provide enough evidence to highlight a difference.

This dissertation has shown that high levels of mismatches between perinatal care demand and care supply due to variation in demand were measured in one tertiary hospital in Switzerland. Furthermore, such understaffing leads to reductions in quality of care in both labour wards and postnatal units. Implementing a monitoring system of demand-supply match paired with escalation mechanisms to early adjust for mismatches could be first steps to maintain and improve quality of care for mothers and their newborns.