• A H K Smith, A L Dixon, and L A Page.
• King's Fund, 11-13 Cavendish Square, London W1G 0AN, UK. a.smith@kingsfund.org.uk
• Midwifery. 2009 Feb 1;25(1):21-31.

Objectiveto explore health-care professionals' views about safety in maternity services. This paper identifies aspects of care that are less safe than they should be, possible ways to improve safety, and potential obstacles to achieving these improvements. This study was part of the King's Fund inquiry into the safety of maternity services in England.Designqualitative study with a sample of health-care professionals who work in maternity services and who responded to the call for evidence. Data were collected by questionnaire and analysed using thematic content analysis.Settingmaternity professionals throughout England were invited to take part.Participantsmidwives, obstetricians, student midwives, nurses, neonatal nurses, general practitioners, managers, hospital doctors and paediatricians. In total, there were 591 respondents.Measurements And Findingsparticipants were asked to respond to open-ended questions identifying aspects of maternity care that were less safe than they should be, potential solutions to improve safety of care, and any barriers to implementing these improvements. Problems described included the increasing social and medical complexity of the pregnant population, low staffing levels, inappropriate skill mix, low staff morale, inadequate training and education, medicalisation of birth, poor management, lack of resources and reconfiguration. Proposed solutions included more staff, better teamwork and skill mix, improved training, more one-to-one care, caseloading, better management, more resources, better guidelines and learning from incidents. Barriers to implementing improvements included stressed staff who were resistant to change, inadequate management/poor staff management relationships and financial restraints.Key Conclusionsthe responses of maternity professionals convey a deep sense of staff anxiety regarding how the problems they face pose a threat to safety.Implications For Practicepolicy makers and professional bodies need to take the concerns expressed by staff seriously. Concerted efforts are required to improve maternity services and support maternity professionals.

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