Expectant mothers are having induction of labour delayed by up to five days because of short staffing in maternity units, an investigation has found.
Concerns have been raised at 10 hospitals, with warnings that the hold-ups are putting women and babies at risk.
Seven of the hospitals have been issued with warnings by the Care Quality Commission (CQC) since last year, with others reporting problems in board papers.
In some cases, women who were classed as “high risk” were forced to wait as long as five days for induction, without evidence that risks were being assessed.
In other cases, the delays occurred later, with women waiting more than 48 hours to be transferred to the delivery suite after the process had been started.
Induction is the inducing of labour by artificial means, which is encouraged if babies are overdue, or if there are risks to mother and baby because of conditions such as high blood pressure, or because the baby is not growing.
In 2021, national guidance from the National Institute of Health and Care Excellence said expectant mothers should be induced at 41 weeks - rather than up to 42 weeks - in order to reduce stillbirths and neonatal births.
A damning report on University Hospitals of Leicester NHS Trust rated two of its maternity sites as inadequate last week. The inspection report noted more than 1,300 “red flags” raised about delays in induction in labour at one of its sites, linked to shortages of staff in the course of six months.
An inspection of Blackpool Victoria Hospital in June 2022 found eight high-risk women waiting up to five days for induction amid severe shortages of midwives.
Monthly data showed 31 delays the previous month, of up to four days, without action taken to ensure induction within 24 hours of a woman’s waters breaking, to prevent the risk of potentially deadly infections.
In an action plan, the trust promised improvements including written risk assessments of women subject to delays and an expansion in the workforce.
One in six inductions at University Hospitals of Morecambe Bay Foundation trust were found to be being delayed, largely due to staffing, CQC found in an inspection in April this year.
Similar problems were found at North Manchester Hospital and Wythenshawe Hospital.
At Wythenshawe, nearly a third of women induced in February were not transferred to the delivery suite within 48 hours, inspectors said.
The reports, analysed by Health Service Journal (HSJ), found similar problems in March at County Durham and Darlington Foundation trust.
Latest figures show around 33 per cent of births are induced, up from 22 per cent in 2011/12.
Earlier this year the Healthcare Safety Investigation Branch said some maternity units had insufficient capacity to accommodate the number of women planned for induction.
It said that women, including those at high risk of complications, were not having their individual risks assessed when offered a date for induction.
Several NHS trusts have reported problems in board papers in recent weeks.
This month Medway FT’s board was told its maternity unit was unable to meet demand for induction of labour because of short-staffing, rating the issue high on its risk register.
Hull University Hospitals Trust also reported delays, while Liverpool Women’s Foundation trust reported 17 cases of delays.
Carolyn Jenkinson, CQC deputy director of secondary and specialist healthcare, told HSJ: “At some maternity services we’ve found women having to wait long periods of time to be induced or for transfer to a labour ward once the induction process has started, and in some cases a lack of effective monitoring during periods of delay.
“Where we have found concerns about delayed treatment – including induction of labour – we have made clear to those trusts that effective oversight of the issue is vital and that all action possible should be taken to mitigate any risk and keep people using the service safe.”
Birte Harlev-Lam, the executive director midwife at the Royal College of Midwives, said: “Safety is paramount, so midwives should only induce labour when there is a midwife available to support the woman and a bed on the labour ward.
“Inevitably, with the well-known staffing and resource issues in maternity services, there may sometimes be a delay, which is why effective monitoring by midwives is so important.”
Leicester trust said it had adopted its own locally defined red flags which were in addition to the standards set by Nice, to help to give it oversight of activity and demand.
Manchester University Foundation trust said it had reduced waiting times since the inspection in March.
County Durham and Darlington Foundation trust said that while a short risk did not pose a clinical risk, the trust was in the process of recruiting more staff to support women in this situation.
Medway trust said it was working to address the increased number of delayed inductions. University Hospitals of Morecambe Bay Foundation trust said any delays in induction of labour of more than four hours were reviewed by a senior clinician.
Trish Armstrong-Child, chief executive of Blackpool Teaching Hospitals NHS Foundation Trust, said: “We accept the findings of the CQC and we want to reassure our communities that we are already working towards making the necessary improvements required.
“The safety of mothers and their children is very important to all of us and we want to make sure that there is strong evidence of this as they continue to use our services over the coming weeks, months and years.”