PONE-D-20-30095

24 hour consultant obstetrician presence on the labour ward and intrapartum outcomes in a large unit in England: a time series analysis.

PLOS ONE

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Academic Editor

PLOS ONE

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Beck Taylor reports funding from the NIHR during the study duration.

Christine MacArthur reports funding from the NIHR during the study duration.

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Additional Editor Comments (if provided):

please make it clear in the results section of the abstract what the primary outcome increase actually is

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Reviewers' comments:

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Reviewer #1: Yes

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Reviewer #1: Yes

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Reviewer #1: No

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Reviewer #1: Yes

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Reviewer #1: The authors seek to evaluate the impact of 24/7 consultant presence in one maternity unit in England on maternal and perinatal outcomes, using a retrospective data analysis of routinely collected hospital data, using a time series analysis. This is an original study, on a topic that is highly relevant for practising obstetricians and health managers and the limitations of a retrospective analysis of routinely collected data are highlighted.

Major issues

This paper focuses on neonatal outcomes and more information on maternal outcomes would be useful. It is such a shame that the maternal data was not of high enough quality. It is clear in the paper there is no information on certain parameters for ITU admission etc, but I wonder if any of the other relevant items from the COS/systematic review such as maternal deaths, start of labour, tears, lengths of waiting time, lengths of second stage or other outcomes are available.

If not could a few more sentences be added explaining the maternal outcomes a little further, so the paper is covering maternal, as well as perinatal outcomes.

Devane D, Begley CM, Clarke M, Horey D, OBoyle C. Evaluating maternity care: a core set of outcome measures. Birth. 2007 Jun;34(2):164-72. doi: 10.1111/j.1523-536X.2006.00145.x. PMID: 17542821.

195 – Is the survey results already published elsewhere, or is this paper the primary dissemination of these results. If so more detail is needed on the methods of the survey. The survey aspect is not reproducible in future studies, with the current description of methods.

Minor issues

Abstract

The wording of the abstract results could be altered slightly. On my initial (quick read) I saw that the primary outcome had significantly increased, and this was not the conclusion. It is clear throughout the paper, that this is expected. However, slightly adjusting the wording in the abstract (which is all many readers will read) could make the message from the paper a little clearer in the abstract.

Should there be a short comment on maternal outcomes in the conclusion?

Line 55 -Add ref for the confidential enquiries

Line 120 – why was the 24/7 consultant cover ceased?

Table 1 – please write out IMD quartile in full, rather than abbreviation

Table 2 – stillbirth (ante or post partum) – should this be intra partum, rather than post?

242 – Could the maternal and neonatal outcomes be described in two separate paragraphs, rather than the PPH sentence mixed with information about the neonates

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Reviewer #1: No

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24 hour consultant obstetrician presence on the labour ward and intrapartum outcomes in a large unit in England: a time series analysis.

PONE-D-20-30095R1

Dear Dr. Taylor,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Andrew Sharp, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: