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Intrapartal care in a Swedish maternity unit after a quality-improvement programme
Karlstad University, Faculty of Social and Life Sciences.ORCID iD: 0000-0003-1382-4386
Karlstad University, Faculty of Social and Life Sciences.ORCID iD: 0000-0003-3385-3731
Karlstad University, Faculty of Social and Life Sciences.
2007 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 23, no 2, 113-122 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: to study the effects of a quality-improvement programme (QIP) on documented intrapartal midwifery care in the context of a conventional maternity unit. The aim of the QIP was to improve intrapartal midwifery care in accordance with the World Health Organization (WHO)'s recommendations for care in normal birth, without decreasing the number of spontaneous vaginal births. DESIGN: an audit instrument, developed from WHO recommendations for care in normal birth, was used to compare birth records from before and after the implementation of a QIP. Two hundred and twelve consecutive birth records were examined in the pre-test and 240 in the post-test period. SETTING: a conventional maternity unit in Western Sweden. FINDINGS: an overall documented improvement towards the recommendations by WHO was observed, especially in items for which guidelines were developed; more women were in active labour, intermittent auscultation increased in first and second stage, and oxytocin augmentation decreased in the first stage. The improved care did not influence the number of spontaneous vaginal deliveries or the duration of active labour and second stage. CONCLUSION AND IMPLICATIONS FOR PRACTICE: a QIP facilitated implementation of WHO's recommendations for care in normal birth. Most of the documented care changed in favour of the WHO recommendations. The findings highlight the importance of professional discussions and use of guidelines to implement changes and to show how midwifery care can change in a conventional ward. However, the findings must be interpreted with some caution because of the sample size and because the findings are based on documented, not observed, care.

Place, publisher, year, edition, pages
2007. Vol. 23, no 2, 113-122 p.
Keyword [en]
intrapartal midwifery care, ocumentation, Implementation, Intrapartal, Quality improvement, WHO
National Category
Medical and Health Sciences
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:kau:diva-1963DOI: 10.1016/j.midw.2006.03.012PubMedID: 17059859Archive number: 10.1016/j.midw.2006.03.012OAI: oai:DiVA.org:kau-1963DiVA: diva2:5212
Available from: 2008-01-29 Created: 2008-01-29 Last updated: 2016-09-16Bibliographically approved
In thesis
1. WHO:s rekommendationer för vård vid normal förlossning: Instrumentutveckling, barnmorskors dokumenterade vård och kvinnors uppfattningar
Open this publication in new window or tab >>WHO:s rekommendationer för vård vid normal förlossning: Instrumentutveckling, barnmorskors dokumenterade vård och kvinnors uppfattningar
2006 (Swedish)Doctoral thesis, monograph (Other academic)
Alternative title[en]
WHO’s recommendations for care in normal birth : Development of an instrument, midwives’ documented care and women’s perceptions
Abstract [en]

The aims of intrapartal care are a healthy mother and child and a positive birth experience for the woman. The aims should be achieved using the least possible number of interventions that is compatible with safety. The overall aim of this thesis was to develop an instrument based on the WHO’s recommendations for care in normal birth, to describe documented intrapartal care in a pre- and post-test following a quality improvement program and to elucidate women’s perceptions of received intrapartal care. The Delphi method was used to develop the instrument. Birth records were scrutinized in the pre-test (n=212) as well in the post-test (n=240). Women’s (n=138) perceptions were collected with a questionnaire.

An instrument with 69 questions and 24 follow-up questions was developed. The results from the pre-test showed that WHO’s recommendations were only partly followed. Intrapartal care for women at low-risk was similar to care for women at high-risk. Areas for improvement were identified and a quality improvement program was carried out during a two-year period. The post-test showed that the intrapartal care changed towards more adherence to WHO’s recommendations, especially for areas where guidelines were written and for women at low-risk. No statistically significant differences were found for the number of spontaneous vaginal deliveries, mother and child at low-risk after birth, active labour longer than 12 hours or second stage longer than one hour. The result from the women’s questionnaire showed that they to a great extent received care which encompassed practices that are demonstrably useful and should be encouraged. The women’s perceptions were that all received care was of great subjective importance.

The instrument developed from WHO’s recommendations can be used to examine intrapartal care. Midwives should carry out a risk assessment on the woman’s arrival at the maternity unit and plan the care together with the woman and significant others. Midwives’ documentation needs to change to incorporate interpersonal aspects. Women’s faith in intrapartal care shows the importance of continuous education for midwives in evidence-based care for normal birth. National evidence-based guidelines for intrapartal care need to be developed.

Abstract [sv]

Målet med förlossningsvården är en frisk mor och ett friskt barn samt en för kvinnan positiv upplevelse av förlossningen. Dessa mål skall eftersträvas med minsta möjliga ingrepp i förlossningens förlopp men med bibehållen säkerhet för mor och barn. Det övergripande syftet med denna avhandling var att, utifrån WHO:s rekommendationer avseende vård vid normal förlossning, utveckla ett instrument för att kartlägga barnmorskors dokumenterade förlossningsvård före och efter ett kvalitetsutvecklingsprogram samt belysa kvinnors uppfattningar av förlossningsvård.

Instrumentutvecklingen genomfördes med Delfimetoden. Förlossningsjournaler granskades vid såväl föremätning (n= 212) som eftermätning (n=240). Kvinnors (n=138) uppfattningar insamlades med en enkät.

Ett instrument omfattande 69 frågor och 24 uppföljningsfrågor utvecklades. Resultatet av föremätningen visar att WHO:s rekommendationer bara delvis följdes. Vården skilde sig i liten utsträckning för kvinnor med låg- respektive högrisk. Förbättringsområden identifierades och ett kvalitetsutvecklingsprogram genomfördes under en tvåårsperiod. Eftermätningen visar att vården förändrades i riktning mot WHO:s rekommendationer, särskilt för de områden där riktlinjer utvecklats samt för kvinnor i lågriskgruppen. Inga statistiskt signifikanta skillnader noterades beträffande antalet spontana förlossningar, antalet mödrar och barn som var lågrisk efter förlossningen, antalet aktiva förlossningar över 12 timmar och antalet förlossningar med utdrivningsskede över 1 timma. Enkätstudien till kvinnorna visar att de i stor utsträckning erhöll vård enligt den praxis som är bra och bör uppmuntras. Kvinnorna uppfattade genomgående att erhållen vård var av stor subjektiv betydelse.

Instrumentet med utgångspunkt från WHO:s rekommendationer kan användas vid kartläggning av förlossningsvård. Barnmorskor bör göra en riskbedömning vid kvinnans ankomst till förlossningen och planera vården tillsammans med kvinnan och anhöriga utifrån denna. Barnmorskors dokumentation behöver förändras för att såväl omfatta medicinsk-tekniska som mellanmänskliga aspekter. Kvinnors tillit till förlossningsvården visar på vikten av att barnmorskor erhåller kontinuerlig fortbildning i evidensbaserad vård avseende normal förlossning. Evidensbaserade nationella riktlinjer för vård vid förlossning behöver utvecklas.

Place, publisher, year, edition, pages
Fakulteten för samhälls- och livsvetenskaper, 2006
Series
Karlstad University Studies, ISSN 1403-8099 ; 2006:14
Keyword
Instrument, intrapartal care, midwives, quality assurance, WHO, women’s, perceptions, Barnmorskor, instrument, kvalitetsbedömning, kvinnors uppfattningar, WHO., förlossningsvård
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-1338 (URN)91-7063-044-5 (ISBN)
Public defence
2006-06-02, Geijersalen, 12A 138, Karlstad universitet, Karlstad, 09:00
Opponent
Supervisors
Available from: 2008-01-29 Created: 2008-01-29 Last updated: 2016-06-16

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