Early labour services: changes, triggers, monitoring and evaluation.

OBJECTIVES: to identify the changes to early labour services, their triggers and monitoring. DESIGN AND SETTING: a mixed methods approach in two stages, firstly a postal questionnaire survey of Heads of Midwifery (HoM) services in NHS Trusts in England (cover sheet to each HoM and questionnaire for each unit in their jurisdiction) and, secondly, semi-structured telephone interviews with a purposive sample of senior midwives. The interviews sought further information about reasons for change; the impact of changes and explored the unit's particular innovations. PARTICIPANTS AND RESPONSE RATE: 145 (89%) NHS Trusts provided data (cover sheet and/or questionnaire); responses were received from all areas and types of unit. Seventeen HoMs or designated senior midwives were interviewed. FINDINGS: 83 of 170 units (49%) had made changes to early labour service provision during the past 5 years, including home assessment; the introduction of triage units and telephone assessment tools. Changes were more likely in high volume units and in consultant units with midwifery-led care areas. Further changes were planned by 93/178 (25%) units. Triggers for changes to early labour services comprised local or unit-based factors, including Category X (non-labour) admissions, response to service users and research evidence. The impact of Category X admissions on workload contributed to the triggers for change. Fifty-six (31%) could provide a confirmed figure or estimate for category X admissions. Experiences of introducing change included issues related to engagement of the workforce and the contribution of clinical leadership. Thirty-eight (48%) units did not routinely monitor use of early labour services. Overall monitoring of services was not significantly more likely in units that had made changes. Audit activity was reported more frequently in units that had made changes to their early labour services. CONCLUSIONS: early labour services had undergone significant changes following a range of triggers but the extent of change was not reflected in monitoring and evaluation activity. IMPLICATIONS FOR PRACTICE: Changes to service provision should be accompanied by monitoring and evaluation. Changes to services require utilisation of appropriate change management strategies.

Converting policy into care: women's satisfaction with the early labour telephone component of the All Wales Clinical Pathway for Normal Labour.

AIMS: This article is a report of a study of women's experiences of, and satisfaction with, telephone communications within the All Wales Clinical Pathway for Normal Labour ('the Pathway'). BACKGROUND: The Pathway was introduced throughout Wales over 2003-2004. Its philosophy emphasizes the desirability of a woman remaining at home until labour is established with assessment by telephone, in contrast to the more common scenario where the phone call is a precursor to admission and face-to-face assessment. METHODS: In 2005-2006, telephone interviews were carried out with 46 low-risk first-time mothers in Wales. This was a mixed-methods study with iterative quantitative and qualitative analysis, focusing on differences in the accounts of women with different levels of satisfaction. FINDINGS: Women were not well prepared for the Pathway; however, satisfaction was more strongly related to interpersonal interactions with midwives. Dissatisfied women reported unclear advice, unmet needs, unaddressed anxieties and negative midwife manner. 'Very satisfied' women were distinguished by feeling welcome to attend the maternity unit and by the perceived adequacy of the advice given. CONCLUSIONS: This study provides new knowledge about telephone interactions between first-time mothers and midwives around labour onset. This is important in a changing healthcare context in which face-to-face interactions are likely to become less routine. Being made to feel welcome to attend the maternity unit might appear counter to the Pathway philosophy, but appeared to reduce women's anxieties about 'being allowed in' or getting to hospital in time, and gave them confidence to remain at home longer.

Attitudes to prenatal testing and termination of pregnancy for fetal abnormality: a comparison of white and Pakistani women in the UK.

OBJECTIVES: To compare the attitudes of women from two different ethnic backgrounds to prenatal testing for a range of conditions, and to see if "clusters" of attitudes to different conditions could be identified, for which prenatal testing might be offered as a package. METHODS: Four hundred and twenty white and Pakistani women living in the UK were surveyed about their attitudes to prenatal testing and termination for 30 different fetal conditions. All participants had recently had a baby. RESULTS: Pakistani women held more favourable attitudes to prenatal testing, but less favourable attitudes to termination than their white counterparts. Both groups were most in favour of termination for the same four conditions: anencephaly, trisomy 13 or 18, quadriplegia, Duchenne muscular dystrophy. The rank ordering of conditions was also similar. Only 4% of Pakistani and 2% of white women wanted no prenatal testing at all. Fewer than a quarter of participants would consider a termination of pregnancy for 85% of the conditions, but only 25% of Pakistani women and 6% of white women would consider termination for none of the conditions. More advanced statistical analyses were used to measure how closely associated the 30 conditions were in respondents' answers. These analyses identified a principal dimension, reflecting the overall perceived seriousness of the conditions, and a cluster of severely disabling conditions-anencephaly, trisomy 13 or 18, quadriplegia, Duchenne muscular dystrophy, and severe learning difficulties-which stood out from the rest. Even within this cluster there remained a considerable amount of individual variation. CONCLUSION: Women in the study wanted to make up their own minds about the conditions that to them merited testing or termination. These findings have implications for obtaining informed consent.