Competing Values Framework: A useful tool to define the predominant culture in a maternity setting in Australia

OBJECTIVE

To identify the predominant culture of an organisation which could then assess readiness for change.

DESIGN

An exploratory design using the Competing Values Framework (CVF) as a self-administered survey tool.

SETTING

The Maternity Unit in one Australian metropolitan tertiary referral hospital.

SUBJECTS

All 120 clinicians (100 midwives and 20 obstetricians) employed in the maternity service were invited to participate; 26% responded.

MAIN OUTCOME MEASURE

The identification of the predominant culture of an organisation to assess readiness for change prior to the implementation of a new policy.

RESULTS

The predominant culture of this maternity unit, as described by those who responded to the survey, was one of hierarchy with a focus on rules and regulations and less focus on innovation, flexibility and teamwork. These results suggest that this unit did not have readiness to change.

CONCLUSION

There is value in undertaking preparatory work to gain a better understanding of the characteristics of an organisation prior to designing and implementing change. This understanding can influence additional preliminary work that may be required to increase the readiness for change and therefore increase the opportunity for successful change. The CVF is a useful tool to identify the predominant culture and characteristics of an organisation that could influence the success of change.

The impact of electronic records on patient safety: a qualitative study

Background

Our aim was to explore NHS staff perceptions and experiences of the impact on patient safety of introducing a maternity system.

Methods

Qualitative semi-structured interviews were conducted with 19 members of NHS staff who represented a variety of staff groups (doctors, midwives, health care assistants), staff grades (consultant and midwife grades) and wards within a maternity unit. Participants represented a single maternity unit at a NHS teaching hospital in the North of England. Interviews were conducted during the first 12 months of the system being implemented and were analysed thematically.

Results

Participants perceived there to be an elevated risk to patient safety during the system’s implementation. The perceived risks were attributed to a range of social and technical factors. For example, poor system design and human error which resulted in an increased potential for missing information and inputting error.

Conclusions

The first 12 months of introducing the maternity system was perceived to and in some cases had already caused actual risk to patient safety. Trusts throughout the NHS are facing increasing pressure to become paperless and should be aware of the  potential adverse impacts on patient safety that can occur when introducing electronic systems. Given the potential for increased risk identified, recommendations for further research and for NHS trusts introducing electronic systems are proposed.

Electronic supplementary material

The online version of this article (doi:10.1186/s12911-016-0299-y) contains supplementary material, which is available to authorized users.

Why do some women choose to freebirth in the UK? An interpretative phenomenological study

BACKGROUND

Freebirthing or unassisted birth is the active choice made by a woman to birth without a trained professional present, even where there is access to maternity provision. This is a radical childbirth choice, which has potential morbidity and mortality risks for mother and baby. While a number of studies have explored women's freebirth experiences, there has been no research undertaken in the UK. The aim of this study was to explore and identify what influenced women's decision to freebirth in a UK context.

METHODS

An interpretive phenomenological approach was adopted. Advertisements were posted on freebirth websites, and ten women participated in the study by completing a narrative (n = 9) and/or taking part in an in-depth interview (n = 10). Data analysis was carried out using interpretative methods informed by Heidegger and Gadamer's hermeneutic-phenomenological concepts.

RESULTS

Three main themes emerged from the data. Contextualising herstory describes how the participants' backgrounds (personal and/or childbirth related) influenced their decision making. Diverging paths of decision making provides more detailed insights into how and why women's different backgrounds and experiences of childbirth and maternity care influenced their decision to freebirth. Converging path of decision making, outlines the commonalities in women's narratives in terms of how they sought to validate their decision to freebirth, such as through self-directed research, enlisting the support of others and conceptualising risk.

CONCLUSION

The UK based midwifery philosophy of woman-centred care that tailors care to individual needs is not always carried out, leaving women to feel disillusioned, unsafe and opting out of any form of professionalised care for their births. Maternity services need to provide support for women who have experienced a previous traumatic birth. Midwives also need to help restore relationships with women, and co-create birth plans that enable women to be active agents in their birthing decisions even if they challenge normative practices. The fact that women choose to freebirth in order to create a calm, quiet birthing space that is free from clinical interruptions and that enhances the physiology of labour, should be a key consideration.

Clinical nursing and midwifery research: grey literature in African countries

AIM

This study reviewed grey literature to assess clinical nursing and midwifery research conducted in southern and eastern African countries over the past decade.

BACKGROUND

The shortage of published nursing research from African countries severely limits the ability of practicing nurses and midwives to base clinical decisions on solid evidence. However, little is known regarding unpublished or unindexed clinical research ('grey literature'), a potentially rich source of information. Identifying these sources may reveal resources to assist nurses in providing evidence-based care.

INTRODUCTION

This scoping review of grey literature on clinical nursing and midwifery research in southern and eastern African countries helped to identify gaps in research and assess whether these gaps differ from published research.

METHODS

Systematic searches of grey literature were performed. Research was included if it was conducted by nurses in 1 of 25 southern or eastern African countries, between 2004 and 2014 and included patient outcomes. Data were extracted on location, institution, research topic, institutional connections and author information. Chi-square tests were performed to compare differences between indexed and non-indexed literature.

RESULTS

We found 262 studies by 287 authors from 17 southern and eastern African countries covering 13 topics. Although all topics were also found in indexed literature and there were statistically significant differences between the number of times, fewer topics were covered in grey literature vs. indexed.

DISCUSSION

Patient satisfaction and experience and traditional health practices were more likely to be published, whereas chronic disease, assault and paediatric-related research were less often published.

CONCLUSIONS AND IMPLICATIONS FOR NURSING AND HEALTH POLICY

Generally, there is a paucity of clinical nursing research in this region. This could reflect the shortage of nurses prepared to conduct research in this region. Nurses may find additional resources for evidence in the grey literature. A complete understanding of the state of nursing science in southern and eastern African countries will help nurses and midwives to understand gaps in clinical research knowledge, potentially direct their research to more critical topics, and inform funding bodies and policy-makers of the situation of nursing science in southern and eastern African countries.

Migrant maternity in an era of superdiversity: New migrants' access to, and experience of, antenatal care in the West Midlands, UK

Rapid increase in the scale, speed and spread of immigration over the past two decades has led to an increase in complexity of populations termed superdiversity. Concerns have been expressed about impacts of the pressure that superdiversity is said to place upon maternity services. High migrant fertility and infant and maternal mortality rates have long been observed in diverse areas with inadequate antenatal monitoring seen as a major causal factor in migrants' maternity outcomes. Using qualitative data from a study of new migrants' access to maternity services in the UK's West Midlands region, with some of the highest infant and maternal mortality rates in Europe, this paper looks at the reasons migrants' access to antenatal care is poor. The paper finds that contrary to earlier studies which pointed to a lack of priority placed on such care by migrants, a combination of structural, legal and institutional barriers prevent migrant women accessing effective antenatal care.

A meta-ethnographic synthesis of fathers' experiences of complicated births that are potentially traumatic

INTRODUCTION

birth is a natural and for many, life enhancing phenomenon. In rare circumstances however birth can be accompanied with complications that may place the mother and infant at risk of severe trauma or death. Witnessing birth complications or obstetric emergencies can be distressing and potentially traumatic for the father.

AIM

the aim of this paper is to report on the findings of a meta-ethnographic synthesis of father's experiences of complicated births that are potentially traumatic.

METHODS

databases searched included CINAHL, Scopus, PubMed and PsycINFO with Full Text. The search was conducted in February and March 2013 and revised in February 2015 for any new papers, and the search was limited to papers published in English, full text and peer-reviewed journals published between January 2000 to December 2013.

INCLUSION CRITERIA

studies were included if they focused on fathers/men's experiences of witnessing a birth with complications including a caesarean section or an adverse obstetric event. Studies included needed to use qualitative or mixed methods research designs with a substantial qualitative component. ANALYTIC STRATEGY: a meta-ethnographic approach was used using methods of reciprocal translation guided by the work of Noblit and Hare (1988) on meta-ethnographic techniques. Quality appraisal was undertaken using the Critical Appraisal Skills Programme (CASP) tool.

FINDINGS

eight qualitative studies with a total of 100 participants were included in the final sample. The men ranged in age from 19 to 50 years.

SYNTHESIS

Four major themes were identified: 'the unfolding crisis', 'stripped of my role: powerless and helpless', 'craving information' and 'scarring the relationship'. Participants described the fear and anxiety they felt as well as having a sense of worthlessness and inadequacy. Men did not receive sufficient information about the unfolding events and subsequently this birth experience impacted on some men's interactions and relationships with their partners.

CONCLUSIONS

witnessing a complicated or unexpected adverse birth experience can be distressing for men and some may report symptoms of birth trauma. Being informed by and receiving support from midwives and other health professionals appears to help mitigate the negative impact of birth complications. Effective support may help address men's confusion about their role, however genuinely including men as recipients of care or service in pregnancy, labour and birth raises important questions about whether the father is also a recipient of maternity care and if the transition to fatherhood is itself becoming a medical event?

Decisions, choice and shared decision making in antenatal clinics: An observational study

OBJECTIVE

The UK Government has prioritised shared decision making (SDM) and choice in maternity services, but no studies have explored the breadth of antenatal decisions or the feasibility of this aspiration. This study aimed to describe the decisions made, investigate the factors associated with choice and explore SDM practice.

METHODS

Cross-sectional audio-recording of consultations in a UK district general hospital. Multi-level regression models were used to investigate associations between choice and doctor, patient, consultation and decision variables.

RESULTS

585 decisions were documented with a mean of 3.0 (SD 1.5) per consultation. No choice was offered in 75% of decisions. Choice was associated with the decision topic, consultation length, Royal College membership status and presence on the specialist register.

CONCLUSIONS

Without a choice, it will be challenging for a patient and their healthcare profession to truly share decisions.

PRACTICE IMPLICATIONS

If universal SDM is the aim, then further work is required to understand the factors impacting choice availability and SDM, while engaging and supporting healthcare professionals to offer options and share decisions with patients.

Historical outbreak of Salmonella hadar

BACKGROUND

This article reports a historical outbreak of Salmonella hadar in a maternity setting. The outbreak occurred following admission of an infected index case, with transmission to 11 other individuals over a three-month period in a maternity and neonatal unit.

METHODS

Despite rigorous assessment of clinical practices, screening of patients and staff, and review of disinfection and sterilization policies, the outbreak was difficult to control. This possibly reflects the capacity of S. hadar to survive well in the environment, and cause prolonged and asymptomatic carriage with intermittent shedding.

FINDINGS

It is likely that the index case was a mother who had contracted infection after eating suspect food. Additionally, infection may have been perpetuated by shared use of tubes of yellow soft paraffin for lubrication of digital rectal thermometers.

CONCLUSION

This outbreak emphasizes the difficulties in controlling outbreaks of S. hadar infection in an obstetric/neonatal setting, and also emphasizes the importance of early stool sampling in any patient with diarrhoeal symptoms.

Maternity Care Plans: A retrospective review of a process aiming to support women who decline standard care

BACKGROUND

All competent adults have the right to refuse medical treatment. When pregnant women do so, ethical and medico-legal concerns arise and women may face difficulties accessing care. Policies guiding the provision of maternity care in these circumstances are rare and unstudied. One tertiary hospital in Australia has a process for clinicians to plan non-standard maternity care via a Maternity Care Plan (MCP).

AIM

To review processes and outcomes associated with MCPs from the first three and a half years of the policy's implementation.

METHODS

Retrospective cohort study comprising chart audit, review of demographic data and clinical outcomes, and content analysis of MCPs.

FINDINGS

MCPs (n=52) were most commonly created when women declined recommended caesareans, preferring vaginal birth after two caesareans (VBAC2, n=23; 44.2%) or vaginal breech birth (n=7, 13.5%) or when women declined continuous intrapartum monitoring for vaginal birth after one caesarean (n=8, 15.4%). Intrapartum care deviated from MCPs in 50% of cases, due to new or worsening clinical indications or changed maternal preferences. Clinical outcomes were reassuring. Most VBAC2 or VBAC>2 (69%) and vaginal breech births (96.3%) were attempted without MCPs, but women with MCPs appeared more likely to birth vaginally (VBAC2 success rate 66.7% with MCP, 17.5% without; vaginal breech birth success rate, 50% with MCP, 32.5% without).

CONCLUSIONS

MCPs enabled clinicians to provide care outside of hospital policies but were utilised for a narrow range of situations, with significant variation in their application. Further research is needed to understand the experiences of women and clinicians.

Establishment of a microsatellite set for noninvasive paternity testing in free-ranging Macaca mulatta tcheliensis in Mount Taihangshan area, Jiyuan, China

BACKGROUND

Within multi-male and multi-female mammalian societies, paternity assignment is crucial for evaluating male reproductive success, dominance hierarchy, and inbreeding avoidance. It is, however, difficult to determine paternity because of female promiscuity during reproduction. Noninvasive molecular techniques (e.g., fecal DNA) make it possible to match the genetic father to his offspring. In the current study, a troop of free-ranging Taihangshan macaques (Macaca mulatta tcheliensis) in Mt. Taihangshan area, Jiyuan, China, was selected for studying the paternity. We successfully screened a set of microsatellite loci from fecal DNA and evaluated the efficiency of these loci for paternity testing using clearly recorded data of maternity.

RESULTS

The results showed that: 1) ten loci out of 18 candidate microsatellite loci were amplified successfully in the fecal samples of Taihangshan macaques. The error probability in maternity assignments and paternity testing was very low as indicated by their power of discrimination (0.70 to 0.95), power of exclusion (0.43 to 0.84), and the values of polymorphic information content ranging from 0.52 to 0.82; 2) the combined probability of exclusion in paternity testing for ten qualified loci was as high as 99.999%, and the combined probability of exclusion reached 99.99% when the seven most polymorphic loci were adopted; 3) the offspring were assigned to their biological mother correctly and also matched with their genetic father.

CONCLUSIONS

We concluded that the ten polymorphic microsatellite loci, especially a core set of seven most polymorphic loci, provided an effective and reliable tool for noninvasive paternity testing in free-ranging rhesus macaques.

Wartime women giving birth: narratives of pregnancy and childbirth, Britain c. 1939-1960

Women in Second World War Britain benefitted from measures to improve maternal and child health. Infant and maternal mortality rates continued to fall, new drugs became available, and efforts were made to improve the health of mothers and babies through the provision of subsidised milk and other foodstuffs. However, in return, women were also expected to contribute to the war effort through motherhood, and this reflected wider cultural ideas in the North Atlantic world in the first half of the twentieth century which equated maternity with military service. The aim of this article is to examine the interplay between narratives of birth and narratives of war in the accounts of maternity from women of the wartime generation. It will explore how the military-maternity analogy sheds light on women's experiences of pregnancy and childbirth in Britain during the Second World War, whilst also considering maternity within women's wider role as 'domestic soldiers', contributing to the war effort through their traditional work as housewives and mothers. In doing so, the article reveals the complexity of women's narratives. It demonstrates that they do not simply conform to the 'medical vs. social' binary, but reflect the wider cultural context in which women gave birth. Women incorporated the dominant discourses of the period, namely those around war, into their accounts.

Impact of introducing practical obstetric multi-professional training (PROMPT) into maternity units in Victoria, Australia

OBJECTIVE

To assess the introduction of Practical Obstetric Multi-professional Training (PROMPT) into maternity units and evaluate effects on organisational culture and perinatal outcomes.

DESIGN

A retrospective cohort study.

SETTING

Maternity units in eight public hospitals in metropolitan and regional Victoria, Australia.

POPULATION

Staff in eight maternity units and a total of 43,408 babies born between July 2008 and December 2011.

METHODS

Representatives from eight Victorian hospitals underwent a single day of training (Train the Trainer), to conduct PROMPT. Organisational culture was compared before and after PROMPT. Clinical outcomes were evaluated before, during and after PROMPT.

MAIN OUTCOME MEASURES

The number of courses run and the proportion of staff trained were determined. Organisational culture was measured using the Safety Attitude Questionnaire. Clinical measures included Apgar scores at 1 and 5 minutes (Apgar 1 and Apgar 5), cord lactate, blood loss and length of baby's stay in hospital.

RESULTS

Seven of the eight hospitals conducted PROMPT. Overall about 50% of staff were trained in each year of the study. Significant increases were found in Safety Attitude Questionnaire scores representing domains of teamwork (Hedges' g 0.27, 95% confidence interval [95% CI] 0.13-0.41), safety (Hedges' g 0.28, 95% CI 0.15-0.42) and perception of management (Hedges' g 0.17, 95% CI 0.04-0.31). There were significant improvements in Apgar 1 (OR 0.84, 95% CI 0.77-0.91), cord lactates (odds ratio 0.92, 95% CI 0.85-0.99) and average length of baby's stay in hospital (Hedges' g 0.03, 95% CI 0.01-0.05) during or after training, but no change in Apgar 5 scores or proportion of cases with high blood loss.

CONCLUSION

PROMPT can be introduced using the Train the Trainer model. Improvements in organisational culture and some clinical measures were observed following PROMPT.

[Multiple sclerosis and pelviperineology: Urinary and sexual dysfunctions and pregnancy]

GOAL

The aim was to review the literature on genito-urinary dysfunction in multiple sclerosis (MS).

MATERIAL

A literature review through the PubMed library until August, 31 2013 was carried out using the following keywords: multiple sclerosis and neurogenic bladder, neuropathic bladder, bladder, management, follow-up, urological complications, urological treatment, sexual dysfunction, female sexual function, male sexual function, erectile dysfunction, anorectal, faecal, constipation, bowel, pregnancy, parturition, delivery, breast-feeding.

RESULTS

Genito-urinary dysfunction is frequent in MS (35-90%) and may happen soon in the disease. Urinary symptoms (10-90%) are manifold resulting in a quality of life alteration and the onset of complications in 30% of the cases requiring a long-term follow-up. Sexual dysfunctions (35-87%) are also manifold affecting all the sexuality domains in men and women. Except the phosphodiesterase V inhibitors, few treatments have been assessed in this population. Pregnancy is nowadays considered as beneficial resulting in a disease slow-down and the lack of disease worsening despite an increase in disease relapse during the post-partum first quarter. It seems to be better to consider getting pregnant after at least one year without any relapse and to emphasize an exclusive breast-feeding.

CONCLUSION

Urinary and sexual dysfunctions are frequent in MS. A transdisciplinary approach including the neurologist and pelviperineology specialists facilitates a disability adapted early management.

Ketamine and atropine decrease pain for preterm newborn tracheal intubation in the delivery room: an observational pilot study

AIM

Various analgesic strategies are used before tracheal intubation of preterm newborns in the delivery room, due to the lack of a standard protocol and difficult venous access. This study evaluated the feasibility and efficacy of short venous catheter insertion and immediate ketamine analgesia for tracheal intubation of preterm newborns at birth in the delivery room.

METHODS

Prospective observational pilot study, with ketamine and atropine used at the paediatrician's discretion. Pain score, heart rate, SpO2 nadirs, procedure duration and neonatal intensive care unit morbidity were recorded.

RESULTS

Fifty-seven consecutive preterm newborns were included between January I and June 30, 2012: 15 in the no analgesia group and 39 in the intravenous ketamine group. Short catheter insertion failed in three newborns. The pain score was lower during laryngoscopy in the ketamine group (4 ± 0.7 vs. 2.9 ± 3.2 in the no analgesia group, p < 0.001). The heart rate nadir during tracheal intubation was 150.7 ± 29.6 bpm (vs. 112.6 ± 35.5 bpm in the no analgesia group, p < 0.01). Surfactant therapy was administered to 79.5% of newborns in the ketamine group (vs. 92.3%, p = 0.29) in the first 30 min of life.

CONCLUSION

Short venous catheter insertion with immediate ketamine analgesia plus atropine for tracheal intubation of preterm newborns in the delivery room was effective in decreasing pain and preventing vagal bradycardia.

Mobile technologies and communication strategies in an urban Midwifery Group Practice setting. An exploratory study

BACKGROUND

Around-the-clock access to a known midwife is a distinct feature of Midwifery Group Practice (MGP) and caseload midwifery settings; although the literature suggests this aspect of working life may hinder recruitment and retention to this model of care. Mobile technologies, known as mHealth where they are used in health care, facilitate access and hence communication, however little is known about this area of midwifery practice.

RESEARCH QUESTION

Which communication modalities are used, and most frequently, by MGP midwives and clients?

METHODS

A prospective, cross sectional design included a purposive sample of MGP midwives from an Australian tertiary maternity hospital. Data on modes of midwife-client contact were collected 24h/day, for two consecutive weeks, and included: visits, phone-calls, texts and emails. Demographic data were also collected.

FINDINGS

Details about 1442 midwife-client contacts were obtained. The majority of contact was via text, between the hours of 07:00 and 14:59, with primiparous women, when the primary midwife was on-call. An average of 96 contacts per fortnight occurred.

CONCLUSION

The majority of contact was between the midwife and their primary clients, reiterating a key tenet of caseload models and confirming mobile technologies as a significant and evolving aspect of practice. The pattern of contact within social (or daytime) hours is reassuring for midwives considering caseload midwifery, who are concerned about the on-call burden. The use of text as the preferred communication modality raises issues regarding data security and retrieval, accountability, confidentiality and text management during off-duty periods. The development of Australian-wide guidelines to inform local policies and best practice is recommended.

Investigating the potential for evidence-based midwifery-led services in very remote Australia: viewpoints from local stakeholders

BACKGROUND

Since the National Maternity Services Review, non-medical models of care involving midwives as the primary care giver are gaining prominence in urban settings in Australia. However, there remains a paucity of evidence about which non-medical primary maternity care models are best suited for rural and remote communities.

AIM

We investigated the perceptions, acceptability and barriers and enablers to the delivery of non-medical primary maternity care models in Far West NSW, as an example of remote Australia.

METHODS

We purposively sampled and invited 24 clinicians and/or policy makers to an in-depth interview via the phone or face-to-face. Quantitative items were coded and analysed descriptively, whereas qualitative responses were analysed for thematic content via two independent authors.

RESULTS

Of 16 eligible participants, 14 consented to participate and were very experienced practitioners from a range of roles and settings. There was strong agreement that evidence supporting non-medical models of care was relevant to the remote context in Far West NSW. Participants reported that pregnant women and health service partners would find midwifery-led care very acceptable and that team models would be the easiest to deliver in their setting. Reported barriers and enablers for the delivery of midwifery-led care conversely reflected each other and emphasised the need for retention of local maternity staff to provide continuity of care.

CONCLUSIONS

Local health service partners are demonstrably ready for further local improvement in providing midwifery-led models of maternity care to women who live in very remote communities in NSW, Australia.

[Pregnancy and delivery satisfaction of 424 patients in Perinatal Health Network « Sécurité Naissance » of Pays-de-la-Loire area]

BACKGROUND

One method of evaluating a perinatal policy measuring user satisfaction is an important issue. The objective of the study was to measure satisfaction with the monitoring of pregnancy, childbirth and maternity stay.

METHODS

Each volunteer maternity received a list of all births during one week in March-April 2008. The first mailing of questionnaires was conducted by post with stamped envelopes for the reply, after 2months in May and June 2008. A second reminder was made in July 2008. Responses to questions were coded using a Likert scale with four degrees with "very satisfied", "satisfied," "not very satisfied" and "not satisfied" with a quote by 4 to 1. The results are presented with the proportions of satisfied women, with radar diagrams. Transformation of responses with scores of 20 was established.

RESULTS

In total, 424 responses were obtained in 22 maternities (/24), on 524 questionnaires sent (response rate 80.9 %). A comparison of mothers who responded to those who did not respond showed an over-representation of senior and middle managers and department. The average response time from birth was ten weeks±1 (8-26). The early prenatal care (known as the 4th month) was ignored (the word) by 58 % of women, but satisfying for those who have had while preparing for the birth, information on ultrasounds, tests on blood testing were satisfactory. A total of 13.2 % of women were hospitalized, and 94.9 % of cases, the information was obtained with 96.5 % satisfaction for the explanations. Mothers were met for the monitoring of pregnancy to 95.4 %. At delivery, the reception was well received with 94.7 % of satisfaction, like attention paid to patients with 93.5 % satisfied. The satisfaction score for delivery in general (with or without cesarean) was 16.5±4.0 (out of 20) with 92.5 % satisfied. The score for the cesarean section was 16.3 versus 16.6 for the low channels (not significant [NS]) in the case of anesthesia of 16.5 versus 16.7 (NS) in case of episiotomy of 15.9 versus 16.9 (P<0.05). The length of postpartum stay was found too short in case of 4.8 % (4.7 days), correct in 78.6 % (4.8 days), too long in 15.9 % (4.8 days). The satisfaction score for delivery in general (with or without cesarean) was 16.5 out of 20 with 92.5 % of satisfied. Also, 73.1 % of mothers tended to agree about the useful information for baby; 77.8 % thought that breastfeeding went well. The total score for pregnancy and childbirth is averaging 16.1, with 95.7 % of satisfied. The dissatisfying factors for 17 women have been linked in univariate to a department, the choice of maternity proximity and the existence of an episiotomy. Multivariate analysis was not significant criteria of discontent.

CONCLUSION

Users respond to this type of investigation and seem satisfied with the care provided, in accordance with published data. The analysis of satisfaction and sources of dissatisfaction can improve treatments. The limits of the notion of satisfaction are analyzed.

The development and validation of an internet-based training package for the management of perineal trauma following childbirth: MaternityPEARLS

BACKGROUND

Birth-related perineal trauma has a major impact on women's health. Appropriate management of perineal injuries requires clinical knowledge and skill. At present, there is no agreement as to what constitutes an effective clinical training programme, despite the presence of sufficient evidence to support standardised perineal repair techniques. To address this deficiency, we developed and validated an interactive distance learning multi-professional training package called MaternityPEARLS.

METHOD

MaternityPEARLS was developed as a comprehensive e-learning package in 2010. The main aim of the MaternityPEARLS project was to develop, refine and validate this multi-professional e-learning tool. The effect of MaternityPEARLS in improving clinical skills and knowledge was compared with two other training models; traditional training (lectures + model-based hands on training) and offline computer lab-based training. Midwives and obstetricians were recruited for each training modality from three maternity units. An analysis of covariance was done to assess the effects of clinical profession and years of experience on scoring within each group. Feedback on MaternityPEARLS was also collected from participants. The project started in January 2010 and was completed in December 2010.

RESULTS

Thirty-eight participants were included in the study. Pretraining and post-training scores in each group showed considerable improvement in skill scores (p<0.001 in all groups). Mean changes were similar across all three groups for knowledge (3.24 (SD 5.38), 3.00 (SD 3.74), 3.30 (SD 3.73)) and skill (25.34 (SD 8.96), 22.82 (SD 9.24), 20.7 (SD 9.76)) in the traditional, offline computer lab-based and e-learning groups, respectively. There was no evidence of any effect of clinical experience and baseline knowledge on outcomes.

CONCLUSIONS

MaternityPEARLS is the first validated perineal trauma management e-learning package. It provides a level of improvement in skill and knowledge comparable to traditional methods of training. However, as an e-learning system, it has the advantage of ensuring the delivery of a standardised, continuously updated curriculum that has global accessibility.

Caseload midwifery in a multi-ethnic community: the women's experiences

OBJECTIVE

to evaluate caseload midwifery in a relatively deprived and ethnically diverse inner-city area.

DESIGN AND SETTING

semi-structured interviews were undertaken with 24 women from diverse ethnic backgrounds, 12 of whom had received caseload care and 12 women from an adjacent area who had received conventional maternity care in a large inner-city maternity unit. Framework analysis was adopted drawing on links with the authors' previous work on women's views of caseload midwifery.

FINDINGS

key themes from previous work fitted well with the themes that emerged from this study. Themes included 'knowing and being known', 'person-centred care', 'social support', 'gaining trust and confidence', 'quality and sensitivity of care' and 'communication'.

KEY CONCLUSIONS AND IMPLICATIONS

women from this socially and ethnically diverse group of women had similar views and wanted similar care to those in previous studies of caseload midwifery. Many of the women receiving caseload care highlighted the close relationship they had with the midwives and as a result of this felt more able to discuss their concerns with them. This has the potential not only for improved quality of care but also improved safety.