Culture, context and the implementation challenge to achieve a better birth experience

Implementing an intervention to promote normal labour and birth: A study of clinicians' perceptions

OBJECTIVE

Prior to implementation of a Normal Labour and Birth Bundle (NLBB) at a regional maternity service in Victoria, Australia, this study aimed to understand clinician factors that may influence the uptake, acceptance and use of the NLBB.

DESIGN

This was a mixed methods study in which The Theory of Planned Behaviour (TPB) provided the framework for the conduct and analysis of the staff survey and focus groups. Descriptive and multiple regression were used to analyse the survey data and thematic analysis was used for the focus group data.

PARTICIPANTS

Participants for the survey and focus groups included clinicians providing publicly funded care and management of labour for women birthing at the health service. Maternity care clinicians were invited to participate in both the survey and the focus groups.

FINDINGS

Seventy-six clinicians (88.8%) responded to the survey. Mean scores for TPB constructs were well above the mid-scale score of 4, indicating strong positive attitudes, high levels of self-efficacy and positive social pressure to use the NLBB and strong intentions to use it in the future. Self-efficacy was the strongest independent predictor (β = 0.45, p < 0.001) of intention to use the NLBB (overall model R2=0.38). A valued consequence of implementing standardised and objective guidelines, highlighted in the focus groups, was the positive impact on clinicians' confidence in their decision-making.

KEY CONCLUSIONS

This study found that midwives and obstetricians were in favour of using a normal labour and birth care bundle and perceived the bundle to align with the expectations of work colleagues and the women they care for. The findings of this study show that clinicians at the health service had strong intentions to use the normal labour and birth care bundle in the future.

IMPLICATIONS FOR PRACTICE

Implementation science is important in embedding and sustaining practice change. Understanding staff perceptions is an essential first step of this process.

Factors influencing midwives' use of an evidenced based Normal Birth Guideline

Problem or issue

Rates of elective and unplanned caesarean section continue to increase in high income countries. Evidence-based clinical guidelines aim to promote and support normal birth but are rarely evaluated.

What is already known

The Queensland Normal Birth Guideline was developed in consultation with stakeholders and disseminated to public and private hospitals and released in 2012. Impact of the Guideline on practice has not been investigated.

What this paper adds

Although most midwives (90%) were aware of the guideline, only 71% reported that it routinely guided practice.