A case study evaluation of implementation of a care pathway to support normal birth in one English birth centre: anticipated benefits and unintended consequences

نویسندگان

  • Debra E Bick
  • Jo Rycroft-Malone
  • Marina Fontenla
چکیده

BACKGROUND The policy drive for the UK National Health Service (NHS) has focused on the need for high quality services informed by evidence of best practice. The introduction of care pathways and protocols to standardise care and support implementation of evidence into practice has taken place across the NHS with limited evaluation of their impact. A multi-site case study evaluation was undertaken to assess the impact of use of care pathways and protocols on clinicians, service users and service delivery. One of the five sites was a midwifery-led Birth Centre, where an adapted version of the All Wales Clinical Pathway for Normal Birth had been implemented. METHODS The overarching framework was realistic evaluation. A case study design enabled the capture of data on use of the pathway in the clinical setting, use of multiple methods of data collection and opportunity to study and understand the experiences of clinicians and service users whose care was informed by the pathway. Women attending the Birth Centre were recruited at their 36 week antenatal visit. Episodes of care during labour were observed, following which the woman and the midwife who cared for her were interviewed about use of the pathway. Interviews were also held with other key stakeholders from the study site. Qualitative data were content analysed. RESULTS Observations were undertaken of four women during labour. Eighteen interviews were conducted with clinicians and women, including the women whose care was observed and the midwives who cared for them, senior midwifery managers and obstetricians. The implementation of the pathway resulted in a number of anticipated benefits, including increased midwifery confidence in skills to support normal birth and promotion of team working. There were also unintended consequences, including concerns about a lack of documentation of labour care and negative impact on working relationships with obstetric and other midwifery colleagues. Women were unaware their care was informed by a care pathway. CONCLUSION Care pathways are complex interventions which generate a number of consequences for practice. Those considering introduction of pathways need to ensure all relevant stakeholders are engaged with this and develop robust evaluation strategies to accompany implementation.

برای دانلود رایگان متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Some Multidimensional Unintended Consequences of Telehealth Utilization: A Multi-Project Evaluation Synthesis

Background Telehealth initiatives have bloomed around the globe, but their integration and diffusion remain challenging because of the complex issues they raise. Available evidence around telehealth usually deals with its expected effects and benefits, but its unintended consequences (UCs) and influencing factors are little documented. This study aims to explore, describe and analyze mult...

متن کامل

The Relationship between Contraceptive Use and Unintended Pregnancies among Married Women in Thatta District, Pakistan

Background & aim: The rate of unintended pregnancy has decreased from 24% to 16% in the last four to five years in Pakistan. However, this rate stills varies among the women living in the rural and urban areas of Pakistan. The females residing in the rural areas are less likely to have many contraceptive choices and receive no/low-quality family planning services; as a result, they end up with ...

متن کامل

Maternal Risk Factors Affecting Low Birth Weight in Rafsanjan Township in 2018: A Case Control Study

Background and Objectives: Low birth weight is one of the most widespread public health problems associated with high infant mortality. This study aimed to identify maternal risk factors affecting low birth weight neonates in Rafsanjan hospitals. Materials and Methods: This case-control study consisted of 120 low birth weight infants (less than 2500 grams) as the case group and 120 normal weig...

متن کامل

Pregnant Women's experiences of Birth Preparedness and Complication Readiness in Ghana

Background & aim: Most of the maternal mortalities are preventable when safe maternal healthcare practices adhere to antenatal care. Lack of birth and emergency preparedness is one of several factors contributing to maternal mortalities. Adequate birth preparedness (BP), as well as emergency, and complication readiness (CR) planning can determine the survival rate of a pregnant woman and her un...

متن کامل

Investigation of the factors related to low birth weight in the south of Iran: a case-control study

Background and Aim: Since birth weight is one of the most important health indicators, we decided to investigate the factors related to the low birth weight (LBW) of the infants in the south of Kerman Province. Material and Method: This case-control study included 300 cases of neonates in Jiroft City. 150 neonates with low birth weight (less than 2500 g) were placed in the case group and our c...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

عنوان ژورنال:
  • BMC Pregnancy and Childbirth

دوره 9  شماره 

صفحات  -

تاریخ انتشار 2009