Midwives' beliefs and concerns about telephone conversations with women in early labour

Abstract

Objectiveto explore midwives' concerns, experiences and perceptions of the purpose of telephone contacts with women in early labour. Designa qualitative design based on interpretive phenomenology. Settingtwo Maternity Units in the Midlands of England. Participantsthree focus groups of labour ward midwife co-ordinators and labour ward midwives and nine in-depth interviews of midwives, obstetricians and labour ward receptionists. Findingsthe principal finding was that midwives are trying to reconcile gatekeeping of labour wards with individual support for women and these two aspects are often in conflict. Women experiencing prolonged or painful early labour often expect to be admitted to labour wards whereas midwives operate from a belief that women should only be accepted onto labour ward in active labour. They hold this view because labour wards are busy places and being admitted early contributes to unnecessary medical intervention. Key conclusionsbecause midwives are trying to reconcile the two conflicting priorities of responding to women's needs and protecting the labour ward from inappropriate admissions, the potential always exists for women's needs to be ‘not heard’ or marginalised. Implications for practicethe primary recommendation is that early labour telephone triage should be a discrete service, staffed by midwives who have been trained for this service, working independently of labour ward workloads.