O50 - Being with computer: Midwives’ perspectives of the impact of the electronic maternity record on their practice providing woman-centred care

Abstract

Increasingly midwives are using digital technology in place of handheld records to record and document midwifery care across the continuum of care in both community and hospital settings. A rationale for this change has been the purported benefits of electronic health records (EHR) in reducing errors of omission, duplication, transcription, and interpretation that are caused by unclear, illegible, absent, and lost information. However, both positive and negative features of EHRs have been reported by clinicians. The objectives of this study were to explore midwives’ experiences using the integrated electronic maternity record (EMR) and their perspectives on the impact of EMR on midwifery practice and the provision of woman-centred care. We conducted a thematic analysis of semi-structured interviews with 15 midwives across two Australian tertiary public hospitals. Participating midwives cared for women across the pregnancy continuum. Midwives practiced in caseload models of care (3) and core hospital models of care (12). Midwives described a significant increase to the documentation burden since the transition from paper to EMR. An overarching theme of reconciling being with woman while being with computer emerged. Midwives described how their professional identity, embedded in their ability to be intimately present with the labouring woman, conflicted with medico-legal requirements of contemporaneous documentation and practicalities, such as the location of the computers. Midwives negotiated these competing demands to keep the woman at the centre of care. The lack of functionality of the EMR led to workflow inefficiencies, workplace tension and loss of job satisfaction. Midwives are focussed on being ‘with woman’ and providing woman-centred care while at the same time fulfilling their professional obligations of documentation. Midwives are well placed to make recommendations on the functionality of the EMR. Translating these findings to practice and education could lead to system improvements.