Seminar: March 13: The influences of facilitators and barriers on the implementation of a physiological approach: in two obstetric units in England

Centre for Maternal and Child Health Research at the School of Health and Psychological Science, City, University of London welcomes Florence Darling to discuss her findings on the influences of facilitators and barriers on the implementation of a physiological approach in two obstetric units in England, as part of the research seminar series.

Abstract
Shifting interventionist approaches to a physiological approach to address increasing and wide variation in routine clinical intervention use in childbirth has proved difficult. To understand why, this research explores the influences of facilitators and barriers on the implementation of a physiological approach.

Aims:

1. Observing midwives’ use of and competences in physiological care practices in two obstetric units.
2. Understanding how facilitators and barrier at an organisational leadership, professional group (midwives and obstetricians) and individual level (women) influenced implementation.

Method: An embedded mixed method explanatory design was used. Data included observations of practices in 12 labours, a training session in a physiological approach, interviews with 2 consultant midwives and obstetricians, 8 midwives, 10 women and 8 partners. A quantitative and qualitative analysis was performed.

Findings: Organisational leadership: A facilitator was committed leadership by two consultant midwives who collaborated with two consultant obstetricians to progress implementation. Resourcing decisions that prioritised an obstetric framework of care was viewed as a barrier by consultant midwives.

Professional Groups: A facilitator was opportunities for midwives to work rotationally across birth settings. Assessments demonstrated a higher level of use and competence in physiological care practices amongst these midwives. Barriers include hierarchical decision-making and centralised surveillance to embed an interventionist approach. Other influences include institutional time, risk preoccupations and a preference for the norm of implementing an interventionist approach. A lack of clinical support and rationalisation by midwives to manage cognitive dissonance from having to implement an interventionist approach erodes competence.

Women: A facilitator was women’s resolve with partners to experience a physiological labour and birth. Barriers include lack of advocacy, assumptions that women who used OUs were open to clinical interventions, assigning responsibility to women for experiencing a physiological labour and birth, a failure to explore options and obtain an informed consent.

About the speaker:
Florence Darling. BSc in Midwifery, MSc in Public Health, MSc in Clinical Research Methods, Semi-Retired Midwife/Researcher. Florence is a PhD student in the Centre for Maternal and Child Health. Florence joined in October 2016 on three year funded PhD studentship with the Worshipful Company of Saddlers. Florence is a registered midwife. The last position held by her was as a lead midwife of a birth centre at an NHS Trust. Attendance at City events is subject to our terms and conditions.