Quality Education for a Healthier Scotland ‘Measuring the quantity and quality of intrapartum midwifery support: the development and testing of a new systematic

Quality Education for a Healthier Scotland

‘Measuring the quantity and quality of intrapartum midwifery support: the development and testing of a

new systematic observation instrument’

Dr Mary Ross-Davie

Educational Project Manager

NHS Education for Scotland

[email protected]

Nursing, Midwifery and Allied Health Professions Research Unit


What women say they want

The Ingredients • Presence of nurse/midwife• Helped to feel in control• Feeling cared for as an individual• Praise and encouragement• Help with breathing and relaxation• Being treated with respect• Being kept informed• Being involved in decisions• Being treated with respect• Smiling, building of rapport•Listening, positive regard•Soft tone, calm voice•Friendly, open and gentle

Lesser and Keane 1956, Shields 1978, Tarkka and Paunonen 1996, Bowers 2002, Tumblin 2001, Miltner 2000, Matthew and Callister 2003, Watkins 1998, Goodman et al 2004, Lundgren 2005, Newburn and Singh 2005, Larkin and Begley 2009



What kind of support is provided? Did the SMILI measure it?

Midwife Behaviours0.7%7.8%

19%

27.6%

34.4%

46%

108%

Emotional Support

Informational Support

Indirect Care

Assessment

Tangible support

Partner support

Advocacy


Quantitative descriptive results: Proportion midwife out of room


Quantitative descriptive results: Quantity of emotional support behaviours





Relationship between women’s views and SMILI data

Variable Low scoring midwives (n=7) %

Overall study mean (n=49) %

High scoring midwives (n=32) %

Proportion midwife of room 13.0 9.3 7.5

Neutral professional demeanour

49.9 37.7 29.8

Lack of attentiveness 36.3 26.2 19.9

Negative behaviours 17.2 11.6 5.0

Emotional Support 280.1 395.5 422

Rapport building 15.4 36.0 42.9

Informational support 30.1 38.9 42.5

Physical support 13.1 18.8 21.4

Partner support 2.3 7.5 8.7

Non-support direct care 3.1 2.9 2.9

Assessment 23.2 27.7 29.1


Does the midwife make a difference? The ‘SMILI’ study

• Statistically significant correlations:

• The proportion of time the midwife was out of the room and the type of birth

• The longer the midwife was out of the room the more likely the woman was to have an operative delivery

SVD CS Forceps/Ventouse

Proportion out of room

7.4 13 12

1

3

5

7

9

11

13

Proportion midwife out of room and type of birth

Proportion out of room

% of ob-servation midwife out of room


Does the midwife make a difference? The ‘SMILI’ study

• Statistically significant correlations:

• The more emotional support given by the midwife the more likely the woman was to have a vaginal birth

• Where emotional support was recorded less than the study average, women 2x as likely to have a forceps or ventouse

SVD LSCS Forceps/Ventous

Verbal sup-port

92.1 14.6 52.9

5

15

25

35

45

55

65

75

85

95

Amount of verbal support by the midwife and type of birth

Typeof birth

% Seen in observation

Documents

Quality Education for a Healthier Scotland ‘Measuring the quantity and quality of intrapartum midwifery support: the development and testing of a new systematic