Hello Carolyn 

Wales has been using the All Wales Clinical Pathway for Normal Labour
since 2004. It is partly a record of care and partly a set of guidelines
for practice, used for the intrapartum care of all women considered to
be low risk. I've recently conducted an ethnographic study of this
pathway, looking at how it was created and implemented, how it used 'on
the ground' by midwives, and how it has been experienced by midwives,
mothers, managers and doctors.  The final project report is available at
http://www.swan.ac.uk/media/Media,20124,en.pdf (or I can send you a copy
in the post if you are interested). 

The findings suggest that the implementation of the pathway has had a
number of unanticipated outcomes for the working practices of midwives,
midwife-doctor relationships and the experiences of women. Although
midwives generally felt that their confidence has been boosted, there
were many reservations expressed about the possible long term impact on
the development of clinical reasoning and clinical judgement (similar to
the concerns raised by  Soo Downe). As a record of care, the pathway
uses the approach of 'documentation by exception'. Many midwives were
concerned about the implications of this 'tick box approach'. The lack
of a written story was considered to have implications for reflection on
the birth by the woman and /or midwife, and also menatthat evidnec was
lacking in complaints or litigation cases.

There is an interesting body of sociological literure about the use of
guidelines and protocols, which suggests that decision making tools are
far from being neutral devices. For example:

Berg, M., 1997. Problems and promises of the protocol. Social Science
and
Medicine 44 (8), 1081-1088.

Berg, M., Horstman, K., Plass, S., van Heusden, M., 2000. Guidelines,
professionals and the production of objectivity: standardisation and the
professionalism of insurance medicine. Sociology of Health and Illness
22
(6), 765-791.

Hunter B., Segrott J (2007) Re-mapping client journeys and professional
identities: A review of the literature on clinical pathways.
International Journal of Nursing Studies, 45 (2008) 608-625


Best wishes
Billie Hunter

Billie Hunter
Professor of Midwifery 
Institute for Health Research 
School of Health Science 
Floor 2 Vivian Tower 
Swansea University 
Swansea SA2 8PP 

Tel: +44(0)1792 518584
Fax: +44(0)1792 295127




-----Original Message-----
From: A forum for discussion on midwifery and reproductive health
research. [mailto:[log in to unmask]] On Behalf Of Denis
Walsh
Sent: 05 December 2008 08:45
To: [log in to unmask]
Subject: Re: Normal birth guideline/pathway

Hi Carolyn,
The best one I have seen is the draft that the Keeping Birth Normal &
Dynamic programme in Scotland has come up with. It covers antenatal,
intrapartum and postnatal but the intrapartum one in particular is
excellent in getting a balance between evidence and midwifery discretion
in decision-making. This web site has the info, though the final
document is not available yet. I was a reviewer for the draft.
http://www.nhshealthquality.org/nhsqis/4517.140.1123.html
Best wishes,
Denis
Dr Denis Walsh
Reader in Normal Birth
University of Central Lancashire
Independent Midwifery Consultant
Home Address:
366 Hinckley Rd
Leicester LE3 0TN
Tel: 0116 2166255
Mob: 07905735777


-----Original Message-----
From: A forum for discussion on midwifery and reproductive health
research.
[mailto:[log in to unmask]] On Behalf Of Jane Sandall
Sent: 04 December 2008 08:29
To: [log in to unmask]
Subject: Fw: Normal birth guideline/pathway

Replies to list please
bw
Jane Sandall
----- Original Message -----
From: "Carolyn Hastie" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, December 03, 2008 6:24 AM
Subject: Normal birth guideline/pathway


Hello everyone,

I'm wondering if anyone has a guideline around the care of women during 
normal birth.  Suggestions around when VE's are indicated etc.

We don't have such a thing, we have guidelines around prolonged labour, 
prolonged pregnancy etc. We rely on the midwives assessment of when
labour 
is no longer normal, understanding that there is a huge variation in
women 
and their process.

Someone from another area asked me if we had one as they have to put
such 
guidelines in place following an incident.

I thought I would ask the collected wisdom here on this list what they
have 
in their places of practice.

I look forward to hearing from you.

with best wishes, Carolyn (Can you believe it is nearly a New Year?)

Carolyn Hastie
Midwifery Manager
Belmont Birthing Services
Hunter New England Health

Conjoint Senior Lecturer
School of Nursing & Midwifery
University of Newcastle

FACMI  IBCLC

Mobile 0428 112 786
Email     [log in to unmask]

Midwife-led versus other models of care for
childbearing women-Latest Cochrane Review

 Author's conclusions
All women should be offered midwifery-led models of care and women
should be
encouraged to ask for this option.