Using a clinical pathway to support normal birth: impact on practitioner roles and working practices

Area of Science:

• Maternal Health
• Healthcare Implementation Science
• Clinical Pathway Effectiveness

Background:

• Rising rates of childbirth interventions prompt the development of clinical pathways.
• The Normal Labour Pathway was implemented in Wales to promote normal childbirth and reduce interventions.

Purpose of the Study:

• To investigate the implementation of the Normal Labour Pathway from the perspectives of midwives, doctors, and managers.
• To evaluate the impact of the pathway on Welsh maternity care and interprofessional dynamics.

Main Methods:

• Ethnographic approach utilizing semiparticipant observation, focus groups, and interviews.
• Thematic analysis of data collected from 56 participants, including midwives, doctors, and managers.

Main Results:

• Midwives viewed the pathway as a decision-making tool; recently qualified midwives were more positive.
• Doctors found the pathway exclusionary, increasing interprofessional tensions.
• No evidence was found that the pathway increased the normal birth rate.

Conclusions:

• The Normal Labour Pathway is a complex intervention with both intended and unintended consequences.
• The study questions the suitability of standardized clinical pathways for the complexities of childbirth.
• Implementation impacted roles and relationships among maternity care practitioners.