Jeffery J, et al. - A qualitative design is conducted to investigate midwives' experiences of performing maternal observations and escalating concerns in rural and urban maternity settings. A number of organisational and cultural barriers exist to the completion of maternal observations and the escalation of concerns. In order to address these the following actions are suggested: standardised training for Midwifery Support Workers, review of training of midwives to ensure it addresses the increasing complexity of the maternal population, identification and agreement in regards to the organisation of maternal observations among staff, an emphasis on increasing the priority placed on maternal observations in all clinical settings, and clarification and reinforcement of escalation procedures for both midwives and senior clinicians.

Methods

• In this study, they investigate midwives' experiences of performing maternal observations and escalating concerns in rural and urban maternity settings in the West Midlands of England.
• A qualitative design involving a series of six focus groups with midwives and Supervisors of Midwives was employed to explore the facilitators of, and barriers to the completion of maternal observations.

Results

• In a total of 6 focus groups, eighteen Midwives and 8 Supervisors of Midwives participated.
• Three key themes emerged from the data: (1) Organisation of Maternal Observations (including delegation of tasks to Midwifery Support Workers, variation in their training, the care model used e.g. one to one care, and staffing issues); (2) Prioritisation of Maternal Observations (including the role of professional judgement and concerns expressed by midwives that they did not feel equipped to care for women with complex clinical needs; and (3) Negotiated Escalation (including the inappropriate response from senior staff to utilization of Modified Early Warning Score systems, and the emotional impact of escalation).