• Experiences and outcomes on the use of telemetry to monitor the fetal heart during labour: findings from a mixed methods study.

      Watson, Kylie; email: kylie.watson@manchester.ac.uk; Mills, Tracey A; Lavender, Tina (2021-07-01)
      Wireless continuous electronic fetal monitoring (CEFM) using telemetry offers potential for increased mobility during labour. United Kingdom national recommendations are that telemetry should be offered to all women having CEFM during labour. There is limited contemporary evidence on experiences of telemetry use or impacts it may have. To gather in-depth knowledge about the experiences of women and midwives using telemetry, and to assess any impact that its use may have on clinical outcomes, mobility in labour, control or satisfaction. A convergent parallel mixed-methods study was employed. Grounded theory was adopted for interviews and analysis of 13 midwives, 10 women and 2 partners. Satisfaction, positions during labour and clinical outcome data was analysed from a cohort comparing telemetry (n = 64) with wired CEFM (n = 64). Qualitative and quantitative data were synthesised to give deeper understanding. Women using telemetry were more mobile and adopted more upright positions during labour. The core category A Sense of Normality encompassed themes of 'Being Free, Being in Control', 'Enabling and Facilitating' and 'Maternity Unit Culture'. Greater mobility resulted in increased feelings of internal and external control and increased perceptions of autonomy, normality and dignity. There was no difference in control or satisfaction between cohort groups. When CEFM is used during labour, telemetry provides an opportunity to improve experience and support physiological capability. The use of telemetry during labour contributes to humanising birth for women who have CEFM and its use places them at the centre and in control of their birth experience. [Abstract copyright: Crown Copyright © 2021. Published by Elsevier Ltd. All rights reserved.]
    • The Recognition of Excessive blood loss At ChildbirTh (REACT) Study: a two‐phase exploratory, sequential mixed methods inquiry using focus groups, interviews and a pilot, randomised crossover study

      Hancock, A; orcid: 0000-0002-2057-3303; email: angela.hancock@manchester.ac.uk; Weeks, AD; orcid: 0000-0002-1909-337X; Furber, C; Campbell, M; Lavender, T (2021-05-27)
      Objectives: To explore how childbirth‐related blood loss is evaluated and excessive bleeding recognised; and to develop and test a theory of postpartum haemorrhage (PPH) diagnosis. Design: Two‐phase, exploratory, sequential mixed methods design using focus groups, interviews and a pilot, randomised crossover study. Setting: Two hospitals in North West England. Sample: Women (following vaginal birth with and without PPH), birth partners, midwives and obstetricians. Methods: Phase 1 (qualitative): 8 focus groups and 20 one‐to‐one, semi‐structured interviews were conducted with 15 women, 5 birth partners, 11 obstetricians, 1 obstetric anaesthetist and 19 midwives (n = 51). Phase 2 (quantitative): 11 obstetricians and ten midwives (n = 21) completed two simulations of fast and slow blood loss using a high‐fidelity childbirth simulator. Results: Responses to blood loss were described as automatic, intuitive reactions to the speed, nature and visibility of blood flow. Health professionals reported that quantifying volume was most useful after a PPH diagnosis, to validate intuitive decisions and guide ongoing management. During simulations, PPH treatment was initiated at volumes at or below 200 ml (fast mean blood loss 79.6 ml, SD 41.1; slow mean blood loss 62.6 ml, SD 27.7). All participants treated fast, visible blood loss, but only half treated slow blood loss, despite there being no difference in volumes (difference 18.2 ml, 95% CI −5.6 to 42.2 ml, P = 0.124). Conclusions: Experience and intuition, rather than blood loss volume, inform recognition of excessive blood loss after birth. Women and birth partners want more information and open communication about blood loss. Further research exploring clinical decision‐making and how to support it is required. Tweetable abstract: During a PPH, clinical decision‐making is intuitive with clinicians treating as soon as excessive loss is recognised.