This evaluation was
a joint project between, Worcester Royal Hospitals
NHS Trust, University Hospitals
Coventry and Warwickshire NHS Trust and the Perinatal
Project lead at each hospital:
Judy Byrne, Senior Midwife, Worcester
Hospitals NHS Trust and
Carmel McCalmont, Acting Head
of Midwifery, Coventry and Warwickshire University
The aim of the field trial was to assess the ‘user
friendliness’ of the notes. Whether the notes
fulfilled the role they were intended to, i.e. clear,
logical documentation of the intrapartum event.
200 sets of notes were issued, 100 to each site.
It was anticipated the trial would take approximately
4 weeks to complete based on the two unit’s
annual delivery rates. However, if longer was required
to ensure a sufficient quantity of notes were used
this was acceptable.
The trial started on 4th August 2003. One unit
decided to gradually introduce the use of the notes,
with women who presented in spontaneous labour,
then for women who required induction of labour and
for women who were undergoing a planned caesarean
The other unit decided to use the notes
to record the birth event for all women admitted
onset of the trial.
Evaluation forms were attached
to the notes, which asked five questions relating
to the layout,
and usefulness of the document for recording
the birth event. This enabled the midwives
feedback and make suggestions about changes
they would like to see made.
Only 50% of evaluation forms were returned, however
one of the reasons for this was because, when midwives
used the notes on a subsequent occasion they did
not feel the need to complete another evaluation
form if their comments remained the same.
The majority of the feedback was positive, most
staff felt the notes were clear and displayed logical
progression. Other staff felt unsure at first, but
commented that they thought the navigation through
the notes would improve with familiarity.
as to what they liked best about the notes, the
most common response was that the
notes were presented as a booklet, all documentation
was together and all professionals write chronologically
Another positive comment received was that the
risk assessment pages really made the midwife think
the significance of antepartum events prior to
the intrapartum period, this was encouraging because
this was the intended purpose of the risk assessment.
What was least liked,
was that the size of some of the text boxes was considered
too small, and there
were comments that too many questions are asked
at the initial assessment.
Some respondents’ felt
there was repetition and too many signatures were
When asked what else should be included,
again the response was varied; from nothing- because
they felt the document was about right as it was
or there was too much in it already.
A common request
was for stickers to record findings from vaginal
examinations, these will be included
in all orders.
The unit wanted to be involved in the field trial
as they felt it was important to be involved in regional
developments. The senior midwives also felt if the
unit had been involved in the field trial and influenced
changes in the document it may have a proactive influence
on any future implementation issues.
The feedback from the unit was again mainly positive,
although there was some initial reservations and
apprehension about trying something new, these did
appear to reduce as the midwives became more familiar
with the notes.
The comments mirrored those received from Redditch
that: progression through the notes was logical and
every one writes in the same document. As with Redditch
it was felt the initial assessment and identification
of risk factors were good and that plans for labour
They felt the notes facilitated good documentation
and the partogram was comprehensive. When writing
contemporaneous records, the birth summary was clearly
laid out with adequate spaced allocated for documentation
of a multiple birth. The ‘explanation of procedures’ page
was also liked by the midwives, as it demonstrated
what procedures had already been discussed.
The aspects of the notes that were least liked were
there was little space on the partogram to record
vaginal examinations. It was explained to the midwives
that vaginal examination stickers will be produced
and distributed with the birth notes; unfortunately
these were not available at the time of the trial.
Some staff felt the layout was initially not easy
to follow, but acknowledged this was probably due
to unfamiliarity with the document. The more familiar
they became with the notes, the more favourably they
appeared to view them.
There was a comment that there was not enough space
to write up a procedure on the operative delivery
page, this has been addressed and more space allocated.
The midwifery managers would have welcomed more
feedback from medical staff.
The field trial of the notes was successful. It
allowed us to confirm that the notes will fulfil
the role they are intended for, which is clear, contemporaneous
documentation of the intrapartum event.
also gave invaluable feedback to develop and improve
the notes further. The result from the
feedback confirms the need for adequate training
of professionals prior to use to aid implementation
and familiarity of the document.
We would like to thank all the midwives and obstetricians
from the Alexandra Maternity Unit, Redditch and
the Coventry Maternity Unit, who took part in the
field trial. We thank them for not only using the
notes to record the care they gave but also taking
time to complete the evaluation forms.
We would also like to thank Judy Byrne, senior midwife,
Worcester hospitals NHS Trusts and Carmel McCalmont,
acting head of midwifery, Coventry and Warwickshire
University Hospitals NHS Trusts. Both of whom agreed
to lead the project and whose findings of the evaluation,
where presented at a regional forum.
To view the
presentation from Coventry
To view the presentation from Redditch click here.
Kate Morse, Specialist Midwife, Perinatal Institute.