Measuring the quantity and quality of midwifery support of women during labour and childbirth: The development and testing of the 'Supportive Midwifery in Labour Instrument'

Abstract

The thesis describes the development and testing of a new computer based systematic observation instrument designed to facilitate the recording and measurement of the quantity and quality of midwifery intrapartum support. The content of the systematic observation instrument, the ‘SMILI’ (Supportive Midwifery in Labour Instrument), was based on a comprehensive review of the literature. The instrument was found to be valid and reliable in a series of studies. The feasibility and usability of the SMILI was extensively tested in the clinical setting in four maternity units in Scotland, UK. One hundred and five hours of direct observation of forty nine labour episodes were undertaken by four trained midwife observers. The clinical study demonstrated that the study and the instrument were feasible, usable and successful in measuring the quantity and quality of midwifery intrapartum support. The data collected has provided significant new information about the support given by midwives in the National Health Service of Scotland, UK. Continuous one to one support was the norm, with 92% of the observed midwives in the room for more than 80% of the observation period. Emotional support, including rapport building, encouragement and praise, was the most frequently recorded category of support.