Back to Basics

Maternity care has consistently become more medicalised with international concerns existing that the societal confidence for natural physiological labour is declining (Nyman 2014). Comparable with international findings,... [ view full abstract ]

Maternity care has consistently become more medicalised with international concerns existing that the societal confidence for natural physiological labour is declining (Nyman 2014). Comparable with international findings, Ireland has seen a decline in the rate of normal or intervention free births. Surprisingly, there are still only small pockets of midwifery-led care services within this country. The National Maternity Hospital introduced the first piloted Irish DOMINO and home-birth service in 1999, DOMINO stands for Domiciliary IN and OUT. This care package values the mutuality and partnership in the relationships between women and midwives while providing holistic midwifery care. In 2014, an ethically approved evaluation of this service noted its achievements (Healy et al, 2014) however, service users requested more tools to assist them obtaining a physiological birth. In addition, the senior midwifery management called for midwives to develop innovations to assist women in normal labour.

The Domino /Home-birth team developed an innovative response entitled “Back to Basics” consisted of three complimenting parts namely pregnancy and birthing booklets; labour hopscotch tool and introduction of mobile fetal monitoring. Care, compassion and commitment were three core values that drove this project to success. A collective leadership style was adopted whereby each team member was driven by a mutual purpose and shared vision namely to provide our service users with support tools to assist in obtaining a normal birth.

The design and content of both booklets is in keeping with the philosophy and values of the team focused on keeping women healthy, mentally, emotionally and physically, with an emphasis on optimal fetal positioning. They are viewed as training manuals for labour and birth containing easy to remember mind maps, practical tips and positive affirmations. An additional objective of these booklets is to empower women through positive reinforcement of their innate ability to birth. These booklets have yielded an exceptional positive response from service users and service providers.

The second component of this initiative is labour hopscotch which has the fundamental principle to encourage women to remain upright and mobile during labour and in this way possibly reduce interventions such as epidurals. A notable benefit is the opportunity it provides for partners and midwives an alternative means of supporting women to achieve a physiological birth. Briefly the labour hopscotch frameworks include the use of mobilisation, positioning, water-therapy and non-pharmacological methods of pain relief.  This framework is currently being evaluated and the initial feedback is very positive from women, their partners and midwives.

The final component of this project was introducting mobile fetal monitoring into the labour ward where over 9000 babies are born annually to further support women to remain upright and mobile. An ethically approved research project provided exceptional positive qualitative and quantitative data.

In conclusion, the “Back to Basics” initiative provided an improvement in the ability to provide compassionate care as reported by the Domino/Home-birth team. Compassionate care leads to greater patient satisfaction (NHS 2014) and a positive virtuous cycle of good leadership leads to empowered midwives and on to empowering women to birth.