'Keeping Birth Normal': Exploratory evaluation of a training package

Background: Alongside midwifery units integrated within a hospital setting can have difficulties in developing midwives’ skill and confidence to support physiological birth, and to maintain a family-centred philosophy of... [ view full abstract ]

Background: Alongside midwifery units integrated within a hospital setting can have difficulties in developing midwives’ skill and confidence to support physiological birth, and to maintain a family-centred philosophy of care. The ‘Keeping Birth Normal’ training package, delivered by Consultant Midwives, was designed to empower midwives to promote normal birth and a social model of maternity within an alongside midwife unit in St George’s Hospital, London.

Methods: Our KBN training evaluation followed an exploratory interpretive design, involving semi-structured observation of the training days, an open-ended questions feedback form and focus groups with the participants at the end of the training days. Feedback form data were analysed descriptively, and focus group and observational data were analysed using a framework analysis approach.

Findings: Overall, participants found the training inspiring and useful. They particularly valued interactive components and the sense of establishment of an on-going community of practice dedicated to the social model of care in the birth centre. The role of the Consultant Midwife facilitators as visible change leaders within this community also emerged as important both in the training itself and in the participants’ anticipation of taking change forward within the institution.

We identified four significant themes and subthemes affecting the perceived value and potential impact of the training:

• Barriers to change- individual resistance, herd mentality, staffing issues and increasing complexity in care provision.
• Role of the facilitators- managing expectations, reminding, developing self-awareness and leading change.
• Practical Tool –balanced content, practical materials, positive safety strategies and “less is more”.
• Building Community –discussions, identity, inspiration and making visible.

Discussion and conclusion: the ‘Keeping Birth Normal’ training appeared a valued and worthwhile training activity in the establishment of a core team dedicated to promoting normal birth and a social model of maternity care offered on an alongside midwifery unit. In future training of this type, training providers should maintain awareness of the community-building aspects of such training, and the opportunity it offers participants to form and strengthen relationships with each other and change leaders in order to implement and sustain development.