title: The influence of maternity units' intrapartum intervention rates and midwives' risk perception for women suitable for midwifery-led care.
abstract: OBJECTIVE
  to test the hypothesis that midwives working in higher intervention units would have a higher perception of risk for the intrapartum care of women suitable for midwifery-led care than midwives working in lower intervention units.
  
  
  METHODS
  an initial retrospective analysis of the computerised records of 9887 healthy Caucasian women in spontaneous labour enabled the categorisation of 11 units as either 'lower intrapartum intervention' or 'higher intrapartum intervention' units. A survey of the midwives involved in intrapartum care in these 11 units, using standardised scenario questionnaires, was used to investigate midwives' options for intrapartum interventions, their perceptions of intrapartum risk and the accuracy of these perceptions in the light of actual maternity outcomes.
  
  
  RESULTS
  midwives working in maternity units that had a higher level of intervention generally perceived intrapartum risks to be higher than midwives working in lower intervention units. However, midwives generally underestimated the ability of women to progress normally and overestimated the advantages of technological interventions, in particular epidural analgesia.
  
  
  CONCLUSIONS
  variations in intrapartum care cannot be solely explained by the characteristics of the women. The influence of the workplace culture plays a significant role in shaping midwives' perceptions of risk, but it seems even more likely that the medicalisation of childbirth has had an influence on midwives' appreciation of intrapartum risks. Intervention rates for low-risk births are often higher than recommended by research. The level of interventions varies across hospitals and higher rates are associated with higher perception of risk by midwives. Attention needs to be given to the influence the workplace plays in shaping midwives' perception of risk; and to the effect of organisational culture on intervention rates.
authors.affiliation: Department of Nursing and Midwifery, University of Hertfordshire, Hatfield, Herts AL10 9AB, UK.
authors.forename: Marianne M P
authors.initials: MM
authors.lastname: Mead
authors.forename: Diana
authors.initials: D
authors.lastname: Kornbrot
mesh_terms: D000328:Adult; D003696:Delivery Rooms / Q000592:standards*; D036861:Delivery, Obstetric / Q000451:nursing*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008880:Midwifery / Q000379:methods / Q000592:standards; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D015404:Nursing Methodology Research; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D010865:Pilot Projects; D011247:Pregnancy; D011248:Pregnancy Complications / Q000451:nursing / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D006113:United Kingdom