title: Intrapartal care in a Swedish maternity unit after a quality-improvement programme.
abstract: OBJECTIVE
  to study the effects of a quality-improvement programme (QIP) on documented intrapartal midwifery care in the context of a conventional maternity unit. The aim of the QIP was to improve intrapartal midwifery care in accordance with the World Health Organization (WHO)'s recommendations for care in normal birth, without decreasing the number of spontaneous vaginal births.
  
  
  METHODS
  an audit instrument, developed from WHO recommendations for care in normal birth, was used to compare birth records from before and after the implementation of a QIP. Two hundred and twelve consecutive birth records were examined in the pre-test and 240 in the post-test period.
  
  
  METHODS
  a conventional maternity unit in Western Sweden.
  
  
  RESULTS
  an overall documented improvement towards the recommendations by WHO was observed, especially in items for which guidelines were developed; more women were in active labour, intermittent auscultation increased in first and second stage, and oxytocin augmentation decreased in the first stage. The improved care did not influence the number of spontaneous vaginal deliveries or the duration of active labour and second stage.
  
  
  CONCLUSIONS
  a QIP facilitated implementation of WHO's recommendations for care in normal birth. Most of the documented care changed in favour of the WHO recommendations. The findings highlight the importance of professional discussions and use of guidelines to implement changes and to show how midwifery care can change in a conventional ward. However, the findings must be interpreted with some caution because of the sample size and because the findings are based on documented, not observed, care.
authors.affiliation: Division for Health and Caring Sciences, Karlstad University, Sweden. Fia.Bojo@kau.se
authors.forename: Ann-Kristin
authors.initials: AK
authors.lastname: Sandin-Bojö
authors.forename: Marie Louise
authors.initials: ML
authors.lastname: Hall-Lord
authors.forename: Ove
authors.initials: O
authors.lastname: Axelsson
authors.forename: Bodil Wilde
authors.initials: BW
authors.lastname: Larsson
mesh_terms: D000328:Adult; D016550:Birthing Centers / Q000458:organization & administration; D002391:Catchment Area, Health; D036861:Delivery, Obstetric / Q000451:nursing* / Q000592:standards; D005260:Female; D005323:Fetal Monitoring / Q000379:methods; D006801:Humans; D007231:Infant, Newborn; D008880:Midwifery / Q000379:methods* / Q000592:standards; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D009730:Nursing Assessment / Q000379:methods* / Q000592:standards; D009731:Nursing Audit; D015403:Nursing Evaluation Research; D007744:Obstetric Labor Complications / Q000451:nursing; D017063:Outcome Assessment, Health Care; D018743:Perinatal Care / Q000379:methods*; D011247:Pregnancy; D015397:Program Evaluation; D019984:Quality Indicators, Health Care; D013548:Sweden; D014944:World Health Organization