title: Implementing a national policy initiative to support normal birth: lessons from the All Wales Clinical Pathway for Normal Labour.
abstract: BACKGROUND
  This article discusses findings from an ethnographic study of a national policy initiative in Wales, United Kingdom. The policy aimed to decrease the caesarean section rate and increase the number of normal births by implementing a clinical pathway for normal labour. The aim of this study was to explore the real life experiences of those involved in the development and use of the policy.
  
  
  METHODS
  A range of qualitative methods was used, including observation, semistructured interviews, focus groups, and documentary analysis. Data were collected from midwives, doctors, midwifery managers, and mothers. Field notes and transcripts were thematically analysed.
  
  
  RESULTS
  The article discusses aspects of the findings related to the early stages of policy formation and development, including the initial phase of national implementation. It considers the challenges presented by creating national policies, discussing positive and negative aspects of the process.
  
  
  CONCLUSIONS
  The key themes discussed are effective consultation and involvement, group processes, "ownership," reaching consensus, and the need for ongoing support. Issues of relevance to maternity care providers in other cultural locations are discussed and recommendations are made.
authors.affiliation: Institute for Health Research, Swansea University, Singleton Park, Swansea, Wales, United Kingdom. b.j.hunter@swan.ac.uk
authors.forename: Billie
authors.initials: B
authors.lastname: Hunter
mesh_terms: D032921:Consensus; D019091:Critical Pathways / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008880:Midwifery / Q000592:standards*; D009313:National Health Programs / Q000458:organization & administration*; D036801:Parturition / Q000502:physiology*; D017060:Patient Satisfaction; D011247:Pregnancy; D014852:Wales