title: Swedish midwives' rating of risks during labour progress and their attitudes toward performing intrapartum interventions: a web-based survey.
abstract: OBJECTIVE
  to study how Swedish midwives working in low-risk labour ward units rate intrapartum risks compared to their midwifery colleagues working in standard care labour wards. A second aim was to describe midwives' attitudes toward performing different types of interventions during a normal labour.
  
  
  METHODS
  an explorative study was carried out in 2009, using a web-based questionnaire containing 31 questions on midwives' risk ratings and attitudes to interventions during labour, as well as personal comments.
  
  
  METHODS
  four labour ward units in Stockholm, Sweden. Two labour ward units with expected normal deliveries ('low-risk') and two standard care units with all types of deliveries.
  
  
  METHODS
  seventy-seven registered clinically practicing midwives.
  
  
  RESULTS
  midwives in all units stated that factors to be considered for risk estimation were: previous delivery outcome, result of cardiotocography test (CTG) on admission to labour ward and quality of amniotic fluid. Midwives working at the low-risk units preferred to be more expectant during normal birth than their colleagues working at the standard care units. Examples of this were regarding second vaginal examination during labour (p=0.001) and/or amniotomy (p=0.012). Furthermore, midwives working at the low-risk units more often considered that first-time mothers could give birth without epidural analgesia during labour (p=0.019) and that the labouring woman should be encouraged to push according to her own spontaneous urge (p=0.040). Midwives at low-risk units were more reluctant to use an intravenous vein catheter than their colleagues at standard care units (p=0.001) and also to use oxytocin in order to augment contractions (p=0.013). Further, the open-ended question showed that attitudes to different types of interventions differed between midwives working at low-risk units or the standard care units working with all types of deliveries.
  
  
  CONCLUSIONS
  the Swedish midwives estimated risks similarly regardless of whether they worked in low-risk or in standard care units, but midwives working at low-risk units reported that they perform less routine interventions and have a more expectant attitude towards performing interventions.
authors.affiliation: Department of Clinical Sciences, Division of Obstetrics and Gynaecology, Danderyd Hospital, Karolinska Institutet, BB Stockholm, SE-182 88 Stockholm, Sweden. ingela.wiklund@bbstockholm.se
authors.forename: Ingela
authors.initials: I
authors.lastname: Wiklund
authors.forename: Jessica
authors.initials: J
authors.lastname: Wallin
authors.forename: Malin
authors.initials: M
authors.lastname: Vikström
authors.forename: Anna-Berit
authors.initials: AB
authors.lastname: Ransjö-Arvidson
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric / Q000451:nursing* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D020407:Internet / Q000706:statistics & numerical data*; D008880:Midwifery / Q000706:statistics & numerical data*; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D015404:Nursing Methodology Research; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000451:nursing*; D017063:Outcome Assessment, Health Care; D011181:Postnatal Care / Q000379:methods* / Q000706:statistics & numerical data; D011247:Pregnancy; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult