title: Converting policy into care: women's satisfaction with the early labour telephone component of the All Wales Clinical Pathway for Normal Labour.
abstract: OBJECTIVE
  This article is a report of a study of women's experiences of, and satisfaction with, telephone communications within the All Wales Clinical Pathway for Normal Labour ('the Pathway').
  
  
  BACKGROUND
  The Pathway was introduced throughout Wales over 2003-2004. Its philosophy emphasizes the desirability of a woman remaining at home until labour is established with assessment by telephone, in contrast to the more common scenario where the phone call is a precursor to admission and face-to-face assessment.
  
  
  METHODS
  In 2005-2006, telephone interviews were carried out with 46 low-risk first-time mothers in Wales. This was a mixed-methods study with iterative quantitative and qualitative analysis, focusing on differences in the accounts of women with different levels of satisfaction.
  
  
  RESULTS
  Women were not well prepared for the Pathway; however, satisfaction was more strongly related to interpersonal interactions with midwives. Dissatisfied women reported unclear advice, unmet needs, unaddressed anxieties and negative midwife manner. 'Very satisfied' women were distinguished by feeling welcome to attend the maternity unit and by the perceived adequacy of the advice given.
  
  
  CONCLUSIONS
  This study provides new knowledge about telephone interactions between first-time mothers and midwives around labour onset. This is important in a changing healthcare context in which face-to-face interactions are likely to become less routine. Being made to feel welcome to attend the maternity unit might appear counter to the Pathway philosophy, but appeared to reduce women's anxieties about 'being allowed in' or getting to hospital in time, and gave them confidence to remain at home longer.
authors.affiliation: Mother and Infant Research Unit, Department of Health Sciences, University of York, UK. jo.green@york.ac.uk
authors.forename: Josephine M
authors.initials: JM
authors.lastname: Green
authors.forename: Helen
authors.initials: H
authors.lastname: Spiby
authors.forename: Clare
authors.initials: C
authors.lastname: Hucknall
authors.forename: Helen
authors.initials: H
authors.lastname: Richardson Foster
mesh_terms: D000293:Adolescent; D000328:Adult; D019091:Critical Pathways; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D008880:Midwifery; D009723:Nurse-Patient Relations; D017060:Patient Satisfaction; D011247:Pregnancy; D015397:Program Evaluation; D055817:Telenursing; D013689:Telephone; D014852:Wales