title: An exploration of the effects of clinical negligence litigation on the practice of midwives in England: A phenomenological study.
abstract: OBJECTIVE
  to explore how midwives׳ personal involvement in clinical negligence litigation affects their midwifery practice.
  
  
  METHODS
  descriptive phenomenological study using semi-structured interviews.
  
  
  METHODS
  in 2006-2007 in-depth interviews were conducted in participants׳ homes or at their place of work and focused on participants׳ experience of litigation. Participants were recruited from various regions of England.
  
  
  METHODS
  22 National Health Service (NHS) midwives who had been alleged negligent.
  
  
  RESULTS
  clinical practice affected was an increase in documentation, fear of practising outside clinical guidelines and electronic fetal monitoring of women at low obstetric risk; these changes were not widespread. Changes in practice were sometimes perceived negatively and sometimes positively. Forming a good relationship with childbearing women was judged to promote effective midwifery care but litigation had affected the ability of a minority of midwives to advocate for women if this relationship had not been established. Litigation could result in loss of confidence leading to self-doubt, isolation, increased readiness to seek medical assistance and avoidance of working in the labour ward, perceived as an area with a high risk of litigation. A blame culture in the NHS was perceived by several midwives. In contrast an open non-punitive culture resulted in midwives readily reporting mistakes to risk managers. Litigation lowered midwifery morale and damaged professional reputations, particularly when reported in the newspapers. Some midwives expressed thoughts of leaving midwifery or taking time off work because of litigation but only one was actively seeking other employment, another took sick leave and one had left midwifery and returned to nursing.
  
  
  CONCLUSIONS
  litigation can have a negative effect on midwives׳ clinical practice and morale and fosters a culture of blame within the NHS.
  
  
  CONCLUSIONS
  education regarding appropriate documentation, use or non-use of electronic fetal monitoring and the legal status of clinical guidelines will enable midwives to respond proportionately to the threat of litigation. A culture of openness and sharing the problem when adverse events occur would help to extinguish the current blame culture in the National Health Service. Litigation must be recognised by management as capable of inducing loss of confidence and reluctance to work in the labour ward. Promoting teamwork will help support these midwives. The potential for litigation in maternity care could affect retention of the midwifery workforce.
authors.affiliation: University of Manchester, UK. Electronic address: j.robertson11@btinternet.com.
authors.forename: Judith H
authors.initials: JH
authors.lastname: Robertson
authors.affiliation: University of Manchester, UK. Electronic address: ann.thomson@manchester.ac.uk.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Thomson
mesh_terms: D001291:Attitude of Health Personnel; D004739:England; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D007588:Job Satisfaction; D008318:Malpractice / Q000331:legislation & jurisprudence; D008427:Maternal Health Services; D019300:Medical Errors / Q000331:legislation & jurisprudence*; D008880:Midwifery / Q000331:legislation & jurisprudence*; D009721:Nurse Midwives / Q000523:psychology*; D015279:Organizational Culture; D011247:Pregnancy; D024382:Professional Role / Q000523:psychology; D011369:Professional-Patient Relations; D013222:State Medicine
keywords: Adverse event; Blame culture; Clinical practice; Litigation; Midwives; Phenomenology