Background
Methods
Ethical approval
Recruitment and sampling
Interviews
Introduce topic: experience of transfer from birth centre/midwifery unit where you planned to give birth to the hospital unit where you had your baby. Invite to tell story in as much detail as possible. | |
Extra questions to follow up: | |
Antenatal: | Reasons for deciding to have your baby in the midwifery unit / birth centre? |
Information given about the possibility of transfer? Written/verbal? Was it what you needed? | |
Knowledge beforehand about why might be transferred and process? | |
Anything you wish you’d known beforehand? | |
During labour (before transfer): | First inklings of complications / need for transfer: when, why, midwife communication, feelings? |
Understanding about reasons for transfer? Risks/benefits? Choice? Feelings? | |
Transfer process? Knowledge, explanations, midwife accompany? | |
Expectations of obstetric unit? | |
Anything you would have liked but didn’t have? | |
Waiting? Ambulance staff? Husband / partner accompanying? Feelings? | |
During transfer: | Describe journey? Midwife? Ambulance staff? Husband? |
Arrival at hospital / delivery suite: | Communication / handover? Midwife continues to look after you? |
Hospital vs. midwifery unit? How did it feel? | |
Husband / birth partner? | |
After the birth: | Explanation afterwards? |
Feelings then and now? Information and support you needed? | |
Now: | How do you feel about the whole experience now? Ongoing problems/ worries? |
Thinking about choice of place of birth? Feelings? | |
Advice to others? Plans for next baby? | |
To close: | Anything that could have been done to make whole experience better? |
Anything to say to midwives? Suggestions for improvements? |
Analysis
Hopes and expectations | Choosing midwifery unit | Physical environment |
Social environment | ||
Friends’ / family experience | ||
No choice / hospital policy | ||
Hopes for birth | Ideal birth | |
Normal / natural birth | ||
Birth plan | ||
Pain relief | ||
Expectations of transfer | Seeking information | |
Seeking reassurance | ||
Blasé | ||
In the midwifery unit | Midwifery care | Care and support |
Feeling understood | ||
Control | ||
Trust | ||
The decision to transfer | Preparation | |
Feelings: disappointment | ||
Feelings: relief | ||
Feelings: anxiety, fear, worry | ||
The transfer journey: in limbo | Change / contrast | Physical environment |
(Dis)comfort | ||
Social environment | ||
Others: midwife / ambulance staff/ husband | ||
Uncertainty / anxiety | Information | |
Not knowing | ||
Fears and worries | ||
Journey time | ||
Passivity | Not asking | |
Choices | ||
Understanding why | Understanding what happened | Seeking information |
Finding resolution | ||
“Debrief” | ||
Feeling guilty | ||
Implications for the future | Plans for future babies | |
Choices in future |
Results
Characteristics of the sample
Characteristic | No. of participants (n=30) |
---|---|
Location (Strategic Health Authority)
| |
North West | 4 |
Yorkshire and the Humber | 1 |
West Midlands | 3 |
East of England | 1 |
London | 4 |
South East Coast | 3 |
South Central | 10 |
South West | 4 |
Type of midwifery unit
| |
Alongside midwifery unit | 12 |
Freestanding midwifery unit | 18 |
Ethnicity
| |
White British | 26 |
White other | 2 |
Asian | 2 |
Country of birth
| |
UK | 27 |
Non-UK | 3 |
NS-SEC*
| |
1 Higher managerial & professional | 8 |
2 Lower managerial & professional | 19 |
3 Intermediate | 1 |
4 Small employers and own account workers | 1 |
5 Lower supervisory and technical | 0 |
6 Semi-routine | 0 |
7 Routine | 1 |
8 Never worked and long-term unemployed | 0 |
Marital status
| |
Married | 19 |
Single (living with partner) | 10 |
Single (living without partner) | 1 |
Age (years)
| |
20-24 | 1 |
25-29 | 12 |
30-34 | 7 |
≥35 | 10 |
Parity
| |
Primiparous | 26 |
Multiparous | 4 |
‘Type’ of transfer
| |
Intrapartum emergency | 5 |
Intrapartum non-emergency | 18 |
Epidural request | 5 |
Postpartum | 2 |
Type of birth
| |
Non-instrumental vaginal | 10 |
Ventouse | 2 |
Forceps | 6 |
Caesarean section | 12 |
Months between birth and interview
| |
1-3 | 10 |
4-6 | 4 |
7-9 | 10 |
10-12 | 6 |