Perceptions, Practice and Power: a grounded theory study on maternity early warning tools and midwifery practice

Background: 

Midwifery practice underpins achieving positive perinatal outcomes. Contemporary healthcare is increasingly framed by risk management which impacts on midwifery practice. One risk management strategy is the use of Maternity Early Warning Tools (MEWTS). This grounded theory study explored the complex interplay between midwifery practice, risk management related to the use of MEWTs. 

Objectives:

The study sought to understand the impact of maternity early warning tools on midwifery practice. Methods Straussian grounded theory supplemented with Clarke’s Situational Analysis was used. Purposive sampling resulted in 18 registered midwives participating in semi-structured interviews. 

Results:

The final theory from this study, The coalescence of perceptions, practice and power, explains the impact of MEWTs on the professional behaviours and attitudes of midwives across levels of experience and seniority. 

Conclusions:

A MEWT does not capture the intricate and detailed assessment and management of a midwife’s care and, in some cases, this singular risk management strategy may serve to emphasize risk. MEWTs have become enmeshed in midwifery practice and are likely to remain so. However, this study clearly showed that tools such as these are part of midwifery practice and should complement and enhance midwifery expertise. 

Key message:

The use of MEWTs in midwifery practice must be embedded in process and policies that minimize risk as well as supporting individual midwives to fulfil their scope of practice and respect the autonomy of the role.