Time-out in prolonged labour: development of a care model to prevent secondary fear of childbirth

• Published in: BMJ open quality 2022-10, Vol.11 (4), p.e001853
• Main Authors: Ringqvist, Anna-Karin, Bergqvist, Liselotte, Brezicka, Thomas, Lundgren, Ingela
• Format: Article
• Language: English
• Subjects: Childbirth & labor; Clinical decision making; Midwifery; Nursing; obstetrics and gynecology; Obstetrics, Gynecology and Reproductive Medicine; Omvårdnad; Quality improvement; Quality Improvement Report; Quality of care; Questionnaires; Reproduktionsmedicin och gynekologi; shared decision making; Systematic review; teamwork; Womens health
• ISSN: 2399-6641; 2399-6641
• DOI: 10.1136/bmjoq-2022-001853

BackgroundDuring qualitative improvement work, the statistics at the hospital reveal prolonged labour as one of the major causes of secondary fear of childbirth (FOC). The aim of this improvement work was to develop and implement a care process for prolonged labour to prevent secondary FOC.Materials and methodsTo explore the factors behind secondary FOC among multiparous women, a follow-up of referral reasons for 600 women with severe FOC was made between 2015 and 2017 at a Swedish University Hospital. In the group with the most common factor, namely prolonged labour, 41 women were interviewed. From their answers, further research and existing professional knowledge, a care process to prevent secondary FOC was designed, ‘Time-out in prolonged labour’ (the Time-out). To improve the quality of the care process, the functional resonance analysis method was used. The findings from the interviews were categorised into three themes: lack of involvement; lack of communication and information; and lack of care plan. The women explained that if these areas had been fulfilled, it may have reduced their FOC.ResultTo prevent the above-mentioned themes, ‘Time-out in prolonged labour’ was developed with supporting factors such as gathering the interprofessional team, collecting information, dialogue within the team and the involvement of the women when deciding the care plan. Result after implementation shows a reduction of referral reason due to prolonged labour for women with severe FOC from 28% in 2016 to 8.5% in 2020.ConclusionsThe Time-out is a good model to prevent secondary FOC. Central aspects of the model are to ensure women’s involvement, good communication and a documented care plan for women in prolonged labour. The supporting factor of interprofessional teamwork is of importance when using the Time-out in practice.