The experiences of women, birth partners and midwives of a dedicated, midwife-led, telephone support line for labour: An interpretative phenomenological analysis

Abstract

Women admitted to the birthing environment during the latent, rather than established, phase of labour are significantly more likely to experience interventions. Consequently, women are recommended to remain at or return home until labour is established. In 2013 an NHS Trust in England implemented a dedicated, midwife-led telephone support line for women in labour, known as the ’24-hour Labour Line’. This is the first documented telephone triage service located away from the hospital setting, with the midwife situated in the ambulance control centre and whose only role is to provide telephone support to women at home during labour.
In the absence of previous literature this research explores the experience of women, birth partners and midwives of accessing, or working on, the 24-hour labour line, with focus on the decision-making process undertaken. A qualitative design was adopted, using Interpretative Phenomenological Analysis. The sample comprised eleven women, four birth partners and five midwives. Data were collected using semi-structured interviews and a reflective diary. Smith et al’s (2022) steps to data analysis were applied. Fourteen ‘Group Experiential Themes’ were identified from the ‘Personal Experiential Themes' of each individual participant.
The dedicated telephone triage line offers virtual support to women and birth partners from trusted professionals during the uncertain period of early labour. The location of the service away from the hospital setting assists midwives to make decisions about care, free from the influence of organisational pressures. Through shared decision-making, women can be empowered to take control of the timing of admission to hospital, enabling their emotional and physical wellbeing to be equally valued during telephone assessment. Through advocating women’s choices, midwives experience tension with their hospital counterparts, which may be attributed to a lack of understanding of the scope of the role and a lack of visibility of the work undertaken by 24-hour labour line midwives. Midwives have found a sense of belonging through working in the ambulance control centre and value working collaboratively with other professional groups, to the perceived advantage of both the public and professionals.
The findings of this study offer support for the implementation of dedicated telephone support lines for early labour to facilitate shared decision-making and increase women’s control over their care during this phase of labour. This study is the first qualitative research to thoroughly explore the experience of women and birth partners of early labour during the COVID-19 pandemic, offering novel understanding of the importance of remote services during this time. New knowledge of the experiences of midwives working in a non-traditional maternity setting and the challenges this brings is provided and recommendations for practice and policy made.

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Identifiers

ORCID for Marie Elizabeth Naish: orcid.org/0000-0003-2551-5441

ORCID for Ellen Kitson-Reynolds: orcid.org/0000-0002-8099-883X

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