Swansea University professor of midwifery Billie Hunter has researched into the clinical pathway in Wales, a system designed to document childbirth more carefully

Wales has one of the highest rates of caesarean sections in the UK. In 2002, the Welsh Assembly government introduced the All-Wales Clinical Pathway for Normal Labour in an effort to reduce the number of avoidable interventions during childbirth, such as caesarean sections. It was designed so that there would be consistent written documentation for midwives to follow.

Professor investigates

Billie Hunter is professor of midwifery at the school of health science at Swansea University. In 2004, Billie won a Leading Practice Through Research (LPTR) award from the Health Foundation, which she used to investigate the clinical pathway in Wales.

Billie's research project looked at how the pathway was being implemented and the impact that it had on working practices in two contrasting settings: the first being a medium-sized, semi-rural maternity unit with 1,400 births a year; the second a large urban district general hospital with 3,600 births a year.

Interviews and evidence

Billie says: 'We interviewed midwives, doctors, managers, mothers and people on the original steering group who set up the pathway. We found evidence that the pathway was being used but was being adapted to suit local needs. We also found that there was a mixed response to the protocols. Some less experienced midwives found relying on the pathway beneficial as it enhanced their clinical judgements. Whilst the pathway empowered some midwives, the converse effect of this was that some doctors felt excluded from the process.'

'Overall, the study has underlined the importance of consulting with and engaging key stakeholders in the process. We've taken our research findings to representatives of the Welsh Assembly government and hope that the research will feed into the development of future clinical pathways.'

The full findings of Billie's research will be published in June 2007. For all enquiries call The Health Foundation Press Office on 0207 257 8017.