Sign for Maternity Ward hanging from ceiling in a hospital

Some women experiencing clinical deterioration during labour may require admission to intensive care units, whilst others may be suitable candidates for high dependency care.

Dr Alison James’ PhD sought to gain a professional consensus regarding the defining features of and definition for, maternity high dependency care in obstetric units remote from tertiary referral units. 

It also examined the factors that influence midwives to either provide maternity high dependency care on the labour ward, or request escalation of care away from the obstetric unit. A three-round modified Delphi survey was followed by a focus group study using video vignettes to promote discussions regarding care escalation.

Findings have been published in Evidence Based Midwifery. In brief, factors influencing midwives’ escalation of care decisions included local service delivery, patient specific/professional factors, and guidelines to a lesser extent. Midwives in the smallest obstetric units did not have access to the facilities/equipment for maternity high dependency care provision and could not provide it. 

Midwives in the larger obstetric units provided maternity high dependency care but identified varying levels of competence and used ‘workarounds’ to facilitate care.

James A, Endacott R & Stenhouse E 2017 'Maternity high dependency care in obstetric units remote from tertiary referral centres: findings of a modified Delphi study' Evidence Based Midwifery 15, (4) 120-127 PEARL.