Detecting and responding to deterioration of a baby during labour: surveys of maternity professionals to inform co-design and implementation of a new standardised approach

Abstract

Objectives: Detecting and responding to deterioration of a baby during labour is likely to benefit from a standardised approach supported by principles of track-and-trigger systems. To inform co-design of a standardised approach and associated implementation strategies, we sought the views of UK-based maternity professionals.

Design: Two successive cross-sectional surveys were hosted on an online collaboration platform (Thiscovery) between July 2021 and April 2022.

Setting: UK.

Participants: Across both surveys, 765 UK-based maternity professionals.

Primary and secondary outcome measures: Count and percentage of participants selecting closed-ended response options, and categorisation and counting of free-text responses.

Results: More than 90% of participants supported the principle of a standardised approach that systematically considers a range of intrapartum risk factors alongside fetal heart rate features. Over 80% of participants agreed on the importance of a proposed set of evidence-based risk factors underpinning such an approach, but many (over 75%) also indicated a need to clarify the clinical definitions of the proposed risk factors. A need for clarity was also suggested by participants' widely varying views on thresholds for actions of the proposed risk factors, particularly for meconium-stained liquor, rise in baseline fetal heart rate and changes in fetal heart rate variability. Most participants (>75%) considered a range of resources to support good practice as very useful when implementing the approach, such as when and how to escalate in different situations (82%), how to create a supportive culture (79%) and effective communication and decision-making with those in labour and their partners (75%).

Conclusions: We found strong professional support for the principle of a standardised approach to detection and response to intrapartum fetal deterioration and high agreement on the clinical importance of a set of evidence-based risk factors. Further work is needed to address: (1) clarity of clinical definitions of some risk factors, (2) building evidence and agreement on thresholds for action and (3) deimplementation strategies for existing local practices.

Keywords: Capacity Building; Health & safety; NEONATOLOGY; OBSTETRICS; Quality Improvement; Surveys and Questionnaires.

Figure 1. Participants’ (n=553) perceived importance of proposed risk factors for detecting and responding to suspected fetal deterioration during labour.