gms | German Medical Science

Background: In the context of an international policy drive to increase midwifery-led care, continuity of carer and the midwifery-led care setting as the place of birth for healthy pregnant women [1], it essential that midwives working in all birth settings have the knowledge, skills and confidence to safely care for women who choose to labour and give birth in water. Across several countries, an increasing number of women are choosing to give birth in water. However, there is anecdotal concern about estimating blood loss in a birth pool environment. In response, over the course of two MSc midwifery dissertation projects, an E-tool was developed and underwent a small scale evaluation, which demonstrated a clear proof of concept and potential [2]. During 2019, a national evaluation of the E-tool is being conducted. This presentation will provide an overview of the large scale evaluation and initial findings together with the next steps in the E-tool’s evolution.

Aim: This study aimed to examine the effectiveness of an E-tool to improve midwives accuracy in visual blood loss estimations during waterbirth.

Design: Adopting a pre-test, post-test methodology comprising 4 parts, consenting participants are invited to complete a pre-test asking them to view a selection of short videos filmed in real-time and using live models in a standard birth pool, each showing a different blood volume. They are asked to estimate the volume and to state if the volume was a postpartum haemorrhage. Part 2 comprised an education section which amplifies aspects of the videos and discusses postpartum haemorrhage. Part 3 (post-test 1) adopts the same content as the pre-test (part1) with blood volumes arranged in a different sequence. Six weeks later this is repeated again (post-test 2). Accuracy in blood loss estimates will be reflected their participant estimations. Coupled with precision over the three-time points, confidence is assessed using the 10-point self-efficacy scale.

Results: The small scale evaluation (N=30 midwives) showed a trend to greater accuracy for larger blood volumes and participants found the online learning flexible and helpful (2). The national evaluation is involving a sample of midwives working in 18 NHS Trusts. Data collection will finish at the end of November 2019 and initial findings pre-publication findings will be shared at this presentation.

Relevancy: It is crucial to optimise women’s choice during childbirth, and waterbirth has become a popular option, particularly in midwifery-led care settings. It is, therefore, necessary that midwives working in all birth settings are confident and competent in assessing maternal blood loss. The plan is to adapt the E-tool into an online professional development resource for midwives and students who care for women during waterbirth.

Conclusions: More women are choosing to have a waterbirth. An E-tool has been developed that has the potential to improve the safety of midwifery care with respect to visual blood loss estimations during waterbirth.

Ethics and conflicts of interest: The proposals to develop and evaluate the E-tool were approved by Oxford Brookes University’s Faculty of Health and Life Sciences Research Ethics Committee and NHS Ethics from Research and Development committees. The research was supported by external funds. The development (video production using expired human blood and live models) and initial evaluation of the E-tool was supported by Santander research project awards. The national evaluation was funded by the Oxford Brookes University research fund. There are no conflicts of interest.