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Midwives’ recognition and response to maternal deterioration: A national cross-sectional study


Ebert, L and Massey, D and Flenady, T and Nolan, S and Dwyer, T and Reid-Searl, K and Ferguson, B and Jefford, E, Midwives' recognition and response to maternal deterioration: A national cross-sectional study, Birth pp. 1-11. ISSN 0730-7659 (2022) [Refereed Article]

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Copyright Statement

© 2022 The Authors. Birth published by Wiley Periodicals LLC. This is an open access article under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) License,(

DOI: doi:10.1111/birt.12665


Background: Early warning systems (EWS) are used across health care settings as a tool for the early identification of clinical deterioration and to determine the need to escalate care. Early detection of clinical deterioration and appropriate escalation of care in maternity settings is critical to the safety of pregnant women and infants; however, underutilization of EWS tools and reluctance to escalate care have been consistently reported. Little is known about midwives' use of EWS in the Australian context.

Methods: Using a cross-sectional approach, we elicited the attitudes, beliefs, and behaviors of a purposive sample of Australian midwives (n = 87) with respect to the Maternal Early Warning Trigger Tool (MEWT). Participants answered a 25-question Likert scale survey and one open-ended question. Qualitative answers were analyzed using consensus coding.

Results: Midwives reported positive attitudes toward the MEWT, describing it as a valuable tool for identifying clinical deterioration, especially when used as an adjunct to clinical judgment. However, midwives also identified training gaps; 25% had received no training, and only half of those who had received training felt it was effective. In addition, professional tension can create a significant barrier to the effective use of the MEWT. Midwives also reported feeling influenced by their peers in their decision-making with respect to use of the MEWT and being afraid they would be chastised for escalating care unnecessarily.

Conclusions: Although the MEWT is valued by Australian midwives as a useful tool, barriers exist to its effective use. These include a lack of adequate, ongoing training and professional tension. Improving interdisciplinary collaboration could enhance the use of this tool for the safety of birthing women and their infants.

Item Details

Item Type:Refereed Article
Research Division:Health Sciences
Research Group:Midwifery
Research Field:Clinical midwifery
Objective Division:Health
Objective Group:Provision of health and support services
Objective Field:Midwifery
UTAS Author:Reid-Searl, K (Professor Kerry Reid-Searl)
ID Code:153701
Year Published:2022
Deposited By:Nursing
Deposited On:2022-10-03
Last Modified:2022-11-02
Downloads:5 View Download Statistics

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