June 06, 2003

A new idea for midwives notes

One of the aspects of the midwife/mother relationship we are emphasising on the Essential Midwifery tour is the way that midwives are being required to keep copious records and how this is severely restricting the amount of time a midwife spends actually “with woman”.

Mo Harris, working at Derriford Hospital has videotaped many births and has revealed that midwives regularly spend only around 10% of their time actually interacting with women, even when they are assigned solely to her care for the duration of the labour. 43% of the time, the midwife is writing up the notes!

There must be a better way of doing this. In other situations where careful note taking is required solutions have been found. Think of the forensic pathologist who must describe, in detail, the findings as an autopsy is carried out, or the Scene of Crime Officer, who must make accurate notes about the intricate details of a crime site for Police records. They need their hands free as they carry out their tasks and they use tape recorders to note their impressions and record their findings as they go. Both will have their taped findings rigorously examined in courts of law.

Midwives could do the same. Modern mini dictaphones are tiny and are easy to fit in pockets . A microphone can be placed on strap around her neck so she can talk freely while using her hands. Times can be spoken and the feedback to the woman about what is happening will form the basis of the record that can be transcribed later onto the computer. Most of the actual paper notes could be abandoned - the tape recording and the computer would form the basis of the medical record. Midwives will need to learn to speak their findings for the benefit of the tape and to remember to turn it on when observations are being carried out.

There would be several peripheral advantages for this system, apart from the obvious one of freeing the midwife from onerous writing. The tape would also record the mother’s reactions and comments by other caregivers, thus ensuring that all people involved in the care had their input noted. This could be very useful when there was a problem, or later when specific detail regarding what was actually said to the woman or the details of the treatment carried out needed to be established.

Another advantage would be that a secretary could transcribe the notes, a move that would save money ( clerical staff are cheaper to employ) and they could do the task quickly (think of the speed of the typists who handle Hansard). Clerical staff are more plentiful than midwives, so this may also ease the chronic shortage of midwives, who could once again concentrate on using their professional skills.

There would need to be some paper notes - perhaps a quick summary of specific times and events that could be matched up with the taped transcript. The current partogram could fulfil this function.

There have already been some moves in Australia to try hand held computers (Palm Pilots, for example) for community nurses to record their treatments and notes as they move from client to client. These gadgets can be programmed to display a series of screens that require quick taps to record drugs given, dosages, observations etc. which are then uploaded at the end of the shift onto the patient record in the main hospital based computer. While this works well in that context, I think recording births would need a different approach, and tape recorders might do the trick. Midwives might also find this easier technology to master than a Palm Pilot.

I will be interested to hear what others think of this proposal. Given the current high levels of dissatisfaction with the onerous record keeping amongst midwives, the shortages of staff and the need to better deploy the skills available, it is time to “think outside the square” and look beyond traditional approaches to solving this pressing problem.

Feedback please!

Posted by andrea at June 06, 2003 04:12 AM

Comments

I whole-heartedly support the idea of midwives using mini dictaphones, especially during a womans labour. I've recently given birth (8 weeks ago)to my second son and from the moment I walked in to the delivery room, the midwife was occupied with note taking and reord checking. I barely saw her, and when I did it was for an official visit. I think anything that allows a midwife to spend more time with her mother-to-be should be encouraged, women in labour don't just need notes taken, they need support and reassurance. The same goes for mums at home, midwives need more time to "sit and chat."

Posted by: Kate on June 16, 2003 10:45 PM

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