Implementing a National Policy Initiative to Support Normal Birth: Lessons From the All Wales Clinical Pathway for Normal Labour


  • Billie Hunter RM, RN, HV, PGCE, PhD

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    • Billie Hunter, RM, RN, HV, PGCE, PhD, is Professor of Midwifery in the Institute for Health Research, Swansea University, Wales UK and Visiting Senior Research Fellow in the Faculty of Health and Medical Sciences, University of Surrey, England, United Kingdom. She conducts research into the working practices of midwives and culture of midwifery, and how these impact the care received by women and their families.

Professor of Midwifery, Institute for Health Research, Floor 2, Vivian Tower, Singleton Park, Swansea University, Swansea SA2 8PP, Wales, United Kingdom. E-mail:


Introduction: This article discusses findings from an ethnographic study of a national policy initiative in Wales, United Kingdom. The policy aimed to decrease the caesarean section rate and increase the number of normal births by implementing a clinical pathway for normal labour. The aim of this study was to explore the real life experiences of those involved in the development and use of the policy.

Methods: A range of qualitative methods was used, including observation, semistructured interviews, focus groups, and documentary analysis. Data were collected from midwives, doctors, midwifery managers, and mothers. Field notes and transcripts were thematically analysed.

Results: The article discusses aspects of the findings related to the early stages of policy formation and development, including the initial phase of national implementation. It considers the challenges presented by creating national policies, discussing positive and negative aspects of the process.

Discussion: The key themes discussed are effective consultation and involvement, group processes, “ownership,” reaching consensus, and the need for ongoing support. Issues of relevance to maternity care providers in other cultural locations are discussed and recommendations are made.

J Midwifery Womens Health 2010;55:226–233 c̊ 2010 by the American College of Nurse-Midwives.