One-to-one care routines and compliance with the national professional recommendation on continuous intrapartum support in Norway: A national survey

INTRODUCTION: In 2010, the Norwegian Directorate of Health introduced the guideline ‘Safe maternity services – quality standards for maternal care’. These standards include adequate staffing with health care personnel for birth units to ensure responsible monitoring and treatment. Birth units are to follow the professional recommendation that every woman has a midwife present during established labor. This study presents data from birth units on compliance with the national recommendation for one-to-one care during labor. METHODS: A web-based questionnaire was emailed to chief midwives of all birth units in Norway (n=48) in May 2018. The questionnaire contained a total of nine multiple-choice, scaled-response-format, and free-text questions. RESULTS: The questionnaire response rate was 100%. All birth units reported that they offered women one-to-one care during labor to a large extent. Sixty-five per cent of the birth units had procedures to ensure that midwives were present during established labor. Deviations from the recommendation were recorded in one-fourth of birth units. Thirty-eight per cent of respondents reported that staff training had been provided; 56% of birth units stated that the recommendation led to an increased presence of midwives during labor. Financial constraints (35%) and difficulty of compliance (27%) were cited as obstacles to meeting the recommendation for one-to-one care during labor. CONCLUSIONS: The majority of birth units reported that they follow the recommendation for one-to-one care during established labor, but compliance with this recommendation in practice remains unclear. Areas of improvement relate to routines describing the presence of midwives during labor, registration of deviations, and staff training in one-to-one care.