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Aims: This article is a report of a study of women's experiences of, and satisfaction with, telephone communications within the All Wales Clinical Pathway for Normal Labour ('the Pathway')., Background: The Pathway was introduced throughout Wales over 2003-2004. Its philosophy emphasizes the desirability of a woman remaining at home until labour is established with assessment by telephone, in contrast to the more common scenario where the phone call is a precursor to admission and face-to-face assessment., Methods: In 2005-2006, telephone interviews were carried out with 46 low-risk first-time mothers in Wales. This was a mixed-methods study with iterative quantitative and qualitative analysis, focusing on differences in the accounts of women with different levels of satisfaction., Findings: Women were not well prepared for the Pathway; however, satisfaction was more strongly related to interpersonal interactions with midwives. Dissatisfied women reported unclear advice, unmet needs, unaddressed anxieties and negative midwife manner. 'Very satisfied' women were distinguished by feeling welcome to attend the maternity unit and by the perceived adequacy of the advice given., Conclusions: This study provides new knowledge about telephone interactions between first-time mothers and midwives around labour onset. This is important in a changing healthcare context in which face-to-face interactions are likely to become less routine. Being made to feel welcome to attend the maternity unit might appear counter to the Pathway philosophy, but appeared to reduce women's anxieties about 'being allowed in' or getting to hospital in time, and gave them confidence to remain at home longer., (© 2011 Blackwell Publishing Ltd.)

Objective: To examine the attitudes of obstetricians in England and Wales concerning prenatal diagnosis and termination of pregnancy and to compare these with a similar survey carried out in 1980., Methods: Postal questionnaires, based on those used in 1980, were sent to a random sample of 555 nonacademic consultant obstetricians, 71% of whom replied., Results: The proportion of consultant obstetricians with a conscientious objection to termination of pregnancy was the same in both surveys, although virtually all conscientious objectors said that they made an exception for serious fetal abnormality. A major change was in the proportion saying that they generally required an undertaking to terminate an affected pregnancy before proceeding with amniocentesis: 75% in 1980 compared with 34% in 1993. As in 1980, lower priority is given to telling women of negative test results than of positive. More obstetricians in 1993 are prepared to consider terminations later in pregnancy, both for fetal abnormality and for social reasons, than was the case in 1980, but many are not prepared to recommend termination as late in pregnancy as the law allows. In some cases this is due to misapprehensions about what is legal. There are particular problems concerning terminations for fetal anomalies that not all would consider serious. One in seven of the 1993 sample would not recommend termination for cystic fibrosis at any gestation. Only 13% would recommend termination for Down's syndrome beyond 24 weeks. There is a need not only for clarification of the law, but also of obstetrician's willingness to implement it.

Objectives: To assess the experiences of obstetricians in England and Wales of serum screening for Down's syndrome., Design: Postal questionnaire survey., Subjects: Questionnaires were sent to all practising obstetricians in England and Wales with nonacademic appointments who had not participated in an earlier (randomly sampled) survey of obstetricians' attitudes (n = 555). Responses were received from 393 (71%), of which 351 were analysed. The data represent about one third of obstetric consultants in England and Wales., Main Outcome Measures: The extent of use of serum screening for Down's syndrome, and the problems encountered., Results: Serum screening for Down's syndrome was being offered on some basis by virtually all obstetricians in the survey. Nearly half the sample said that they did not have adequate resources for counselling all the women to whom screening was offered. Many problems were reported, which in all cases were more common than equivalent problems encountered with serum screening for neural tube defects. Over 80% (289) said that women not understanding the test was a problem., Conclusions: There is considerable confusion associated with serum screening for Down's syndrome. The precedent of serum screening for neural tube defects does not seem to have lessened the problems experienced, rather the contrary. Many obstetricians report inadequate resources for counselling, which is consistent with the high prevalence of problems associated with women not understanding the test. There is an urgent need to consider what counselling should consist of and who should undertake it and to ensure that necessary resources are available.