Open Access Highly Accessed Research article

Measuring the quality and quantity of professional intrapartum support: testing a computerised systematic observation tool in the clinical setting

Mary C Ross-Davie1*, Helen Cheyne2 and Catherine Niven3

Author Affiliations

1 Educational Projects Manager, Midwifery and Reproductive Health, NHS Education for Scotland, Westport 102Westport, Edinburgh EH3 9DN, UK

2 Royal College of Midwives Professor of Midwifery & Professor of Maternal and Child Health Research, NMAHP Research Unit, University of Stirling, Stirling FK9 4LA, UK

3 Emeritus Professor, University of Stirling, Stirling FK9 4LA, UK

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BMC Pregnancy and Childbirth 2013, 13:163  doi:10.1186/1471-2393-13-163

Published: 14 August 2013



Continuous support in labour has a significant impact on a range of clinical outcomes, though whether the quality and quantity of support behaviours affects the strength of this impact has not yet been established. To identify the quality and quantity of support, a reliable means of measurement is needed. To this end, a new computerised systematic observation tool, the ‘SMILI’ (Supportive Midwifery in Labour Instrument) was developed.

The aim of the study was to test the validity and usability of the ‘Supportive Midwifery in Labour Instrument’ (SMILI) and to test the feasibility and acceptability of the systematic observation approach in the clinical intrapartum setting.


Systematic observation was combined with a postnatal questionnaire and the collection of data about clinical processes and outcomes for each observed labour.

The setting for the study was four National Health Service maternity units in Scotland, UK. Participants in this study were forty five midwives and forty four women.

The SMILI was used by trained midwife observers to record labour care provided by midwives. Observations were undertaken for an average of two hours and seventeen minutes during the active first stage of labour and, in 18 cases, the observation included the second stage of labour. Content validity of the instrument was tested by the observers, noting the extent to which the SMILI facilitated the recording of all key aspects of labour care and interactions. Construct validity was tested through exploration of correlations between the data recorded and women’s feelings about the support they received. Feasibility and usability data were recorded following each observation by the observer. Internal reliability and construct validity were tested through statistical analysis of the data.


One hundred and four hours of labour care were observed and recorded using the SMILI during forty nine labour episodes.


The SMILI was found to be a valid and reliable instrument in the intrapartum setting in which it was tested. The study identified that the SMILI could be used to test correlations between the quantity and quality of support and outcomes. The systematic observational approach was found to be an acceptable and feasible method of enquiry.

Intrapartum; Labour; Support; Midwife; Systematic; Observation; Quantity; Quality; Clinical outcomes