Maternity guidelines: Aid or hindrance?

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Abstract
This questionnaire survey was performed to explore the attitudes of 295 obstetricians and midwives in a teaching and a district general hospital, towards the maternity directorate guidelines, and to document the possible barriers that may hinder their adherence and suggestions for improvement. The response rate was 61%. There was a tendency in both hospitals to agree that guidelines help learning and improve the quality of care, but make practice defensive, stop innovation, narrow the clinical freedom and do not reduce cost. A significantly higher number in the district hospital valued the guidelines as an aid to use the most up-to-date knowledge. Interestingly, about half of the staff in both hospitals were neutral regarding the role guidelines play in increasing professional satisfaction. The major barrier for lack of adherence was the belief that the individual guidelines were not comprehensive enough to cover daily practice. The trend of the responses was similar in both hospitals with the exception of three areas, where there were significant differences; pressure of time in the teaching hospital, and senior disagreement and lack of resources in the district hospital. Using bullet points for clarity within guidelines, shortening the guidelines, announcing new editions in directorate meetings, and frequent updating were the most common suggestions for improvement. The variations in staff response between the two hospitals highlight the importance of tailoring guidelines to match the working environment and the staff views rather than rigidly dictating practice.