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

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

Weekday and weekend sedentary time and physical activity in differentially active children

ObjectivesTo investigate whether weekday–weekend differences in sedentary time and specific intensities of physical activity exist among children categorised by physical activity levels.DesignCross-sectional observational study.MethodsSeven-day accelerometer data were obtained from 810 English children (n = 420 girls) aged 10–11 years. Daily average min day−1 spent in moderate to vigorous physical activity were calculated for each child. Sex-specific moderate to vigorous physical activity quartile cut-off values categorised boys and girls separately into four graded groups representing the least (Q1) through to the most active (Q4) children. Sex- and activity quartile-specific multilevel linear regression analyses analysed differences in sedentary time, light physical activity, moderate physical activity, vigorous physical activity, and moderate to vigorous physical activity between weekdays and weekends.ResultsOn weekdays Q2 boys spent longer in light physical activity (p < 0.05), Q1 (p < 0.001), Q2 boys (p < 0.01) did significantly more moderate physical activity, and Q1–Q3 boys accumulated significantly more vigorous physical activity and moderate to vigorous physical activity than at weekends. There were no significant differences in weekday and weekend sedentary time or physical activity for Q4 boys. On weekdays Q2 and Q3 girls accumulated more sedentary time (p < 0.05), Q1 and Q2 girls did significantly more moderate physical activity (p < 0.05), and Q1–Q3 girls engaged in more vigorous physical activity (p < 0.05) and more moderate to vigorous physical activity (p < 0.01) than at weekends. Q4 girls’ sedentary time and physical activity varied little between weekdays and weekends.ConclusionsThe most active children maintained their sedentary time and physical activity levels at weekends, while among less active peers weekend sedentary time and physical activity at all intensities was lower. Low active children may benefit most from weekend intervention strategies