Table 3

Themes, subthemes and sample quotes from the 20 interviews with clinicians

Theme/subthemeSample quotesNumber of interviews themes/subthemes mentioned in
1. Parents’ involvement
 Contact and involvement“[…] if it is on that trolley, by the bed, they can at least see what is being done for the baby and what is going on.” (21; midwife)
“Even the babies that are just 32 weekers/33 weekers who won't necessarily need resuscitation but it just means that they're there with mum before whizzing them away.” (4; ANNP)
“Because you know, I think for the mother a C-section is not what you've planned for […] so at least you are with the baby which is more natural. More natural in an unnatural way.” (3; ANNP)
“I think because it was a section the screen was up, so they obviously couldn't see it happening.” (10; neonatal nurse)
 Positive emotions for parents“So for that I think it's perfect, because mum actually did say that she like the fact that she could see the baby and touch the baby.” (12; SHO)8
 Staff communication“I found the big positive was that you weren't far away in a corner and so you immediately started to talk to the parents about the baby.” (15; consultant neonatologist)
“It's easier to say while you are there ‘Oh we're just giving a few breaths’ rather than shout across the room.” (16; SHO)
“Massive difference [between practitioners] and […] having a trolley shouldn't make you interact with parents because you are near somebody's legs.” (24; ANNP)
2. Reservations about neonatal care at birth beside the mother
 Impact on clinicians“It doesn't bother me in the slightest.” (9; ANNP)
“Although, the worry for junior doctors, which is why some people don't like it, is not actually the equipment itself, it's more that you feel that you are on show. Your skills are going to be judged.” (12; SHO)
“You're then sort of setting a precedent for ‘OK, well we'll do this in front of your child’ and then it's when they're on intensive care, and they then expect, which, you know, it might be fine, their baby's…their LPs to be done in front of them and their intubation and everything else.” (15; consultant neonatologist)
 Impact on parents“I guess, we sort of thought, when we left, we also discussed and said ‘well, would that be traumatic for them to see, or would it be beneficial?’ And we actually felt it would be quite traumatic for them, the fact that they had to do chest compressions, but I understand that afterwards, they didn't find it traumatic.” (15; consultant neonatologist)12
3. Practical challenges in providing neonatal care at the bedside
 Cord length“I think, again, the one in theatre when we used it was quite a short cord, so it was difficult and they couldn't do the delayed cord clamping because it just wouldn't reach.” (19; SHO)10
 Caesarean section“I think because it was a section the screen was up, so they obviously couldn't see it happening.” (10; neonatal nurse)
“Yes it was a section so it was just a bit…trying to get in there and there were the surgeons there and that was more logistically a bit tricky.” (19; SHO)
“[…] we had to cover the trolley with a sterile cover and that kind of came up over the trolley and covered the switches and that kind of thing, so I completely forgot the clock because I couldn't see it, it was completely covered over.” (1; ANNP)
“I think one issue which I hadn't appreciated previously was the sterile versus partially sterile versus sterile nature […] and we're blurring those margins.” (2; consultant obstetrician)
“The baby was a bit blue and it didn't yell. It was fine but because I was there with the trolley and I had a nice warm surface and a towel, during that time I was able to rub the baby, dry him, stimulate him, and so within 30 seconds he was beginning to cry and respond and that's much easier to do than with the surgeon just holding the baby and I don't know but in that situation had the trolley not been there the surgeon may have wimped out before two minutes so that we could have taken the baby over to the resuscitaire.” (1; ANNP)
4. Comparison of the trolley with usual resuscitation equipment“No, I suppose the reason I like the old one is because on the sides they have like the side which flip out—they're like mini shelves that you can put stuff on like different size tubes and the laryngoscope, CO2 monitor and then clearly everything is next to you and you are not relying on this new method where it is a separate box and they were handing it to you. I just felt that you are more prepared when you go there because you get everything already set up.” (12; SHO)
“It is basically just the same, it's just obviously you have got a small working area on the trolley, especially if you have got a term baby on it, there doesn't seem like much room and the sides are quite low so you feel like you have to stand next to it—well you do have to stand right next to the baby the whole time. Whereas, on the big resuscitaire you can just put the side up and walk away from it.” (14; ANNP)
5. Training and integration of bedside care into clinical routine
 Teething problems“It's something just to get used to really rather than being a big issue. I think it's just more a case of teething problems and people on obstetrics knowing that they need to use it and where it needs to be and that kind of thing.” (14; ANNP)
“Overall it's different, so you have to get used to it don't you?” (25; senior paediatric registrar)
“A lot of the times we have got the delivery suite bleep. You know, you are only called a minute before the baby's out, so there is no time to go and get the trolley.” (C8; ANNP)
“Then, because you have a CTG machine and the actual obstetrician doing the delivery, I mean, they were getting a little bit tiresome of us because they felt we were actually on top of them.” (12; SHO)
“I think space actually, for us to get around is very good. I think being…you can see…not really you can see more, but it is more accessible because you can get all the way round.” (15; consultant neonatologist)
 Training“I would want to be with somebody experienced using the trolley” (16; SHO)
“I did have some apprehensions when I first started using it but I think that was due to my own confidence in actually physically using it. But I think once you have done it a couple of times it is second nature and it is so easy to see all the equipment and everything.” (9; ANNP)
  • ANNP, advanced neonatal practitioner; number, participant number; SHO, senior house officer.