Decision-making in Swiss home-like childbirth: A grounded theory study

Publication date: Available online 16 June 2017
Source:Women and Birth
Author(s): Yvonne Meyer, Franziska Frank, Franziska Schläppy Muntwyler, Valerie Fleming, Jessica Pehlke-Milde
BackgroundDecision-making in midwifery, including a claim for shared decision-making between midwives and women, is of major significance for the health of mother and child. Midwives have little information about how to share decision-making responsibilities with women, especially when complications arise during birth.AimTo increase understanding of decision-making in complex home-like birth settings by exploring midwives' and women's perspectives and to develop a dynamic model integrating participatory processes for making shared decisions.MethodsThe study, based on grounded theory methodology, analysed 20 interviews of midwives and 20 women who had experienced complications in home-like births.FindingsThe central phenomenon that arose from the data was "defining/redefining decision as a joint commitment to healthy childbirth". The sub-indicators that make up this phenomenon were safety, responsibility, mutual and personal commitments. These sub-indicators were also identified to influence temporal conditions of decision-making and to apply different strategies for shared decision-making. Women adopted strategies such as delegating a decision, making the midwife's decision her own, challenging a decision or taking a decision driven by the dynamics of childbirth. Midwives employed strategies such as remaining indecisive, approving a woman's decision, making an informed decision or taking the necessary decision.Discussion and conclusionTo respond to recommendations for shared responsibility for care, midwives need to strengthen their shared decision-making skills. The visual model of decision-making in childbirth derived from the data provides a framework for transferring clinical reasoning into practice.



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