Influencing factors in midwives’ decision-making during childbirth: A qualitative study in the Netherlands

Publication date: Available online 20 June 2018
Source:Women and Birth
Author(s): Meta Weltens, Jascha de Nooijer, Marianne J. Nieuwenhuijze
BackgroundDutch maternity care is based on the principle that pregnancy and childbirth are physiological processes. However, the last decade an increase of intra-partum referrals to obstetric-led care has been observed. Most of these referrals are among nulliparous women, non-urgent and occur during the first stage of labour. The increase in referrals seems not associated with better perinatal outcomes.ObjectiveGain understanding of underlying factors in the decision-making process prior to referral to obstetric-led care among midwives attending childbirth in midwifery-led care.MethodA qualitative study based on in-depth interviews with Dutch midwives (n=10) working in midwifery-led care. We performed a thematic analysis based on the hypothetico-deductive and the intuitive-humanist theory.ResultsMidwives mentioned knowledge as the basis of a reasoned decision. This included both theoretical knowledge, and knowledge from clinical experience. Influences of others, like the needs and wishes of labouring women were another factor influencing the decision-making, especially in non-urgent situations. Under subjective factors, the fear of being held responsible for professional choices emerged.Key conclusionThe decision-making process during childbirth is multi-factorial. The women's needs and wishes are recognized as of great influence on the decision-making process during childbirth, which is not included as a factor in the hypothetico-deductive or the intuitive-humanist theory.Implication for practiceThe influence of women's needs and wishes should be part of models about the intra-partum decision-making process. Midwives should find strategies to support women to make well-informed choices that include adequate information on the consequences of medicalisation in obstetric-led care.



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