Abstract
Background: Dutch 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.
Objective: Gain understanding of underlying factors in the decision-making process prior to referral to obstetric-led care among midwives attending childbirth in midwifery-led care.
Method: A 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.
Results: Midwives 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 womenwere 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 conclusion: The 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 practice: The influence of women's needs and wishes should be part of models about the intrapartum 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. (c) 2018 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
Original language | English |
---|---|
Pages (from-to) | E197-E203 |
Number of pages | 7 |
Journal | Women and Birth |
Volume | 32 |
Issue number | 2 |
DOIs | |
Publication status | Published - Apr 2019 |
Keywords
- Midwifery
- Referral
- Intra-partum
- Decision-making
- Influencing factors
- LABOR
- CARE