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

Meta Weltens*, Jascha de Nooijer, Marianne J. Nieuwenhuijze

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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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 languageEnglish
Pages (from-to)E197-E203
Number of pages7
JournalWomen and Birth
Issue number2
Publication statusPublished - Apr 2019


  • Midwifery
  • Referral
  • Intra-partum
  • Decision-making
  • Influencing factors
  • CARE


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