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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2017

Open Access 01-12-2017 | Research article

Factors influencing the clinical decision-making of midwives: a qualitative study

Authors: Darie O. A. Daemers, Evelien B. M. van Limbeek, Hennie A. A. Wijnen, Marianne J. Nieuwenhuijze, Raymond G. de Vries

Published in: BMC Pregnancy and Childbirth | Issue 1/2017

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Abstract

Background

Although midwives make clinical decisions that have an impact on the health and well-being of mothers and babies, little is known about how they make those decisions. Wide variation in intrapartum decisions to refer women to obstetrician-led care suggests that midwives’ decisions are based on more than the evidence based medicine (EBM) model – i.e. clinical evidence, midwife’s expertise, and woman’s values - alone. With this study we aimed to explore the factors that influence clinical decision-making of midwives who work independently.

Methods

We used a qualitative approach, conducting in-depth interviews with a purposive sample of 11 Dutch primary care midwives. Data collection took place between May and September 2015. The interviews were semi-structured, using written vignettes to solicit midwives’ clinical decision-making processes (Think Aloud method). We performed thematic analysis on the transcripts.

Results

We identified five themes that influenced clinical decision-making: the pregnant woman as a whole person, sources of knowledge, the midwife as a whole person, the collaboration between maternity care professionals, and the organisation of care. Regarding the midwife, her decisions were shaped not only by her experience, intuition, and personal circumstances, but also by her attitudes about physiology, woman-centredness, shared decision-making, and collaboration with other professionals. The nature of the local collaboration between maternity care professionals and locally-developed protocols dominated midwives’ clinical decision-making. When midwives and obstetricians had different philosophies of care and different practice styles, their collaborative efforts were challenged.

Conclusion

Midwives’ clinical decision-making is a more varied and complex process than the EBM framework suggests. If midwives are to succeed in their role as promoters and protectors of physiological pregnancy and birth, they need to understand how clinical decisions in a multidisciplinary context are actually made.
Literature
1.
Renfrew MJ, McFadden A, Bastos MH, Campbell J, Channon AA, Cheung NF, Audebert Delage Silva DR, Downe S, Powell Kennedy H, Malata A, McCormick F, Wick L, Declercq E. Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care. Lancet. 2014;384(9948):1129–45.CrossRefPubMed
2.
3.
4.
Styles M, Cheyne H, O’Carroll R, Greig F, Dagge Bell F, Niven C. The Scottish Trial of Refer or Keep (the STORK study): midwives’ intrapartum decision making. Midwifery. 2011;27(1):104–11.CrossRefPubMed
5.
Cheyne H, Dalgleish L, Tucker J, Kane F, Shetty A, McLeod S, Niven C. Risk assessment and decision making about in-labour transfer from rural maternity care: a social judgment and signal detection analysis. BMC Med Inform Decis Mak. 2012;12:122.CrossRefPubMedPubMedCentral
6.
Offerhaus PM, Geerts C, de Jonge A, Hukkelhoven CW, Twisk JW, Lagro Janssen AL. Variation in referrals to secondary obstetrician-led care among primary midwifery care practices in the Netherlands: a nationwide cohort study. BMC Pregnancy Childbirth. 2015;15:42.CrossRefPubMedPubMedCentral
7.
Page M, Mander R. Intrapartum uncertainty: a feature of normal birth, as experienced by midwives in Scotland. Midwifery. 2014;30(1):28–35.CrossRefPubMed
8.
Mead MM, Kornbrot D. The influence of maternity units’ intrapartum intervention rates and midwives’ risk perception for women suitable for midwifery-led care. Midwifery. 2004;20(1):61–71.CrossRefPubMed
9.
Wiegers TA, van der Zee J, Kerssens JJ, Keirse MJ. Variation in home-birth rates between midwifery practices in The Netherlands. Midwifery. 2000;16(2):96–104.CrossRefPubMed
10.
Offerhaus PM, Korfker D, de Jonge A, van der Pal-de Bruin KM, Scheepers PLH, Lagro-Janssen TLM. Midwives and variation in referral decisions during labour. In: Offerhaus P. Patterns in primary midwife-led care in the Netherlands. Nijmegen; 2015. p. 104–17.
11.
Healy S, Humphreys E, Kennedy C. Midwives’ and obstetricians’ perceptions of risk and its impact on clinical practice and decision-making in labour: an integrative review. Women Birth. 2016;29(2):107–16.CrossRefPubMed
12.
Fontein Y. The comparison of birth outcomes and birth experiences of low-risk women in different sized midwifery practices in the Netherlands. Women Birth. 2010;23(3):103–10.CrossRefPubMed
13.
Shafaroodi N, Kamali M, Parvizy S, Mehraban AH, O’Toole G. Factors affecting clinical reasoning of occupational therapists: a qualitative study. Med J Islam Repub Iran. 2014;28:8.PubMedPubMedCentral
14.
Ramezani Badr F, Nasrabadi AN, Yekta ZP, Taleghani F. Strategies and criteria for clinical decision making in critical care nurses: a qualitative study. J Nurs Scholarsh. 2009;41(4):351–8.CrossRefPubMed
15.
16.
17.
Fonteyn ME, Kuipers B, Grobe SJ. A description of think aloud method and protocol analysis. Qual Health Res. 1993;3(4):430–41.CrossRef
18.
Lundgrén-Laine H, Salanterä S. Think-aloud technique and protocol analysis in clinical-decision making research. Qual Health Res. 2009;20(4):565–75.CrossRefPubMed
19.
Puhl RM, Heuer CA. The stigma of obesity: a review and update. Obesity (Silver Spring). 2009;17(5):941–64.CrossRef
20.
Daemers DO, Wijnen HA, van Limbeek EB, Bude LM, Nieuwenhuijze MJ, Spaanderman ME, de Vries RG. The impact of obesity on outcomes of midwife-led pregnancy and childbirth in a primary care population: a prospective cohort study. BJOG. 2014;121(11):1403–13.CrossRefPubMed
21.
22.
Guest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation and variability. Field Methods. 2006;18(1):59–82.CrossRef
23.
Cleary M, Horsfall J, Hayter M. Data collection and sampling in qualitative research: does size matter? J Adv Nurs. 2014;70(3):473–5.CrossRefPubMed
24.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef
25.
Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nurs Health Sci. 2013;15:398–405.CrossRefPubMed
26.
Harding J. Qualitative data analysis from start to finish. Los Angeles, London, New Delhi, Singapore, Washington DC: Sage; 2013.
27.
Heverly MAFD, Newman FL. Constructing case vignettes for evaluating clinical judgment: an empirical model. Eval Program Plann. 1984;7:45–55.CrossRef
28.
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57.CrossRefPubMed
29.
30.
Porter S, Crozier K, Sinclair M, Kernohan WG. New midwifery? A qualitative analysis of midwives’ decision-making strategies. J Adv Nurs. 2007;60(5):525–34.CrossRefPubMed
31.
Simpson KR, James DC, Knox GE. Nurse-physician communication during labor and birth: implications for patient safety. J Obstet Gynecol Neonatal Nurs. 2006;35(4):547–56.CrossRefPubMed
32.
Fullerton JT, Hollenbach KA, Wingard DL. Practice styles, a comparison of obstetricians and nurse-midwives. J Nurse Midwifery. 1996;41(3):243–50.CrossRefPubMed
33.
Hunter B, Segrott J. Renegotiating inter-professional boundaries in maternity care: implementing a clinical pathway for normal labour. Sociol Health Illn. 2014;36(5):719–37.CrossRefPubMedPubMedCentral
34.
Downe S, Finlayson K, Fleming A. Creating a collaborative culture in maternity care. J Midwifery Womens Health. 2010;55(3):250–4.CrossRefPubMed
35.
O’Connell R, Downe S. A metasynthesis of midwiveséxperience of hospital practice in publicly funded settings: compliance, resistance and authenticity. Health. 2009;13(6):589–609.CrossRefPubMed
36.
Thompson SM, Nieuwenhuijze MJ, Low LK, de Vries R. Exploring Dutch midwives’ attitudes to promoting physiological childbirth: A qualitative study. Midwifery. 2016;42:67–73.CrossRefPubMed
37.
Scamell M, Alaszewski A. Fateful moments and the categorisation of risk: Midwifery practice and the ever-narrowing window of normality during childbirth. Health Risk Soc. 2012;14(2):207–21.CrossRef
38.
Hall WA, Tomkinson J, Klein MC. Canadian care providers’ and pregnant women’s approaches to managing birth: minimizing risk while maximizing integrity. Qual Health Res. 2012;22(5):575–86.CrossRefPubMed
39.
Orme L, Maggs C. Decision-making in clinical practice: how do expert nurses, midwives and health visitors make decisions? Nurse Educ Today. 1993;13:270–6.CrossRefPubMed
40.
Stuurgroep zwangerschap en geboorte. Een goed begin; veilige zorg rond zwangerschap en geboorte. Utrecht: Ministerie van Volksgezondheid, Welzijn en Sport; 2009.
41.
42.
Maassen MS, Hendrix MJ, Van Vugt HC, Veersema S, Smits F, Nijhuis JG. Operative deliveries in low-risk pregnancies in The Netherlands: primary versus secondary care. Birth. 2008;35(4):277–82.CrossRefPubMed
43.
Offerhaus PM, Hukkelhoven CW, de Jonge A, van der Pal de Bruin KM, Scheepers PL, Lagro Janssen AL. Persisting rise in referrals during labor in primary midwife-led care in the Netherlands. Birth. 2013;40(3):192–201.CrossRefPubMed
44.
MacDorman MF, Declercq E, Menacker F, Malloy MH. Neonatal mortality for primary cesarean and vaginal births to low-risk women: application of an “intention-to-treat” model. Birth. 2008;35(1):3–8.CrossRefPubMed
45.
Declercq E, Barger M, Cabral HJ, Evans SR, Kotelchuck M, Simon C, Weiss J, Heffner LJ. Maternal outcomes associated with planned primary cesarean births compared with planned vaginal births. Obstet Gynecol. 2007;109(3):669–77.CrossRefPubMed
46.
Villar J, Valladares E, Wojdyla D, Zavaleta N, Carroli G, Velazco A, Shah A, Campodonico L, et al. Caesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey on maternal and perinatal health in Latin America. Lancet. 2006;367(9525):1819–29.CrossRefPubMed
47.
Metadata
Title
Factors influencing the clinical decision-making of midwives: a qualitative study
Authors
Darie O. A. Daemers
Evelien B. M. van Limbeek
Hennie A. A. Wijnen
Marianne J. Nieuwenhuijze
Raymond G. de Vries
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2017
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-017-1511-5

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