Midwives' decision making during normal labour and birth: a decision making framework

Abstract

Background/Aims Understanding how midwives make decisions and what influences those decisions during labour and birth might illuminate why childbirth is straightforward for some women but needs a more interventionist route for others. The aim of this study was to explore midwifery decision-making during normal labour and birth. Methods An interpretivist epistemology with a case-study approach was used for this study, which involved data collection at two case sites. The participants were midwives on duty at two labour suites of large regional teaching hospitals in the East Midlands. Focus group interviews, observations, diary keeping and documentary reviews were included. Results There were five main themes. The central theme was ‘the hybrid midwife’. Within this theme, midwives were found to be operating in dualistic belief systems. They were operating between woman-centred, intuitive philosophies and associated decision-making approaches, and organisation-centred, hypothetico-deductive philosophies and related decision-making strategies. From the literature review and study findings, the situated, dynamic midwifery decision-making framework ‘focus on straightforward labour and birth’ was developed to assist in midwifery decision-making. Conclusions Decision-making in normal labour and birth is a complex phenomenon, influenced by many factors. Midwives have to balance decision-making strategies that are appropriate for childbearing women across all risk categories. However, they do not always appear to be fully prepared for the reality of decision-making in clinical practice.