Affiliation: | 1. School of Health Sciences (HESAV), University of Applied Sciences and Arts, Western Switzerland (HES-SO), Lausanne, Switzerland;2. School of Sociology and Southwest Institute of Research on Women SIROW, University of Arizona, Tucson, United States;3. Institute of Midwifery, School of Health Professions, Zurich University of Applied Sciences, Switzerland |
Abstract: | BackgroundDecision-making in midwifery, including a claim for shared decision-making between midwives and women, is of major significance for the health of mother and child. Midwives have little information about how to share decision-making responsibilities with women, especially when complications arise during birth.AimTo increase understanding of decision-making in complex home-like birth settings by exploring midwives’ and women’s perspectives and to develop a dynamic model integrating participatory processes for making shared decisions.MethodsThe study, based on grounded theory methodology, analysed 20 interviews of midwives and 20 women who had experienced complications in home-like births.FindingsThe central phenomenon that arose from the data was “defining/redefining decision as a joint commitment to healthy childbirth”. The sub-indicators that make up this phenomenon were safety, responsibility, mutual and personal commitments. These sub-indicators were also identified to influence temporal conditions of decision-making and to apply different strategies for shared decision-making. Women adopted strategies such as delegating a decision, making the midwife’s decision her own, challenging a decision or taking a decision driven by the dynamics of childbirth. Midwives employed strategies such as remaining indecisive, approving a woman’s decision, making an informed decision or taking the necessary decision.Discussion and conclusionTo respond to recommendations for shared responsibility for care, midwives need to strengthen their shared decision-making skills. The visual model of decision-making in childbirth derived from the data provides a framework for transferring clinical reasoning into practice. |