Decision-making in Swiss home-like childbirth : a grounded theory study

Meyer, Yvonne (HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland) ; Frank, Franziska (School of Sociology and Southwest Institute of Research on Women SIROW, University of Arizona, Tucson, United States) ; Schläppy Muntwyler, Franziska (HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland) ; Fleming, Valerie (Institute of Midwifery, School of Health Professions, Zurich University of Applied Sciences, Switzerland) ; Pehlke-Milde, Jessica (Institute of Midwifery, School of Health Professions, Zurich University of Applied Sciences, Switzerland)

Background: Decision-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. Aim: To 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. Methods: The study, based on grounded theory methodology, analysed 20 interviews of midwives and 20 women who had experienced complications in home-like births. Findings: The 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 conclusion: To 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.


Keywords:
Article Type:
scientifique
Faculty:
Santé
Branch:
Sage-femme
School:
HESAV
Institute:
Unité de recherche en santé, HESAV
Date:
2017-12
Pagination:
9 p.
Published in:
Women and birth
Numeration (vol. no.):
December 2017, vol. 30, issue 6, pp. e272–e280
DOI:
ISSN:
1871-5192
Appears in Collection:



 Record created 2021-06-17, last modified 2021-06-21


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