A review of the literature : Midwifery decision-making and birth

Journal article

Jefford, Elaine, Fahy, Kathleen and Sundin, Deborah. (2010). A review of the literature : Midwifery decision-making and birth. Women and Birth. 23(4), pp. 127-134. https://doi.org/10.1016/j.wombi.2010.02.001
AuthorsJefford, Elaine, Fahy, Kathleen and Sundin, Deborah

Clinical decision-making was initially studied in medicine where hypothetico-deductive reasoning is the model for decision-making. The nursing perspective on clinical decision-making has largely been shaped by Patricia Benner's ground breaking work. Benner claimed expert nurses use humanistic-intuitive ways of making clinical decisions rather than the ‘rational reasoning’ as claimed by medicine. Clinical decision-making in midwifery is not the same as either nursing or medical decision-making because of the woman–midwife partnership where the woman is the ultimate decision-maker.

CINHAL, Medline and Cochrane databases were systematically searched using key words derived from the guiding question. A review of the decision-making research literature in midwifery was undertaken where studies were published in English. The selection criteria for papers were: only research papers of direct relevance to the guiding research question were included in the review.

Decision-making is under-researched in midwifery and more specifically birth, as only 4 research articles met the inclusion criteria in this review. Three of the studies involved qualified midwives, and one involved student midwives. Two studies were undertaken in England, one in Scotland and one in Sweden. The major findings synthesised from this review, are that; (1) midwifery decision-making during birth is socially negotiated involving hierarchies of surveillance and control; (2) the role of the woman in shared decision-making during birth has not been explored by midwifery research; (3) clinical decision-making encompasses clinical reasoning as essential but not sufficient for midwives to actually implement their preferred decision.

We argue that existing research does not inform the discipline of the complexity of midwifery clinical decision-making during birth. A well-designed study would involve investigating the clinical reasoning skills of the midwife, her relationship with the woman, the context of the particular birthing unit and the employment status of the midwife. The role of the woman as decision-maker in her own care during birth also needs careful research attention.

Keywordsdecision-making; birth; midwives; decision-implementation; second stage
JournalWomen and Birth
Journal citation23 (4), pp. 127-134
PublisherElsevier Australia
Digital Object Identifier (DOI)https://doi.org/10.1016/j.wombi.2010.02.001
PubMed ID20227360
Scopus EID2-s2.0-77958514580
Page range127-134
Research GroupSchool of Nursing, Midwifery and Paramedicine
Publisher's version
All rights reserved
File Access Level
Output statusPublished
Publication dates
Online12 Mar 2010
Publication process dates
Accepted03 Feb 2010
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