Knowledge and skills used for clinical decision-making on childbirth interventions: A qualitative study among midwives in the Netherlands

D. C. Zondag*, T. M. van Haaren-Ten Haken, P. M. Offerhaus, V. Y. F. Maas, M. J. Nieuwenhuijze

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

5 Citations (Scopus)
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Abstract

INTRODUCTION Appropriate use of interventions in maternity care is a worldwide issue. Midwifery-led models of care are associated with more efficient use of resources, fewer medical interventions, and improved outcomes. However, the use of interventions varies considerably between midwives. The aim of this study was to explore how knowledge and skills influence clinical decision-making of midwives on the appropriate use of childbirth interventions. METHODS A qualitative study using in-depth interviews with 20 primary care midwives was performed in June 2019. Participants’ clinical experience varied in the use of interventions. The interviews combined a narrative approach with a semi-structured question route. Data were analyzed using deductive content analysis. RESULTS ‘Knowledge’, ‘Critical thinking skills’, and ‘Communication skills’ influenced midwives’ clinical decision-making towards childbirth interventions. Midwives obtained their knowledge through the formal education program and extended their knowledge by reflecting on experiences and evidence. Midwives with a low use of interventions seem to have a higher level of reflective skills, including reflection-in-action. These midwives used a more balanced communication style with instrumental and affective communication skills in interaction with women, and have more skills to engage in discussions during collaboration with other professionals, and thus personalizing their care. CONCLUSIONS Midwives with a low use of interventions seemed to have the knowledge and skills of a reflective practitioner, leading to more personalized care compared to standardized care as defined in protocols. Learning through reflectivity, critical thinking skills, and instrumental and affective communication skills, need to be stimulated and trained to pursue appropriate, personalized use of interventions.

Original languageEnglish
Article number56
JournalEuropean Journal of Midwifery
Volume6
Issue numberSeptember
DOIs
Publication statusPublished - 1 Sept 2022

Bibliographical note

Funding Information:
There was no source of funding for this research.

Publisher Copyright:
© 2022 Zondag L. D. C. et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License. (https://creativecommons.org/licenses/by/4.0/)

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