Meyer Yvonne, Frank Franziska, Schläppy Muntwyler Franziska, Fleming Valerie, Pehlke-Milde Jessica
School of Health Sciences (HESAV), University of Applied Sciences and Arts, Western Switzerland (HES-SO), Lausanne, Switzerland.
School of Sociology and Southwest Institute of Research on Women SIROW, University of Arizona, Tucson, United States.
Women Birth. 2017 Dec;30(6):e272-e280. doi: 10.1016/j.wombi.2017.05.004. Epub 2017 Jun 16.
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.
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.
The study, based on grounded theory methodology, analysed 20 interviews of midwives and 20 women who had experienced complications in home-like births.
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.
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.
助产决策，包括助产士与产妇共同决策的主张，对母婴健康具有重要意义。助产士对于如何与产妇分担决策责任了解甚少，尤其是在分娩过程中出现并发症时。
通过探究助产士和产妇的观点，增进对类似家庭环境下复杂分娩决策的理解，并建立一个整合参与式共同决策过程的动态模型。
本研究基于扎根理论方法，分析了20名助产士以及20名在类似家庭环境下分娩时出现并发症的产妇的访谈内容。
数据中出现的核心现象是“将决策定义/重新定义为对健康分娩的共同承诺”。构成这一现象的子指标包括安全性、责任、相互承诺和个人承诺。这些子指标还被确定会影响决策的时间条件，并适用于不同的共同决策策略。产妇采用的策略包括授权决策、认可助产士的决策、质疑决策或根据分娩动态做出决策。助产士采用的策略包括犹豫不决、批准产妇的决策、做出明智的决策或做出必要的决策。
为了回应关于共同承担护理责任的建议，助产士需要加强他们的共同决策技能。从数据中得出的分娩决策可视化模型为将临床推理转化为实践提供了一个框架。
