Monash Nursing and Midwifery, Monash University, Peninsula Campus, Building E, Moorooduc Hwy, Frankston, Victoria, 3199, Australia.
Monash Nursing and Midwifery, Monash University, Peninsula Campus, Building E, Moorooduc Hwy, Frankston, Victoria, 3199, Australia; Department of Midwifery, School of Health, Federation University, Mt Helen Campus Ballarat, Victoria, Australia.
Midwifery. 2022 Jun;109:103322. doi: 10.1016/j.midw.2022.103322. Epub 2022 Mar 23.
Informed decision-making is a vital component of midwifery philosophy and a core recommendation of the global respectful maternity care charter; however, women and midwives report a lack of informed decision-making in actual practice. Research reveals informed decision-making improves physical and mental health outcomes for women, regardless of childbearing experience, and is a protective factor for midwives' job satisfaction. There is currently little known about midwives' experiences of facilitating informed decision-making, and associated barriers.
To critically appraise and synthesize the best qualitative evidence exploring midwives' experiences of facilitating women's informed decision-making.
A systematic search of key databases and grey literature for qualitative research in English language published between 2010-2019. Quality assessment followed CASP guidelines and this review is reported in accordance with PRISMA guidelines. Thirteen studies were included in the final review. Data were synthesised narratively.
Midwives were shown to have a strong desire to facilitate informed decision-making, yet reported a disparity between philosophy and practice due to multiple barriers. Barriers included; lack of specific knowledge and training, fear of blame and litigation, structural constraints including lack of time and fragmented models of midwifery care, and multidisciplinary philosophical disparities.
Existing literature identifies informed decision-making is the gold-standard in providing safe and respectful maternity care, yet this review demonstrates that it is not well executed in actual practice. Midwives recognise this disparity and identify barriers which require urgent education, research, policy and practice solutions.
知情决策是产科学理念的重要组成部分，也是全球尊重孕产妇保健宪章的核心建议；然而，女性和助产士报告说，实际实践中缺乏知情决策。研究表明，知情决策可改善女性身心健康结果，无论其生育经验如何，并且是助产士工作满意度的保护因素。目前，人们对助产士在促进知情决策方面的经验以及相关障碍知之甚少。
批判性评估和综合探索助产士在促进女性知情决策方面经验的最佳定性证据。
系统检索 2010-2019 年间以英文发表的定性研究的主要数据库和灰色文献。质量评估遵循 CASP 指南，本综述按照 PRISMA 指南进行报告。最终综述纳入了 13 项研究。数据以叙述方式进行综合。
助产士表现出强烈的促进知情决策的愿望，但由于多种障碍，报告说在哲学和实践之间存在差距。障碍包括：缺乏特定的知识和培训、害怕指责和诉讼、结构限制，包括缺乏时间和分散的助产护理模式，以及多学科哲学差异。
现有文献认为知情决策是提供安全和尊重孕产妇保健的黄金标准，但本综述表明，在实际实践中并未很好地执行。助产士认识到这种差距，并确定了需要紧急教育、研究、政策和实践解决方案的障碍。
