Monash Nursing and Midwifery, Monash University, Melbourne Victoria, Australia.
Monash Nursing and Midwifery, Monash University, Melbourne Victoria, Australia. Electronic address: https://twitter.com/https://twitter.com/GabbyBrand6.
Midwifery. 2023 Dec;127:103868. doi: 10.1016/j.midw.2023.103868. Epub 2023 Nov 2.
Midwifery philosophy promotes informed decision-making. Despite this, midwives report a lack of informed decision-making in standard maternity care systems.
Previous research has shown a woman's ability to make informed decisions within her maternity care significantly impacts her childbearing experience. When informed decision-making is facilitated, women report positive experiences, whereas when lacking, there is an increased potential for birth trauma.
To explore midwives' experiences of facilitating informed decision-making, using third-stage management as context.
Five midwives from Victoria, Australia, were interviewed about their experiences with informed decision-making. These interviews were guided by portraiture methodology whereby individual narrative portraits were created. This paper explores the shared themes among these five portraits.
Five individual narrative portraits tell the stories of each midwife, providing rich insight into their philosophies, practices, barriers and enablers of informed decision-making. These are then examined as a whole dataset to explore shared themes, and include; 'informed decision-making is fundamental to midwifery practice' 'the system', and 'navigating the system'. The system contained the sub-themes; hierarchy in hospitals, the medicalisation of birth, and the impact on midwifery practice, and 'navigating the system' - contained; safety of the woman and safety of the midwife, and the gold-standard of midwifery.
Midwives in this study valued informed decision-making as fundamental to their philosophy but also faced barriers in their ability to facilitate it. Barriers to informed decision-making included: power-imbalances; de-skilling in physiological birth; fear of blame, and interdisciplinary disparities. Conversely enablers included continuity models of midwifery care, quality antenatal education, respectful interdisciplinary collaboration and an aim toward a resurgence of fundamental midwifery skills.
产科学哲学提倡知情决策。尽管如此，助产士报告说，在标准的产妇护理系统中缺乏知情决策。
先前的研究表明，女性在其产妇护理中做出知情决策的能力对其分娩体验有重大影响。当促进知情决策时，女性报告有积极的体验，而当缺乏时，则增加了分娩创伤的可能性。
以第三产程管理为背景，探讨助产士在促进知情决策方面的经验。
来自澳大利亚维多利亚州的 5 名助产士接受了有关其知情决策经验的访谈。这些访谈由肖像学方法指导，通过该方法创建了个人叙事肖像。本文探讨了这五幅肖像中的共同主题。
五幅个人叙事肖像讲述了每位助产士的故事，深入了解了他们的哲学、实践、知情决策的障碍和促进因素。然后，作为一个整体数据集进行检查，以探讨共同主题，包括：“知情决策是助产实践的基础”、“系统”和“系统导航”。系统包含了医院等级制度、生育医学化以及对助产实践的影响等子主题，以及“系统导航”——包含了妇女和助产士的安全、以及黄金标准的助产实践。
本研究中的助产士重视知情决策，认为这是他们哲学的基础，但在促进知情决策方面也面临障碍。知情决策的障碍包括权力失衡、生理分娩技能的丧失、害怕指责以及跨学科差异。相反，促进因素包括助产护理的连续性模式、高质量的产前教育、尊重的跨学科合作以及恢复基本助产技能的目标。
