Department of Obstetrics and Gynaecology, Stavanger University Hospital, Gerd-Ragna Bloch Thorsens gate 8, 4011 Stavanger, Norway.
Master Programme in Midwifery, UiT - The Arctic University of Norway, Tromsoe, Norway.
Midwifery. 2025 Jan;140:104192. doi: 10.1016/j.midw.2024.104192. Epub 2024 Sep 26.
For health care providers to ensure appropriate decision-making in clinical settings during childbirth, facilitators and barriers must be identified.
Women who experience a sense of control by participating in the decision-making process, are more likely to have a positive birth experience. However, decision-making may involve hierarchies of close observation and control.
The aim of the scoping review was to map and summarise existing literature on the process of clinical decision-making during childbirth from the perspective of labouring women, relatives and health care providers.
We carried out a scoping review in line with Joanna Briggs Institute scoping review methodology. The search identified studies in Scandinavian or English languages from 2010 - Jan 2023 comprising evidence at different levels of the pyramid, resulting in 18.227 hits. Following the PRISMA checklist, the final inclusion comprised 62 papers.
Four main categories summarized the importance of the following factors: 1) Woman-caregiver relationship, with sub-categories The importance of communication and Midwifery care, 2) Consent and legal issues, 3) Organization, with sub-categories Medicalization, Working atmosphere, and Complexity, and 4) Decision-making tools and models, with sub-categories Shared decision-making, and Other tools and models for decision-making.
Balancing intuition and expertise of caregivers with evidence-based practices, is crucial to ensure women's participation in decision-making. Furthermore, a trusting relationship between the mother, partner, and health care provider is of utmost importance. Shared decision-making, which appeared to be the primary model for clinical decision-making regardless context, requires reflective practice and is a communication strategy.
为了确保医疗保健提供者在分娩期间能够在临床环境中做出适当的决策，必须确定促进因素和障碍。
参与决策过程的女性会感到更有控制感，从而更有可能拥有积极的分娩体验。然而，决策可能涉及到密切观察和控制的层次结构。
本次范围综述的目的是从产妇、亲属和医疗保健提供者的角度绘制和总结现有的关于分娩期间临床决策过程的文献。
我们按照乔安娜·布里格斯研究所的范围综述方法进行了范围综述。该搜索确定了 2010 年至 2023 年 1 月在斯堪的纳维亚语或英语发表的研究，包含了金字塔不同层次的证据，共产生了 18227 个结果。根据 PRISMA 清单，最终纳入了 62 篇论文。
四个主要类别总结了以下因素的重要性：1）女性-护理人员关系，包含子类别沟通和助产护理的重要性，2）同意和法律问题，3）组织，包含子类别医疗化、工作氛围和复杂性，以及 4）决策工具和模型，包含子类别共同决策和其他决策工具和模型。
在确保妇女参与决策的过程中，平衡护理人员的直觉和专业知识与基于证据的实践至关重要。此外，母亲、伴侣和医疗保健提供者之间的信任关系至关重要。共同决策似乎是临床决策的主要模式，无论背景如何，都需要反思性实践，是一种沟通策略。
