gms | German Medical Science

Background/Aim: Decision making processes play a central role when complications arise during both clinical and out-of-clinic births. Women who plan a home birth or a birth at a midwife led birth centre generally have a low risk for developing medical pathologies. Nevertheless, during any birth, unexpected complications may arise. The independent management of such complex situations is a central role of the professional duties of midwives. Additionally, involving the women in decision making processes is also part of the professional commitment. The goal of this study is to develop a more precise understanding of these processes and additionally analyse factors that influence these decision making processes. Study results will contribute to advancing theoretical models for decision making in midwifery.

Methods: To achieve the research objectives, this investigation was undertaken using Grounded Theory Methodology (GTM) following Corbin und Strauss (1996). A total of 40 problem-centered interviews (Witzel, 2000) were conducted in the Cantons of Zurich (German-speaking) and Waadt (French speaking). In each language region, 10 interviews were conducted with midwives and 10 interviews with women who had experienced a complication during birth. It was intended that midwives and women form so-called “tandem” pairs, which means that they describe their own perspectives about the same birth. Interviews were transcribed verbatim according to a simplified version of the GAT (Gesprächsanalytisches Transkriptionssystem; Selting, 1998). The analysis of the data was performed using GTM, namely, open, axial and selective coding were conducted parallel (in terms of time) to data collection.

Findings: Preliminary results point to the central role of leeways in decision-making in that the decisions must be flexible enough both to consider the clinical situation and to respect the women’s perspective. An analysis of factors that under complex birth situations may impact on the decisions made, such as urgency with which a decision must be made, or based on the midwife’s experience, were found to reduce or expand, respectively, flexibility in the decision making process. Currently, the emerging categories and subcategories are being further developed and linked in the paradigmatic model. Publishable findings will be available at the latest in December 2013.

Discussion and Recommendations: Until the analysis is fully completed, it is premature to discuss the implications from this research or to develop recommendations.