gms | German Medical Science

Background:In recent years, the possible health risk during childbirth has become the focus of public attention in particularly through the discussion of professional liability insurance of midwives in Germany. Concerns about legal consequences and litigation has led to a risk orientation in maternity care [1]. Therefore, the concept of risk and risk management has become a central principle in the care of women during childbirth [2]. Regional and national differences in intervention rates [3], [4] lead to the assumption that other factors than medical indications, such as the risk perception of obstetric health professionals, might have an impact on decision-making. However, it is unknown what German midwives and obstetricians perceive as a risk or risky situation during childbirth.

Aim/Research Question: This study addresses the risk perception of obstetric staff. The purpose of the exploratory sequential Mixed-Method-Design is to gain insights into what obstetric health professionals perceive as risk or as risky situations in the clinical setting in Germany. The results of this first part will be used for a quantitative survey to investigate the correlation of personal and systemic factors on the risk perception and decision-making during childbirth.

Methods: Four focus group discussions with midwives and obstetricians were conducted between July and December 2019. The sample was selected based on a purposive sampling and pre-defined criteria. The transcribed data was analyzed according to the Content Analysis [5] and a qualitative data analysis software (MAXQDA) was used to help analyze the data. The Ethic-Committee of the Hochschule für Gesundheit, University of Applied Sciences, has granted ethical approval. This work is part of a Ph.D. research work.

Results: Preliminary results show that midwives and obstetricians perceive risk in different ways in the clinical setting in Germany. For both, the perception refers to medical and personal levels, but the participants described in particular structural and organizational factors, such as lack of personnel, very high workload and spatial equipment, which are responsible for triggering situations perceived as risky. Based on these results, case vignettes are developed for the following survey.

Relevance: Getting insights into the risk perception of obstetric health care professionals as a potential determinant influencing decision-making processes during childbirth is crucial to the improvement of the care during childbirth.

Recommendations/Conclusion: Midwives and obstetricians describe situations during childbirth as risky, especially when structural or organizational deficiencies are present. To what extent this also influences the decisions for or against interventions will be examined in the second partial study. In addition, counteracting political actions need to be taken and working and organizational concepts need to be developed, that allow a reduction of the risk perception caused by systemic factors at a structural and organizational level in order to ensure adequate care for women giving birth.

Ethics and conflicts of interest: A vote on ethics was obtained. The research was financed by own resources. There are no conflicts of interest.