Context: A key dimension in midwifery decision making and practice for safe labour care

Elizabeth Chodzaza, Elaine Haycock-Stuart, Aisha Holloway, Ursula Kafulafula

Research output: Contribution to journalArticlepeer-review

Abstract

Background/Aims
Research into midwifery decision making to date is limited and, where it exists, theoretical understanding has focused on the cognitive aspects of the process. Understanding the real-life context in which midwives work and how this influences their decision making during labour is important for safer maternity care. This study aimed to explore the contextual factors that influence the decision making of midwives at secondary and tertiary level health facilities during the first stage of labour in the real context of practice.

Methods
Using a focused ethnographic methodology, data from nine midwives working in two hospital labour ward settings were collected from October 2013 to May 2014. A total of 27 participant observations of midwives supporting women in the first stage of labour, 26 semi-structured interviews with midwives, and a documentary analysis of maternal labour records were conducted. All data were analysed using theme and category formation.

Results
Four major themes that influenced midwifery decision making for the safe care of women in labour were found: dominance of the medical profession over maternity care, shortage of midwifery staff, limited material resources, and midwifery strategies for maternal and child safety.

Conclusions
Understanding and improving clinical decision making requires consideration of contextual factors. For safe maternal care during the first stage of labour, midwives need to be supported to manage contextual factors for favourable outcomes for the mother and neonate.
Original languageEnglish
JournalAfrican Journal of Midwifery and Women's Health
Volume14
Issue number3
Early online date30 Sep 2020
DOIs
Publication statusE-pub ahead of print - 30 Sep 2020

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