Midwives decision-making during the second-stage of labour

Abstract

Aim: The aim of the study was to explore midwifery practice during the second-stage of labour to understand how midwives make decisions at this time.

Background: Whilst there is much discussion within the literature about the various care issues that may present themselves as dilemmas for midwives throughout the second-stage, little information is available about how midwives make decisions during this time.

Methods: A qualitative single instrumental case study methodology has been applied to facilitate an in-depth understanding of midwives decision-making in the second-stage and the use of observation and interview to gather a rich data set to examine the case.

Key Findings: Midwives employed fast thinking using pattern-matching to make rapid decisions during the second-stage which was supported by a slower more focused assessment of cues using the principles of the Hypothetico-deductive model. Within the Alongside Midwifery Unit (AMU) midwives used observation, interpretational and interpersonal skills to assess labour and inform their decision-making. This skill-set did not appear to transfer to the Obstetric Unit (OU) where the focus of care shifted to the completion of tasks and was influenced by midwives perceptions of surveillance and the introduction of technology.

Conclusion: Decision-making during the second-stage was influenced by context and midwives used their skills to assess labour progress holistically paying attention to physiological and behavioural cues exhibited by women on the AMU.

Implications for Practice: The skill-set used by midwives on the AMU did not transfer to the OU where midwives perceived that their ability to make autonomous decisions was reduced and the focus of care shifted from being woman-centred to task-centred.

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Identifiers

ORCID for Tracy Long-Sutehall: orcid.org/0000-0002-6661-9215

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