Aim: To produce an empirically grounded model of optimal midwifery decision-making during 2nd stage labour so that decision-making can be taught and evaluated against a standard. This has been focused through the lens of the research question: “How can midwives engage in optimal decision-making during 2nd stage labour; and more generally within the midwifery partnership with each woman?”
Methodology: Twenty-six midwives were interviewed and invited to give both a positive and a negative decision-making story concerned with 2nd stage labour. Analysis of data involved the iterative development of an analytic framework which was then used to re-analyse each story to ensure data saturation. Data was used to understand what the necessary and sufficient conditions are for optimal midwifery decision-making.
Results: Good clinical reasoning is a necessary condition for optimal midwifery decision-making, but it is not sufficient. Good midwifery practice is a necessary condition for optimal midwifery decision-making, but it is not sufficient. Collectively, good clinical reasoning and good midwifery practice produce optimal midwifery decisions. The elements that make up these two core categories are presented in a new model of Optimal Decision Making in Midwifery.
Implications: Midwifery education and practice should be designed to build clinical reasoning skills to a high level of proficiency and simultaneously ensure that midwives work in woman-centred ways. The model of Optimal Decision Making in Midwifery provides midwives with a framework for decision-making that can be taught, used as an aid-memoir and as a way to facilitate joint decision-making with other maternity care providers. Future national collaborative work seeks to pilot and validate the model in a number of maternity care settings. The value of this future work is the option to test the model within units which practise different philosophies of birth and hence within different models of maternity care. This future work seeks to confirm the global utility of a toll, which can support higher quality, women-centred midwifery care and the potential to improve practice both on a national and international level.