102 Chapter 4 house or in the corner of the room, and only interfering when invited by the woman and her partner. . . . which is a birth where the healthcare providers are invisible, where a woman can determine her own posture, determine her own coping strategy and have as little interference as possible. (Midwife 12) Midwives with a more wait and see approach described that they use guidelines as a tool in clinical decision-making. Other midwives in our study explained they considered it important to follow the national guidelines or local protocols in all or nearly all circumstances. These midwives seemed to have a more ‘check and control’ approach. They felt that by strictly following the national guidelines or local protocols the best possible physical outcomes could be guaranteed. These midwives emphasized that interventions helped them to obtain additional information about possible pathology, which gave them a feeling of certainty and safety. In the quote, an example of the check and control approach is given. However, it should be noted that an oral glucose tolerance test (OGTT) is not standard care for all women in the Netherlands, it is only indicated and offered when women have specific risk factors. I agree that if someone is really overweight or has diabetes in the family, it’s good to perform an OGTT. It gives me the feeling of “I have checked it, so that is good” . . . That also provides a bit of control, a bit of certainty. (Midwife 17) The differences in attitude towards the use of interventions between midwives with a wait and see approach and midwives with a check and control approach became most clear when midwives talked about prevention of pathology, indications for ultrasound scans, and their belief that they need to advocate for non-intervention in physiologic childbirth. In their stories, the midwives expressed a variation in the application of interventions like artificially rupture of membranes, vaginal examinations, or administration of oxytocin postpartum. Influences on midwives’ attitudes When describing the background of their attitude towards interventions, the midwives in our study mentioned different experiences, beliefs, and values, such as experiences in collaboration, trust and fear, and woman-centeredness. Experiences in collaboration In all interviews, midwives discussed how collaboration with other healthcare providers influenced their attitude towards the use of interventions. Regarding collaboration with providers of obstetrician-led care, midwives with a ‘check and control’ approach repeatedly mentioned that they wanted to satisfy the obstetrician, and seemed to be influenced by the perceived hierarchy.
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