118 Chapter 5 with the woman, and regional protocols (10, 12, 13, 17). In addition, studies by Weltens et al. (2018) and Seijmonsbergen-Schermers et al. (2020) suggest that perspectives on birth as a physiological event differ between regions in the Netherlands. In a previous study, we found that midwives with a ‘wait and see’ attitude seem to have a more restricted approach towards interventions compared to midwives with a ‘check and control’ attitude (11). However, studies on the influence of knowledge and skills on midwives’ clinical decision-making are limited. Research on this subject is important because these are influenceable factors: knowledge and skills can be taught. This offers possibilities for behavioural change, contributing to appropriate use of interventions and improvement of the quality of midwifery care. Therefore, the objective of this study is to explore how knowledge and skills influence clinical decisionmaking of midwives towards the appropriate use of childbirth interventions. M ethods 2.1 Study design This study was part of a larger qualitative study exploring factors that may explain variations between midwives in decision-making on childbirth interventions (11). We used in-depth interviews that combined a narrative approach with a semi-structured question route to indicate relevant topics (Box 1). In accordance with a narrative approach, we invited the participating midwives to elaborate and share their stories about situations during pregnancy, birth, and postpartum period where the use of interventions was an issue. The narrative approach made it possible to explore, from a broader perspective, how midwives used their knowledge and skills during clinical decision-making (18). Box 1. Question route for interviews - What do you think is the definition of a medical intervention in midwifery care? - Please describe a situation during maternity care (pregnancy, birth or postpartum) in which many interventions were performed. - Please describe a situation during maternity care (pregnancy, birth or postpartum) in which few interventions were performed. - Which factors influence whether or not a medical intervention is performed?
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