125 Knowledge and skills used for clinical decision-making on childbirth interventions ‘During childbirth I try to say to myself: “hold back, you don’t have to [artificial rupture the membranes]. The woman does not benefit from that. She will only have more severe contractions. That’s of no benefit”.’ (Midwife 20) Midwives who utilize high rates of interventions as part of their clinical practice described how they apply interventions to control the process of labour or because this is the standard procedure. ‘We make a fetal growth scan at 30 weeks. That’s more because it makes us feel safe. And because we know we detect more small babies. We just want to check it.’ (Midwife 17) Summarizing, midwives in the group that utilize low rates of interventions as part of their clinical practice seemed to use critical thinking skills for a reflective process where appropriate use of interventions is being pursued. They have a reflection moment in action, which makes them wait and evaluate whether an intervention is beneficial at that moment. Such moments were not described by midwives in the group that utilize high rates of interventions. 3.3 Communication skills – making knowledge work In the interviews, midwives stated how the communication skills they use in their interaction with women are differed from the ones they use in their interaction with colleague healthcare professionals. 3.3.1 Communication with women: giving and gaining background information In their communication with women, the midwives in our study use instrumental and affective communication. 3.3.1.1 Instrumental communication All midwives in our study used instrumental communication to explain information to women. However, midwives who utilize low rates of interventions as part of their clinical practice explained that they communicate extensively about treatment options to facilitate women to make an informed choice. Some of them spoke about open communication, including conversations about uncertainties or their own professional experiences with specific interventions, such as induction of labour, ultrasound, and fetal monitoring. These midwives also expressed a broader view on childbirth interventions and the role of healthcare professionals in the application of interventions. ‘In general, we find it easier to give more [interventions] than to give less [interventions]. Healthcare providers see more danger in not intervening than in intervening. I think it is my job to make this clear to the woman and her partner.’ (Midwife 12) 5
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