126 Chapter 5 Midwives who utilize high rates of interventions as part of their clinical practice seem to enact a different communication style regarding treatment options. They discussed about how they suggest a certain care pathway and ask the woman if she agrees with this plan. These midwives seem to provide only limited information about a selection of care options that fit in the care pathway, suggesting that they use an opt-out approach when outlining the treatment plan for pregnancy and birth. ‘In case of a high maternal body mass index or someone who has used drugs, I assimilate the individual care pathway according to these risk factors. I always go through everything with the client and then say: "let’s do fetal growth ultrasounds anyway, and an OGTT". That’s what I explain.’ (Midwife 17) 3.3.1.2. Affective communication Midwives who utilize low rates of interventions as part of their clinical practice indicated also a range of affective communication skills they use when interacting with pregnant women. These midwives spoke about situations they had encountered where women had requested more or fewer interventions than suggested by the national guidelines or local protocols. They described how they took time to actively listen to these women and started a conversation to investigate the underlying motives for the request. ‘Someone may say that she wants to give birth at home, even when it’s preterm. But then I still know nothing. Is she traumatised? Would she like to experience this once? […] Actually, the conversation starts at that point. You need to know a lot more.’ (Midwife 12) In contrast, midwives who utilize high rates of interventions as part of their clinical practice seemed less inclined to investigate underlying motives in such situations, and described how they quickly shift to arranging practical matters or to refer to obstetrician-led care. They discussed situations where women requested fewer interventions then recommended in guidelines or local protocols, and how they usually do not grant such requests. If a woman requested more interventions, for example an induction of labour, they arranged a consultation in obstetrician-led care without exploring the woman’s motives extensively. ‘She was pregnant of her third child, an unplanned pregnancy, and she was anxious from the beginning. She asked for a planned caesarean. So, we have sent her to the obstetrician at an early stage of pregnancy.’ (Midwife 8) 3.3.2. Communication with colleagues: the ability to speak up Midwives who utilize low rates of interventions as part of their clinical practice seem to use more persuasive communication strategies during interaction
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