129 Knowledge and skills used for clinical decision-making on childbirth interventions Reflection has been described as an important learning strategy for professionals to create awareness of their own skills and attitude on the actual performance (33). Probably, explication of reflective skills and training of these skills can enhance the reflectivity of midwives (34). The Optimality Index – Netherlands (OI-NL) is a tool that can support reflection on maternity care practices from a physiological perspective and facilitate optimal birth practices: maximal outcome with minimal intervention (30). Effective communication: the balance between communications skills Midwives who utilize high rates of interventions as part of their clinical practice seem mainly focused on the need to provide information by using instrumental communication, which fits with an informed consent approach. Midwives who utilize low rates of interventions as part of their clinical practice showed additional attention for women’s need to feel known, by using more affective communication skills and gaining insight in women’s knowledge and motives. Such a balance between both communication styles is needed to invest in an effective partnership between woman and midwife (24, 25), and is more in line with the model of shared decision-making (SDM) (35). However, an informed consent approach can unjustly be mistaken for SDM by care professionals, because they ask for assent but there is no dialogue as medium for the decision-making process (35). In our study, we observed that midwives, mainly in the group with a high use of interventions, used informed consent instead of offering relevant knowledge on various options and working together with the woman to establish choices that fit her circumstances. Applying SDM means that a midwife explains the various options and their evidence base. This makes clinical decision-making less dependent on personal beliefs of the individual midwife (35), and leads to more awareness about appropriate use of interventions instead of standardised use. Thomas et al. (2020) emphasises that major changes are necessary in educational structures and maternity care systems to promote critical reflexivity required for SDM (36). This supports our findings that these skills need further development for care providers to be fully competent. Strengths and limitations We used purposive sampling and included a diverse population of midwives in terms of years of midwifery experience, place of education, and midwifery practice characteristics. In total, seven midwives who utilize high rates of interventions as part of their clinical practice participated in this study and thirteen midwives who utilize low rates of interventions as part of their clinical practice participated. This unequal distribution of participants possibly might have influenced the results of this study, because midwives in the low intervention group already work as reflective practitioner. Factors such as teams size, and place of midwifery training might influence clinical decision-making, but was not investigated in this study. We reached data saturation in both groups. Attention was paid to the methodological rigor, with a reflective journal being kept by the first author and all key decisions 5
RkJQdWJsaXNoZXIy MTk4NDMw