130 Chapter 5 during data collection and analysis being peer reviewed by the second author. Complementary, we re-read the interviews after we finalized the findings, to falsify the results and limit bias. A limitation of this study was that midwives could only be included based on the practice level of interventions, because the Perined database cannot be analysed on the level of individual midwives. Therefore, the assumption was made that individual midwives provide care in accordance with the level of childbirth interventions of the midwifery practice they work at. However, midwives are autonomous healthcare professionals and make individual decisions whether to perform an intervention or not. We cannot rule out that some misclassification took place. However, the interviewers were blinded for this classification, and we observed no signs of misclassification during the analysis of both groups. Conclusions The results of this study suggests that there are differences in knowledge and skills between primary care midwives, probably influencing clinical decisionmaking and the use of childbirth interventions. The knowledge and skills of a reflective practitioner seem to lead to more personalized care compared to standardized use of interventions as defined in protocols. This personalized care helps in the pursuit for appropriate use of childbirth interventions and may reduce medicalization in childbirth. Reflection on experiences and evidence, a balanced communication style with instrumental and affective communication skills, and the use of critical thinking skills during reflectionin-action need to be taught and trained to midwives to pursue an appropriate and personalized use of interventions.
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