192 Chapter 9 professionals should be made aware of the unwarranted variation in childbirth interventions. Chapter 4 In this descriptive, qualitative study, we used in-depth interviews to explore experiences, beliefs, and values that shape midwives’ attitudes toward the use of childbirth interventions. We conducted the interviews (n=20) in June 2019 and used inductive content analysis. We identified two main themes: (1) attitudes toward interventions, and (2) influences on midwives’ attitudes. Midwives in our study described their attitudes toward interventions as oriented to either wait and see or check and control. Care based on wait and see displayed a more supportive style of behaviour, and care based on check and control appeared to display a more directive style of behaviour. Collaboration with other healthcare providers, trust and fear in the process of pregnancy and childbirth, and beliefs about woman-centeredness influenced the attitude of midwives. We learnt that all midwives in our study had the intention to perform interventions only when appropriate. However, midwives with a wait and see attitude seemed to have a more restrictive approach toward interventions compared with midwives with a check and control attitude. Midwives need to be aware of how their experiences, beliefs, and values shape their attitudes toward the use of interventions. This awareness could be a first step toward the reduction of unwarranted interventions. Chapter 5 In this chapter, we explored how knowledge and skills influence midwives’ clinical decision-making about the appropriate use of childbirth interventions. We interviewed 20 community midwives in June 2019. Participants’ clinical experience varied in the use of interventions. The interviews had a narrative approach and we analysed the data using deductive content analysis. We identified that knowledge, critical thinking skills, and communication skills influenced midwives’ clinical decisions about childbirth interventions. Midwives obtained their knowledge through the formal education program and expand their knowledge through reflection on experiences and scientific evidence. Midwives with a low use of interventions seemed to have a higher level of reflective skills, including reflection-in-action. These midwives used a more balanced communication style with instrumental and affective communication skills in interaction with women. They offered women a range of options, encourage shared decision-making, and actively explore patients' preferences. Additionally, these midwives had more skills to engage in discussions during collaboration with other professionals. On the other hand, midwives with a high use of interventions tend to use more directive communication, presenting interventions as standard procedures rather than
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