195 Summary patients’ preferences and other contextual factors. Providing care according to these protocols will make it more difficult to personalise care and possibly increase unwarranted practice variation. Healthcare professionals should be educated about the differences between national guidelines and regional protocols and understand the scientific rationale for the recommendations. It is essential to recognize that midwives’ attitudes, knowledge and skills differ and are influencing factors on practice variation. Midwives may also be influenced by the culture of shared working environments such as MCNs. Based on our research it seems that there should be more focus on midwives as reflective practitioners. More attention to skills as a reflective practitioner could contribute to a more personalised approach to clinical decisionmaking about childbirth interventions. Additionally, midwives can use these skills in the context of MCNs for effective interdisciplinary collaboration and the development of regional protocols. Together with guidance on how to translate national guidelines into regional protocols, this results in a more nuanced approach that is responsive to patient preferences, addresses uncertainty, and consequently reduces unwarranted interventions. To develop the skills of a reflective practitioner, midwives need to reflect on their clinical decisions and whether they are influenced by their personal values and beliefs. Midwives can be helped to understand their own practice through the use of reflective models and with intervision meetings with colleagues, which helps to make sense of their experiences and identify patterns in practice. 9
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