98 Chapter 4 intervention rates in midwife-led care and obstetrician-led care within the same region (15). This suggests that culture in the work environment influences care providers within the same region towards comparable use of interventions, and that variations are not merely individual. The wide variation between referral rates among Dutch midwives support the theory that the attitude towards use of interventions differ between midwives (13). Furthermore, fundamental differences between midwives in their willingness to support the physiology of pregnancy and childbirth are known to result in different individual attitudes towards childbirth interventions (16). According to the theory of planned behavior, individual experiences, beliefs, and values influence a person’s attitude, which subsequently, together with social influences and self-efficacy, shapes the intention to perform a specific behavior (17,18). Therefore, the midwife’s attitude is an interacting factor in the use of interventions. However, systematic studies on the background of midwives’ attitudes and how this influences the use of interventions in perinatal care are limited. The purpose of this study was to explore deeper and identify the experiences, beliefs, and values that shape midwives’ attitudes, and how these factors influence their clinical decision-making when deciding to use interventions. These findings can direct further research into deeper understanding of the factors that influence practice variation in the use of interventions. Methods Study design We conducted a qualitative study using in-depth interviews that combined a narrative approach with a semi-structured question route to indicate relevant topics (Table 1). In accordance with the narrative approach, we invited the participating midwives to elaborate and share stories about situations during pregnancy, birth, and the postpartum period where decisions were made on the use of interventions. At start of the interview, midwives described their definition of a childbirth intervention. The narrative approach made it possible to explore which experiences, beliefs, and values of the midwives were important during their clinical decision-making (19). Using a semi-structured interview helped to ensure that all relevant topics were explored. Although acknowledging that not all individuals in perinatal care refer to themselves as women, we have chosen to use ‘women’ and feminine prepositions. Setting and participants Based on data from the Dutch national register Perined, we selected midwifery practices varying in rates of homebirth, episiotomy, and referral during pregnancy or birth. In total, we invited midwives from 56 practices for an interview. Twenty-two primary care midwives accepted the invitation and we interviewed twenty midwives in June 2019. We excluded one midwife because a colleague from the same practice was already interviewed, and one midwife
RkJQdWJsaXNoZXIy MTk4NDMw