99 Experiences, beliefs, and values influencing midwives’ attitude because no suitable date could be found. The reason for the non-response of the 34 remaining practices is unknown. Table 1. Interview guide What do you think is the definition of a medical intervention in midwifery care? Please describe a situation during maternity care (pregnancy, birth or postpartum) in which many interventions were performed. Please describe a situation during maternity care (pregnancy, birth or postpartum) in which few interventions were performed. When do you experience the need to perform a medical intervention? Which factors influence whether or not a medical intervention is performed? How do you involve clients in the performance of interventions? How do you evaluate the use of interventions in midwifery care? Data collection Before the interviews, we distributed a short questionnaire to collect the participants’ demographic characteristics and usage of childbirth interventions in their midwifery practice. Interviews were face-to-face conversations at a safe setting chosen by the participant. The interviews were conducted by four interviewers who had a midwifery background, but no personal relationships with the participants. We audio-recorded and transcribed the interviews verbatim for analysis. The transcribed interviews were sent to the participants for participant validation, however, no adjustments were requested. The anonymized and encrypted transcripts, together with field notes, were stored safely and locked, solely accessible to the research team. Rigor and reflectivity We used several strategies to ensure methodological rigor (20). The first two interviews of each interviewer were observed by a colleague interviewer to ensure consistency and quality. After the first four interviews, the research team made small adjustments to the interview guide to strengthen the narrative approach through peer debriefing. Field notes were kept from each interview to achieve data triangulation. Throughout the study, we reflected on the analytic process as a group to arrive at consensus through investigator triangulation. We used the standards for reporting qualitative research (SRQR) as guidance for writing the current article (21). Ethical considerations According to the Act governing research involving human subjects in The Netherlands (WMO), formal ethical approval by a research ethics committee is only required for medical research where participants are subject to interventions or procedures or are required to follow specific, research-related rules of behavior (22). None of these apply to this research. All the midwives gave informed consent and were aware of their rights. 4
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