Document Type

Thesis

Publication details

Jefford, E 2012, 'Optimal midwifery decision-making during 2nd stage labour: the integration of clinical reasoning into midwifery practice', PhD thesis, Southern Cross University, Lismore, NSW.

Copyright E Jefford 2012

Abstract

Research Question:

What are the necessary and sufficient conditions for optimal midwifery decisionmaking during 2nd stage labour?

Thesis:

Good clinical reasoning and good midwifery practice are the necessary and sufficient conditions for optimal midwifery decision-making during 2nd stage labour.

Background Literature:

Previous research in decision-making primarily focussed on antenatal period. Literature on 2nd stage labour including the factors perceived to influence the midwife was extremely limited. No research has addressed the research question for this study.

Methodology:

Post-Structural Feminism provided the methodological foundations for this study. A modification of Denzin‟s Interpretative Interactionism was used as research design. Twenty-six midwives were interviewed and invited to give both a negative and a positive decision-making story.

Key Findings:

Collectively, good clinical reasoning and good midwifery practice produce optional midwifery decision-making during 2nd stage labour. Out of a total of 16 stories there were only five cases of optimal midwifery decision-making during 2nd stage labour. Second stage labour is a unique and rapidly changing situation and this research found that the woman being the final decision-maker was not essential to optimal decision-making during this time. Further, some midwives abdicated responsibility for decision-making to the women and/or their support people.

Conclusion:

Midwifery education and practice should be designed to build clinical reasoning skills to a high level of proficiency. Midwifery, as a woman-centred discipline, however, needs more than cognitive clinical reasoning to reach optimal decisions. Midwives take a woman-centred approach to care and need to be able to make an independent decision if and when the woman is unable to participate fully in decisionmaking.

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