The Midwife and Decision-Making Processes

Globally, research shows great variation in midwives decision-making at birth, which contributes to adverse outcomes in maternity care. Decision-making models adopted by midwifery have deficits: insufficiently detail to guide reasoning processes; lack midwifery philosophy and context which midwifery is practised. To support midwifery's professional identity, a midwifery specific decision-making model needed to be developed encompassing two necessary conditions; 'Good Clinical Reasoning' (GCR) and 'Good Midwifery Practice' (GMP). GCR & GMP can be taught separately but are part of an indivisible whole. This model is grounded in theory, midwives' clinical practice, midwifery philosophy and regulation. This model gives guidance of factors to consider when making decisions and how to use clinical reasoning. It provides guidance how to conceptualise and include the woman and interests of the woman/baby in midwifery decision-making from a woman-centred midwifery philosophy. This model has undergone further validation using expert panels (UK and Australia). This work demonstrated it as a valid and reliable model to assess midwives decision-making processes in the 2nd stage labour.