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Applying a midwifery-specific decision-making tool to midwives' clinical reasoning and midwifery practice when managing a woman's perineum in labor: An exploratory study

Jefford, Elaine; Jomeen, Julie; Guy, Frances; Newcombe, Belinda; Martin, Colin

Authors

Elaine Jefford

Julie Jomeen

Frances Guy

Belinda Newcombe

Colin Martin



Abstract

INTRODUCTION: Many of the risk factors for perineal trauma are modifiable, and midwives are in an ideal position to mitigate such risks. To date, no investigation using a midwifery-specific decision-making tool has sought to determine how midwives make decisions within a midwifery philosophy/context or identify the factors that may contribute to that decision making about perineal management. We sought to apply such a tool to midwives' narratives and explore their clinical reasoning and midwifery practice when managing a woman's perineum in labor. METHODS: A qualitative interview-based study with practicing midwives in one regional Australian maternity unit was conducted. The decision-making matrix specified by a psychometrically robust and validated measure of clinical decision making and midwifery practice-guided analysis. RESULTS: Effective clinical decision making in response to perineal trauma is contingent on a heuristic and individualized "working hypothesis" that combines distinct elements of an optimal clinical decision- making process. Midwives' narratives highlighted their ability to engage in some form of clinical reasoning. Some elements of midwifery practice was lacking within several midwives' narratives, thus resulting in them abdicating their professional role. CONCLUSION: The manner and processes by which midwives engage effectively with perineal management are complex. However, a significant influence on this process appears to be recollections from original training in perineal management, which appears to be largely rote and taught by example. We recommend balance between practical experience and synthesis with current evidence within a midwifery philosophy to optimize perineal care and risk modification.

Citation

Jefford, E., Jomeen, J., Guy, F., Newcombe, B., & Martin, C. (2018). Applying a midwifery-specific decision-making tool to midwives' clinical reasoning and midwifery practice when managing a woman's perineum in labor: An exploratory study. International journal of childbirth, 8(1), 54-66. https://doi.org/10.1891/2156-5287.8.1.54

Journal Article Type Article
Acceptance Date Oct 31, 2017
Online Publication Date May 1, 2018
Publication Date Jan 1, 2018
Deposit Date Jun 8, 2018
Publicly Available Date Oct 27, 2022
Journal International Journal of Childbirth
Print ISSN 2156-5295
Electronic ISSN 2156-5295
Publisher Springer Publishing Company
Peer Reviewed Peer Reviewed
Volume 8
Issue 1
Pages 54-66
DOI https://doi.org/10.1891/2156-5287.8.1.54
Keywords Clinical reasoning; Decision making; Midwifery abdication; Midwifery education; Perineal
Public URL https://hull-repository.worktribe.com/output/869142
Publisher URL http://ingentaconnect.com/contentone/springer/ijc/2018/00000008/00000001/art00006

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