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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 labour: An exploratory study

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

Authors

Elaine Jefford

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 labour.

Methods: A qualitative interview-based study with practising 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 individualised ‘working hypothesis’ that combines distinct elements of optimal clinical decision-making process. Midwives narratives highlighted 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 contemporary evidence-base within a midwifery philosophy to optimise perineal care and risk modification.

Journal Article Type Article
Publication Date May 1, 2018
Print ISSN 2156-5295
Electronic ISSN 2156-5295
Publisher Springer Publishing Company
Peer Reviewed Peer Reviewed
Volume 8
Issue 1
Pages 54-66
APA6 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 labour: An exploratory study. International journal of childbirth, 8(1), 54-66. https://doi.org/10.1891/2156-5287.8.1.54
DOI https://doi.org/10.1891/2156-5287.8.1.54
Keywords CLINICAL REASONING; DECISION MAKING; MIDWIFERY ABDICATION; MIDWIFERY EDUCATION; PERINEAL
Publisher URL http://ingentaconnect.com/contentone/springer/ijc/2018/00000008/00000001/art00006
Copyright Statement ©2018 University of Hull

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