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Decision-making pervades all aspects of midwifery practice across the world. Midwifery is informed by a number of decision-making theories, but it is sometimes difficult to marry these theories with practice. This book provides a comprehensive exploration of decision-making for midwives irrespective of where in the world you practice or in which model of care.

This book teaches students and educators in the midwifery field how to tackle dilemmas and decision making. Combining theory and practice, and promoting critical thinking, this book provides key knowledge alongside case studies of how to approach real-life dilemmas in midwifery.Written and edited by experts in the field, this book gives midwives and student midwives the opportunity to experience a systematic approach to facing dilemmas and decision making through the use of clinical scenarios. This is done in a safe space through an annotated thinking aloud framework where students and educators can have open discussions. Student midwives and practitioners are given the opportunity to explore professional dilemmas they might not have witnessed and uncover new theories that will influence future decisions. Linked to the 2019 NMC Standards for Midwifery, this book is essential reading for all stages of the midwifery career including those supporting students, coordinating care teams and those supporting multi-cultural communities. The midwives' personal reflections explore best practice and take account of other professional perspectives, including facilitators and barriers to interdisciplinary working. Learners will be able to consider a number of factors including concepts and theories, ethics and legal accountability, to explore how they interplay in making decisions.  

Background Continuity of care by a primary midwife during the antenatal, intrapartum and postpartum periods has been recommended in Australia and many hospitals have introduced a caseload midwifery model of care. The aim of this paper is to evaluate the effect of caseload midwifery on women’s satisfaction with care across the maternity continuum. Methods Pregnant women at low risk of complications, booking for care at a tertiary hospital in Melbourne, Australia, were recruited to a randomised controlled trial between September 2007 and June 2010. Women were randomised to caseload midwifery or standard care. The caseload model included antenatal, intrapartum and postpartum care from a primary midwife with back-up provided by another known midwife when necessary. Women allocated to standard care received midwife-led care with varying levels of continuity, junior obstetric care, or community-based general practitioner care. Data for this paper were collected by background questionnaire prior to randomisation and a follow-up questionnaire sent at two months postpartum. The primary analysis was by intention to treat. A secondary analysis explored the effect of intrapartum continuity of carer on overall satisfaction rating. Results Two thousand, three hundred fourteen women were randomised: 1,156 to caseload care and 1,158 to standard care. The response rate to the two month survey was 88 % in the caseload group and 74 % in the standard care group. Compared with standard care, caseload care was associated with higher overall ratings of satisfaction with antenatal care (OR 3.35; 95 % CI 2.79, 4.03), intrapartum care (OR 2.14; 95 % CI 1.78, 2.57), hospital postpartum care (OR 1.56, 95 % CI 1.32, 1.85) and home-based postpartum care (OR 3.19; 95 % CI 2.64, 3.85). Conclusion For women at low risk of medical complications, caseload midwifery increases women’s satisfaction with antenatal, intrapartum and postpartum care. Trial registration Australian New Zealand Clinical Trials Registry ACTRN012607000073404 (registration complete 23rd January 2007).

Background New portable health technologies may offer solutions to challenges in current maternity care, but little is known about their current usage, existing problems, or areas of unmet needs. Purpose To better understand the use of health technology in community midwifery care in the UK. Methods Midwives with current or recent experience working in community settings were recruited using social media. Semi-structured interviews were undertaken. These were transcribed and thematically analyzed. Results Thirteen midwives were interviewed between October 2021 and March 2022. The main themes and subthemes were: (1) Problems with current equipment: (a) Issues in the context of remote working, b) Concerns regarding accuracy, and c) Midwives’ perceptions of service user experiences. (2) Equipment challenges working within the UK National Health Service: (a) Lack of availability of appropriate equipment, and (b) Lack of autonomy in how to utilize equipment. 3) Areas of unmet needs. Conclusion This study has shown that there are several areas of unmet needs for community midwives that should be investigated. However, and arguably more pressing, is improving the availability and quality of health technologies and other equipment that is already widely used. Midwives were interested in technologies that support decision making, reduce the number of hospital visits for their patients, improve their workload, and reduce medicalisation. At the same time, there is fear that technology may displace midwives’ wisdom. Where new technologies are introduced, support and training should be provided to address potential resistance.

Optimising the use of caesarean section (CS) is of global concern. Underuse leads to maternal and perinatal mortality and morbidity. Conversely, overuse of CS has not shown benefits and can create harm. Worldwide, the frequency of CS continues to increase, and interventions to reduce unnecessary CSs have shown little success. Identifying the underlying factors for the continuing increase in CS use could improve the efficacy of interventions. In this Series paper, we describe the factors for CS use that are associated with women, families, health professionals, and health-care organisations and systems, and we examine behavioural, psychosocial, health system, and financial factors. We also outline the type and effects of interventions to reduce CS use that have been investigated. Clinical interventions, such as external cephalic version for breech delivery at term, vaginal breech delivery in appropriately selected women, and vaginal birth after CS, could reduce the frequency of CS use. Approaches such as labour companionship and midwife-led care have been associated with higher proportions of physiological births, safer outcomes, and lower health-care costs relative to control groups without these interventions, and with positive maternal experiences, in high-income countries. Such approaches need to be assessed in middle-income and low-income countries. Educational interventions for women should be complemented with meaningful dialogue with health professionals and effective emotional support for women and families. Investing in the training of health professionals, eliminating financial incentives for CS use, and reducing fear of litigation is fundamental. Safe, private, welcoming, and adequately resourced facilities are needed. At the country level, effective medical leadership is essential to ensure CS is used only when indicated. We conclude that interventions to reduce overuse must be multicomponent and locally tailored, addressing women's and health professionals' concerns, as well as health system and financial factors.

Objective To describe a framework for people making and using evidence-informed health system and public health recommendations and decisions. Background We developed the GRADE Evidence to Decision (EtD) framework for health system and public health decisions as part of the DECIDE project, in which we simultaneously developed frameworks for these and other types of healthcare decisions, including clinical recommendations, coverage decisions and decisions about diagnostic tests. Developing the framework Building on GRADE EtD tables, we used an iterative approach, including brainstorming, consultation of the literature and with stakeholders, and an international survey of policy-makers. We applied the framework to diverse examples, conducted workshops and user testing with health system and public health guideline developers and policy-makers, and observed and tested its use in real-life guideline panels. Findings All the GRADE EtD frameworks share the same basic structure, including sections for formulating the question, making an assessment and drawing conclusions. Criteria listed in the assessment section of the health system and public health framework cover the important factors for making these types of decisions; in addition to the effects and economic impact of an option, the priority of the problem, the impact of the option on equity, and its acceptability and feasibility are important considerations that can inform both whether and how to implement an option. Because health system and public health interventions are often complex, detailed implementation considerations should be made when making a decision. The certainty of the evidence is often low or very low, but decision-makers must still act. Monitoring and evaluation are therefore often important considerations for these types of decisions. We illustrate the different components of the EtD framework for health system and public health decisions by presenting their application in a framework adapted from a real-life guideline. Discussion This framework provides a structured and transparent approach to support policy-making informed by the best available research evidence, while making the basis for decisions accessible to those whom they will affect. The health system and public health EtD framework can also be used to facilitate dissemination of recommendations and enable decision-makers to adopt, and adapt, recommendations or decisions.

Caesarean section rates are increasing worldwide and are a growing concern with limited explanation of the factors that influence the rising trend. Understanding obstetricians' and midwives' views can give insight to the problem. This systematic review aimed to offer insight and understanding, through aggregation, summary, synthesis and interpretation of findings from studies that report obstetricians' and midwives' views on the factors that influence the decision to perform caesarean section. The electronic databases of PubMed (1958-2016), CINAHL (1988-2016), Maternity and Infant Care (1971-2016), PsycINFO (1980-2016) and Web of Science (1991-2016) were searched in September 2016. All quantitative, qualitative and mixed methods studies, published in English, whose aim was to explore obstetricians' and/or midwives' views of factors influencing decision-making for caesarean section were included. Papers were independently reviewed by two authors for selection by title, abstract and full text. Thomas et al's 12 assessment criteria checklist (2003) was used to assess methodological quality of the included studies. The review included 34 studies: 19 quantitative, 14 qualitative, and one using mixed methods, involving 7785 obstetricians and 1197 midwives from 20 countries. Three main themes, each with several subthemes, emerged. Theme 1: \"clinicians' personal beliefs\"-('Professional philosophies'; 'beliefs in relation to women's request for CS'; 'ambiguous versus clear clinical reasons'); Theme 2: \"health care systems\"-('litigation'; 'resources'; 'private versus public/insurance/payments'; 'guidelines and management policy'). Theme 3: \"clinicians' characteristics\" ('personal convenience'; 'clinicians' demographics'; 'confidence and skills'). This systematic review and metasynthesis identified clinicians' personal beliefs as a major factor that influenced the decision to perform caesarean section, further contributed by the influence of factors related to the health care system and clinicians' characteristics. Obstetricians and midwives are directly involved in the decision to perform a caesarean section, hence their perspectives are vital in understanding various factors that have influence on decision-making for caesarean section. These results can help clinicians identify and acknowledge their role as crucial members in the decision-making process for caesarean section within their organisation, and to develop intervention studies to reduce caesarean section rates in future.

Design and provision of good quality maternity care should incorporate what matters to childbearing women. This qualitative systematic review was undertaken to inform WHO intrapartum guidelines. Using a pre-determined search strategy, we searched Medline, CINAHL, PsycINFO, AMED, EMBASE, LILACS, AJOL, and reference lists of eligible studies published 1996-August 2016 (updated to January 2018), reporting qualitative data on womens' childbirth beliefs, expectations, and values. Studies including specific interventions or health conditions were excluded. PRISMA guidelines were followed. Authors' findings were extracted, logged on a study-specific data form, and synthesised using meta-ethnographic techniques. Confidence in the quality, coherence, relevance and adequacy of data underpinning the resulting themes was assessed using GRADE-CERQual. A line of argument synthesis was developed. 35 studies (19 countries) were included in the primary search, and 2 in the update. Confidence in most results was moderate to high. What mattered to most women was a positive experience that fulfilled or exceeded their prior personal and socio-cultural beliefs and expectations. This included giving birth to a healthy baby in a clinically and psychologically safe environment with practical and emotional support from birth companions, and competent, reassuring, kind clinical staff. Most wanted a physiological labour and birth, while acknowledging that birth can be unpredictable and frightening, and that they may need to 'go with the flow'. If intervention was needed or wanted, women wanted to retain a sense of personal achievement and control through active decision-making. These values and expectations were mediated through womens' embodied (physical and psychosocial) experience of pregnancy and birth; local familial and sociocultural norms; and encounters with local maternity services and staff. Most healthy childbearing women want a positive birth experience. Safety and psychosocial wellbeing are equally valued. Maternity care should be designed to fulfil or exceed womens' personal and socio-cultural beliefs and expectations.

This study investigates the impact of generative artificial intelligence literacy (GAIL) on self-directed learning skills (SDL) among nursing and midwifery students. Additionally, it examines whether general attitudes toward artificial intelligence (GAAI) mediate this relationship. Artificial intelligence (AI) has the potential to support the development of clinical decision-making and problem-solving skills in nursing and midwifery education, particularly by enhancing students’ self-directed learning abilities. A cross-sectional, descriptive and correlational study design was used. The study was conducted in three universities in Türkiye between January and February 2025. 656 nursing and midwifery students participated, selected through cluster sampling. Data were collected using the GAIL, GAAI and SDL scales. The survey form included descriptive questions regarding participants' socio-demographic characteristics and AI usage patterns. Structural equation modeling was conducted to analyze direct and indirect relationships among variables. A significant positive effect of GAILS on GAAIS was found (β = 0.75, p < .01). GAILS also had a direct and significant effect on SDLS (β = 0.60, p < .01). However, GAAIS did not mediate the relationship between GAILS and SDLS (β = 0.02, p > .05). AI literacy significantly enhances SDL in nursing and midwifery students. However, positive attitudes toward AI do not independently foster SDL, highlighting the need for structured AI education in healthcare curricula. Future studies should explore long-term AI literacy interventions to assess their impact on academic outcomes and their potential contributions to clinical reasoning and decision-making skills.

The digital information environment poses challenges for pregnant women and other people seeking care, as well as for their midwives and other health care professionals (HCPs). They can encounter questions, concerns, information gaps, and misinformation, which can influence health care decisions. This scoping review examines how HCPs are affected by the modern digital information environment including health misinformation, its effects on the women and people they care for, and its implications for care provision. English-language peer-reviewed literature, published from January 1, 2020, to May 31, 2024, with keywords related to midwifery, misinformation, and health equity collected and analyzed by a team of midwives and maternal care professionals and mapped onto a patient-centered conceptual model. A total of 105 studies were ultimately included. Further, 95 papers identified specific digital information environment issues that affected clients; 58 specifically highlighted digital information environment issues impacting HCPs; 91 papers identified specific topics of common questions, concerns, misinformation, information voids, or narratives; 57 papers identified patient or population vulnerability; and 75 included mentions of solutions or recommendations for addressing a digital information environment issue around clients seeking care from midwives and other HCPs. When mapped onto the Journey to Health model, the most prominent barrier was access to care and information. Individual-level issues dominate the step related to knowledge, awareness, and belief, with more social norms and wider engagement appearing at steps related to intent. Client-specific themes dominate the left-hand side of the model and provider-specific issues dominate the right-hand side of the model. Misinformation, information voids, unaddressed questions and concerns, and lack of access to high-quality health information are worldwide prevalent barriers that affect both patients and HCPs. We identified individual, provider-level, health systems, and societal-level strategies that can be used to promote healthier digital information environments.