Decision-making related to augmentation of labour : women's and midwives' perceptions regarding influencing factors

This thesis had two aims. The first was to describe women s experiences of participating in decision-making related to augmentation of labour (Paper I). The second aim was to describe midwives perceptions and experiences of decision-making regarding augmentation of labour (Paper II).

Methods: Paper I is an interview study with 20 newly delivered women who had received oxytocin infusion for augmentation of labour during childbirth. The interviews were performed in the postnatal wards, 1-3 days post-partum, in five hospitals in Stockholm, Sweden, in year 2001. Open-ended interviews were used with an interview guide Paper II is a study based on 3 focus group discussions, in year 2003, with 20 midwives with experiences from working at labour wards in the Stockholm area, Sweden. A facilitator started with a statement followed by an open-ended question. A qualitative approach using modified grounded theory technique was used to analyse data for both studies. The interviews and focus group discussions were tape recorded and transcribed. The data was broken into smaller components, examined, compared and thereafter conceptualised and categorized.

Results: Paper I. Support and guidance from midwives in combination with knowledge and expectations about the intervention seemed to be important for women s satisfaction with decision-making concerning augmentation of labour. Four patterns of decision-making were found, ranging from being invited and participating in decision-making to wanting to participate but not being invited to. The desire for information exceeded the desire for involvement in decision-making. Paper II. The midwives described how regulations and guidelines, shortage of delivery rooms, influence of obstetricians, women in labour and midwives professional self had an effect on decision-making regarding augmentation of labour. How the midwives handled some of these factors was found to have decisive influence on the decision-making process and thus midwives as navigators was identified as the core category.

Conclusions: Women might not have enough knowledge to decide about augmentation of labour and therefore prefer to leave the decision to the midwives. They could therefore gain from better parental education with not only information about the labouring process, but also training in coping strategies to be capable to influence the birthing process. Midwives have to handle factors that can lead to both practical and ethical consequences. The profession of being in-between might stress the midwives sine they need and want to be loyal to all included regulations and persons. It could thus be an advantage for midwives to discuss their working conditions and co-operation with obstetricians, colleagues and labouring women.

List of scientific papers

I. Blix-Lindstrom S, Christensson K, Johansson E (2004). Womens satisfaction with decision-making related to augmentation of labour. Midwifery. 20(1): 104-12.
https://pubmed.ncbi.nlm.nih.gov/15020032

II. Blix-Lindstrom S, Johansson E, Christensson K (2005). Midwives performance during decision-making related to augmentation of labour. [Manuscript]