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Decision-making in midwifery: A tripartite clinical decision

02 August 2016
12 min read
Volume 24 · Issue 8


Decision-making within midwifery practice is complex and challenging, and is directly linked to the standard of care provided. In the literature around decision-making there are alternative approaches mentioned, which are founded on the notion that decision-making is either: logical, such as Elstein et al's (1978) four-stage model; intuitive, such as the intuitive-humanistic model; or an amalgamation of the two. The extent to which these existing models can be applied to midwifery decision-making is discussed, and an adapted decision-making model is presented. This modified model attempts to address the complexity of decision-making in midwifery practice, with reference to a clinical case study to illustrate its function.

This paper aims to consider clinical decision-making within midwifery and critically analyse three decision-making approaches—the hypothetico-deductive approach, the intuitive-humanistic approach and the dual process theory—in relation to a chosen case. Using a modified decision-making tool, a tripartite decision (Box 1) will be discussed and the key elements involved in decision-making within midwifery explored. Pseudonyms have been used when discussing the tripartite decision in order to maintain confidentiality (Nursing and Midwifery Council (NMC), 2015).

Laura*, a woman at term, was visited at home for an early labour assessment. On arrival she appeared to be experiencing one uterine contraction every 7 minutes. Contractions were moderate to palpate, but did not seem to be causing her too much discomfort. The rationale for a vaginal examination to assess her cervical effacement and dilatation was discussed and the woman requested this procedure. Upon examination, it was found that the cervix was mid-anterior, soft and stretchy, 0.5 cm long and 4 cm dilated, which could be stretched to 6 cm. Although 4 cm dilated, the woman's uterine contractions were incoordinate, and too lacking in strength and frequency to diagnose active labour.

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