A review of clinical decision making: models and current research. J Clin Nurs. 2006; 17:(2)187-95

Bajwa SU, Kitchlew N, Shahzad K, Rehman KU Brief communication: phronesis knowledge as enabler of intuitive decision making. Knowledge Organization. 2015; 42:(1)40-9

Barber K The complexity of decision-making in midwifery: A case study. British Journal of Midwifery. 2012; 20:(4)289-94

Barnfather T Can intuitive knowledge be taught in midwifery practice?. British Journal of Midwifery. 2013; 21:(2)131-6

Benner P From novice to expert. Am J Nurs. 1982; 82:(3)402-7

Benner PNew Jersey: Prentice Hall; 2000

Benner P, Tanner C Clinical judgment: how expert nurses use intuition. Am J Nurs. 1987; 87:(1)23-31

Blumenthal-Barby JS, Krieger H Cognitive biases and heuristics in medical decision making: a critical review using a systematic search strategy. Med Decis Making. 2015; 35:(4)539-57

Carper B Fundamental patterns of knowing in nursing. ANS Adv Nurs Sci. 1978; 1:(1)13-23

Cervone HF Systematic vs intuitive decision making and the Pareto principle: Effective decision-making for project teams. OCLC Systems & Services: International digital library perspectives. 2015; 31:(3)108-11

Cook DA Much ado about differences: why expert-novice comparisons add little to the validity argument. Adv Health Sci Educ Theory Pract. 2015; 20:(3)829-34

Cross RECheshire: Books for Midwives; 1996

Dale S Heuristics and biases: The science of decision-making. Business Information Review. 2015; 32:(2)93-9

Draper ES, Kurinczuk JJ, Kenyon S(eds.). Leicester: MBRRACE-UK; 2015

Dreyfus SE, Dreyfus HLUniversity of California, Berkeley: Operations Research Centre; 1980

Elstein A, Shulman L, Sprafka SCambridge: Harvard University Press; 1978

Freeman LM, Griew K Enhancing the midwife–woman relationship through shared decision making and clinical guidelines. Women Birth. 2007; 20:(1)11-15

Goodman B, Ley TLondon: SAGE Publications; 2012

Griffith R Understanding accountability in midwifery practice: Key concepts. British Journal of Midwifery. 2011; 19:(5)327-8

Griffith R Accountability in midwifery practice: answerable to mother and baby. British Journal of Midwifery. 2012; 20:(8)601-2

HM Government. The Nursing and Midwifery Order. 2001. (accessed 14 July 2016)

Jefford E, Fahy K, Sundin D Decision-Making Theories and their usefulness to the midwifery profession both in terms of midwifery practice and the education of midwives. Int J Nurs Pract. 2011; 17:(3)246-53

Jordan B Authoritative knowledge and its construction.(eds.). Berkeley: University of California Press; 1997

Kahneman DLondon: Penguin; 2011

Kennedy C, O’Reilly P, Fealy G, Casey M, Brady AM, McNamara M Comparative analysis of nursing and midwifery regulatory and professional bodies’ scope of practice and associated decision-making frameworks: a discussion paper. J Adv Nurs. 2015; 71:(8)1797-811

Klein G A naturalistic decision making perspective on studying intuitive decision making. Journal of Applied Research in Memory and Cognition. 2015; 4:(3)164-68

Klein G, Calderwood R, Clinton-Cirocco A Rapid Decision Making on the Fire Ground. Proc Hum Fact Ergon Soc Annu Meet. 1988; 30:(6)576-80

Knight M, Tuffnell D, Kenyon S, Shakespeare J, Gray R, Kurinczuk JJ(eds.). Oxford: National Perinatal Epidemiology Unit; 2015

Ménage D Part 1: A model for evidence-based decision-making in midwifery care. British Journal of Midwifery. 2016a; 24:(1)44-9

Ménage D Part 2: A model for evidence-based decision-making in midwifery care. British Journal of Midwifery. 2016b; 24:(2)137-43

McFall JP Rational, normative, descriptive, prescriptive, or choice behavior? The search for integrative metatheory of decision making. Behavioral Development Bulletin. 2015; 20:(1)45-59

Mok H, Stevens PA Models of decision making.(eds.). Philadelphia: Elsevier; 2005

Muoni T Decision-making, intuition, and the midwife: Understanding heuristics. British Journal of Midwifery. 2012; 20:(1)52-6

National Institute for Health and Care Excellence. Intrapartum care for healthy women and babies CG190. 2014. (accessed 14 July 2016)

London: NMC; 2012

London: NMC; 2015

Okoli JO, Weller G, Watt J Information processing and intuitive decision-making on the fireground: towards a model of expert intuition. Cognition Technology and Work. 2016; 18:(1)89-103

Payne LK Toward a theory of intuitive decision-making in nursing. Nurs Sci Q. 2015; 28:(3)223-8

Raynor M, Marshall J, Sullivan A(eds.). Philadelphia: Elsevier; 2005

Rew L Acknowledging intuition in clinical decision making. J Holist Nurs. 2000; 18:(2)94-108

Standing MMaidenhead: Open University Press; 2010

Thompson C, Dowding D Decision making and judgement in nursing – an introduction.(eds.). London: Churchill Livingstone; 2002

Decision-making in midwifery: A tripartite clinical decision

02 August 2016
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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