Decision-making in midwifery: A tripartite clinical decision
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
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.
Register now to continue reading
Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:
Limited access to our clinical or professional articles
New content and clinical newsletter updates each month