Part 1: A model for evidence-based decision-making in midwifery care
This two-part paper proposes a model of evidence-based decision-making for midwifery. In part 1, the nature of the woman–midwife partnership, decision-making theories, and the meaning of evidence are explored with reference to the literature. The impact of risk culture on decision-making and the role of guidelines are discussed. The case is made for a new fit-for-purpose model of decision-making on which to base personalised care in increasingly complex maternity care systems. To do this, the argument is made for a radical, broader definition of evidence that includes information from the woman, the midwife, research findings and other resources. These are set within an environmental context. Part 2 will introduce and explain the new model for evidence-based decision-making in midwifery.
Decision-making in midwifery care differs from that of many other areas of health care. Midwives work with primarily healthy women who are going through a normal physiological process, but also a life-changing journey. Throughout this journey, midwives are advocates for women (International Confederation of Midwives (ICM), 2011), responsible for providing safe, responsive and compassionate care in partnership with women, and facilitating choices (Nursing and Midwifery Council (NMC), 2009; 2012). Moreover, midwives are not caring for one person, but for a dyad: the woman and her baby (born or unborn). Respecting this dyad is crucial for the health of women and families (Association for Improvements in the Maternity Services, 2012). In this paper, the word ‘woman’ is used for ease of reading, but always acknowledges and represents the mother–baby dyad. Similarly, for ease of reading the midwife is sometimes referred to as ‘her’ rather than him/her, although it is acknowledged that some midwives are male.
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