How are decisions made to access a planned epidural in labour? Midwife-woman interactions in antenatal consultations

Cole, Lindsay; Turnbull, Deborah; Dahlen, Hannah

doi:10.1016/j.midw.2019.102618

Cited by 6 publications

(3 citation statements)

References 23 publications

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“…Exceptions include analyses of surgical practice 141 and physiotherapy sessions, 142 and performing obstetric ultrasound scans. 143 In the context of maternity care, CA studies have examined antenatal appointments [144][145][146][147] and genetic counselling, 13,148,149 as well as calls to a homebirth helpline. 150,151 Very few studies have examined interactional practices of situated decisionmaking in the fast-moving, time-limited context of childbirth.…”

Section: Conversation Analytic Studies In the Context Of Labour And B...mentioning

confidence: 99%

Shared decision-making during childbirth in maternity units: the VIP mixed-methods study

Annandale

Baston

Beynon-Jones

et al. 2022

Health Soc Care Deliv Res

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Background NHS policy emphasises shared decision-making during labour and birth. There is, however, limited evidence concerning how decision-making happens in real time. Objectives Our objectives were as follows – create a data set of video- and audio-recordings of labour and birth in midwife-led units; use conversation analysis to explore how talk is used in shared decision-making; assess whether or not women’s antenatal expectations are reflected in experiences and whether or not the interactional strategies used (particularly the extent to which decisions are shared) are associated with women’s postnatal satisfaction; and disseminate findings to health-care practitioners and service users to inform policy on communication in clinical practice. Design This was a mixed-methods study. The principal method was conversation analysis to explore the fine detail of interaction during decision-making. Derived from the conversation analysis, a coding frame was developed to quantify interactions, which were explored alongside questionnaire data concerning women’s antenatal expectations and preferences, and women’s experiences of, and postnatal satisfaction with, decision-making. Semistructured interviews with health-care practitioners explored factors shaping decision-making. Setting and participants The study took place in midwife-led units at two English NHS trusts. A total of 154 women (aged ≥ 16 years with low-risk pregnancies), 158 birth partners and 121 health-care practitioners consented to be recorded. Of these participants, 37 women, 43 birth partners and 74 health-care practitioners were recorded. Key findings Midwives initiate the majority of decisions in formats that do not invite women’s participation (i.e. beyond consenting). The extent of optionality that midwives provide varies with the decision. Women have most involvement in decisions pertaining to pain relief and the third stage of labour. High levels of satisfaction are reported. There is no statistically significant relationship between midwives’ use of different formats of decision-making and any measures of satisfaction. However, women’s initiation of decisions, particularly relating to pain relief (e.g. making lots of requests), is associated with lower satisfaction. Limitations Our data set is explored with a focus on decision initiation and responses, leaving other important aspects of care (e.g. midwives’ and birth partners’ interactional techniques to facilitate working with pain) underexplored, which might be implicated in decision-making. Despite efforts to recruit a diverse sample, ethnic minority women are under-represented. Conclusions Policy initiatives emphasising patient involvement in decision-making are challenging to enact in practice. Our findings illustrate that women are afforded limited optionality in decision-making, and that midwives orient to guidelines/standard clinical practice in pursuing particular decisional outcomes. Nonetheless, the majority of women were satisfied with their experiences. However, when women needed to pursue decisions, particularly concerning pain relief, satisfaction is lower. Conversation analysis demonstrates that such ‘women-initiated’ decision-making occurs in the context of midwives’ avoiding pharmacological methods of pain relief at particular stages of labour. Future research We suggest that future research address the following – the barriers to inclusion of ethnic minority research participants, decision-making in obstetric units, systematic understanding of how pain relief decisions are pursued/resolved, conversation analysis of interactional elements beyond the specific decision-making context, interactional ‘markers’ of the emotional labour and inclusion of antenatal encounters. Trial registration This trial is registered as ISRCTN16227678 and National Institute for Health and Care Research (NIHR) CRN Portfolio (CMPS):32505 and IRAS:211358. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 36. See the NIHR Journals Library website for further project information.

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Section: Conversation Analytic Studies In the Context Of Labour And B...mentioning

confidence: 99%

Shared decision-making during childbirth in maternity units: the VIP mixed-methods study

Annandale

Baston

Beynon-Jones

et al. 2022

Health Soc Care Deliv Res

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“…There is little research that focuses specifically on the structure or function of WCC, despite the importance of providing WCC in the midwifery profession (Brady et al, 2019; Cole et al, 2020; Crepinsek et al, 2022). In this regard, the results of a study conducted by Crepinsek et al (2022) to review documents from 142 countries showed that the phrase “WCC” was used in only 3.5% of the documents (Crepinsek et al, 2022).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of woman‐centred care status by Iranian midwives and providing strategies to improve women‐centred care: A sequential explanatory mixed method study protocol

Mashayekh‐Amiri

Nourizadeh

Mohammad‐Alizadeh‐Charandabi

et al. 2023

Nursing Open

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AimThe present study aimed to evaluate the status of WCC provided by Iranian midwives.DesignA sequential explanatory mixed method study protocol.MethodsThe present study was conducted in three phases: quantitative, qualitative and mixed. The first phase is a cross‐sectional study that will be performed on midwives working in health centres, public and private hospitals in Iranian. The second phase is a qualitative study, in which purposeful sampling will be used, meaning that the midwives who are part of the extreme cases according to the results of quantitative phase and are willing and able to express their own experiences regarding WCC will be selected. Also, pregnant and parturient women under their cover will also be interviewed. Finally, in the mixed phase, we will use a combination of two quantitative and qualitative studies, a literature review and expert opinion using a Delphi method to provide strategies to improve and promote WCC in midwives.ResultsAchieving this goal is expected to provide positive outcomes such as strengthening the midwives professional relationship with women and reducing health care costs.No Patient or Public Contribution.

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“…As far as Italian is concerned, the doctor-patient gynaecological encounters seem to be (of all doctor-patient interactions) the least investigated from an epistemic perspective (e.g., Fatigante and Bafaro 2014;Cole et al 2019Cole et al , 2020Orletti 2019;Ericsson et al 2021). Regarding the use of epistemic disclaimers, as far as we know, the sole study dedicated to their usage is the one recently published by Menichetti et al (2021), who, in the context of triadic interactions that occur between doctors and 20 couples seeking assisted reproductive technology consultations, focus on the epistemic functions of Non lo so [lit., I don't know that] although used solely by doctors.…”

Section: Introductionmentioning

confidence: 99%

The Italian Epistemic Disclaimer Non so [I Don’t Know] in a Corpus of Gynaecological Interactions

Bongelli,

Zuczkowski,

Riccioni

2023

Languages

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Viewing conversations from an epistemic perspective involves analysing how participants navigate their knowledge, handle uncertainty, and address their lack of knowledge. This article focuses on the use of epistemic disclaimers, i.e., linguistic expressions that speakers employ to indicate uncertainty or lack of knowledge, in a collection of Italian gynaecological conversations throughout pregnancy. Specifically, the study examines the occurrences, features, and pragmatic functions of the epistemic disclaimers, with a specific focus on Non so, which is the Italian equivalent of “I don’t know” in English, the most extensively researched epistemic disclaimer. The study aims to (1) investigate the types and frequency of uncertain and unknowing epistemic disclaimers in the gynaecological corpus and (2) identify their characteristics and pragmatic functions. The primary findings indicate that epistemic disclaimers are primarily used to convey unknowledge rather than uncertainty. However, while patients use more epistemic disclaimers than doctors, they mainly use them to communicate unknowledge, whereas doctors mainly use them to express uncertainty. Regardless, their usage does not appear problematic in conversational terms since the topics for which they are used fall outside the domains of knowledge of each party.

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How are decisions made to access a planned epidural in labour? Midwife-woman interactions in antenatal consultations

Cited by 6 publications

References 23 publications

Shared decision-making during childbirth in maternity units: the VIP mixed-methods study

Shared decision-making during childbirth in maternity units: the VIP mixed-methods study

Evaluation of woman‐centred care status by Iranian midwives and providing strategies to improve women‐centred care: A sequential explanatory mixed method study protocol

The Italian Epistemic Disclaimer Non so [I Don’t Know] in a Corpus of Gynaecological Interactions

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