New midwifery? A qualitative analysis of midwives' decision-making strategies

Aim. This paper is a report of a study to explore the reasons why midwives decided to adopt observed decision-making strategies relating to the use of technology. Background. Literature on the development of midwifery and nursing has suggested that they are developing more egalitarian relationships with clients in decision-making processes. Methods. A qualitative approach was adopted, using participant observation with a convenience sample of midwives (n = 16), and a focus group of midwives (n = 8). Data collection took place over 9 months in 2004. Findings. The dominant mode of decision-making was bureaucratic decision-making, which involved adherence to written policies and procedures. The least frequently used was 'new professional' decision-making, which involved collaboration with clients. The reasons for midwives' approaches could be categorized under three main headings: first, context, including possible litigation, management strategies, workload pressures, and medical dominance; second, midwives' characteristics, including both lack of experience and the reliance on tradition of some experienced midwives; and third, women's perceived characteristics, some of whom were seen by midwives as either unwilling or unable to participate in decision-making. There was also implicit evidence that some midwives were uncomfortable with the new professional rebalancing of power relations between professionals and the laity. Conclusion. Managers need to question whether the strategies they adopt hinder or support clinicians in their efforts to involve women in decisions. Clinicians need to consider whether they wish to be selective or universal in their use of new professional strategies.