How midwives facilitate informed decisions in the third stage of labour – an exploration through portraiture

Problem: Midwifery philosophy promotes informed decision-making. Despite this, midwives report a lack of informed decision-making in standard maternity care systems. Background: Previous research has shown a woman's ability to make informed decisions within her maternity care significantly impacts her childbearing experience. When informed decision-making is facilitated, women report positive experiences, whereas when lacking, there is an increased potential for birth trauma. Aim: To explore midwives’ experiences of facilitating informed decision-making, using third-stage management as context. Methods: Five midwives from Victoria, Australia, were interviewed about their experiences with informed decision-making. These interviews were guided by portraiture methodology whereby individual narrative portraits were created. This paper explores the shared themes among these five portraits. Findings: Five individual narrative portraits tell the stories of each midwife, providing rich insight into their philosophies, practices, barriers and enablers of informed decision-making. These are then examined as a whole dataset to explore shared themes, and include; ‘informed decision-making is fundamental to midwifery practice’ ‘the system’, and ‘navigating the system’. The system contained the sub-themes; hierarchy in hospitals, the medicalisation of birth, and the impact on midwifery practice, and ‘navigating the system’ – contained; safety of the woman and safety of the midwife, and the gold-standard of midwifery. Discussion and conclusion: Midwives in this study valued informed decision-making as fundamental to their philosophy but also faced barriers in their ability to facilitate it. Barriers to informed decision-making included: power-imbalances; de-skilling in physiological birth; fear of blame, and interdisciplinary disparities. Conversely enablers included continuity models of midwifery care, quality antenatal education, respectful interdisciplinary collaboration and an aim toward a resurgence of fundamental midwifery skills.