Midwives’ and the facilitation of informed decisions – a narrative literature review

Problem: The issues of birth trauma, women’s rights and obstetric violence are at the forefront of maternity care discussions in Australia and globally, now more than ever. These issues share a common theme, the woman’s right, and ability to make informed decisions about her body and her baby.
Background: Midwifery philosophy promotes the facilitation of informed decisions as gold-standard for effective and respectful midwifery care. Research also indicates that informed decision-making is a protective factor for women’s health and safety as well as midwives’ job satisfaction and longevity in the industry. And yet, evidence shows that both midwives and women, report a lack of informed decision-making in actual practice.
Aim: This narrative literature review aims to synthesise qualitative publications from the last decade, culminating in a story which presents the experiences and perceptions of midwives when facilitating informed decision-making.
Methods: A systematic search of key databases and grey literature for qualitative research in English between 2010-2019 was conducted. Quality assessment followed CASP guidelines and this review is reported in accordance with PRISMA guidelines. Thirteen studies were included in the final review.
Findings: Midwives supported the value of informed decision-making, and aimed to provide this in the majority of cases. However, multiple and recurring barriers were revealed. These included lack of specific knowledge and training, fear of blame and litigation, structural constraints including lack of time and fragmented models of midwifery care, and workplace cultures, including differences in multidisciplinary philosophy.
Conclusion: Informed decision-making has been shown to be a priority to midwives wishing to work in alignment with midwifery philosophies. Despite this, midwives report multiple barriers to the facilitation of informed decisions, and identify specific barriers which require examination and solutions at education, policy, practice and research levels.