On speaking terms: a Delphi study on shared decision-making in maternity care

BMC Pregnancy and Childbirth

Antoine Lagro-Janssen⁴  Raymond de Vries¹  Ank de Jonge²  Irene Korstjens³  Marianne J Nieuwenhuijze³ 

[1] CAPHRI, University Maastricht, Universiteitssingel 60, 6229 ER Maastricht, the Netherlands;Midwifery Science/EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands;Research Centre for Midwifery Science, Faculty Midwifery Education & Studies, Zuyd University, Universiteitssingel 60, 6229 ER Maastricht, the Netherlands;Department of General Practice, Women Studies Medicine, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, the Netherlands

关键词: Childbirth;    Pregnancy;    Delphi study;    Maternity care;    Shared decision-making;    Choice;   

Others  :  1127174
DOI  :  10.1186/1471-2393-14-223

 received in 2014-02-20, accepted in 2014-06-27,  发布年份 2014

【 摘 要 】

Background

For most women, participation in decision-making during maternity care has a positive impact on their childbirth experiences. Shared decision-making (SDM) is widely advocated as a way to support people in their healthcare choices. The aim of this study was to identify quality criteria and professional competencies for applying shared decision-making in maternity care. We focused on decision-making in everyday maternity care practice for healthy women.

Methods

An international three-round web-based Delphi study was conducted. The Delphi panel included international experts in SDM and in maternity care: mostly midwives, and additionally obstetricians, educators, researchers, policy makers and representatives of care users. Round 1 contained open-ended questions to explore relevant ingredients for SDM in maternity care and to identify the competencies needed for this. In rounds 2 and 3, experts rated statements on quality criteria and competencies on a 1 to 7 Likert-scale. A priori, positive consensus was defined as 70% or more of the experts scoring ≥6 (70% panel agreement).

Results

Consensus was reached on 45 quality criteria statements and 4 competency statements. SDM in maternity care is a dynamic process that starts in antenatal care and ends after birth. Experts agreed that the regular visits during pregnancy offer opportunities to build a relationship, anticipate situations and revisit complex decisions. Professionals need to prepare women antenatally for unexpected, urgent decisions in birth and revisit these decisions postnatally. Open and respectful communication between women and care professionals is essential; information needs to be accurate, evidence-based and understandable to women. Experts were divided about the contribution of professional advice in shared decision-making and about the partner’s role.

Conclusions

SDM in maternity care is a dynamic process that takes into consideration women’s individual needs and the context of the pregnancy or birth. The identified ingredients for good quality SDM will help practitioners to apply SDM in practice and educators to prepare (future) professionals for SDM, contributing to women’s positive birth experience and satisfaction with care.

【 授权许可】

   
2014 Nieuwenhuijze et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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