Background
Step 1. |
Choice talk, introducing that a decision-making needs to be made and exploring what role the woman wants to play. |
Step 2. |
Option talk, exploring the woman’s values and preferences, informing her about the options and its consequences, deliberating with her and involving her partner or significant others. |
Step 3. |
Decision talk, making the final decision, safeguarding the woman’s sense of autonomy, clarity over the decision and informing other professionals involved in the care for the woman. |
Methods
Expert panel
Design and data collection
Round 1
Round 2
Round 3
Data analysis
Results
First round | Second round | Third round | |
---|---|---|---|
N = 48 | N = 42 | N = 32 | |
No. (%) | No. (%) | No. (%) | |
Age (mean (SD)) | 45 (9.4) | 45 (9.4) | 45 (9.2) |
Gender | |||
Female | 43 (89.6) | 39 (92.9) | 30 (93.8) |
Male | 5 (10.4) | 3 (7.1) | 2 (6.3) |
Background | |||
Midwife | 31 (64.6) | 29 (69.0) | 24 (75.0) |
Obstetrician | 9 (18.8) | 6 (14.3) | 5 (15.6) |
Physician | 3 (6.3) | 3 (7.1) | 1 (3.1) |
Representatives of care users | 3 (6.3) | 2 (4.8) | 1 (3.1) |
Other | 2 (4.2) | 2 (4.8) | 1 (3.1) |
Present professional activity* | |||
Maternity care | 28 (58.3) | 26 (61.9) | 22 (68.8) |
Research | 15 (31.3) | 11 (26.2) | 9 (28.1) |
Education | 11 (22.9) | 10 (23.8) | 6 (18.8) |
Professional organisation | 5 (10.4) | 5 (11.9) | 4 (12.5) |
Policy making | 7 (14.6) | 4 (9.5) | 2 (6.3) |
Work experience in years (mean (SD)) | |||
Maternity care | 12.5 (9.0) | 12.0 (9.0) | 12.7 (9.0) |
Region in which currently active | |||
Netherlands | 32 (66.7) | 27 (64.3) | 22 (68.8) |
Europe | 8 (16.7) | 9 (21.4) | 6 (18.8) |
North America | 7 (14.6) | 5 (11.9) | 3 (9.4) |
Australia | 1 (2.1) | 1 (2.4) | 1 (3.1) |
Round 1
Round 2
-
Decision-making scenarios during pregnancy:
-
Decision-making scenarios during birth:
No consensus
Round 3
No consensus
Care providers’ advice
Involvement of the partner
Discussion
Scenario | |
---|---|
I
|
Interaction around decisions during PREGNANCY
|
Decisions with more or less equal (treatment) options or decisions with inconclusive evidence that one option is better than the others. | |
Choice talk
| |
The care provider creates an open dialogue to discuss the choices and decisions based on respect, empathy, trust and comfort. | |
The care provider explores which role the woman is willing to play in the decision-making process. | |
The care provider encourages all women to play an active role in the decision-making process and supports her throughout. | |
Option talk
| |
The care provider is aware of the available evidence, guidelines and decision aids, is capable of assessing their quality, and can apply them to the woman’s individual situation. | |
The care provider explores what the woman already knows and provides additional or corrective information if necessary. | |
The care provider provides objective and accurate information on the available options. | |
The care provider informs the woman using accessible language tailored to her social and cultural background. | |
The care provider explores available options, also those the woman is not immediately interested in. | |
The care provider explores the values and preferences of the woman. | |
The care provider explores the underlying motives for the woman’s preferences. | |
The care provider gives the woman ample time and space to process this information. | |
Complex decisions are discussed over the course of several consultations. | |
With the woman's consent, the care provider will involve the partner in the decision-making process. | |
The care provider involves the partner in the conversation around information. | |
The care provider involves the partner in the deliberation of the options. | |
The care provider respects the woman’s choice to involve a third party in the decision-making process. | |
The woman should always feel autonomy in the decision-making process. | |
Decision talk
| |
Once a decision is taken, it is clearly stated. | |
The care provider verifies whether the decision was understood. | |
The care provider stresses that the woman can change her mind about her decision at any time. | |
During the pregnancy, the care provider revisits the decisions that were made. | |
The care provider will inform other care providers involved in the care for the woman about the woman's decisions and underlying motivations with. | |
The care provider makes sure that the autonomy of the woman is respected | |
The care provider makes sure that her/his preference is not forced upon the woman. | |
The care provider puts forward her/his viewpoint based on evidence about the benefits and harms. | |
II.
|
Interaction around decisions during PREGNANCY
|
Decisions with an option that is clearly better - based on research or experience. | |
If there is an option that is clearly better, the care provider will explain this to the woman. | |
The care provider encourages the woman to express her thoughts and opinions. | |
The care provider listens to and respects the woman's input. | |
The care provider ensures that the woman has understood the information provided. | |
If the woman is responsive, the care provider will always ask for informed consent. | |
III.
|
Interaction around decisions during BIRTH
|
Decisions with more or less equal (treatment) options or decisions with inconclusive evidence that one (treatment) option is better than the others. | |
During the pregnancy, the care provider discusses the possibility of unforeseen decision moments during birth. | |
During the pregnancy, the care provider explores with the woman possible dilemmas surrounding decisions during birth. | |
During the pregnancy, the care provider discusses the woman's needs, preferences and expectations concerning labour and birth, and puts the preferences on paper (e.g. in a birth plan). | |
The care provider makes it clear that the woman can change her mind about any decisions and choices regarding her birth plan. | |
Preferably, a woman in labour should not be confronted with choices or decisions for the first time. | |
The care provider exudes calm and takes the time to explain and discuss the situation. | |
The care provider briefly describes the essence of the situation and the available options. | |
The care provider always checks whether the woman has heard and understood her/him. | |
The woman will always be asked for her consent. | |
IV.
|
Interaction around decisions during BIRTH
|
Urgent decisions with an option that is clearly better - based on research or experience. | |
During the pregnancy, the care provider explains that acute situations may arise during birth that require quick decisions. | |
The care provider takes a moment to explain the situation to the woman and her partner. | |
The care provider strives to eliminate a rushed feeling. | |
During an acute situation, the care provider explains that s/he will take the lead. | |
If possible, the care provider obtains the explicit consent of the woman before taking any measures. | |
The care provider will discuss the situation again after the birth. | |
V.
|
Competencies
|
Establish a relationship and open dialogue with the woman (and her partner) based on respect and recognition of cultural diversity. | |
Evaluate available evidence and experience, and provide the woman with accurate, honest information in the context of her individual situation. | |
Enable and activate the woman to participate in the decision-making process, support her to deliberate about the options and express her preferences and views. | |
Reduces tension and guides the process to reach a shared decision. |