Decisions in the Delivery Room: How Do Obstetricians Come to Their Decisions?

Autor(en): Hellmers, C.
Krahl, A.
Schuecking, B.
Stichwörter: CESAREAN-SECTION; decision-making criteria; guidelines; maternal request; obstetrical interventions; Obstetrics & Gynecology
Erscheinungsdatum: 2010
Volumen: 70
Ausgabe: 7
Startseite: 553
Seitenende: 560
Purpose: Hospital birth is strongly medically controlled and has high intervention rates. The purpose of this project was to explore the decision criteria applied by obstetricians when carrying out obstetrical interventions such as Caesarean sections, episiotomies, induction of labour and cardiotocography. Furthermore, the study investigated changes in decision-making processes. Material and Methods: The study had a longitudinal qualitative design. Semi-structured problem-centred interviews according to Witzel, which additionally took the approach of Meuser and Nagel for expert interviews into account, were conducted with obstetricians (T1: n = 26; T2: n = 23) at two hospitals. Results: Following Mayring, the evaluation of the interviews demonstrated a variety of categories which contributed to decision-making in obstetrical interventions. A total of twenty categories were identified. Analysis showed that medical indications predominated in the decision-making process and, additionally, that there was a strong tendency to rely on intra-departmental guidelines. Professional experience and maternal requests did affect decision-making in addition to other subjective and structural components. Most criteria did not change over time. Only growing professional experience led to changes in decision-making. Conclusion: Decision-making in obstetrics is a multifactorial process. Medical and non-medical criteria are used. The results indicate that decisions for or against interventions are always closely related to the professional experience of the obstetricians. Experts need to evaluate how decisions on individual obstetric situations occurring during birth are taken. An ability to reflect on their decision-making processes is therefore indispensable for obstetricians.
ISSN: 00165751
DOI: 10.1055/s-0030-1250065

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