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Decision making between women and their caregivers during labour ranged from being unilateral to joint and was associated with various emotions

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Decision making between women and their caregivers during labour ranged from being unilateral to joint and was associated with various emotions
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  Qualitative Decision making between women and their caregiversduring labour ranged from being unilateral to joint andwas associated with various emotions VandeVusse L. Decision making in analyses of women’s birth stories.  Birth 1999 Mar;  26  :43–52. QUESTION: Howaredecisionsmadebywomenandtheircaregiversduringlabourandwhataretheassociatedpatternsofcontrol? Design  A reanalysis of 33 birth stories using an exploratory,descriptive design. Setting Midwestern USA. Participants 15 women between 18 and 39 years of age who repre-sented a variety of birth experiences. 8 women wereprimiparous and 7 were multiparous. 12 women wereEuro-American and 3 were “women of colour”. All women had given birth within the previousm 4 months. Methods  Women told their birth stories in any way they wished.Interviews were audiotaped, transcribed verbatim, andanalysed using content and thematic analysis. Codersfrom different disciplines were also recruited to providefresh perspectives and new interpretations of the data. Main findings 4 types of decision making and their associated patternsof control were identified. The first type of decisionmaking was a   unilateral   decision made by the caregiversthat was  contested   by the women.Women responded withstrong, negative emotions (eg, unsettled, sadness, andanger)andeitherrefusedcareoradaptedandsubmittedto the caregiver’s decision.The second type was a   unilat-eral   decision made by the caregivers that was  uncontested   by the women. Women responded by adapting, agree-ing,and quietly complying with the decision rather thanactivelyparticipatinginthedecisionitself.Thethirdtype was making   no active decision   at all and  suspending control while waiting   to see what would happen as the labour progressed.This type was used in situations with no par-ticular urgency, and women and their caregivers took the time to gather more data, evaluate the situation, andallow the labour to progress. The fourth type described shared (joint)   control between the woman and thecaregiver. The decision was made through explanationsgiven by the caregiver to the woman and throughrequests made by either the woman or caregiver. Women were involved in this type of decision making and could make informed choices, which resulted inpositive emotional responses. Conclusions  The decision making patterns of women and their caregivers during labour ranged on a continuum fromunilateral decisions made by the caregiver to joint deci-sions made by both the caregiver and the woman. Women responded to these patterns with various emo-tions ranging from feeling unsettled, punished, sad,angry, and devalued to feeling appreciative, honoured,confident, and comfortable (fig 1). Joint: Caregiver and womanUnilateral: Caregiver to woman Shared: Through explanationsShared: Through requestsSuspended while waiting: Through no active decisionUncontested: Through agreementContested: Through adaptationContested: Through refusalappreciative, honored Control of decisionsWomen’s expressedemotions confident, comfortableneutral, reassuredsurprised, resignedsad, angry, devaluedunsettled, punished +_  Model of patterns of control and decision-making related toemotions expressed in women’s birth stories.Reproduced from Vande Vusse L.Birth 1999;  29:  43–52 with permission. COMMENTARY  The study by VandeVusse highlights the important contribution of women in develop-ing effective strategies for the management of childbirth. The qualitative methodologyusedisanappropriateapproachtoexploringthequestionofwomen’sviewsondecisionmaking during labour.Story telling as an investigative method is well established in thesocial sciences and its use in healthcare research is growing. 1  A rigorous approach todata analysis is reported, which supports the identification of 4 types of decision mak-ing and their associated patterns of control. Although the North American setting may limit the applicability of the findings, thestudy is interesting and may provoke midwives and other healthcare providers to reflect on their own practice.In particular,practitioners may wish to explore ways that womencan be involved in decision making at key stages in the birth process so that the birthexperience is a positive one.In this study,64% of the births were attended by physicians,24% by lay midwives,and 9% by certified nurse midwives.The difference in professional background of birth attendants may have influenced the pattern of control within thedecision making process. The author, however, points out that an attempt was made tooversample women who did not have a doctor in attendance in order to maximise therange of reported experiences.It should also be recognised that one third of the samplecomprised women who had a caesarean section. The ethnicity of the women who participated in the study is also relevant to theinterpretation of the findings. A wide range of literature supports the diversity of howchildbirth is experienced by different ethnic groups, especially between eastern and western cultures,and there is increasing emphasis on the value of consultation betweenhealthcare providers and people from ethnic groups. 2 Unfortunately, the onlyinformation provided for this study is that 12 of the women were of Euro-Americandescent and 3 were “of colour”, and there is no discussion of ethnicity as a factor in thedecision making process. In conclusion, this is an interesting and informative study, which may be worthy of replication within a UK context. Soraya Meah, RN, RM, MSc  Lecturer in Nursing/Clinical Effectiveness Manager University of Liverpool  Liverpool,UK  1 Borges S, Waitzkin H.  Women Health   1995; 23 :29–56.2 North N. Consumers, service users, or citizens? In: North N, Bradshaw Y, editors.  Perspec-tives in health care. London: Macmillan, 1997:130–49. Source of funding:Noexternal funding. For correspondence:  Dr L VandeVusse, Marquette University,College of Nursing, Nurse-Midwifery Program,Clark Hall,PO  Box 1881,Milwaukee,WI 53201-1881,USA. Qualitative EBN Volume 3 April 2000 59 group.bmj.comon January 27, 2016 - Published by http://ebn.bmj.com/ Downloaded from   various emotionsunilateral to joint and was associated withcaregivers during labour ranged from being Decision making between women and their doi: 10.1136/ebn.3.2.59 2000 3: 59 Evid Based Nurs http://ebn.bmj.com/content/3/2/59 Updated information and services can be found at: These include:  References  #BIBL http://ebn.bmj.com/content/3/2/59 This article cites 2 articles, 0 of which you can access for free at: serviceEmail alerting box at the top right corner of the online article. Receive free email alerts when new articles cite this article. Sign up in the Notes http://group.bmj.com/group/rights-licensing/permissions To request permissions go to: http://journals.bmj.com/cgi/reprintform To order reprints go to: http://group.bmj.com/subscribe/ To subscribe to BMJ go to: group.bmj.comon January 27, 2016 - Published by http://ebn.bmj.com/ Downloaded from 

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