Facilitators and Barriers of Independent Decisions by Midwives During Labor and Birth

Introduction: The purpose of this study was to explore the factors that affect labor management decisions of midwives in hospitals and freestanding birth centers. Methods: Aqualitative study was conducted using one-on-one tape recorded interviews of midwives who had experience managing labor and birth in both hospitals and freestanding birth centers. Ten interviews consisting of several open-ended questions were conducted, coded, and analyzed in a stepwise fashion to identify codes, categories, and themes. Seven participants reviewed the final framework and confirmed credibility and trustworthiness. Results: Four overall themes were identified: trust birth, the woman, the environment, and the labor team. Discussion: When making labor management decisions, midwives are affected by their trust in birth, the woman, the health care team, and the birth environment. Midwives report more resistance when making labor management decisions in hospitals. The findings of this study provide insight into both the decision making of midwives and how factors in different environments, in this case hospitals and freestanding birth centers, influence the ability of midwives to make independent labor management decisions. J Midwifery Womens Health 2012; 57: 49-54 (C) 2011 by the American College of Nurse-Midwives.