On speaking terms: choices and decision-making during the perinatal period

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Pregnancy is a transition period in which choices are made with long-term impact on babies, women and their partners. Midwives can enhance women’s experience of childbirth and health by seeking shared decision-making and fine-tuning midwifery care to individual women’s wishes and needs, taking into account that women may differ in the way they want to be involved in the decision- making process. The focus is on decision-making in everyday practice for healthy women.

This PhD-project uses mixed methods to explore women and care providers’ views on decision-making during the perinatal period. First, a focus group study was conducted in midwifery practices to explore pregnant women’s views on midwives’ support in care. Second, recently collected quantitative data were studied on healthy pregnant women’s preferences and choices concerning birthing position and the impact of these choices on women’s well-being. Next, real life interaction around choices in birthing positions was
observed during second stage of labour. Finally, we explored the views of experts in shared decision-making, maternity care providers and user representatives on the process of making shared decision in maternity care using the Delphi technique. Using this variety of methods, we aim to unravel decision-making needs and process in physiologic childbirth from the pregnant women’s perspective.


In this thesis, we explore women’s views and experiences of decision-making in maternity care and care providers’ ideas on how to facilitate women’s involvement in decision-making. We aim to contribute to enabling care providers for women-centred care.


What are the wants and needs of pregnant women with regard to psychosocial support during the transition to motherhood?
Do women participate in decision-making around birthing positions during labour and does this affect their well-being?
What are ingredients for quality criteria for shared decision-making in different situations during pregnancy and birth, and what professional competencies are needed for shared decision-making in maternity care?


Having choices and being involved in decision-making contribute to more positive birth experiences. Women’s views on the process of decision-making in maternity care are important to establish a women-centered model of care. More insight in this process is necessary to promote shared decision-making in maternity care and enable midwives and other care providers to support women in their choices by discussing women’s preferences and fine-tuning the care to their needs. Limited research is available on decision-making processes of healthy pregnant women. The Dutch midwifery care system offers ample opportunities to investigate choices, wants and needs of women with a physiologic pregnancy. The ultimate goal is strengthening women during their transition to parenthood. Research in healthy pregnant women adds to the international
literature on decision-making in maternity care.


Prof. A.L. Lagro-Janssen MD PhD, UMC Radboud, Nijmegen


M. Nieuwenhuijze RM MPH, PhD, head Research Centre for Midwifery Science, faculty Midwifery Education & Studies, Maastricht, Zuyd University I. Korstjens PhD, lecturer/researcher, Research Centre for Midwifery Science, faculty Midwifery Education & Studies, Maastricht, Zuyd University A. de Jonge RM PhD, researcher, Midwifery Science/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam Prof. R. de Vries, Research Department Midwifery Science, faculty Midwifery Education & Studies, Maastricht, Zuyd University/ CAPHRI, Maastricht University


M. Nieuwenhuijze RM, PhD


Begin datum: juli 2008
Eind datum: mei 2014