Introduction
Shared decision‐making is considered to be a key aspect of woman‐centered care and a strategy to improve communication, respect, and satisfaction. This scoping review identified studies that used a shared decision‐making support strategy as the primary intervention in the context of perinatal care.
Methods
A literature search of PubMed, CINAHL, Cochrane Library, PsycINFO, and SCOPUS databases was completed for English‐language studies conducted from January 2000 through November 2019 that examined the impact of a shared decision‐making support strategy on a perinatal decision (such as choice of mode of birth after prior cesarean birth). Studies that only examined the use of a decision aid were excluded. Nine studies met inclusion criteria and were examined for the nature of the shared decision‐making intervention as well as outcome measures such as decisional evaluation, including decisional conflict, decisional regret, and certainty.
Results
The 9 included studies were heterogeneous with regard to shared decision‐making interventions and measured outcomes and were performed in different countries and in a variety of perinatal situations, such as women facing the choice of mode of birth after prior cesarean birth. The impact of a shared decision‐making intervention on women's perception of shared decision‐making and on their experiences of the decision‐making process were mixed. There may be a decrease in decisional conflict and regret related to feeling informed, but no change in decisional certainty.
Discussion
Despite the call to increase the use of shared decision‐making in perinatal care, there are few studies that have examined the effects of a shared decision‐making support strategy. Further studies that include antepartum and intrapartum settings, which include common perinatal decisions such as induction of labor, are needed. In addition, clear guidance and strategies for successfully integrating shared decision‐making and practice recommendations would help women and health care providers navigate these complex decisions.
Respectful communication is a key component of any clinical relationship. Shared decision making is the process of collaboration that occurs between a health care provider and patient in order to make health care decisions based upon the best available evidence and the individual's preferences. A midwife and woman (and her support persons) engage together to make health care decisions, using respectful communication that is based upon the best available evidence and the woman's preferences, values, and goals. Supporting a woman's autonomy, however, can be particularly challenging in maternity care when recommended treatments or interventions are declined. In the past, the real or perceived increased risk to a woman's health or that of her fetus as a result of that choice has occasionally resulted in coercion. Through the process of shared decision making, the woman's autonomy may be supported, including the choice to decline interventions. The case presented here demonstrates how a shared decision-making framework can support the health care provider-patient relationship in the context of informed refusal.
Electronic fetal heart rate monitoring is the most common form of intrapartal fetal assessment in the United States. Intermittent auscultation of the fetal heart rate is an acceptable option for low-risk laboring women, yet it is underutilized in the hospital setting. Several expert organizations have proposed the use of intermittent auscultation as a means of promoting physiologic childbirth. Within a shared decision-making model, the low-risk pregnant woman should be presented with current evidence about options for fetal heart rate assessment during labor.
This survey found that there is considerable variation in ethics education in terms of content, format, and evaluation among accredited midwifery education programs in the United States. Midwifery educators have an opportunity to explore the ethical dilemmas unique to maternity care from a midwifery perspective. There is also the opportunity to create a comprehensive and dynamic midwifery ethics curriculum, which incorporates both stand-alone ethics courses and ethics concepts that are woven throughout the core midwifery curriculum.
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