Aim. This paper is a report of a study to explore the reasons why midwives decided to adopt observed decision-making strategies relating to the use of technology.Background. Literature on the development of midwifery and nursing has suggested that they are developing more egalitarian relationships with clients in decision-making processes.Methods. A qualitative approach was adopted, using participant observation with a convenience sample of midwives (n = 16), and a focus group of midwives (n = 8). Data collection took place over 9 months in 2004.Findings. The dominant mode of decision-making was bureaucratic decision-making, which involved adherence to written policies and procedures. The least frequently used was 'new professional' decision-making, which involved collaboration with clients. The reasons for midwives' approaches could be categorized under three main headings: first, context, including possible litigation, management strategies, workload pressures, and medical dominance; second, midwives' characteristics, including both lack of experience and the reliance on tradition of some experienced midwives; and third, women's perceived characteristics, some of whom were seen by midwives as either unwilling or unable to participate in decision-making. There was also implicit evidence that some midwives were uncomfortable with the new professional rebalancing of power relations between professionals and the laity.Conclusion. Managers need to question whether the strategies they adopt hinder or support clinicians in their efforts to involve women in decisions. Clinicians need to consider whether they wish to be selective or universal in their use of new professional strategies.
Bibliographical noteReference text: Beardwood B., Walters V., Eyles J. & French S. (1999) Complaints against nurses: a reflection of the 'new managerialism' and consumerism in health care. Social Science and Medicine 48(3), 363–374. Links
Benner P. (1984) From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Addison Wesley, London.
Burtch B. (1987) Community midwifery and state measures: the new midwifery in British Columbia. Contemporary Crises 10(4), 399–420. Links
Charlton B. & Myles A. (1998) The rise and fall of EBM. Quarterly Journal of Medicine 91(5), 371–374. Links
Craib I. (1984) Modern Social Theory: From Parsons to Habermas. Harvester Wheatsheaf, Brighton.
Dingwall R. & McIntosh J. (1978) Introduction to the doctor–nurse game. In Readings in the Sociology of Nursing (Dingwall R. & McIntosh J., eds), Churchill Livingstone, Edinburgh, pp. 1–15.
Dreyfus H. & Dreyfus S. (1986) Mind Over Machine: The Power of Human Intuition and Expertise in the Era of the Computer. Blackwell, Oxford.
Eddy D. (1990) Anatomy of a decision. Journal of the American Medical Association 263, 441–443. Links
Fleming V. (1998a) Women-with-midwives-with-women: a model of interdependence. Midwifery 14, 137–143. Links
Fleming V. (1998b) Women and midwives in partnership: a problematic relationship? Journal of Advanced Nursing 27, 8–14. Links
Foucault M. (1977) Discipline and Punish: The Birth of the Prison. Pantheon, New York.
Freidson E. (1970) Profession of Medicine: A Study of the Sociology of Applied Knowledge. Dodd Mead, New York.
Gold R. (1958) Roles in sociological field observations. Social Forces 36, 217–223. Links
Habermas J. (1970) Towards a theory of communicative competence. Inquiry 13, 360–375. Links
Harrison S., Dowswell G. & Wright J. (2002) Practice nurses and clinical guidelines in a changing primary care context: an empirical study. Journal of Advanced Nursing 39(3), 299–307. Links
Hewison A. (1998) The new public management and the new nursing: related by rhetoric? Some reflections on the policy process and nursing. Journal of Advanced Nursing 29(6), 1377–1384. Links
Hood C. (1991) A public management for all seasons? Public Administration 69, 3–9. Links
Hsia L. (1991) Midwives and the empowerment of women: an international perspective. Journal of Nurse-Midwifery 36(2), 85–87. Links
Hunt S. & Symonds A. (1995) The Social Meaning of Midwifery. Macmillan, London.
ICM (2007) Retrieved from http://www.internationalmidwives.org/pdf/disclosure2.pdf on 16 April 2007.
Kirkham M. (2004) Informed Choice in Maternity Care. Palgrave, London.
Kirkpatrick I., Ackroyd S. & Walker R. (2005) The New Managerialism and Public Service Professions. Palgrave, London.
Lee T. (1989) 2000 plus: the new nursing. Professional Nurse 41(15), 126–129. Links
MacDonald M. (2006) Gender expectations: natural bodies and natural births in the new midwifery in Canada. Medical Anthropology Quarterly 20(2), 235–256. Links
Marx K. (1983) Preface to a contribution to the critique of political economy. In The Portable Karl Marx (Kamenka E., ed.), Penguin, Harmondsworth, pp. 158–161.
McCourt C. (2006) Supporting choice and control? Communication and interaction between midwives and women at the antenatal booking visit. Social Science and Medicine 62, 1307–1318. Links
Page L. (2000) The New Midwifery: Science and Sensitivity in Practice. Churchill Livingstone, Edinburgh.
Parker D. & Lawton R. (2000) Judging the use of clinical protocols by fellow professionals. Social Science and Medicine 51, 669–677. Links
Parsons T. (1951) The Social System. Free Press, New York.
Porter S. (1994) New nursing: the road to freedom? Journal of Advanced Nursing 20, 269–274. Links
Porter S. (1995) Nursing's Relationship with Medicine. Avebury, Aldershot.
Royal College of Nursing (1987) Position Statement on Nursing. RCN, London.
Salvage J. (1990) The theory and practice of the 'New Nursing'. Nursing Times 86(4), 42–45. Links
Salvage J. (1992) The New Nursing: empowering patients or empowering nurses? In Policy Issues in Nursing (Robinson J., Gray A. & Elkan R., eds), Open University Press, Milton Keynes, pp. 9–23.
Silverman D. (2001) Interpreting Qualitative Data, 2nd edn. SAGE, London.
Strauss XX. & Corbin XX. (1998) Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. SAGE, Thousand Oaks, CA.
Weber M. (1978) Economy and Society. University of California Press, Berkeley.
Wennberg J. (1991) Unwanted variations in the rules of practice. Journal of the American Medical Association 265, 1306–1307. Links
Wigens L. (1996) The conflict between 'new nursing' and 'scientific management' as perceived by surgical nurses. Journal of Advanced Nursing 25, 1116–1122. Links
Witz A. (1992) Professions and Patriarchy. Routledge, London.
- clinical decision-making • focus groups • midwifery • new professionalism • observation • qualitative research