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Decision-making during obstetric emergencies: A narrative approach.
Gabriel M Raoust1,2, Johan Bergström3, Maria Bolin4
1Department of Clinical Sciences Lund, Division of Obstetrics and Gynecology, Faculty of Medicine, Lund University, Lund, Sweden.
Plos One
|January 26, 2022
Summary
Physicians
Area of Science:
- Medical Sociology
- Obstetrics & Gynecology
- Healthcare Management
Background:
- Childbirth safety varies globally, with disparities in intervention rates and outcomes between countries and maternity units.
- Obstetric interventions can reduce maternal and neonatal morbidity but risk harm if not medically indicated.
- Physician decision-making in obstetric emergencies is central to understanding these variations.
Purpose of the Study:
- To explore physicians' sense-making and meaning-making in obstetric emergency decision-making.
- To investigate psychological and organizational factors influencing physician decisions during childbirth emergencies.
- To understand how experience shapes obstetric decision-making.
Main Methods:
- Qualitative study using a narrative approach with 17 obstetricians and gynecologists.
- Conducted in-depth interviews, using event retelling and art images, across four Swedish maternity units (Oct 2018 - Feb 2020).
- Employed inductive thematic narrative analysis to interpret data and construct themes and decision-making perspectives.
Main Results:
- Identified eight key themes: loneliness, time awareness, responsibility, calmness, experience, midwife support, mindset/setting, and hedging.
- Constructed three decision-making perspectives: individual-centered, dialogue-distributed, and chaotic flow-orientation.
- Revealed that psychological and organizational factors influence physician decision-making, which is imbued with meaning through individual motivations.
Conclusions:
- Physician decision-making in obstetric emergencies is a complex interplay of psychological and organizational factors.
- Decision-making meaning is derived from individual motivations and rationales, evolving with experience and time.
- Findings offer insights for improving teamwork, training, and patient safety in obstetrics.
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