Midwives' experiences of facilitating informed decision-making - a narrative literature review

Informed decision-making is a vital component of midwifery philosophy and a core recommendation of the global respectful maternity care charter; however, women and midwives report a lack of informed decision-making in actual practice. Research reveals informed decision-making improves physical and mental health outcomes for women, regardless of childbearing experience, and is a protective factor for midwives' job satisfaction. There is currently little known about midwives' experiences of facilitating informed decision-making, and associated barriers.

To critically appraise and synthesize the best qualitative evidence exploring midwives' experiences of facilitating women's informed decision-making.

A systematic search of key databases and grey literature for qualitative research in English language published between 2010-2019. Quality assessment followed CASP guidelines and this review is reported in accordance with PRISMA guidelines. Thirteen studies were included in the final review. Data were synthesised narratively.

Midwives were shown to have a strong desire to facilitate informed decision-making, yet reported a disparity between philosophy and practice due to multiple barriers. Barriers included; lack of specific knowledge and training, fear of blame and litigation, structural constraints including lack of time and fragmented models of midwifery care, and multidisciplinary philosophical disparities.

Existing literature identifies informed decision-making is the gold-standard in providing safe and respectful maternity care, yet this review demonstrates that it is not well executed in actual practice. Midwives recognise this disparity and identify barriers which require urgent education, research, policy and practice solutions.