Information, involvement, or partnership? Exploring intrapartum decision-making during the implementation of a...

Despite being recognised as a critical component of high-quality care, shared decision-making is still not consistently achieved during childbirth. TeamBirth is a care process developed to promote intrapartum teamwork and shared decision-making, adapted to the Swedish context and implemented in two labour wards. This study aims to explore how care providers engage women and their partners in intrapartum decision-making during the implementation of the adapted Swedish version of TeamBirth.

A qualitative design, based on 23 observations comprising 79 huddles, and 65 interviews with the care providers involved, was used. Data were collected April 2022 - June 2023, and analysed deductively using directed content analysis, guided by the Conceptual Framework for Patient and Family Engagement in Healthcare.

Four levels of engagement were found. No Engagement involved care providers giving instructions without explanations. Providing Information entailed brief updates followed by instructions, with limited opportunities for questions. Involvement, the most common level, included discussions and planning with women and their partners, although final decisions were made by care providers. Partnership and Shared Leadership, the least observed level, was characterised by dialogue and joint decisions. Barriers for engagement included limited Swedish proficiency, high workload, and critical situations, whereas continuous support, effective pain management, and use of the TeamBirth care process were enabling factors.

Engagement in decision-making occurred on a continuum, with modifiable factors including workload, continuous support, and use of TeamBirth. Although conducted during the implementation of a care process designed to improve engagement, Partnership and Shared Leadership remained the least observed level.