Characteristics of clinical judgement performed by hospital-based expert midwives

—Clinical judgment process along the first stage of labor—

Abstract

Purpose
This study aims to clarify the characteristics and sequence of processes that expert hospital-based midwives perform during the progress of the first stage of labor.
Method
In this study, the author defined midwives who had a prominent degree of skill and knowledge in the delivery of midwifery care to expectant and delivering mothers as expert midwives. The subjects were four expert midwives who worked in this study in the maternity ward of the general hospital. The author used participatory observation and semi-structured interviews to gather data from the four expert midwives. The 4 midwives were observed during labor care and followed with interviews upon completion of their duties.
Data were analyzed by qualitative inductive analysis for the purpose of categorization of characteristics of clinical judgment performed by hospital-based expert midwives
Result
Using their past experience, expert midwives were able to recognize important labor progress features from the time of the first meeting with parturient women. Expert midwives had "total perspective" to link three elements of labor with parturient women's psychological background and risk factors; they controlled the general condition of parturient women while "identifying individual labor progress". In addition expert midwives "ascertained negative factors" that would negatively affect the progress of labor and "chose care measures" to control or minimize them. Furthermore, while delivering midwifery care, expert midwives "sensed a predictive turning point in the labor progress" or "created one intentionally" as needed. Expert midwives repeatedly "rebuilt the perspective of labor progress", "ascertained negative factors again", "chose new care measures" and made clinical judgments to adjust their care plans. Midwifery convictions and well-matured techniques skilled interventions were the base of the expert midwives judgment. In addition, building relations with parturient women was also one important step to obtain useful information and apply it when making clinical judgment.
Conclusion
Predicting the "turning point" during labor progress or creating one intentionally contributes to securing safety of the mother and child by preventing deviation of normal labor progress. This process is characteristic of the clinical judgment performed by hospital-based midwives whose main duty is to care for high-risk delivering mothers.