Exploring Japanese midwives' clinical decision making for onset of labor

Abstract

Purpose

This study explored and clarified the conditions of clinical judgments regarding the onset of labor.

Methods

A cross-sectional study with 467 midwives was conducted. The backgrounds of the midwife subjects (years of experience as a midwife, number of deliveries assisted) for different starting times of labor (as determined using a revised version of Question 25 of the afternoon session of the 101st national midwife license examination) answer groups were analyzed using the Kruskal-Wallis test, and the reasons given for judging the starting time of labor (free response) were coding and classified into 4 elements of labor.

Results

Responses were collected from 251 subjects, and 203 were used for analysis. Background factors were as follows: 192 (94.6%) worked at medical institutions, they had 12.1 ± 9.2 years of experience (mean ± SD), and had assisted 394.1 ± 679.0 deliveries. As for the breakdown of the starting time of delivery, 3 respondents (1.5%) answered “4 a.m.,” 42 (20.7%) answered “8 a.m.,” 123 (60.6%) answered “9 a.m.,” 4 (2.0%) answered “11 a.m.,” and 31 (15.3%) answered “cannot be judged from the presented information.” Midwives' backgrounds did not vary according to answer groups. In addition to the definition of the starting time of labor, descriptions such as the mother's facial expression and degree of pain also varied for differing time answer groups.

Conclusion

Clinical judgments of the start of labor varied among the midwives, suggesting that the differences depending on practice wisdom, such as the information to be focused on and its interpretation.