The Impact of Uncertainty on Decision Making in Prenatal Consultations: Obstetricians' and Midwives' Perspectives

Abstract

This article examines decision making in prenatal consultations, how obstetricians (OBs) and midwives differ, and the role of uncertainty in these processes. Using participant-observation, comparative case-study methodology, pregnant women were observed and audio-recorded in their pre- and postnatal appointments, and in-depth, semistructured interviews were conducted with mothers and providers. Although decision-making processes appear similar between the OBs and midwives, closer analysis, employing problematic integration theory, reveals marked differences in providers' probabilistic and evaluative orientations that carry clear implications for both mothers and providers during pregnancy care.

ACKNOWLEDGMENTS

The author thanks Austin Babrow for comments on previous drafts of this article. She also extend her thanks to the mothers and providers who opened up their lives and their practices to her to make this research possible.

Notes

¹Midwives in the United States are typically classified as either certified nurse-midwives (CNMs) or direct-entry (or “lay”) midwives. CNMs are first trained as nurses, then typically obtain a master's degree in midwifery. CNMs usually practice under the supervision of an OB (Rooks, 1997). Direct-entry midwives receive training from outside the medical community and practice autonomously (Rooks, 1997). The present study examined direct-entry midwives: One was apprentice-trained, and the other attended a school of midwifery. Both midwives in this study obtained their certified professional midwife (CPM) credential by passing a test administered by the North American Registry of Midwives.

²All participants' names have been changed to protect their privacy.

³A situation in which an individual requires resuscitation.

⁴This may lead a reader to ask whether the same risk of malpractice applies to midwives. While the literature on this is scant, midwives consistently tell me in interviews that litigation is not a major issue for them, in part because of their relatively low pay, and in part because they believe that the strong relationships they foster with women help to guard against the possibility of litigation.