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The rhetoric of informed choice: perspectives from midwives on intrapartum fetal heart rate monitoring.

Hindley C, Thomson AM

Lecturer Midwifery, Midwifery and Social Work, School of Nursing, University of Manchester, UK. carol.hindley@manchester.ac.uk

OBJECTIVE: To investigate midwives' attitudes, values and beliefs on the use of intrapartum fetal monitoring. DESIGN: Qualitative, semi-structured interviews. SUBJECTS AND SETTING: Fifty-eight registered midwives in two hospitals in the North of England. RESULTS: In this paper two main themes are discussed, these are: informed choice, and the power of the midwife. Midwives favoured the application of informed choice and shared a unanimous consensus on the definition. However, the idealistic perception of informed choice, which included contemporary notions of empowerment and autonomy for women expressing an informed choice, was not reportedly translated into practice. Midwives had to implement informed choice on intrapartum fetal monitoring within a competing set of health service agendas, i.e. medically driven protocols and a political climate of actively managed childbearing. This resulted in the manipulation of information during the midwives' interactions with women. This ultimately meant that the women often got the choice the midwives wanted them to have. CONCLUSIONS: The information that a midwife imparts may consciously or subconsciously affect the woman's uptake and understanding of information. Therefore, the midwife has a powerful role to play in balancing the benefits and risk ratios applicable to fetal heart rate monitoring. However, a deeply ingrained pre-occupation with technological methods of intrapartum fetal monitoring over many years has made it difficult for midwives to offer alternative forms of monitoring. This has placed limits on the facilitation of informed choice and autonomous decision making for women.

Published 3 November 2005 in Health Expect, 8(4): 306-14.
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