Decision-making in obstetric emergencies. Individual differences and professional boundaries

Abstract: In affluent nations, variations in obstetric care, particularly during emergencies, perplexingly manifest in differing intervention and outcome rates. Although these variations mirror systemic disparities, they are also suggested to reflect the interplay of social and professional interactions between obstetricians/gynecologists and midwives, stemming from adherence to distinct professional paradigms and the influence of personal factors on decision-making and collaboration. This thesis sought to unpack these complexities by exploring individual differences and professional perspectives in decision-making during obstetric emergencies through a blend of interpretive and statistical approaches in a series of studies.Utilizing a narrative methodology with in-depth interviews and subsequent thematic analysis, Papers I and IV investigated the experiences of obstetricians/gynecologists (N=17) and midwives (N=27) during obstetric emergencies. Paper I used images of artwork as associative triggers in interviews, helping to illuminate decisionmakingprocesses, while Paper IV critically evaluated its thematic findings through the sociological lens of “boundary work”. Concurrently, Papers II and III employed psychometric instruments, including online questionnaires and the Five Factor Model personality test, to collect and analyze data from obstetricians/gynecologists and midwives (N = 472 for Paper II and N = 447 for Paper III). This involved investigating variables, such as Decision-Making styles, Negative Impact of Inductions, Healthcare Crisis Experience, and Job Satisfaction, alongside personality dimensions and complementary variables through various statistical tests.The studies revealed a diversity of findings: Paper I highlights that obstetricians/gynecologists navigate flexible decision-making environments, crystallizing into one of three distinct styles intertwining with their identities and practice narratives. Paper II unveils a specific personality profile among obstetricians/gynecologists and demonstrates correlations between personality traits, particularly Neuroticism, and distinct decision-making styles, while spotlightinggender and experience as significant influential factors. Paper III identifies divergent perspectives between the professions regarding labor inductions and job satisfaction, and highlights correlations among job satisfaction, views on labor inductions, and Neuroticism. Lastly, Paper IV underscores the multifaceted roles of midwives, who navigate, and sometimes resist, medical hierarchies to advocate for women’s physical and emotional well-being during childbirth, in a manner reshaping healthcare norms yet potentially sustaining historical tensions with obstetricians/gynecologists.This research highlights the intricate ways in which the personal and professional identities of obstetricians/gynecologists and midwives impact decision-making during obstetric emergencies. These insights invite a thoughtful reevaluation: How can training, support systems, and collaboration be recalibrated to encompass theseinfluential dynamics comprehensively? How can we as practitioners create work environments that not only acknowledge but also actively integrate varied personal perspectives and professional values and goals?