Professional Decision Making in Childbirth.

Medical interventions in childbirth have risen rapidly in high income countries over the last decade and this global phenomenon is reflected in the United Kingdom with, for example, caesarean section rates in England rising by 17% in the last four years to account for an average 45% of all births in 2024. Medical interventions in childbirth can be essential and have contributed to saving the lives of millions of women and children but the underpinning issues for this large rise in medical interventions in childbirth are not clear although certainly complex and multi - factorial.

The management of risk in childbirth is a central consideration as it is well documented as a key influence for professional decision making. The aim of this research study is to describe and analyse the influences on contemporary professional decisions for medical interventions in childbirth, within which risk - - how it is perceived and negotiated by clinicians and birthing parents, and the context and frameworks that support decisions to intervene or not intervene - is likely to be key.

This is a qualitative observational study with ethnography as the methodology. This approach is appropriate to explore how risk and decision making are constructed in real time contemporary frontline professional practice because it will observe what clinicians actually do (not just what they say they do) and how they create their decisions and rationales through their everyday work and professional and organisational interactions.

This research study is important because it will contribute to further understanding professional decision making for medical interventions in childbirth within a national background context of rising medical interventions, and concern about maternity care. There is not to our knowledge published qualitative research regarding this contemporary context.

This study explores professional decision making in a co - located Obstetric Unit (OU) and Alongside Midwifery Unit (AMU) in one NHS trust. A one study site is not a limitation for an in depth ethnography that will describe and analyse and the influences and complexities of contemporary clinician decision making, and from that build new insights and themes. This study as a qualitative ethnographic study will generate rich in-depth research insights that may be transferable to similar maternity settings.

Inclusion criteria

Maternity clinicians (midwives and obstetricians, who are the clinical decision makers in childbirth)

Exclusion criteria

Non maternity clinicians (neonatologists, anaesthetists, maternity support workers, who may be influential to decisions made but are not the accountable decision makers)