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Introduction
Multiple investigations have determined that poor interprofessional collaboration
has been detrimental to the safety and experience of maternity care, as evidenced
in the publication of the recent Ockenden review in the UK. The Labouring Together
study was conducted to explore women's and clinicians' perceptions and experiences
of collaboration in maternity care, using a conceptual theory of collaboration to
identify barriers and enablers in the context of Victoria, Australia.
Methods
A sequential, mixed-methods, multi-site case study approach was used to explore collaboration
and shared decision-making in maternity care in four diverse case studies of public
and private hospitals. Cross-sectional surveys were conducted in each case, using
validated scales to determine midwives’, obstetrician’s and GPs’ assessment of organisational
context and attitudes toward collaboration, followed by in-depth interviews to explore
their perceptions and experiences.
Results
Participants rated the context of each case study similarly for the provision of woman-centred
care, and whilst the attitudes of most participants were positive toward collaboration,
midwives were found to have a significantly more positive attitude than obstetricians
(p<.001 95% CI 2.64-7.93) and GPs (p<.001 95% CI 5.48-12.10). The conceptual framework of Working Together to Get The Best Outcomes emerged from inductive analysis, with major subthemes of ‘Organisation of care: working for the organisation’ and ‘Partnering in care: working together with women’. Interprofessional tensions are avoided through professional altruism and positive
role-modelling of interprofessional respect and trust. However, multiple barriers
to effective collaboration in maternity care were identified; and whilst participants
agreed that women should have autonomy for collaborative decision-making, most identified
barriers to achieving this ideal.
Conclusion
Results of the Labouring Together study indicate that although individual attitudes
toward collaboration are largely positive, fundamental barriers to collaboration in
maternity care remain, and shared decision-making with women is not routine practice
in Victoria, Australia.
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© 2022 Published by Elsevier Inc.
