Healthcare professionals’ perceptions of risk management on pregnancy and childbirth: An integrative review

IF 2.6 3区医学 Q1 NURSING

Midwifery Pub Date : 2025-03-12 DOI:10.1016/j.midw.2025.104376

Khayla Timothy , Barbara Lloyd , Carmel Bradshaw

{"title":"Healthcare professionals’ perceptions of risk management on pregnancy and childbirth: An integrative review","authors":"Khayla Timothy , Barbara Lloyd , Carmel Bradshaw","doi":"10.1016/j.midw.2025.104376","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Risk management in maternity care aims to reduce incidents and harm to women and babies, contributing to quality care. However, there is growing concern that risk management policies may lead to unnecessary interventions during pregnancy and childbirth, resulting in both short- and long-term morbidity for women and their babies.</div></div><div><h3>Aim</h3><div>To evaluate healthcare professionals’ perceptions of the effect of risk management on pregnancy and childbirth.</div></div><div><h3>Methods</h3><div>A five-stage methodological framework was utilised in this review. A comprehensive integrative review was undertaken using a computer-assisted database approach including CINAHL, EMBASE, MEDLINE (Pubmed), PsycINFO and Scopus from 2016–2024. This review is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-analysis for Scoping Reviews (PRISMA-ScR).</div></div><div><h3>Findings</h3><div>The review identified five papers from four different countries. Two overarching themes were generated: The impact of the dominant medical model on risk management and decision-making in maternity care and the differences and similarities in healthcare professional's perceptions of risk management. The increasing medicalisation of pregnancy and childbirth shifts healthcare professionals' focus towards documentation and administrative tasks, driven by liability fears, rather than addressing clinical risks and providing woman-centred care.</div></div><div><h3>Conclusion</h3><div>Complex factors influence risk management in maternity care. Risk management is affecting the way healthcare professionals think and operate. This review reveals that the medical model significantly shapes healthcare professionals’ perceptions of risk management, often undermining midwives' autonomy and impacting decision-making in pregnancy and childbirth. Education and training are essential to restore midwives' autonomous roles, ensuring that women receive the most appropriate, safest and highest quality of care.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"145 ","pages":"Article 104376"},"PeriodicalIF":2.6000,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Midwifery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0266613825000956","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"NURSING","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Risk management in maternity care aims to reduce incidents and harm to women and babies, contributing to quality care. However, there is growing concern that risk management policies may lead to unnecessary interventions during pregnancy and childbirth, resulting in both short- and long-term morbidity for women and their babies.

Aim

To evaluate healthcare professionals’ perceptions of the effect of risk management on pregnancy and childbirth.

Methods

A five-stage methodological framework was utilised in this review. A comprehensive integrative review was undertaken using a computer-assisted database approach including CINAHL, EMBASE, MEDLINE (Pubmed), PsycINFO and Scopus from 2016–2024. This review is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-analysis for Scoping Reviews (PRISMA-ScR).

Findings

The review identified five papers from four different countries. Two overarching themes were generated: The impact of the dominant medical model on risk management and decision-making in maternity care and the differences and similarities in healthcare professional's perceptions of risk management. The increasing medicalisation of pregnancy and childbirth shifts healthcare professionals' focus towards documentation and administrative tasks, driven by liability fears, rather than addressing clinical risks and providing woman-centred care.

Conclusion

Complex factors influence risk management in maternity care. Risk management is affecting the way healthcare professionals think and operate. This review reveals that the medical model significantly shapes healthcare professionals’ perceptions of risk management, often undermining midwives' autonomy and impacting decision-making in pregnancy and childbirth. Education and training are essential to restore midwives' autonomous roles, ensuring that women receive the most appropriate, safest and highest quality of care.

查看原文本刊更多论文

背景：产科护理中的风险管理旨在减少事故和对妇女及婴儿的伤害，从而提高护理质量。目的：评估医护人员对风险管理对妊娠和分娩影响的看法：方法：本综述采用了五阶段方法框架。采用计算机辅助数据库方法进行了全面的综合综述，包括 2016-2024 年间的 CINAHL、EMBASE、MEDLINE (Pubmed)、PsycINFO 和 Scopus。本综述按照《系统综述和范围综述元分析首选报告项目》（PRISMA-ScR）进行报告：审查发现了来自四个不同国家的五篇论文。产生了两个首要主题：主流医疗模式对孕产妇护理风险管理和决策的影响，以及医护人员对风险管理认识的异同。妊娠和分娩的医疗化程度越来越高，使医护人员的工作重心转移到文件记录和行政工作上，这是由对责任的担忧所驱动的，而不是应对临床风险和提供以妇女为中心的护理：结论：影响孕产妇护理风险管理的因素错综复杂。风险管理正在影响医护人员的思维和工作方式。本综述揭示了医疗模式在很大程度上影响了医护人员对风险管理的认识，往往削弱了助产士的自主性，影响了孕产期的决策。要恢复助产士的自主角色，确保妇女获得最适当、最安全和最优质的护理，教育和培训至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Midwifery 医学-护理

CiteScore

4.50

自引率

7.40%

发文量

221

审稿时长

13.4 weeks

期刊介绍： Midwifery publishes the latest peer reviewed international research to inform the safety, quality, outcomes and experiences of pregnancy, birth and maternity care for childbearing women, their babies and families. The journal’s publications support midwives and maternity care providers to explore and develop their knowledge, skills and attitudes informed by best available evidence. Midwifery provides an international, interdisciplinary forum for the publication, dissemination and discussion of advances in evidence, controversies and current research, and promotes continuing education through publication of systematic and other scholarly reviews and updates. Midwifery articles cover the cultural, clinical, psycho-social, sociological, epidemiological, education, managerial, workforce, organizational and technological areas of practice in preconception, maternal and infant care. The journal welcomes the highest quality scholarly research that employs rigorous methodology. Midwifery is a leading international journal in midwifery and maternal health with a current impact factor of 1.861 (© Thomson Reuters Journal Citation Reports 2016) and employs a double-blind peer review process.