title: Midwives׳ decision making about transfers for 'slow' labour in rural New Zealand.
abstract: Midwives who provided Lead Maternity Care (LMC) to women in rural areas were invited to share their experiences of decision making around transfer in labour. Ethics approval was obtained from the NZ National Ethics Committee.
  
  
  OBJECTIVE
  to explore midwives׳ decision making processes when making transfer decisions for slow labour progress from rural areas to specialist care.
  
  
  METHODS
  individual and group interviews were conducted with a purposive sample of rural midwives. The recalled decision processes of the midwives were subjected to a content and thematic analysis to expose experiences in common and to highlight aspects of probabilistic (normative), heuristic (behavioural), and group decision making theory within the rural context.
  
  
  METHODS
  New Zealand.
  
  
  METHODS
  15 midwives who provided LMC services to women in their rural areas.
  
  
  RESULTS
  'making the mind shift', 'sitting on the boundary', 'timing the transfer' and 'the community interest' emerged as key themes. The decision processes were also influenced by the woman׳s preferences and the distance and time involved in the transfer.
  
  
  CONCLUSIONS
  the findings contribute insights into the challenge of making transfer decisions in rural units; particularly for otherwise well women who were experiencing slow labour progress. Knowledge of the fallibility of our heuristic decision making strategies may encourage the practitioner to step back and take a more deliberative, probabilistic view of the situation. In addition to the clinical picture, this process should include the relational and aspirational aspects for the woman, and any logistical challenges of the particular rural context.
authors.affiliation: School of Midwifery Otago Polytechnic, 296 Blueskin Road, Port Chalmers, Private Bag 1910, 9054 Dunedin, New Zealand. Electronic address: jean.patterson@op.ac.nz.
authors.forename: Jean
authors.initials: J
authors.lastname: Patterson
authors.affiliation: Graduate School of Nursing Midwifery and Health, Victoria University of Wellington, P.O. Box 600, Wellington, New Zealand. Electronic address: Joan.Skinner@vuw.ac.nz.
authors.forename: Joan
authors.initials: J
authors.lastname: Skinner
authors.affiliation: Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology, P.O. Box 123, Broadway, Sydney, NSW 2007, Australia. Electronic address: Maralyn.Foureur@uts.edu.au.
authors.forename: Maralyn
authors.initials: M
authors.lastname: Foureur
mesh_terms: D003657:Decision Making; D005260:Female; D006801:Humans; D007746:Labor Presentation; D008880:Midwifery / Q000592:standards*; D009520:New Zealand; D009723:Nurse-Patient Relations; D010360:Patient Transfer / Q000379:methods*; D011247:Pregnancy; D036301:Qualitative Research; D019035:Rural Health Services; D012424:Rural Population
keywords: Decision making; Decision theory; Midwives; Rural area; Rural transfer; Slow labour