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- Raoust, Gabriel
(författare)
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Decision-making in obstetric emergencies. Individual differences and professional boundaries.
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)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?
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| 2. |
- Raoust, Gabriel M, et al.
(författare)
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Decision-making during obstetric emergencies: A narrative approach
- 2022
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 17
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Tidskriftsartikel (refereegranskat)abstract
- This study aims to explore how physicians make sense of and give meaning to their decision-making during obstetric emergencies. Childbirth is considered safe in the wealthiest parts of the world. However, variations in both intervention rates and delivery outcomes have been found between countries and between maternity units of the same country. Interventions can prevent neonatal and maternal morbidity but may cause avoidable harm if performed without medical indication. To gain insight into the possible causes of this variation, we turned to first-person perspectives, and particularly physicians' as they hold a central role in the obstetric team. This study was conducted at four maternity units in the southern region of Sweden. Using a narrative approach, individual in-depth interviews ignited by retelling an event and supported by art images, were performed between Oct. 2018 and Feb. 2020. In total 17 obstetricians and gynecologists participated. An inductive thematic narrative analysis was used for interpreting the data. Eight themes were constructed: (a) feeling lonely, (b) awareness of time, (c) sense of responsibility, (d) keeping calm, (e) work experience, (f) attending midwife, (g) mind-set and setting, and (h) hedging. Three decisionmaking perspectives were constructed: (I) individual-centered strategy, (II) dialogue-distributed process, and (III) chaotic flow-orientation. This study shows how various psychological and organizational conditions synergize with physicians during decision-making. It also indicates how physicians gave decision-making meaning through individual motivations and rationales, expressed as a perspective. Finally, the study also suggests that decision-making evolves with experience, and over time. The findings have significance for teamwork, team training, patient safety and for education of trainees. Copyright: © 2022 Raoust et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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| 3. |
- Raoust, Gabriel, et al.
(författare)
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Personality traits and decision-making styles among obstetricians and gynecologists managing childbirth emergencies
- 2023
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Ingår i: Scientific Reports. - 2045-2322. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- The successful management of a childbirth emergency will be dependent on the decision-making of involved obstetricians and gynecologists. Individual differences in decision-making may be explained through personality traits. The objectives of the present study were (I) to describe personality trait levels of obstetricians and gynecologists and (II) to examine the relationship between obstetricians' and gynecologists' personality traits and decision-making styles (Individual, Team and Flow) in childbirth emergencies; also controlling for cognitive ability (ICAR-3), age, sex and years of clinical experience. Obstetricians and gynecologists, members of the Swedish Society for Obstetrics and Gynecology (N = 472) responded to an online questionnaire that included a simplified version of the Five Factor Model of personality (IPIP-NEO), and 15 questions concerning childbirth emergencies based on a model of decision-making styles (Individual, Team and Flow). The data was analyzed using Pearson's correlation analysis and multiple linear regression. Swedish obstetricians and gynecologists scored (P < 0.001) lower on Neuroticism (Cohen's d = - 1.09) and higher on Extraversion (d = 0.79), Agreeableness (d = 1.04) and Conscientiousness (d = 0.97) compared to the general population. The most important trait was Neuroticism, which correlated with the decision-making styles Individual (r = - 0.28) and Team (r = 0.15), while for example Openness only trivially correlated with Flow. Multiple linear regression showed that personality traits with covariates explained up to 18% of decision-making styles. Obstetricians and gynecologists have notably more distinct personality levels than the general population, and their personality traits relate to decision-making in childbirth emergencies. The assessment of medical errors in childbirth emergencies and prevention through individualized training should take account of these findings.
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| 4. |
- Raoust, Gabriel, et al.
(författare)
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Swedish maternity care professionals’ perception of labor induction
- 2024
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Ingår i: Midwifery. - 0266-6138. ; 133
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Tidskriftsartikel (refereegranskat)abstract
- Background: Sweden recently adopted new labor induction guidelines lowering the threshold for post-term pregnancies to 41+ weeks. Despite evidence-based foundation, these guidelines stirred controversy among maternity care professionals, who voiced concerns about potential risks and unintended consequences, such as a rising Caesarean section rate. Midwives also highlighted potential impacts on their roles, workload, and working environment; implications that could affect obstetricians and gynecologists as well. Investigating Swedish maternity care professionals’ views on labor induction could benefit policymakers, managers, and birthing women alike. Aim: The aim of this study was to describe and compare midwives to obstetricians/gynecologists, with regards to their views on labor induction, and how this relates to other work-related variables such as overall job satisfaction, clinical experience, gender, age, personality, and workload. Methods: Swedish midwives (N = 207, 99 % women, M = 45.2 years), and obstetricians/gynecologists (N = 240, 83 % women, M = 44.3 years) responded to an online questionnaire reflecting aspects of maternity care work. The data was analyzed using Welch's t-test and Pearson's correlation analysis. Results: A large difference was observed in labor induction views between midwives and obstetricians/gynecologists (d = 1.39), as well as lower job satisfaction with midwives (d = -0.26). Overall job satisfaction further correlated negatively with views on labor induction (r = -0.30). Conclusions: Labor inductions might pose challenges to midwives and could bring to light underlying tensions between obstetricians/gynecologists and midwives. Given the modest response rate of the study, we cautiously suggest that while the development of new maternity care guidelines should be grounded in evidence, they should also embrace concerns and insights from a diversity of professional perspectives.
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