Information, involvement, or partnership? Exploring intrapartum decision-making during the implementation of a team-based intervention to support woman-centred care
5 affiliations
- 1Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- 2Department of Women’s Health and Allied Health Professionals, Karolinska University Hospital, Stockholm, Sweden
- 3Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden
- 4Ariadne Labs, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- 5Department of Women’s and Children’s Health, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
Abstract
Introduction: Despite being recognised as a critical component of high-quality care, shared decision-making is still not consistently achieved during childbirth. TeamBirth is a care process developed to promote intrapartum teamwork and shared decision-making, adapted to the Swedish context and implemented in two labour wards. This study aims to explore how care providers engage women and their partners in intrapartum decision-making during the implementation of the adapted Swedish version of TeamBirth. Methods: A qualitative design, based on 23 observations comprising 79 huddles, and 65 interviews with the care providers involved, was used. Data were collected April 2022 – June 2023, and analysed deductively using directed content analysis, guided by the Conceptual Framework for Patient and Family Engagement in Healthcare. Results: Four levels of engagement were found. No Engagement involved care providers giving instructions without explanations. Providing Information entailed brief updates followed by instructions, with limited opportunities for questions. Involvement, the most common level, included discussions and planning with women and their partners, although final decisions were made by care providers. Partnership and Shared Leadership, the least observed level, was characterised by dialogue and joint decisions. Barriers for engagement included limited Swedish proficiency, high workload, and critical situations, whereas continuous support, effective pain management, and use of the TeamBirth care process were enabling factors. Conclusions: Engagement in decision-making occurred on a continuum, with modifiable factors including workload, continuous support, and use of TeamBirth. Although conducted during the implementation of a care process designed to improve engagement, Partnership and Shared Leadership remained the least observed level.
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BibTeX
@article{johnson2026information,
title = {{Information, involvement, or partnership? Exploring intrapartum decision-making during the implementation of a team-based intervention to support woman-centred care}},
author = {Karin Johnson and Monica E. Nyström and Anna Ivert and Olof Stephansson and Amber Weiseth and Sissel Saltvedt and Malin Edqvist},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0358750},
url = {https://doi.org/10.1371/journal.pone.0358750},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Information, involvement, or partnership? Exploring intrapartum decision-making during the implementation of a team-based intervention to support woman-centred care
AU - Karin Johnson
AU - Monica E. Nyström
AU - Anna Ivert
AU - Olof Stephansson
AU - Amber Weiseth
AU - Sissel Saltvedt
AU - Malin Edqvist
PY - 2026
DA - 2026/09/23
JO - PLOS One
DO - 10.1371/journal.pone.0358750
UR - https://doi.org/10.1371/journal.pone.0358750
AB - Introduction: Despite being recognised as a critical component of high-quality care, shared decision-making is still not consistently achieved during childbirth. TeamBirth is a care process developed to promote intrapartum teamwork and shared decision-making, adapted to the Swedish context and implemented in two labour wards. This study aims to explore how care providers engage women and their partners in intrapartum decision-making during the implementation of the adapted Swedish version of TeamBirth. Methods: A qualitative design, based on 23 observations comprising 79 huddles, and 65 interviews with the care providers involved, was used. Data were collected April 2022 – June 2023, and analysed deductively using directed content analysis, guided by the Conceptual Framework for Patient and Family Engagement in Healthcare. Results: Four levels of engagement were found. No Engagement involved care providers giving instructions without explanations. Providing Information entailed brief updates followed by instructions, with limited opportunities for questions. Involvement, the most common level, included discussions and planning with women and their partners, although final decisions were made by care providers. Partnership and Shared Leadership, the least observed level, was characterised by dialogue and joint decisions. Barriers for engagement included limited Swedish proficiency, high workload, and critical situations, whereas continuous support, effective pain management, and use of the TeamBirth care process were enabling factors. Conclusions: Engagement in decision-making occurred on a continuum, with modifiable factors including workload, continuous support, and use of TeamBirth. Although conducted during the implementation of a care process designed to improve engagement, Partnership and Shared Leadership remained the least observed level.
SN - 1932-6203
ER -