Gut feelings in obstetrics and midwifery: the role of intuition in deciding when to perform cesarean section during labor

Abstract

Purpose To describe the role of intuition for maternity care workers in deciding when a cesarean section should be advised during labor. Material and methods Focus group discussions with midwives and gynecologists, and nonparticipating observation at an obstetric ward. Results The decision about when to propose a cesarean section during labor is the result of interaction between objective and intuitive factors. Junior delivery ward workers report that they use more analytic reasoning for objective diagnosis of fetal distress, non-progressive labor, macrosomia or other indications for cesarean section; with increasing experience, however, non-analytic reasoning takes the overhand. Both consciously and unconsciously, other activities going on outside the individual delivery room seem to influence the decision. Out of the 50 deliveries observed, 38 births occurred through vaginal deliveries and 12 through cesarean sections. Maternity care workers clearly have “gut feelings” that the course of labor is moving toward a cesarean section. We were unable to detect any predictable pattern in the transition from gut feeling to decision. Conclusion Intuition plays a still not completely uncovered role in the decision to advise cesarean section during labor. The level of consciousness at which professionals use intuition or gut feeling and are aware of it in decision making is variable. Intuition or gut feelings seem to contribute more to the decision process as the level of experience increases.