Shared Decision-Making


Shared decision-making is a collaborative process that acknowledges patients' authority in their health care decisions (Barry and Edgman-Letivan, 2012). Shared decision-making offers the opportunity for patients to receive complete and accurate information, to clarify values, and to receive decisional support (Romano, 2013). Through the course of care, the midwife communicates evidence-based information, engages the patient in an exploration of their respective values, knowledge, and experience, and elicits a preference based on the results of that exploration.
Maternity care in the United States is becoming increasingly complex and procedure-intensive, and patients often have inadequate knowledge to make informed decisions (Gee and Corry, 2012). Advantages for using a shared decision-making process are higher client satisfaction, more positive relations among the care team, and higher levels of trust.

Midwives are uniquely poised to lead the maternity care community in implementing a more meaningful shared decision-making process. As patient-centered care is the heart and foundation of midwifery care, midwives have the skill to work in therapeutic partnership with women to navigate the uncertain evidence in maternity care. Through shared exploration of values and goals, midwives and patients develop a plan of care that balances the ethical obligations of beneficence and non-maleficence with respect for autonomy.

For more key points, information and background on shared decision-making please see the ACNM Position Statement on Shared Decision-Making in Midwifery Care. Click here.

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  1. American College of Nurse Midwives (2016). ACNM position statement on shared decision-making. Retrieved from:
  2. American College of Nurse Midwives (2011). Quality patient care in labor and delivery: A call to action position statement. Retrieved from:
  3. Agency for Healthcare Research and Quality (2014). The SHARE approach: Essential steps of shared decision-making. Retrieved from:
  4. Barry, M. & Edgman-Letivan, S. (2012) Shared decision-making-pinnacle of patient-centered care. New England Journal of Medicine, 336(9):780-781. doi: 10.1056/NEJMp 1109283.
  5. Berlin, E.A, & Fowkes, W.A. (1983). A teaching framework for cross-cultural health care: Application and family practice. Western Journal of Medicine, 139:934-938.
  6. Childbirth Connection. (2018). What is informed decision making and why should I care? Retrieved from:
  7. Consensus statement on NPC: Supporting healthy andnormal physiologic childbirth: A consensus statement by ACNM, MANA, and NACPM. (2013). Journal of Perinatal Education, 22(1):14-8. doi: 10.1891/1058-1243.22.1.14. 
  8. Dalrymple, S. (2013) Labor comfort and pain management decision tool. High River AB. (403) 601-4071.
  9. Declercq, E.R., Sakala, C., Corry, M.P., Applebaum, S., Herrlich, A. (2013). Listening to mothers III: Pregnancy and birth. Retrieved from:
  10. Elwyn, G.,Durand, M.A,Song, J., Aarts, J., Barr, P.J., Berger, J., Cochran, N., . . . Van der Weijden, T. (2017). Elwyn 3 talk model. British Medical Journal, 359, 4891.
  11. Gee, R.E. & Corry, M.P. (2012). Patient engagement and shared decision making in maternity care? Obstetrics and Gynecology, 120(5):995-997. doi:http://10.1097/AOG.Ob013e31827046ac.
  12. Groopman, J., & Hartzband, P. (2011). Groopman-Spectrum decision-making tool. Your Medical Mind: How to Decide What is Right for You. New York: Penguin Press
  13. Less is More Medicine. (n.d.). Shared decision making (SDM) aids, sample conversations, handouts and videos. Retrieved from: 
  14. Less is More Medicine. (2016). Use your BRAIN: A decision support tool. Retrieved from:
  15. Marciano, P. (2018). RESPECT model: Leader. Retrieved from:
  16. Nieuwenhuijze, M.J, Low, L.K, Korstjens, I., Lagro-Janssen, T. (2014). The role of maternity care providers in promoting shared decision-making regarding birthing positions during the second stage of labor. Journal of Midwifery and Women's Health, 59:277-285.
  17. O'Connor, A., Stacey, D., & Boland, L. (2015). Ottawa decision support tutorial. Retrieved from
  18. Romano, A. (2013). From the TMC blog: Shared decision-making in maternity care. Retrieved from:
  19. Smith, R. C. (2002) Patient-Centered Interviewing, 2nd ed. Philadelphia: Lippincott Williams & Wilkins. The Health Foundation. (2018). MAGIC: Shared decision making. Retrieved from:



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