• self-competence for childbirth;
  • Delphi method;
  • expert maternity care provider

Paper Presentation

  1. Top of page
  2. Paper Presentation


Childbirth in America is changing. With today's escalating elective induction of labor and cesarean rates and their potential negative health outcomes, it is essential to identify women who embody effectiveness, ability, sufficiency, and/or success in childbirth; in other words, women who are self-competent. The purposes of this study were to investigate expert maternity care providers’ descriptions of, understanding of, and clinical experiences with women who exhibit self-competence for childbirth and to identify the defining attributes of self-competence for childbirth.


A Delphi study consisting of an expert panel of 108 maternity care providers was undertaken. Four survey rounds designed to first elicit qualitative opinions and subsequently bring the panel to consensus about the characteristics, antecedents, and outcomes of women who are self-competent for childbirth were conducted.


A variety of birth settings from across the United States.


One hundred and eight panelists (13 doulas, 19 nurses, 48 midwives attending births in homes, birth centers and hospitals, and 28 family practice physicians, obstetricians/gynecologists, and perinatologists), certified, licensed, or registered in their area of expertise who have provided hands-on care to laboring women for at least the past 5 years.


The first qualitative Delphi study round identified panelists’ opinions regarding the antecedents, characteristics, and outcomes associated with women who are self-competent for childbirth. Coded statements from this round formed the basis of the second and third rounds, which elicited group consensus. The final (fourth) survey round was a “member check”; panelists declared their degree of agreement with the final study results and identified whether results described their nulliparous patients.


First round qualitative content analysis resulted in more than 400 codes that were condensed into 195 statements ranked in subsequent Delphi rounds. In the second and third round analysis, we identified 62 consensus statements. Fourth round analysis resulted in continued panel agreement

Conclusion/Implications for Nursing Practice

Study results provide increased understanding of the phenomenon of self-competence for childbirth and provide conceptual validation and an item pool for subsequent instrument development measuring self-competence for childbirth. Results also provide a basis for discussion among maternity care providers about how patients cope with their individual labor and delivery experiences, and may provide the basis for a more standard nomenclature identifying women who are self-competent in childbirth.