Objective: Childbirth in America is changing. With today’s escalating elective induction of labor and cesarean section rates and their potential negative health outcomes, it is essential to identify attributes of women who continue to birth powerfully with great grace and skill, embodying effectiveness, ability, sufficiency and/or success for accomplishing  childbirth; in other words, women who are self-competent for childbirth. 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.

Design: 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.

Setting: 108 expert maternity care providers from across the United States.

Patients/Participants: 108 panelists (13 doulas, 19 nurses, 48 midwives attending births in homes, birth centers and hospitals, and 28 family practice physicians, OB/GYNs, 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.

Methods: 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 if results described their nulliparous patients.

Results: First round qualitative content analysis revealed over 400 codes which were condensed into 195 statements ranked in subsequent Delphi rounds. Second and third round analysis identified 62 consensus statements. Fourth round analysis revealed 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 can be seen to birth with exceptional grace and skill.

Keywords: self-competence for childbirth, Delphi method, expert maternity care provider