Integrative power in Swiss home-like childbirths: A qualitative multiple case study

•Relaying on integrative power strengthens midwives’ decision-making abilities.•Mastering integrative power improves collaborative relationships among health professionals and improves health outcomes.•Exercising integrative power increases women's participation in decision and improves quality of care. To increase understanding of integrative power in decision-making in home-like childbirth from midwives' and women's perspectives. A qualitative multiple case study. Two regions of Switzerland, a French and a German-speaking. Twenty interviews with midwives and 20 with women and some partners who had experienced complications in home-like births. Data were collected from in-depth interviews relevant for casestudy. Four cases during second stage of labour were carefully selected using literal replication logic. Interview transcripts were analysed in developing case descriptions and in interpreting mechanisms related to perception of power in making decision. The analysis of each case and a cross-case comparison showed that mechanisms for building integrative power, such as creation of relationships, cooperation, loyalty, legitimacy and respect, were highly visible in midwifery decision-making activities. The study highlighted the visibility of integrative power mechanisms in decision-making in homelike settings. Until now, mechanisms of positive power in midwifery have been poorly described in literature. Integrative power could be a promising strategy to reinforce decision-making strategies. Therefore, clinical and policy measures explicitly addressing the positive aspects of power should be developed and evaluated.