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Scholes et al. BMC Pregnancy and Childbirth 2012, 12:19 http://www.biomedcentral.com/1471-2393/12/RESEARCH ARTICLEOpen AccessClinical decision-making: midwifery students' recognition of, and response to, post partum haemorrhage in the simulation environmentJulie Scholes1, Ruth Endacott2,3*, MaryAnne Biro3, Bree Bulle4, Simon Cooper5, 4,4,5,5-Tetramethyl-2-(2-methylprop-1-en-1-yl)-1,3,2-dioxaborolane Maureen Miles3,9, Carole Gilmour6, Penny Buykx7, Leigh Kinsman7, Rosemarie Boland8, Jan Jones3,9 and Fawzia ZaidiAbstractBackground: This paper reports the findings of a study of how midwifery students responded to a simulated post partum haemorrhage (PPH). Internationally, 25 of maternal deaths are attributed to severe haemorrhage. Although this figure is far higher in developing countries, the risk to maternal wellbeing and child health problem means that all 3-(tert-Butyldimethylsilyloxy)propan-1-amine midwives need to remain vigilant and respond appropriately to early signs of maternal deterioration. Methods: Simulation using a patient actress enabled the research team to investigate the way in which 35 midwifery students made decisions in a dynamic high fidelity PPH scenario. The actress wore a birthing suit that simulated blood loss and a flaccid uterus on palpation. The scenario provided low levels of uncertainty and high levels of relevant information. The student's response to the scenario was videoed. Immediately after, they were invited to review the video, reflect on their performance and give a commentary as to what affected their decisions. The data were analysed using Dimensional Analysis. Results: The students' clinical management of the situation varied considerably. Students struggled to prioritise their actions where more than one response was required to a clinical cue and did not necessarily use mnemonics as heuristic devices to guide.