Karen Duke and Dr. Lynn Callister, Nursing
The birthing time is often one of great joy and anticipation, and is a significant juncture in any woman’s life. What is said and done for a woman during this intense time period can be critical in either improving a woman’s experience and ability to mother, or destroying it. Nurses in South Africa have been known for being abusive and violent with patients. With such negative treatment women may be less inclined to seek healthcare in the future, and their ability to mother may be decreased. This impairs their baby’s and their own health and well-being. This study aimed to look at the experiences of women as they go through the birthing experience in a public hospital in South Africa. In order to gather information for this project I volunteered as a Doula (Labor Support Person), and also as a Prevention of Mother to Child Transmission (PMTCT) worker at a public hospital. I was there for four months, during which I conducted ethnographic interviews which included: individual, in-depth, semi-structured interviews using broad, open-ended questions. This was designed to elicit a discussion that focused on what the women felt was most important to talk about. An interview guide was developed, which included broad questions about the women themselves and also about their experience during pregnancy, birth, and post-partum. A total of 9 postpartum women, and one nurse were formally interviewed during this time. In the analysis of the interviews I divided the women by their reported HIV status: there were 3 HIV positive women, and 6 HIV status unknown women. Data was analyzed to assess the differing needs and perspectives of HIV positive women versus HIV unknown women.
The women who reported being HIV positive had intense feelings concerning fear of death during the delivery, or death of their baby. This seemed to be their primary concern during pregnancy more so than the other women. The other women viewed the experience as a normal experience that most women go through. The HIV positive women focused more on the dangers of pregnancy, and had more anxiety about a bad outcome from the situation. One of the women reported a fear of transmitting HIV to the doctors and nurses. More education needs to be done in regards to transmission, and reassurance from the staff about their own safety may be helpful.
There needs to be more education about HIV to both HIV positive women and HIV negative women. Only one of the HIV positive women knew anything about ways to reduce risk of transmission to their baby, which is a sad testament to the effectiveness of current education of women. Long-term education can also help the women as they plan current actions. Giving an overview of the course of the illness should be of primary concern when conducting HIV education.
Some of the women reported horrifying abuse by the nurses and doctors, but it is interesting to note that no HIV positive women reported any abuse. There needs to be more research into the abuse of women in hospitals, but these finding contradict previous findings of HIV positive women being abused more often. One cause of the decreased reporting could be lower expectations among HIV positive women in regards to care. With such a high incidence of abuse it is likely to happen to both HIV positive and negative women throughout the various deliveries.
There was a remarkably high rate of c-section reported among women in the study. There needs to be additional research in the future as to the causes of this and the overall c-section rate at the hospital, especially whether they are truly indicated c-sections. Only one of the HIV positive women knew that cesarean deliveries reduced their risk of transmission, and she was the only one that had a cesarean solely for this purpose. One of the HIV positive women delivered vaginally, and the other one had a c-section for CPD. They did not state any knowledge about a decreased risk for transmission with cesarean birth. There is a need to accomplish additional research in the future as to the prevalence and success of patient education in this regard.
HIV positive women reported having a positive experience, and birth having a beneficial effect on them. It appears that a positive result from birth has been achieved with these women, and they will be better prepared to be mothers as a result of it. They appeared to view the birth of their baby’s as a joyous occasion, and one that improved their self-perception. The stigma was avoided during their hospital stay, leaving them more capable to mother. If this outcome can be maintained with all HIV positive mothers, there will be more hope for these mothers and better outcomes for theirs and their baby’s futures. Nurses are the ones that initiate this positive outcome, and bear the responsibility of these positive outcomes, as well as the negative ones.
This study demonstrates that HIV status has not affected women’s experiences negatively. This is contrary to previous research, but more research needs to be done on the psychosocial needs of HIV positive women during pregnancy and delivery, and more education about HIV needs to be conducted in healthcare settings.
This study had many limitations and setbacks. The small number of women interviewed is a limitation, as well as only selecting participants from one hospital. This was due to limited time in South Africa, as well as language barriers. Due to the sensitive topic of this study, no interpreter was used so participants had to speak English fluently. This limited the variety and number of participants I interviewed. It was also difficult to find a good time and quiet place to interview women, as they were interviewed while still in the hospital.
Conducting this study has helped me in my profession as a nurse. I am better able to deal with cultural differences, and complications with pregnancy as a result of completing this study. Having this experience also helped me to get a job as a labor and delivery nurse, as this experience provided unique qualifications for me. I hope to continue this research, and attempt to improve conditions in South Africa as I engage in nursing in the future.