Ethel Tovar and Dr. Lynn C. Callister, Nursing
A woman’s childbirth experience is unique and can have a lasting impact, initially affecting neonatal care and impacting perspectives on the childbirth experience . This experience can be perceived as an overwhelming event for primiparous mothers, which can lead to a sense of vulnerability. For this reason, at the time of delivery, birth plan decisions may be malleable.
The purpose of this descriptive qualitative study was to gain an understanding of childbearing women’s perceptions three to nine months after their birth experience. It was hoped that this would reveal factors that influenced their decision changes from “unmedicated” or “wait and see” to epidural analgesia/anesthesia pain management.
The study participants consisted of a purposive sample of 7 English speaking women who gave birth at Intermountain Health Care Urban South facilities: Orem Community Hospital, American Fork Hospital or Utah Valley Regional Medical Hospital. The study participants were mostly Caucasian women and some Hispanic, Pacific Islander, and Native American women. The inclusion criteria included primiparous or multiparous women of childbearing age who gave birth to healthy term infants. Most had vaginal births. These mothers had previously been interviewed about their selected birth plan choices of “unmedicated” or “wait and see” and during labor opted for epidural analgesia/anesthesia. These women were asked to participate in a follow up interview to identify key factors in their decisions that may have become more apparent months after the birth experience.
Some participants had changed residence since their initial interviews creating a challenge in locate all women who were initially interviewed. Another obstacle that was overcome was establishing the appropriate setting and relationship where the study participants felt welcome to share their information. This was necessary in obtaining qualitative data that could be studied.
A thirty to sixty minute audio taped interview was held at a convenient location for the study participants. Participants were asked to respond to an open ended question: “You were interviewed about your birth experience a few months ago. As you reflect on your childbirth experience, what additional thoughts or feelings do you have that have changed over time?” Additional clarifying questions were asked, as appropriate, such as “What could the nurse have done to provide additional support?”, “What was a main factor in altering your original birth plan?”, “What aspects of the health care you received could be improved?”, and “What non-pharmacological strategies of pain management were suggested?”
The organizational aspects of literature review as well as data collection and analysis were key components of the project. The primary tasks of this project included organizing interviews with participants, conducting interviews, transcribing the audiotapes, and analyzing the narrative responses. Responses to the interview questions were tape recorded and transcribed verbatim, with participant identifying information removed. An analysis of responses to the open ended questions was done and major themes were identified. These themes were analyzed further with the narrative data from the interviews.
Several mothers described a sense of unfamiliarity with the course of labor as well as potential events that could alter their birth plans. One mother said “I’m not one to really take pain very well and I was pretty scared to go through that and I worried and that’s why I chose to do the epidural.” Many participants indicated that having experienced labor, they would be more likely to work through the pain naturally.
Many described expectations and plans for pain management that were not met, which consequently left them feeling unsure of their initial choice of “unmedicated” pain management. One mother reported feeling alone in her decision to manage her pain naturally. She said “…after a while, they [the nurses] just left and said call them whenever I wanted to get checked so they weren’t there much. They just left and…I don’t know. I just felt like I was left alone to suffer…” and shortly after, opted for an epidural method of pain management.
Some described subtle pressures which impacted their decisions regarding a course of pain management. One mother said “the nurse influenced my decision to get an epidural because she told me that the pain was probably going to get worse and that the labor was probably going to last several hours.” Another mother discussed her thought process regarding her decision to receive an epidural. She said, “I just got impatient…I was a little scared because I didn’t know long this was going to last and if I can do this and it was not really what I was expecting.”
An awareness of the combination of physiological and psychological factors influencing women’s birth plans is significant because nurses can apply this knowledge to enhance and better meet the expectations of a birth plan for all mothers. Gaining insights about women’s perceptions can help nurses be aware of concerns, provide supportive care and minimize anxiety and fear. This can amplify the positive aspects of the childbirth experience for the mother, which is a short moment for the nurses but only the beginning of a life stage transition for these families. Further research can be conducted to determine specific behaviors from health care professionals that augment a sense of support or detract from a mother’s confidence in her birth plan.
More in depth discussion of the findings will be present in an honors thesis and the results of this research project will be submitted for presentation in a spring research conference for the College of Nursing.
In conclusion, this was an exceptional learning experience. The opportunity to conduct a research project, as an undergraduate, provided a glimpse of an existing aspect of nursing care that is the focus of current study and research. The interview techniques used to obtain adequate narrative data will have continued application in the overall experience of hospitalized individuals in every area of nursing I pursue professionally.