Rachel Matthews and Dr. Lynn Callister, Nursing

Entering a hospital is often an intimidating and stressful event for patients. They enter a world about which they often know very little. They may enter with apprehension about the unknown, their illness, or excitement about starting a new phase of life with the birth of a child. As they are experiencing the unknown, patients are often put into situations where they are told what to do and when to do it, sometimes with little or no explanation. Tasks that health care personnel consider routine are not only unfamiliar, but also are often very invasive, leaving patients feeling uncomfortable, helpless, or very vulnerable. These feelings can lead to loss of dignity. The purpose of this descriptive qualitative study was to gain an understanding of the perceptions of childbearing women about maintenance of dignity while laboring and giving birth.

Study participants were recruited to this study by referrals from other participants and by announcements posted in local married student housing. Participants were first-time mothers who gave birth vaginally to healthy term infants in the last four to five months. A thirty to sixtyminute audio-taped interview was held in the home of the study participant. An interview guide was utilized and the women were first asked to describe their birth experience. Other clarifying questions were asked, such as, “Did you ever feel a sense of loss of control during your labor and birth experience?” and “What is important for nurses caring for women to know and do to ensure that the woman feels respected and that a sense of dignity is maintained?”.

Fifteen first-time mothers were interviewed. Demographic forms were analyzed using SPSS to obtain descriptive statistics. Audiotapes were transcribed verbatim and analyzed for common themes. Themes were identified and amplified using rich narrative data obtained during the interviews. My main tasks in conducting the research project were to recruit participants, interview them, transcribe the interviews, and help in the analysis of the interviews.

My hypothesis was that modesty and information-sharing would be the main themes of maintaining dignity. These were two of the themes; however, most women thought their modesty was maintained during the actual labor and birth, which was a surprise finding. This was, in part, due to the expectations of the women. Most women expected to have their modesty compromised to a certain extent and prepared themselves for this experience. Several mothers mentioned that the nurses pulled the curtain in front of the door, so that even if the door was opened, no one could see inside. One thing that was bothersome to some study participants was the number of caregivers in the room. Many mothers made comments that, looking back on the experience, they should have felt more loss of dignity than they did at the time. In general, however, their expectations were worse than their experience, so loss of dignity was not felt. There were also more themes than I hypothesized, which will be discussed as follows.

The following additional themes were identified following analysis of the narrative data: the doctor and nurse role, feeling valued and respected, feeling control over decision making, feeling in control of self, feeling supported, feeling that joy was shared, and communicating effectively. The role of the doctor and nurse were outlined as mothers expressed surprise that the physician was there for such a short period of time. Mothers also spoke often of the importance of the nurse’s role in supporting them, citing her constant presence as important in the support.

Under the theme of feeling valued and respected, participants expressed the importance that health care providers respect their opinions, emotions, decisions, and the fact that they are in pain. Closely tied to feeling valued and respected is the theme of control over decision making. The amount of control a woman wanted varied. Some felt very vulnerable and became passive, deferring their caregivers to make decisions. Other women had strong desires to be involved in the decision making. As long as the amount of control a woman wanted and the amount of control she received were the same, dignity was maintained.

Feeling in control of self was an aspect of dignity maintenance for participants. Circumstances that affected the way some mothers perceived control of self included pain, fatigue, and the amount of information to which the mother had access. Feeling supported by the health care team was also a theme. One mother said, “Their confidence eased my nervousness and scared feelings.” The theme of feeling that the joy of the birth was shared was also important to women. Several mothers mentioned that a positive greeting and attitude of the nurse helped establish an encouraging environment for labor and delivery.

Many of the women found that communicating information was a key part of maintaining dignity and control. One study participant talked about the importance of communicating information to patients: [T]he more information you give your patient, within reason, is good for the patient because then they really… feel like that’s something that they have the opportunity to change.” Communication between healthcare workers was also mentioned. Allison discussed this when she said, “They were working together, which was nice. So I didn’t feel like I told one person one thing and then the other had no clue. They seemed to communicate really well.”

My hypothesis was that loss of dignity would be felt most during the labor and birth. However, a surprising finding was that many study participants mentioned concerns with loss of dignity after the actual labor and birth, during the postpartum period in the days following the birth. The main postpartum concerns were lack of communication, lack of support, and failure to maintain modesty. These were surprising findings that require further research.

This experience has been invaluable to me. I have learned to challenge the norm and look for other solutions to problems than the readily accepted ones. I have carried the knowledge I learned about dignity into other areas of my practice. I have graduated and am now working with all ages of patients on a cardiac unit. Much of what was said by these first-time mothers can be applied to other areas of the hospital and I have used the knowledge gained through this experience to help maintain the dignity in my patients. More research needs to be done in other areas of the hospital to identify other areas of dignity maintenance that are specific to the patient population on each unit. I plan to continue in my research by studying rhetoric and communication or by continuing research on postpartum maintenance of dignity.