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Nurses play pivotal role in dignifying childbirth, BYU professor says

Ask most women to describe their childbearing experience and it’s highly unlikely the word “dignified” would be part of the description. However, a new Brigham Young University study has identified steps health care professionals can take to create and preserve dignity in the delivery room.

By demonstrating respect for childbearing women and providing them with a sense that they are in control of the birthing process, nurses can help mothers leave the delivery room with positive feelings about their baby's delivery, says BYU nursing professor Lynn Callister.

“This is important because it improves the quality of the experience,” said Callister, explaining that dignity is maintained when women feel they are in control of their childbearing situation. “Even though this is an experience that lasts hours at most, it’s a life-changing event that influences a woman for the rest of her life.”

Although previous studies have shown that personal control is tied to a woman’s satisfaction with childbirth, Callister’s findings, reported in the current issue of the “Journal of Obstetric, Gynecologic and Neonatal Nursing,” focus on developing a deeper understanding of how to maintain dignity while laboring and giving birth. The study was co-authored by BYU undergraduate Rachel Matthews.

The researchers examined the experience of first-time mothers who had given birth in the last three months. In one-on-one interviews, each woman was asked to describe her baby’s birth. Responses were then categorized, and common issues were identified.

Mothers explained that nurses best demonstrate respect for the birth experience by sharing joy, communicating clearly, paying attention to mothers’ requests and showing appreciation for childbearing women's strength and courage.

“Giving birth is a birthday party,” said Callister. “Having a sense that her caregivers are celebratory, that they have a desire to individualize her care and listen to what she is saying is so important to giving birth.”

Beyond the moral obligation to treat childbearing women with respect, there are also economic implications for preserving dignity and improving the quality of the birth experience, says Callister.

Since women are the gatekeepers and decision makers for family health in the majority of households in the United States, the quality of care they receive while giving birth has a lasting impact on their perceptions about the quality of a particular health care facility.

“Studies have demonstrated that when women have a quality experience with a health care facility, they are more likely to make future health care decisions that involve that same institution,” Callister said. “If a woman has a positive birth experience in a medical center, for example, she is more likely to take an elderly parent to that emergency room for care.”

Participants in the study spoke repeatedly of the importance of the nurse’s role in supporting them, explaining the nurse’s presence, encouragement and experience helped them feel more dignified. The realization of the importance of the nurse's role even surprised some of the mothers.

“The birthing experience doesn't really depend on your doctor,” one participant said. “He’s there the last five or ten minutes. It's the nurse that's with you through the whole twelve hours. She plays even a bigger role than the doctor.”

Although the nurse’s influence proved to be vital to the mother’s experience, control over personal behavior, which was often related to pain management, was another common response among the women surveyed.

Women’s desired level of control over decisions varied. Some felt very vulnerable and became passive, deferring to their caregivers to make decisions.

“I prefer to take advice from a doctor,” said Tara, a 20-year-old volunteer in the study. “He knows more than I do. I don't want to make decisions that I don't know much about.”

Other women had strong desires to be involved in the decision making.

“I'm the one who's in charge of the childbirth experience, not the doctors, or the nurses or the hospital,” said another woman during the study. “This is between me, the baby and my husband. Everybody else is there to support, not to take control.”

Respondents also expressed appreciation that their emotions, decisions, physical comfort and privacy were taken seriously. The perception that they were valued and respected helped maintain a sense of dignity.

“Research on dignity in childbirth is essential reading for all nurses who work with pregnant women,” said Margaret Comerford Freda, a professor in the Department of Obstetrics and Gynecology and Women's Health at the Albert Einstein College of Medicine of Yeshiva University. “Dr. Callister’s research provides evidence for nurses to use in their daily practice and helps nurses to better understand how to care for women and infants.”

With approximately 6 million women becoming pregnant in the United States each year, the potential effect of nurses -- both economically for hospitals and emotionally for childbearing women -- is substantial.

“I believe this research confirms what nurses innately know about labor support,” Callister said. “Hopefully, this study will inspire and encourage them to enhance the care they are offering and ask themselves how they can improve their practice to ensure that patients' dignity is maintained.”

Writer: Cara Helfand

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