Experiences of non-progressive and augmented labour among nulliparous women: a qualitative interview study in a Grounded Theory approach

<p>Abstract</p> <p>Background</p> <p>Non-progressive labour is the most common complication in nulliparas and is primarily treated by augmentation. Augmented labour is often terminated by instrumental delivery. Little qualitative research has addressed experiences of non-progressive and augmented deliveries. The aim of this study was to gain a deeper understanding of the experience of non-progressive and augmented labour among nulliparas and their experience of the care they received.</p> <p>Methods</p> <p>A qualitative study was conducted using individual interviews. Data was collected and analysed according to the Grounded Theory method. The participants were a purposive sample of ten women. The interviews were conducted 4–15 weeks after delivery.</p> <p>Results</p> <p>The women had contrasting experiences during the birth process. During labour there was a conflict between the expectation of having a natural delivery and actually having a medical delivery. The women experienced a feeling of separation between mind and body. Interacting with the midwife had a major influence on feelings of losing and regaining control. Reconciliation between the contrasting feelings during labour was achieved. The core category was named Dialectical Birth Process and comprised three categories: Balancing natural and medical delivery, Interacting, Losing and regaining control.</p> <p>Conclusion</p> <p>A dialectical process was identified in these women's experiences of non-progressive labour. The process is susceptible to interaction with the midwife; especially her support to the woman's feeling of being in control. Midwives should secure that the woman's recognition of the fact that the labour is non-progressive and augmentation is required is handled with respect for the dialectical process. Augmentation of labour should be managed as close to the course of natural labour and delivery as possible.</p

Necessidade de cuidado e desejo de participação no parto de gestantes residentes em Londrina-Paraná

A participação da mulher na tomada de decisão, nas ações de promoção à saúde, é um direito que deve ser respeitado. Este estudo buscou compreender a necessidade de cuidado e o desejo de participação nas decisões sobre o parto de gestantes de Londrina-PR. Utilizou-se a pesquisa fundamentada na fenomenologia social. As gestantes foram entrevistadas no período de agosto a novembro de 2008. Foram analisados 14 depoimentos, resultando na formação de quatro categorias: preferência pelo tipo de parto, insegurança, necessidade de cuidado e tomada de decisão no parto. Os resultados evidenciaram que, apesar de desejarem participar do seu parto e de verbalizarem suas necessidades, escolhas e preferências, as mulheres não encontram condições favoráveis para que suas necessidades de cuidado e o desejo de participação nas decisões sobre o parto sejam viabilizados; fato que interfere nas relações face a face e impede o direito à escolha informada em relação ao parto.Women's participation in decision making involving health care promotion is a right that should be respected. This study aimed to better understand the need for care and the desire to participate in delivery decisions among pregnant women in Londrina, PR, Brazil. This study was based on social phenomenology. The pregnant women were interviewed from August to November, 2008. Statements from 14 pregnant women were analyzed and were divided into four categories: type of delivery preference; insecurity; the need for care; and decision-making in delivery. Results showed that although women expressed their needs and their wish to participate in the decisions regarding their delivery, they did not find favorable conditions so that their care needs and desire to participate in delivery decisions were made possible, a fact which interferes in face-to-face relationships and impedes the right to informed choices with respect to the delivery process.La participación de la mujer en la toma de decisiones y en las acciones para promover la salud, es un derecho que debe ser respetado. Este estudio trata de comprender la necesidad de cuidado y el deseo de participar en las decisiones sobre el parto de las mujeres embarazadas residentes en Londrina-PR. Es una investigación basada en la fenomenología social. Las embarazadas fueron entrevistadas en el período de agosto a noviembre de 2008. Se analizaron 14 declaraciones, lo que resultó en la formación de cuatro categorías: preferencia por el tipo de parto, inseguridad, necesidad de atención y toma de decisiones en el parto. Los resultados mostraron que a pesar de desear participar de su parto y de verbalizar sus necesidades, opciones y preferencias, las mujeres no encontraron condiciones favorables para que sus necesidades de atención y el deseo de participar en las decisiones sobre el parto sean viabilizadas; hecho que interfiere en las relaciones cara a cara e impide el derecho a la elección informada en relación al parto