INTRAPARTUM NURSES’ BELIEFS ABOUT CHILDBIRTH: A DESCRIPTIVE QUALITATIVE STUDY IN NURSES THAT PROVIDE CARE TO WOMEN IN LABOR AND BIRTH

Abstract

In the United States, a large gap exists between what is known as best evidence in maternal-newborn health and the routine practices at the frontline of maternity care. Intrapartum nurses are uniquely positioned to promote practices that are evidencebased and support the normal physiologic process of birth. This qualitative study explored intrapartum nurses’ beliefs about childbirth and the influence of their beliefs on their clinical practice, particularly practices that promoted normal physiologic birth. Semi-structured qualitative interviews were conducted with 10 intrapartum registered nurses using Rubin and Rubin’s (2012) responsive interview model. All participants practiced on a labor and delivery unit within an academic teaching hospital. Interviews were audio-recorded and transcribed verbatim. Initial descriptive codes were identified through open coding. Data was coded using Atlas.ti 6.2 and analyzed using qualitative descriptive analysis. Participants described five underlying beliefs. The beliefs included (a) childbirth is a profound event in a women’s life, (b) providing care to women in childbirth is rewarding, (c) women should be supported in their choice for the type of birth that’s right for them, (d) women’s satisfaction with their birth is important, and (e) intrapartum nurses are experts in the care of women in labor and birth. These five beliefs affected the way in which participants provided care to women during labor and birth. Factors external to the participants’ beliefs were also identified which influenced nursing practice. They included the establishment of safety, the organizational culture, patient satisfaction, and characteristics of today’s childbearing women. These factors challenged the participants’ beliefs and affected nursing care. In summary, the five underlying beliefs identified by the participants were challenged by factors that influenced the way in which they were able to provide evidence-based nursing care. These factors were identified as barriers to woman-centered nursing care, particularly nursing care practices that support and promote normal physiologic birth. Future research is recommended to explore the impact of external factors to nurses’ beliefs, with emphasis on the culture of the health care organization and childbearing women’s expectations related to the quality and safety of intrapartum nursing care practices.