Date of Award

Spring 5-19-2017

Degree Type

Thesis

Degree Name

MA Strategic Communication

Department

Communication and the Arts

Advisor

Danielle Catona, Ph.D.

Committee Member

Renee Robinson, Ph.D.

Keywords

communication accommodation, patient-provider communication, maternity care, decision making

Abstract

Background. Over 4.3 million mothers and newborns receive maternity care in the United States each year (Sakala & Corry, 2008). Childbirth is the leading reason for hospitalization yearly in the United States, with 23% of all individuals discharged from hospitals being either a mother or a newborn. The most common operating room procedure is cesarean section, and six of the fifteen most commonly performed hospital procedures are associated with childbirth (Sakala & Corry, 2008). Women may be led to believe that these medical interventions during labor and delivery are necessary without ever being properly educated, resulting in an intervention filled experience that places unnecessary risks on both mother and baby (Lothian, 2012).

While extensive research has proven the benefits of an intervention-free birth for low risk pregnancies, the rates for these interventions continues to rise. According to the Centers for Disease Control and Prevention (2014), cesarean sections in low risk pregnancies in the United States rose from 18.4% in 1997 to 32.7% in 2013. Federal regulations and guidelines state that every woman has the right to make maternity care decisions based on accurate up-to-date information (Goldberg, 2009).

Prior to giving birth, expecting mothers should be given the ability to make decisions regarding which interventions, if any, will be administered during the progression of labor. Despite the research that supports both shared decision-making and informed decision- making models, women undergoing maternity care are often uninformed, leaving them unable to make proper decisions. This misinformation leads to maternity patients agreeing with practitioners’ predetermined decisions and not being active decision-makers in their own care (Stevens & Miller, 2012). A possible reason for expecting mothers not taking an active role in their decision-making may be a direct result of providers under-accommodating expressed patients' needs relaying labor and delivery-related information.

Method. Semi-structured interviews were conducted with three mothers who gave birth to their first child within the past two years. Interviewees were recruited by a maternity nurse affiliated with a private university. Mothers had varied labor experiences but all delivered via cesarean section. Interview questions explored the lived experience of labor and delivery and how provider communication affected mothers' decisions to receive or not receive a medical intervention.

Results. A qualitative analysis using the constant comparison method revealed five themes related to labor and delivery decision-making: (1) reason for C-section/lack of decision-making, (2) provider’s description of risks/benefits, (3) delivery day communication, (4), pre-delivery day communication, and (5) overall provider satisfaction.

Discussion. It was discovered that the participants in this research were not as involved in their decision-making as is recommended by the shared decision-making model. However, despite not being the final decision maker participants were satisfied overall with their provider. The results may inform medical education training for providers in maternity care, as well as patient education materials for expecting mothers. Additional research in this area is needed to further determine the affect patient-provider communication has on maternity care decision-making.

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