Paper
Thursday, July 22, 2004
Birth Plan Decision-Making Between Nurse-Midwives and Clients
Mary Ellen Doherty, PhD, RN, CNM, Department of Nursing, Department of Nursing, University of Massachusetts-Lowell, Lowell, MA, USA
| Learning Objective #1: Describe the three patterns of interaction identified in this study |
| Learning Objective #2: Describe the components of birth plans and the various ways to facilitate the completion of birth plans |
Objective: To describe participation in decision-making between nurse-midwives and clients regarding the development of a birth plan. Design: Qualitative, a field study. Population, Sample, Setting, Year: Pregnant women receiving nurse-midwifery care for the first time; eight certified nurse-midwives and twenty prenatal clients; Northeastern USA; 2000 Concept Studied: The decision-making process Methods: Purposive sample; modified participant-observation and audiotaping of prenatal visits; post visit telephone interviews with each client and nurse-midwife separately. Content analysis was used to analyze the transcriptions and fieldnotes. Findings: Three distinct patterns of interaction emerged from the data. The "pattern of directives" was characterized by the nurse-midwives taking a pro-active stance for clients to complete birth plans. In the "pattern of emergence" a birth plan was in a state of evolving and focused on clarifying and resolving issues. The "pattern of validation" involved the review of completed birth plans with attention to their viability. More than half of the clients participating in the study had developed a birth plan prior to 36 weeks gestation. Conclusions: A birth plan is an important communication document which involves anticipatory work, reflection, and decision-making about the conduct of normal labor and birth. Nurse-midwives are in a strategic position to help clients in this endeavor. The findings of this study have not only generated knowledge about client-provider communication and decision-making in a prenatal setting but also suggest applicability across the entire spectrum of healthcare. Implications: Research of this nature benefits both the recipients of care and the providers of that care. The manner in which nurses approach a birth plan with clients has important implications for clinical practice.
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Sigma Theta Tau International
July 22-24, 2004