Thematic Analysis of Women's Perspectives on the Meaning of Safety During Hospital-Based Birth

doi:10.1016/j.jogn.2018.02.008

Journal of Obstetric, Gynecologic & Neonatal Nursing

Volume 47, Issue 3, May 2018, Pages 324-332

https://doi.org/10.1016/j.jogn.2018.02.008 Get rights and content

Abstract

Objective

To explore women's birth experiences to develop an understanding of their perspectives on patient safety during hospital-based birth.

Design

Qualitative description using thematic analysis of interview data.

Participants

Seventeen women ages 29 to 47 years.

Methods

Women participated in individual or small group interviews about their birth experiences, the physical environment, interactions with clinicians, and what safety meant to them in the context of birth. An interdisciplinary group of five investigators from nursing, medicine, product design, and journalism analyzed transcripts thematically to examine how women experienced feeling safe or unsafe and identify opportunities for improvements in care.

Results

Participants experienced feelings of safety on a continuum. These feelings were affected by confidence in providers, the environment and organizational factors, interpersonal interactions, and actions people took during risk moments of rapid or confusing change. Well-organized teams and sensitive interpersonal interactions that demonstrated human connection supported feelings of safety, whereas some routine aspects of care threatened feelings of safety.

Conclusion

Physical and emotional safety are inextricably embedded in the patient experience, yet this connection may be overlooked in some inpatient birth settings. Clinicians should be mindful of how the birth environment and their behaviors in it can affect a woman's feelings of safety during birth. Human connection is especially important during risk moments, which represent a liminal space at the intersection of physical and emotional safety. At least one team member should focus on the provision of emotional support during rapidly changing situations to mitigate the potential for negative experiences that can result in emotional harm.

Section snippets

Design

This qualitative descriptive study used thematic analysis of interviews conducted individually and in small groups with a purposive sample of women residing in the San Francisco Bay Area who had previously given birth in a variety of settings. The study was approved by the institutional review boards at the University of California, San Francisco and Stanford University.

Participants and Settings

Seventeen women ages 29 to 47 years participated: 3 were interviewed individually as the only respondents to the invitation

Safety Experienced as a Continuum

When asked about the meaning of safety, most participants focused on the competence of providers as a key aspect of safety. Many defined safety as a birth in which the woman and newborn are “safe,” “healthy,” or “okay.” A few participants explicitly expanded on this perspective to articulate an emotional component of safety during birth and point out that some aspects of safety, particularly communication, may not be captured by clinical measures. Indeed, one suggested that the acts of

Discussion

We explored women's experiences and understanding of safety during labor and birth in U.S. hospitals. Our participants reported a wide range of types of births: spontaneous vaginal and emergency cesarean births; “easy” births at term; and births complicated by prematurity, fetal distress, and extremely serious maternal complications. Despite the wide variation in how their births unfolded, we found common themes with regard to how participants thought about safety during birth. Participants'

Acknowledgment

Supported by grant number P30HS023506 from the Agency for Healthcare Research and Quality.

Audrey Lyndon, PhD, RNC, FAAN, is an associate professor and Chair of the Department of Family Health Care Nursing, University of California San Francisco, San Francisco, CA.

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It was found that as contractions intensify and become more painful, women describe their need to be in a place of safety in order to focus on each contraction. In a qualitative study of 17 women, Lyndon et al. (2018) explored what safety means to women in the context of a hospital birth experience. The participants referred to both physical and emotional safety, which are physical and psychological needs.
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Audrey Lyndon, PhD, RNC, FAAN, is an associate professor and Chair of the Department of Family Health Care Nursing, University of California San Francisco, San Francisco, CA.

Jennifer Malana, MSN, RN, is a doctoral student in the Department of Family Health Care Nursing, University of California San Francisco, San Francisco, CA.

Laura C. Hedli, MS, is a writer in the Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA.

Jules Sherman, MFA, is a design consultant in the Department of Pediatrics, Stanford University, Palo Alto, CA.

Henry C. Lee, MD, MS, is an associate professor in the Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA.

: The authors report no conflict of interest or relevant financial relationships.

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ResearchThematic Analysis of Women's Perspectives on the Meaning of Safety During Hospital-Based Birth

Abstract

Objective

Design

Participants

Methods

Results

Conclusion

Section snippets

Design

Participants and Settings

Safety Experienced as a Continuum

Discussion

Acknowledgment

Journal of Obstetric, Gynecologic, & Neonatal Nursing

International Journal of Gynaecology and Obstetrics

Sexual and Reproductive Healthcare

Midwifery

Women and Birth

Midwifery

Posttraumatic stress disorder in new mothers: Results from a two-stage U.S. national survey

Birth

Promoting engagement by patients and families to reduce adverse events in acute care settings: A systematic review

BMJ Quality and Safety

Using thematic analysis in psychology

Qualitative Research in Psychology

Identification by families of pediatric adverse events and near misses overlooked by health care providers

Canadian Medical Association Journal

Listening to Mothers III: New mothers speak out

Listening to Mothers III: Pregnancy and birth

Research
Thematic Analysis of Women's Perspectives on the Meaning of Safety During Hospital-Based Birth