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Deciding when it’s labour : the experience of women who have received antepartum care at home Palmer, M. Lynne

Abstract

Antepartum care at home, including self-assessment teaching and help-seeking guidelines, replaces hospital care for some Canadian women who have a diagnosis of preterm labour. It is not known how these women decide if they are experiencing a subsequent episode of labour or whether or not they should seek help. The purpose of this study was to describe the decision-making process used by women to identify and respond to a subsequent episode of labour when they had received antepartum care at home for preterm labour prior to 34 weeks gestation. Grounded theory was chosen as the research method. Twelve women were interviewed, and interview transcriptions and their self-kept symptom records were analyzed. "Reconciling body knowledge and professional knowledge" was found to be the core psychosocial process that these women used to decide if their symptoms represented labour and whether or not to seek help. Women in the study described, "knowing something's not right" as they used their body knowledge to appraise a change in symptoms compared to their baseline symptoms. Study participants used helpseeking guidelines to decide when to return to hospital for the first episode of symptoms after receiving antepartum care at home. However, when they returned to hospital to "see what's going on," and body knowledge did not coincide with professional knowledge, an overriding tension between not wanting to take a risk for the baby versus not wanting to over-react, influenced their future decisions. These women re-established their baselines of nonthreatening symptoms at a higher level by "setting a new normal" to decide if future episodes represented labour. Reconciling body knowledge and professional knowledge was a deliberate strategy used by these women to prevent humiliation associated with appearing to over-react. Research findings offer guidance to health care professionals to respond optimally to the emotional needs of women experiencing recurrent preterm labour symptoms. Greater understanding of why women delay help-seeking illuminates the importance of buffering factors that cause women to doubt their body knowledge. Nursing interventions should be geared to reducing anxiety and reinforcing beliefs in self-efficacy related to identifying labour and seeking help in a timely fashion.

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