الفهرس 
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Abstract
The birth of a child is a wonderful, life-changing time for the mother and her family. It is a personal and individual journey that is different for every woman. Vivid and detailed memories of the journey often lead to a permanent perception of the birth experience. Supportive care during birth has been found to improve the whole birth experience. And also has been identified as a key element in the WHO vision of quality of care for pregnant women and newborn. Labor support is defined as the intentional human interaction between intrapartum nurse and a laboring woman that assists with coping during labor and birth. It can be classified as emotional, physical and informational support.
Despite the fact that labor support may be the best evidence-based practice (EBP), it is not commonly implemented in all maternity settings. While nurses‘ intentions may be to provide the best labor support, many factors interfere with their capacities to give this proofed base standard of care. Such factors as numerous responsibilities, shortage of staff, conflicts in organizations, subjective norms, education, personal beliefs, collaboration and teamwork.
The aim of this study was to explore women’s perception of nursing supportive behaviors during labor.
To fulfill the study aim: An exploratory descriptive research design was utilized.
Setting:
The study was conducted at the postpartum unit at Damanhur National Medical Institute affiliated to the Ministry of Health.
Subjects:
The study subjects were selected by using a non-randomized sampling technique where a convenient sample of 320 postnatal women were recruited from the aforementioned setting. The inclusion criteria included: age from 20-34 years, experienced normal pregnancy and labor, and delivered a healthy infant of 37 or more week’s gestation and willing to participate in the study.
Tools of the study:
Two tools were used for data collection. Tool I: socio-demographic and reproductive history structured interview schedule which contained 3 parts: It was developed and used by the researcher to collect the basic data. Tool II: the Bryanton Adaptation of the Nursing Support in Labor Questionnaire (BANSILQ), which was used to elicit the perception of adult postpartum women about the helpful supportive nursing behaviors during labor after being translated and modified to suit the Egyptian culture. It was composed of 25 items divided into 3 sections: emotional, informational and tangible support. Tools reliability was tested by Alpha Cronbach test (internal consistency) and results were satisfactory.
A pilot study was carried out on 32 women (who were excluded from the main study subjects) to ascertain the clarity and the applicability of the tools as well as to estimate the time needed to complete the sheet and to detect any problem peculiar to the tools.
Collection of data
Collection of data covered a period of four months started from the beginning of September till the end of December. Statistical analysis was done by the researcher by using statistical package for social science (SPSS version 20) program. The collected data was revised, categorized, coded, computerized, tabulated and analyzed.
The main findings yielded by the study were:
General characteristics:
Socio-demographic data:
- The age of nearly three-quarters (72.19%) of the study subjects ranged between 20 to less than 30 years. And those who were 30-34years constituted more than one quarter (27.81%) of the study sample.
- More than two- fifths (42.81%) of the study subjects had secondary or equal level of education, while more than one- fifth (22.81% & 20.94%) of them were either illiterate or just able to read and write or had primary level of education respectively.
- The majority (83.13%) of the study subjects were housewives and 16.87% of them were working.
- More than three-fifths (63.44%) of the study subjects were urban dwellers and more than one- third (36.56%) of them were rural citizens.
Reproductive history:
- The mean number of pregnancies was 2.58 ±1.61, the mean number of deliveries was 2.30 ±1.52
- No history of abortion was reported by more than three- quarters (75.94%) of the study subjects.
- The vast majority (95.00 %&96.25%) of the study subjects had no stillbirth and died children respectively. The mean number of living children was 2.32 ±1.59 children.
- The majority of the study subjects (99.52%) had normal delivery and only 0.48% had C.S delivery.
- No complications in the previous births were reported by the majority of the study subjects (89.47%).
- The majority of the study subjects (85.43%) delivered at the hospital. while, 14.57% delivered at a private clinic.
Present history:
History of current pregnancy:
- The mean duration of current pregnancy was 39.22 ± 1.60 weeks.
- All (100%) of the study subjects had antenatal visits during pregnancy and more than three-quarters (79.38%) of them went to private clinic for antenatal follow up.
- The majority of the study subjects (94.37%) had four or more visits during their current pregnancy and (90.63%) of them were in their first trimester during the initial visit. The mean number of antenatal visits was 6.45 ± 2.01.
- About three- quarters (74.69%) of the study subjects received health education about labor, doctors were the main source of information for more than three-fifths (65.27%) of the study subjects .
Profile of current delivery:
- The mean duration of delivery among the study subjects was 20.32 ±4.12 hrs.
- Oxytocin (stimulants) was used by slightly more than four- fifths (81.48%) of the participants, while 18.52% of them needed to take cytotec combined with oxytocin
- All (100%) neonates were alive at delivery with a mean weight of 3.10± 0.57 and mean height of 47.83±4.20.
Women’s perception of Nursing supportive behaviors during labor as measured by (BANSILQ):
- Concerning emotional support, the most frequently reported response as very helpful (48.12%) was that the nurse ” Made me feel cared about as an individual” followed by the statement ” Treated me with respect”(43.75%). Statements which denoted ”helpful emotional support” to the respondents as they perceived them were” Accepted what I said/did without judging”(69.37%) followed by the statement of” Provided a sense of security”(62.18%).
- As regard to informational support, the most frequently reported response (45.00%) as ”very helpful” was that the nurse ”Instructed me in breathing/relaxing” followed by the statement:” Kept me informed about my progress ”(31.25%). Statements which denoted ”helpful” informational support to the respondents as they perceived them were:” Praised me & Kept me informed about my progress ”(63.44%) followed by the statement of” Included me in making decisions ”(59.06%).
- In relation to tangible (physical) support, the most frequently reported response (53.12%) as very helpful was that the nurse ”Assisted me in breathing/relaxing” followed by the statement:” Gave me pain medication ”(52.81%). Statements which denoted ”helpful” tangible support to the respondents as they perceived them were:” Tried to carry out my wishes & touched me ”(67.81%) followed by the statement of” Attempted to lessen demands on me ”(63.44%).
The majority (69.1%) of the study subjects obtained satisfactory total score while those who obtained good total score constituted 17.5% and only 13.4% of women obtained poor total score.
Relationship between nursing support during labor and socio-demographic data, reproductive and current pregnancy history and profile of current delivery:
- A statistically significant correlation was detected among the study subjects’ perception of labor support in relation to the occupation (p=0.003) and current residence (p=0.002).
- No statistically significant correlation was detected among the study subjects’ perception of labor support and their reproductive history
- A statistically significant correlation was detected among the study subjects in relation to some of their current pregnancy history as the place of follow up, (hospital p= 0.015), (private clinic=0.011), (health care unit p=<0.001) and for the source of knowledge, (others as mother and sister p=0.001).
Based on the findings of the present study, the following recommendations are suggested:
1. Nursing supportive behaviors during labor should be emphasized by decision makers at Ministry of Health and Population, as well as by leaders of the profession in the country especially to those in teaching hospitals.
2. Medical and midwifery schools should be encouraged to include nursing supportive behaviors during labor within their curriculum.
3. Workshops on benefits of nursing supportive behaviors during labor should be encouraged.
4. Further researches are recommended:
-Replication of the present study at different settings and among larger samples for better generalization.
-Assessment of barriers that prevent nurses from providing labor support behaviors.