Female patients' experiences of conflicting expectations concerning pregnancy when getting long-term kidney dialysis

Abstract

Aim: The aim was to explore and describe female patients experiences of the conflicting expectations concerning pregnancy when getting long-term kidney dialysis. Method: A descriptive phenomenological study was conducted. The context of the study referred to the dialysis unit in a level 3 hospital (an academic hospital) in Gauteng, South Africa, where patients receive haemodialysis and continuous ambulatory peritoneal dialysis on an outpatient basis. The study population comprised of female patients of childbearing age who received dialysis in this unit. In-depth interviews were conducted with eight participants who were purposively selected. Female patients who met the inclusion criteria and who wished to have children or declared conflict with significant family members about getting pregnant were invited to participate. Only one main question was asked: How do you experience the expectations of your husband/partner and other family members that you should get pregnant while the doctors and nurses tell you that you should not get pregnant while you are on kidney dialysis? Probing questions were used to make sure relevant and rich data were collected. Field notes made by the researcher during and immediately after the interviews added to an accurate description of the participants experiences. The recorded interviews were transcribed verbatim by the researcher. The interviews and field notes were read and re-read thereby allowing the researcher to get a good understanding of the initial whole of the data. Thereafter, the data were divided into units of meaning which were grouped into clusters of meanings that were then used to detect a provisional pattern to recognise the essential meanings (constituents). The constituents were linked to each other to define the essence of the phenomenon which represented the whole of the experiences. Findings: The essence (meaning) of the experiences was: being-for-oneself and beingfor- others in order to live with conflicting expectations regarding pregnancy when getting long-term kidney dialysis. The essence was supported by the following constituents (meaning units): living with contradictory expectations from their mothers and future families-in-law; living with cultural transition; and attempts to be composed by living in the present and hoping for the future. The description of the essence and substantiating constituents were followed by a discussion in which literature was used to add to the understanding of the essence the phenomenon The participants experienced their mothers and future families-in-law wished for them to bear grandchildren. Their mothers accepted their pregnancy limitation and supported their being-for-oneself whereas their future families-in-law demanded grandchildren and did not support their being-for-oneself but placed the burden of being-for-others on them. Participants demonstrated cultural transition by making the informed choice to postpone pregnancy until after a kidney transplant or by considering alternative methods of having children. However, future families-in-law who held on to traditional African cultural beliefs that necessitated women to bear children, placed demands on the participants being-forothers that they could not comply with. The participants attempted to avoid conflict by not discussing their pregnancy limitation. The participants experienced emotional pain related to the effect of childlessness on themselves as well as on their mothers, partners and supporting family members. The possibility of pregnancy after having a kidney transplant gave participants, their partners and their family members the hope of having children in the future and resolving the conflict in expectations they were experiencing in the present time.