Measures to enhance the cooperation of primigravida patients during vaginal examinations in a midwifery obstetric unit in South Africa

Abstract

The study aimed to explore and describe measures to enhance the cooperation of primigravida patients during vaginal examinations in the first stage of labour. Vaginal examinations are performed during the first stage of labour to monitor the process and to determine the need for surgical intervention in case of complications. The researcher observed at a midwives obstetric unit that on average two out of five primigravida patients per week refuse vaginal examinations. The progress of labour can thus not be determined, and the midwives have no choice than to refer them to a nearby hospital for monitoring and further management. A descriptive and contextual qualitative study was done. Data was collected through semi-structured individual interviews with 10 midwives from a midwifery obstetric unit in a community health centre in the Tshwane District in the Gauteng Province of South Africa. Three categories emerged namely: 1) create a conducive environment, 2) render support during the procedure, and 3) enhance patient involvement. The sub-categories refer to how to create a good nurse-patient relationship, gain the trust of the patient, overcome language barriers, obtain verbal informed consent for the procedure, ensure privacy during the procedure, enable peer support, and involve the patients in decision-making. The authors conclude that primigravida patients are afraid of vaginal examinations due to a lack of information with regard to the procedure. Early preparation, family support and the involvement of the patients in decision-making can enhance their cooperation. Midwifery policy guidelines should include measures to enhance the cooperation of primigravida patients during vaginal examinations. Culturally sensitive language policies should be implemented to ensure that interpreters/translators are available to patients.