A Grounded Theory Study of Birthing People’s Decision-Making on Labor Pain Management

Abstract

Using a Constructivist Grounded Theory (CGT) approach, this study addressed the following research questions: 1) What sociocultural factors contribute to decision-making about labor pain management among nulliparous birthing people? and 2) How does the pain management decision develop or change from antepartum to delivery among nulliparous birthing people? Data to address the research questions was collected through semi-structured interviews. Seventeen nulliparous participants, at least 37 weeks pregnant, partook in initial interviews following their antepartum outpatient visit. Nine participants were retained for follow-up interviews that took place either at the hospital or over the phone between one day and four months postpartum. The overarching theme, Navigating Decision-making amid Uncertainty, was supported by two theoretical categories: 1) Shaping decisions, which involved receiving advice from social networks, engaging with social media, and awaiting provider-led education, and 2) Shifting decisions, which involved responding to labor realities and considering support system guidance. Of the follow-up participants, seven initially intended to avoid an epidural. However, only two of the seven did so. This shift was often a result of unanticipated pain intensity exacerbated by medical interventions such as the foley balloon and IV Pitocin. Policy and practice changes that promote person-centered care and informed decision-making should be considered. These findings offer a novel perspective on decision-making among nulliparous birthing people. They can serve as a step toward evaluating the potential for an intervention to promote informed decision-making about pain management during labor.