The way in which a nurse communicates with his or her patient can affect how patients respond to the care offered by the nurse. Respect and caring are both basic to the therapeutic nurse-patient relationship.¹ For the therapeutic relationship to develop and flourish, communication is key, and respect and caring are part of this communicative dialogue.²

Communication could possibly be the sole most important skill that nurses bring to their profession. Caring is clearly reflected in communication skills. Selected principles of caring communication that can be useful to the intrapartum nurse in the clinical setting include:²

Mendenhall⁴ describes techniques to maximize the listening aspects of communication. These include listening for the feelings behind what the other person is saying, paying attention to nonverbal cues (body language), attending to body language as a listener, reminding yourself that what people say is information about them and not about you, and developing an attitude of curiosity using such questions as “Are you then saying?” to act as a guide. Barriers to therapeutic communication include excessive questioning, false reassurance, change of subject, and judgmental attitude.⁵

Another critical aspect of communication is the relationship of culture to communication. All human interactions are affected by culture, and culture is acquired through communication.⁶ Culture is passed on as beliefs, values, and mores by significant others such as parents, other family members, and significant others. Culture is a result of what is learned from the environment around us and how one thinks and behaves. Patients, especially laboring women, bring their culture to the therapeutic relationship, and this is transmitted as part of the communication process. During labor, cultural taboos and cultural preferences play a role, for example, drinking hot fluids instead of cold, clicking fingers and moaning during contractions, refusing medications (because culturally this is what is expected), and breastfeeding beliefs. Also, words spoken in one language may mean one thing in one culture but can take on an opposite or divergent meaning in a different culture or language.

Effective communication, using verbal and nonverbal techniques, can positively affect the patient’s birth outcome and satisfaction with the birth experience. Communication presents a real challenge for the intrapartum nurse. Laboring women are often in pain, are experiencing a critical developmental period in their lives, have high anxiety around the time of labor and birth, and, in general, have more stressors during the birth process. Preferences and cultural mores are reflected in the response to the birth experience. Intrapartum nurses are challenged to bring therapeutic communication skills to the labor setting.

A woman’s satisfaction during the birth process depends on the type of perceived support she receives in labor and a nurse’s ability to establish rapport and effectively deliver pertinent information. Nurses empower laboring women by maintaining a free flow of information about their birthing progress. The verbal and nonverbal aspects of the interaction are key.

The language of words in the communication dialogue surrounding the birth experience is reflected in the nurse-patient relationship. Some⁷,⁸ have argued that the health care providers’ language does not support a positive image of the woman and her role in the birth process. Phrases such as “failure to progress in labor,” the term “delivery v. birth,” all appear and sound degrading and dysfunctional. They imply that the woman is passive (or a hindrance) and that health care providers are in control. It is difficult to provide support and praise when the value system begins to pervade the birth language. The nurse’s words surrounding birth can instill doubt and negativity or hope, safety, and control.

The power of words in obstetrics gives rise to a fuller examination of just what is being spoken to women during labor. Language provides cues as to biases and attitudes as well as issues of power and control. Additional words and phrases commonly used in labor that need reconsideration include the following: confinement, incompetent cervix, inadequate pelvis, arrest of dilatation and descent, how to “conduct” labors, “down there,” and “checking you.”⁸

Mackey and Stepans⁹ studied women’s evaluations of their labor and delivery nurses. In this study, 61 child-birth-prepared, middle-class Caucasian, multigravidae rated their nurses favorably by 90%, and 10% were rated unfavorably. Intrapartum nurses were evaluated favorably
primarily for positive participation, acceptance, information giving, encouragement, presence, and competence. Nurses’ recognition of a laboring woman’s need for information and the nurses’ willingness to provide this were felt to be essential by women in labor. Nurses answered questions, gave information before questions were asked, informed women of laboring progress and fetal status, explained procedures, and interpreted orders for women. Most nurses encouraged confidence in the woman’s ability to cope with labor and reinforced progress even when it was minimal.

The disappointments with nursing staff included nurses not respecting how women were managing their own labors, nurses not respecting them as individuals, not being present or in attendance enough, nonsupportive behavior (lacking warmth and compassion), and refusing to talk with the woman or focusing on technical aspects of care. Some patients expressed difficulty in obtaining information about their labor progress and care from their labor nurses.

Bergstrom¹⁰ evaluated the way in which caregivers performed vaginal examinations during the second stage of labor. Providers used words such as “I am going to check you,” or “I am going to touch you,” and “I want to check you again with your next push.” Laboring women rarely asked what “checking you” meant. Caregivers frequently used the vaginal examination as a subject of their discussion during a contraction. The caregiver often assumed the more active role in the discussion. A strategy to improve upon this common interaction in the labor setting is for caregivers to use verbal communication skills to more clearly explain intrusive procedures and negotiate with women when vaginal examinations are undertaken.