4.2 ADOLESCENT MATERNITY CLIENTS
4.2.1 Adolescent Client's Perceptions of the Maternity Services
4.2.1.1 Perceived Friendly Care
The following table contains the emergent sub-categories and properties of AMC perceived friendly care that emerged from the data:
Table 1:Subcat~ories and Properties of AMC Perceived Friendly Care
Core category Sub-eat~ories Property
Being addressed in a HCp behaviours that polite manner.
Perceived Friendly Care Being physically handled
demonstrate caring
in a gentle way.
Being listened to.
Being helpful.
Being friendly.
HCp behaviours that Providing reassurance.
demonstrate support Demonstrating understanding.
Non-judgmental.
Having one's needs anticipated.
Clients' needs Having one's needs
responded to.
Birth companion.
For reader clarity, each of the sub-categories in table 1 will be discussed individually.
4.2.1.1a HCp Behaviours that Demonstrate Caring
The first sub-category to the core category 'Perceived Friendly Care' is 'Behaviours that Demonstrate Caring'. The table below contains the properties of this sub- category, as well as resultant AMC behaviours/feelings:
C .
h D
rti f' HC Beh .
T bl 2 Pa e : rope eso ;p avlOurs t at emonstrate ann2'
Sub-category Property Resultant AMC
behaviour / feeling Being addressed in a Feeling safe.
polite manner. Being able to seek
HCp behavioursthat assistance.
demonstrate caring Being physically handled
Feeling respected.
in a gentle way.
Being listened to. Being seen as an individual.
Addressing clientsin a polite manner
A health care provider with a caring attitude was essential to the adolescent client perceiving care as being 'friendly'. For many of the respondents, care was perceived as being friendly when the health care provider spoke to theminwhat they described to be a 'nice' way.
"They don't shout. They are just nice. You talk to them and you tell them your problem, and they understand. "
(Antenatal AMC)
"She won't shout at us, treat us well because we are human beings. "
(Antenatal AMC)
Ibis way of interacting with them made the adolescent clients feel more comfortable with the health care provider and more able to communicate their problem or need, as they perceived the health care provider to be understanding.
Being Physically Gentle
The manner in which physical care was given also conveyed caring or non-caring to the adolescent client. When asked to describe health care providers with whom they were happy, a postnatal respondent described the health care provider who took care of her during labour and delivery as follows:
"She was very gentle with me. She didn't rough handle me. "
(postnatal AMC) Ibis client saw kindness or tendernessinhow the nurse carried out physical procedures.
Another respondent described the way the doctor who examined her conducted the abdominal palpation.
"He just felt the correct places not pull this down or pull that up or something. You know he just checked my stomach and he was gentle with me. "
(Antenatal AMC)
More than one client mentioned that care was perceived as being friendly when health care providers were physically gentle with them. Gentleness on the part of the health care provider conveyed caring to the adolescent client.
Being listened to
Caring was also conveyed to clients when they perceived that health care providers had listened to them and acted in accordance with the information that they in turn supplied.
"Yesterday there was a white lady there and] went to the toilet yesterday, and]came and told her you know, '] went to the toilet and here's my card, ] am after this
person '. She was, she madeitthat ] was after that person. "
(Antenatal AMC)
Inthis situation, the respondent felt that the health care provider had been good to her by listening to her when she informed her of her place in the queue and by seeing to it that she was able to take up her original place, rather than being expected to go to the back of the queue.
This sentiment was also expressed by another respondent who described her idea of a 'good' HCp as someone who listens and responds:
"You tell the nurse and she must understand you and she must tell you what's it about and how to treatit. "
(Antenatal AMC)
4.2.1.1b HCp Behaviours that Demonstrate Support
'HCp Behaviours that Demonstrate Support' is the second sub-category of the core category 'Perceived Friendly Care' for AMC. The table below contains its properties as well as resultant AMC behaviours/feelings:
S
h D
'HC Beh .
Table3: Properties of :p aVlOUS t at emonstrate upport
Sub-category Property Resultant AMC
behaviourIfeeling Being helpful. Feeling significant.
Being friendly. Not being dismissed.
HCp behavioursthat Providing reassurance. Having one's needs met.
demonstrate support Demonstrating Feeling understood.
understanding. Feeling accepted.
Not focusing on age.
Being helpful
Respondents also seemed to relate better to HCps who were not dismissive of them, but who were instead perceived as being helpful. The respondent below describes a situation where she was almost turned away from the antenatal clinic because she did not have her birth certificate with her.
"And that white woman walked in and she said, 'no send her,
if
she don't (sic) have her birth certificate " you know, 'we can still see to her'. "(Antenatal AMC) When asked to recall a health care provider with whom she had had a good
experience in the antenatal clinic, the respondent remembered the health care provider who had rescued her from being sent home for not having her birth certificate with her. She found this person tobehelpful towards her and thus caring, as opposed to the health care provider who almost turned her away from the clinic.
Being Friendly
For many respondents the issue of the health care providers being friendly seemed to be linked with the concept of providing support.
"1founditwas very nice because the nurses were very supportive and they are very friendly compared to other clinics. "
(Postnatal AMC)
"She must be friendly. "
(Antenatal AMC)
Friendly health care providers were perceived to be 'nice' and clients appear to feel more favourably about the care they then render. The care is also then perceived to be more supportive.
Providing reassurance
Health care providers who appear to give reassurance were also perceived to be supportive. When asked to describe instances of care with which adolescent clients were happy, a postnatal respondent described the support that she received while in labour from the nurse who looked after her.
"] was like in pain and] was very uncooperative and she was like ....even though she was screaming at me. She was only screaming at me like reasonably. Telling me,
'okay fine, don't do this, don't do that '. "
(postnatal AMC) She felt that this nurse was very supportive to her by reassuring her and telling her what not to do, despite her being uncooperative. Another postnatal respondent had a similar experience and said that the health care providers had been good to her. When asked to describe exactly what they had done to make her arrive at this conclusion, she said the following:
"They don't just shout at us like .... they just tell you that you mustn 't scream when you are in labour. And they attend you, tell you to keep quiet, it will be okay. "
(postnatal AMC)
She saw the attention the health care providers had paid to her during labour when she was in pain as supportive and reassuring.
Demonstrates Understanding
When the health care provider showed understanding towards the client, he or she was perceived as rendering 'friendly' care.
"She was like okay fine, understanding even though she got irritated at some point.
She still was like, okay fine understanding and doing her job. "
(postnatal AMC)
"I mean they must be more understanding towards young girls because most ofthem don't know what to expect and you know, exactly what they are supposed to do. "
(postnatal AMC) This respondent describes the health care provider who took care of her during her labour as not being affected by her behaviour, but tried to do what was needed in the situation, despite the client's behaviour. This made the respondent feel that even though the health care provider did get 'irritated' with her, the health care provider was still able to be understanding and render appropriate care to her.
Non-judgmental
When health care providers were non-judgmental they were perceived to be more caring and supportive by the clients. A good example of this is when they did not criticize adolescent clients for becoming pregnant at a young age.
"They were so patient. And they don't bother about how to ... maybe when you are a young lady. They don't treat you as you are mistaken. "
(postnatal AMC)
This respondent felt that the health care providers did not make her feel as if she had made a mistake by falling pregnant. Instead, she found them to be very patient in their dealings with her, which made her very pleased about the care they rendered.
Another respondent felt that even though the health care provider who attended to her did not say anything positive about her being pregnant, he did not bring up the issue of her age.
"He never mentioned my age, hewasjust nice to me. "
(Antenatal AMC) In doing so, the health care provider was perceived as being 'nice' by the adolescent respondent. Hence, health care providers who did not focus on the client's age were seen as non-judgmental and therefore, deemed tobemore caring.
4.2.1.1c Clients' Needs
This is the last sub-category in relation to the core category of AMC 'Perceived Friendly Care'. The following table contains properties related to 'Clients' Needs', together with resultant AMC behaviours/feelings:
fCIi ts' Need I 4 P
Tabe : roperties 0 en s
Property Resultant AMC
Sub-category
behaviourIfeelin~
Being understood.
Having one's needs Feeling respected.
anticipated. Feeling significant.
Clients' needs Having one's needs Ability to access care / responded to. infonnation that is Birth companion. needed.
Feeling supported.
Anticipating the needs ofthe client
Health care providers were also perceived to be 'friendly' when they were able to anticipate the needs of clients and respond to them without the client having to ask.
"I didn't even have to ask him questions. He told me about when you are giving birth this is what you would see, what do you expect. He was very nice with me. "
(Antenatal AMC)
Inthe statement above, the client was very pleased with the care she received because the health care provider gave her health education, without her having to initiate the discussion by asking a question. The respondent also felt more comfortable with the health care provider because he wanted to hear from her.
"He even asked me, 'what are you expecting to see '. You know it was ....youfeel comfortable. "
(Antenatal AMC)
In this situation the health care provider did not simply give her infonnation. Instead, he wanted to know what she was expecting to see when she went into labour. This made the client feel like the health care provider was interested in what she had to say. The result was that she immediately felt comfortable with the health care provider because she perceived him to be caring.
Responding to the needs ofthe client
When clients felt that health care providers responded to their needs they appeared to bemore satisfied with the care they received.
"When I am feel (sic) pain, they help me. "
(postnatal AMC) A good example of this is when they received pain relief during labour after telling health care providers that they were experiencing pain or after health care providers noticed that they were in pain. This made the client feel that the health care providers were aware of them as a person and as such responded to their needs.
Another example of where a health care provider responded to the needs of the client is evidenced below:
"Like last week, they wouldn't allow him (referring to the boyfriend ofthe client) to come in the room. Yesterday, we asked the doctor, is he allowed to come. He said,
yes, you are allowed, come in '. "
(Antenatal AMC)
This adolescent client was accompanied by her boyfriend when she went to the clinic for her antenatal appointments. Onprevious occasions the health care providers had not allowed her boyfriend into the consulting room while she was being attended.
However, the respondent persevered and at the last visit enquired ifher boyfriend could remain with her during the consultation. The health care provider allowed the boyfriend tobepart of the consultation and this decision made the respondent feel more comfortable with this particular health care provider.
Birth companion
Being supported by a significant other was perceived tobeof great benefit by the adolescent maternity clients. Some antenatal clients felt that they wanted to have someone, other than the nursing staff, with them when they were in labour. Postnatal
(postnatal AMC) (Antenatal AMC) (postnatal AMC) (postnatal AMC)
"] wouldn't have made it without my mother. "
"My mum and my aunty. "
respondents on the other hand were glad that they had someone with them during labour. While some of the antenatal respondents wanted their boyfriends to be with them during labour, many showed a preference for a female birth companion.
"My brother's girlfriend came. "
"] will go home and take my mother. "
Irrespective of who the adolescent client chose to accompany them, the need for extra support was clear.