Women's Voices: Prenatal Care Expectations of Women Living in Rural Hawai‘i

Abstract

Background: Despite access to prenatal care services, pregnant women in rural Hawai`i do not adequately utilize them. Underutilization of prenatal care can include delayed access to care and missed and infrequent appointments leading to suboptimal health outcomes. Prenatal care services include health screening, promotion, maintenance and education, risk assessment, interventions to prevent or treat pregnancy complications, and referrals for additional services. Pregnant women who receive adequate care are more likely to have healthier babies and fewer complications during labor and recovery. Conversely, underutilization of prenatal care can include delayed initiation of care and missed or infrequent appointments, potentially leading to suboptimal outcomes. Research in rural Hawai`i suggests that underutilization of prenatal care could be the result of personal, social, and environmental contexts. The purpose of this study was to illuminate factors contributing to the underutilization of prenatal care by women living in rural Hawai`i, by exploring their expectations and experiences with prenatal care. Method and Findings: This study used a qualitative descriptive design to describe the emic perspective of pregnant women living in rural Hawai`i using a purposive sample and a cross-sectional design. The scope of the study included women who were pregnant for the first time and seeking or already enrolled in prenatal care. The data analysis resulted in four themes: 1) “My Body Knows How to Do”: The Normalcy of Pregnancy; 2) Seeking Knowledge, Seeking Choices, 3) “What’s the Point?”: When Care During Pregnancy Is Not Satisfying; and 4) Having a Voice. Conclusions: The results of this small study sample indicated that women in rural Hawai`i viewed pregnancy as a normal process, wanted relevant information and choices during their prenatal care, and desired to have collaborative relationships with prenatal care providers who were supportive and attentive. When these elements were present, women were more likely to continue utilization of that care.