Listening to women at risk for preterm birth.

Frequently missing from discussions of the high rates of preterm and low birthweight births in the United States are the voices of pregnant women. In this article, we share the voices of low-income pregnant women who were participants in a 5-year randomized clinical study of nurse telephone intervention to reduce preterm birth. Data were gathered from three sources: a log kept by the study nurses in which they recorded events as they occurred; a telephone survey of randomly selected participants using a structured interview after the program was completed; and spontaneous comments from notes and letters written by study participants. Patients commonly perceived barriers to care, and related them to the nurses. The most frequent barriers concerned communication: miscommunication and misunderstanding between a woman and provider; miscommunication and misunderstanding involving providers giving conflicting information to patients; inaccurate information from provider to patient; failure of a provider to respond to a patient's request for information; and a general feeling among patients that providers were unsympathetic or uncaring. The perspectives of these women raise important questions for nurses and for other healthcare providers about the way we communicate both information and attitudes of caring to pregnant women.