M I D W I F ER Y A N D W O M E N ’ S H EA LT H

Garment needs of pregnant women based on content analysis of

in-depth interviews
Simone SM Ho, Winnie WM Yu, Terence T Lao, Daniel HK Chow, Joanne WY Chung and Yi Li

Aims. This study aims to identify the needs, concerns and problems of pregnant women when using maternity support
garments.
Background. Maternity support belt is regarded as helpful in reducing low back pain during pregnancy. However, several
garment-related problems exist which might lead to poor adherence behaviour undermining the benefit of garment therapy.
Design. A qualitative exploratory study.
Methods. Semi-structured interviews were conducted with 10 pregnant Chinese women who experienced low back pain during
pregnancy. All the interviews followed an interview guide and different maternity support garments were shown to the
participants as a method of tangible objects to stimulate responses. Content analysis was used to analyse the data.
Results. The results showed that 60% of pregnant women discontinued using maternity support garments due to excessive heat,
perceived ineffectiveness, itchiness, excessive pressure around the abdomen and inconvenience of adjustment. The content
analysis generated five main themes of needs including effective function, safety, skin comfort, ease to put on and take off and
aesthetics of maternity support garments.
Discussion. The findings of the five main themes of needs were largely consistent with previous studies examining medical
garments for overall satisfaction and compliance. The results revealed that women’s physiological and psychological changes
during pregnancy influenced their clothing preferences on both functional and aesthetical values.
Conclusions. Maternity support garments are convenient and easily-accessible therapy to manage LBP during pregnancy and
are frequently recommended and worn by pregnant women. However, inappropriate choice of garment therapy not only led to
ineffectiveness but also undesirable effects. The key findings of the five main themes of garment needs in pregnant women will
facilitate healthcare professionals in providing evidence-based advice to assist patients in the selection of an appropriate and
optimal maternity support garment.
Relevance to clinical practice. These recommendations in the clinical practice will assist patients in making well informed
treatment decisions and ultimately improve the quality of care.

Key words: garment therapy, low back pain, maternity, midwifery, nursing, pregnant

Accepted for publication: 8 November 2008

Authors: Simone SM Ho, PhD, RN, Assistant Professor, The
Nethersole School of Nursing, The Chinese University of Hong
Kong, Hong Kong; Winnie WM Yu, PhD, CText FTI, FHKITA,
Associate Professor, Institute of Textiles and Clothing, The Hong
Kong Polytechnic University, Hong Kong; Terence T Lao, MD,
Professor, Department of Obstetrics and Gynaecology, The Chinese
University of Hong Kong, Hong Kong; Daniel HK Chow, PhD,
Professor, Department of Health Technology & Informatics, The
Hong Kong Polytechnic University, Hong Kong; Joanne WY Chung,
PhD, RN (H.K.), RN (N.S.W.), Professor, School of Nursing, The
Hong Kong Polytechnic University, Hong Kong; Yi Li, PhD,
Professor, Institute of Textiles and Clothing, The Hong Kong
Polytechnic University, Hong Kong
Correspondence: Dr Winnie WM Yu, ST 737, Institute of Textiles
and Clothing, The Hong Kong Polytechnic University, Hunghom,
Kowloon, Hong Kong. Telephone: (852) 2766 6525.
E-mail: tcyuwm@inet.polyu.edu.hk

2426  2009 The Authors. Journal compilation  2009 Blackwell Publishing Ltd, Journal of Clinical Nursing, 18, 2426–2435
doi: 10.1111/j.1365-2702.2009.02786.x
Midwifery and women’s health
Introduction
Low back pain (LBP) is considered a major health complaint
from pregnant women with reported incidences varying from
50–80% (Fast 2003, Wu et al. 2004). Among a wide range
of pain relief treatments, maternity support belt is regarded
as helpful in reducing back and pelvic pain symptoms
(Ritchie 2003); though little evidence is available (Ho et al.
2009). However, problems such as skin irritation, discomfort
during movement and inconvenience for toileting
(Carr 2003) have led to poor adherence behaviour which
undermines the benefit of maternity support garments. The
wearers’ bodily changes affected the design of ergonomic
garments (Civitci 2004). As pregnancy places a woman’s
body in a continual physiological and psychological adaptive
state (Colman & Colman 1990), the physiological and
psychological changes during pregnancy would probably
affect women’s clothing preferences and wearing behaviours.
Therefore, the objective of this study was to identify the
need, concerns and problems of different maternity support
garments and the garment attributes contributing to satis-
faction, by means of in-depth interviews with detailed
content analysis.
Literature review
Medical garment treatment
The need for functional clothing is growing for medical use
(Yip & Yu 2006). Research for medical clothing relating to
patients’ satisfaction and compliance was mainly focused on
pressure garments for burns patients (Macintyre & Baird
2006), lymphoedema (Kligman et al. 2004), varicose veins
(O’Hare 1997); and haemorrhage (Hensleigh 2002) or
protective clothing for skin cancer (Gambichler et al. 2006),
hip fractures (Myers et al. 1995) and incontinence (Clarke-
O’Neill et al. 2007). Williams et al. (1998) found that
comfort, colour, ease of movement and donning were the
factors of overall satisfaction with the pressure garments for
burns patients. Johnson et al. (1994) also reported that the
perceived body temperature in the garment, activity limita-
tions and garment discomfort are the significantly associated
with compliance of pressure garments. Myers et al. (1995)
found that the elderly patients in using hip protective
garments most concerned about the effectiveness, fit, com-
fort, laundering, cost, not showing and ‘looks well’. O’Hare
(1997) reported that comfort and fit promoted the compli-
ance with compression garments for venous disorders.
However, little research has been conducted to investigate
the pregnant women’s ergonomic needs for support garment
 2009 The Authors. Journal compilation  2009 Blackwell Publishing Ltd, Journal of Clinical Nursing, 18, 2426–2435
Garment needs of pregnant women
that helps to reduce LBP. Chan (2000) studied 45 pregnant
women’s priorities when purchasing maternity garment using
a questionnaire. Yu and Wong (2001) used pictures of
different types of maternity support garments to elicit
responses from three pregnant women and two medical
professionals in a focus group to identity their preferred
garment features. Therefore, an in-depth analysis of the
pregnant women’s needs would be useful to identify the
design features and fabric properties that contribute to
the satisfaction of maternity support garment. This study
used real objects of different maternity support garments
which helped to convey a more concrete stimulus, particu-
larly the handfeel of the fabric, which enabled the
participants to form clearer expressions of feelings.
Methods
Qualitative approach
This study used in-depth interview as a qualitative approach
which allows the researcher to explore and define the users’
personal views of their ergonomic needs for maternity
support garments; and applied content analysis for examining
individual participant’s psychological feeling and attitude
towards garment treatment during pregnancy. Detailed data
of their preferences, decision processes and priorities of
maternity support garments were categorised with codes and
organised systematically.
Study sample
In-depth interviews were conducted at an antenatal clinic of a
regional hospital in Hong Kong. The inclusion criteria were
women in the third trimester of pregnancy who had experi-
enced LBP during current pregnancy and able to communi-
cate fluently in Cantonese. The sample size was determined
based on a guiding principle of data saturation, that is
sampling to a point at which no new information is obtained
and redundancy is achieved (Polit & Beck 2004).
Data collection procedure
Ethical approval was obtained and participation was on a
voluntary basis. Written informed consents were obtained
after explanation of the purpose and procedure of the study.
Background information of the participants was collected
using a questionnaire including demographic and clinical
data. Lumbar back pain was assessed by a Numeric Rating
Scale (NRS), with 0 representing no pain and 10 representing
the worst pain imaginable. The NRS is a valid and reliable
2427
SSM Ho et al.
instrument to evaluate pain intensity in LBP patients (Grotle
et al. 2005).
Prior to the main study, a pilot interview was undertaken
to check clarity of wordings and logical flow of the questions.
The questions were approved by a panel representing
different professions, such as nurses and textile experts to
improve face validity. Three pregnant women were recruited
from the same antenatal clinic for the pilot interview. The
interviews were semi-structured, which used an interview
guide and showed different garment samples (Fig. 1) to each
participant so as to stimulate answers by means of real
objects. The interviews began with some general questions
(a) Maternity brief
60·5% Nylon, 30% Viscose, 9·5% Spandex
(c) Maternity brief with legs
Fibre contents not specified
(e) Maternity belt
Fibre contents not specified
(g) Cradle
64% polyester, 23% spandex, 9% cotton, 4% nylon
Figure 1 Different maternity support garments used in the interviews.
2428  2009 The Authors. Journal compilation  2009 Blackwell Publishing Ltd, Journal of Clinical Nursing, 18, 2426–2435
about pregnancy as a warming up session to encourage
conversation, it then proceeded to discuss the needs for and
the use of maternity support garments. The respondents in
the pilot study found that the questions were easy to
understand and were relevant to the topic of interest. No
major amendments were made to the questions. The main
interviews lasted between 45 minutes to an hour and were
audio-recorded. Data collection continued until data satura-
tion was reached and no new themes emerged.
All interviews took place in a private room at an antenatal
clinic. Since the interviews took place directly after their
antenatal visits, the venue was preferred by the subjects
(b) Maternity brief
Fibre contents not specified
(d) Maternity brief
70% cotton, 30% elastane
(f) Maternity belt
45% nylon, 15% polyester, 15% spandex, 17·5% cotton, 7·5% rayon
(h) Vest
82% nylon, 18% spandex
Midwifery and women’s health
because of the convenience and familiarity with the facility.
This arrangement helps to promote participants’ commitment
to attend since uncertainty in transportation to unfamiliar
facility might deter participation.
Validity and reliability
In qualitative research, the criterion of validity that are used
to establish the trustworthiness of qualitative data is credi-
bility (Whittemore et al. 2001). Credibility refers to the
conscious effort to establish confidence in the truth of the
data and accurate interpretations of the meaning of the data
(Lincoln & Guba 1985, Carboni 1995). To ensure credibility
of data in this study, a comfortable and private setting was
provided throughout the interview to enhance a free and
interactive atmosphere for prolonged engagement; that is
essential for building trust and rapport between the partic-
ipants and the interviewer to ensure an adequate scope of
data coverage. The interviewer continuously observed the
responses that allow the interaction to focus on the aspects
relevant to the phenomenon being studied to provide
adequate depth of the responses. These techniques were used
to ensure the generation of useful, accurate and abundant
information (Polit & Beck 2004).
Data analysis
Content analysis was used based on a categorisation scheme
to code and interpret the data (Polit & Beck 2004). This
method is useful for unstructured materials and sensitive to
the context. Before content analysis, each audio file of
interview dialogue was transcribed into Chinese and then
translated into English by the same researcher to ensure
consistency and validity (Twinn 1997). All the dialogue
details were carefully reviewed and coded for correspondence
to the identified categories, which would be meaningful to the
research problems (Strauss 1998). The process of coding data
involved seeking recurring themes in the data representing
patterns in different categories and themes.
Results
The method of showing real objects of different maternity
support garments to the participants was useful as it provided
tangible samples to stimulate more distinct responses. In
particular, subjects tended to touch the garments by hands
before commenting on the thermal, moisture and tactile
comfort. A total of 13 pregnant Chinese women were invited
to participate in the study by convenience sampling. They all
accepted but three of them were not interviewed because of
 2009 The Authors. Journal compilation  2009 Blackwell Publishing Ltd, Journal of Clinical Nursing, 18, 2426–2435
Garment needs of pregnant women
delivery or not showing up. Based on the theoretical
saturation principle, the final sample consisted of 10 pregnant
Chinese women. In qualitative research, a sample of 10 good
informants who can communicate effectively on their expe-
riences is reasonably adequate for understanding the studied
phenomenon (Polit & Beck 2004). The subjects were aged
33Æ4 (SD 2Æ8) ranging from 29–37, either Para 0 or Para 1
who worked full time (60%) or were housewives (40%).
Their mean gestational age was 36Æ1 (SD 3Æ8). The mean
intensity of pain was reported 4Æ0 (SD 2Æ2) and peak pain
intensity was 5Æ7 (SD 1Æ8) on the NRS from 0–10. The clinical
presentation of pain onset and intensity was consistent with
previous studies (Wu et al. 2004).
Maternity support garment was made known to all
participants that it helps to reduce back pain during
pregnancy. Prior to the interview, 90% of the participants
had experiences in wearing maternity support belt or brief,
the source of information mainly came from their relatives,
friends and salespersons in maternity product store. How-
ever, only 30% have worn the belt throughout the whole
period of pregnancy. The reasons for discontinuation
included excessive heat, perceived ineffectiveness, itchiness,
excessive pressure around the abdomen and inconvenience of
adjustment. Table 1 shows five main themes of needs,
concerns and problems expressed by the participants in using
maternity support garments.
Effective function
Eighty per cent of the participants felt that it is most
important that the maternity support garments are able to
relieve back pain during pregnancy. When they were asked to
name the possible causes of LBP, the responses varied. 80%
of them said it was related to the increasing foetal weight and
altered posture, so they believed that pain relief could be
achieved through effective support to the abdomen (60%)
and the back (20%). However, 40% of them questioned
whether the commercially available garments would provide
the necessary functions:
I think may be the weight of the belly forcing downward and the
posture…because you may change your posture with the fetus or my
spine becomes curved due to the fetus…curved forward…you may
not be aware of it, but your body posture will change due to the
heavy load on the waist…If you want to convince me to buy one (a
maternity support garment), it is important that it works. Can it (the
maternity support garment) really help to lift up the belly and relieve
the backache? I don’t know if this supporting panty works or not…I
think this (the cradle G) is better because the belly is provided an
uplifting support by the shoulders. (P8, clerk aged 34)
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SSM Ho et al.

Table 1 Percentage of participants expressed their needs/concerns/ the principle is to press it down…you give it some pressure…it (the
problems in using maternity support garment back panel) should touch the area where I feel painful (P1, teacher

Needs/concerns/ % of aged 35)

Themes problems participants
This abdominal band (pointing to her own maternity support belt)
Effective Pain relief function 80 provides more support probably because it (the abdominal panel) is 2
function Supportive function 80 inches wide…it (the abdominal panel) has to be at least 1Æ5 inches
Supports abdomen 60
wide for better support…it will be good if it is adjustable because the
Supports back 20
position of the waist and the (back) pain region is different for
Safety Baby’s comfort 30
and growth different people. (P2, nurse aged 34)
Risk of fall 20
Some participants felt that the supporting force provided
Skin Comfort 90
comfort Hot and sweating 100 by the abdominal panel was useful in reducing LBP. One
Itchiness, skin rash 100 participant explained that when she clasped their hands
or infection under the lower abdomen to provide an upward lift during
Fabric too thick 80 walking, the vertical movement of the abdomen was
Breathable fabric 90
reduced which seemed to lessen the strain over the back
Water absorbent 80
Cotton 100
muscles:
Polyester or nylon 40
Sometimes I feel a lot of pain after walking for a long time, I will use
Soft and smooth fabric 90
my hands to support my belly. (P7, clinic assistant aged 37)
Pressure (too tight) 80
Pressure over breasts 10 This (the belt E) is supportive…to reduce the movement of the belly.
Aesthetics Simple style 70
If the movement is reduced then the burden (over the back) will also
Looks good 80
Fashionable or sporty 30 be reduced. If the burden can be reduced then it will not be so
Fits body well 70 painful…Because I have a support belt so I don’t need to support my
(nice shape, not bulky) belly with my hands…(P10, manager aged 36)
Resembles undergarment 40
Adjustable feature 70
Accessories 30 Safety
Invisible 60
No skin marks 40 Forty per cent of the participants expressed the concern about
Colour 90 the safety issue when wearing the maternity support gar-
Easy to put Simple and convenient 100 ments. Concern for fall was raised because there were two
on and take off to put on and take off garment samples looked difficult to wear due to the non-
stretchability of leg opening of the brief C (Fig. 1c) and the
complicated strapping design of the cradle G respectively
I think the weight of my baby made the low back pain worse…when (Fig. 1g):
my walking and sitting postures are not correct, I sometimes feel the
The lower part of the body is already bulky, this brief (the brief C)
pain…I hope that it (the maternity support garment) can really
will be too tight and too difficult to wear and it is not safe for
support my abdomen well and really relieve my (back) pain after I use
pregnant women to wear...(P3, housewife aged 30)
it (the maternity support garment)... (P3, housewife aged 30)
It (the cradle G) is difficult to wear during the later period of
One participant who has been using the maternity support
pregnancy…it (the cradle G) is inconvenient…I’ll trip (over the
belt (a different style from the garment samples in our study)
straps) and fall! (P1, teacher aged 35)
throughout the current pregnancy felt that the wide band
below abdomen and the belt pressure at low back centre were Another safety concern is that the tightness around the
most useful to relieve the back pain. Another suggested that abdomen was perceived as a factor that may influence the
the level of support would be affected by the band width and foetus’s comfort and growth. Two participants were very
adjustability for suitable tension and fitting: sensitive to avoid any potential adverse effect to the foetus:

The pain level is 5 out of 10 if I am not using the support belt, if I use If it (the abdominal panel) is too tight then I will be concerned about
it, I don’t feel painful if I wear it properly…or I lie down on the bed my baby whether it (the pressure) will affect the baby’s growth. (P2,
and put a cushion over that area (pointing at the lower back centre), nurse aged 34)

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Midwifery and women’s health
If I wear it (the maternity support belt) non-stop for a few
hours, my baby will kick. He will kick me at the part
where the belt is binding the body…the baby feels that
something is pressing against him and he will always kick
me. So I will make him feel comfortable as much as I
can…If he is not comfortable, he will kick me. (P10,
manager aged 36).
Skin comfort
All participants were felt a strong need for skin comfort as
reflected by their concerns for itchiness, skin rash or
infection. These conditions were thought to be caused by
heat and humidity when wearing the maternity support
garments due to the thick and non-breathable materials. They
all preferred cotton fabrics because they felt that it has good
water absorbent and heat transfer properties and is non-
irritating to wear especially in the summer. The garment
made of polyester and nylon was perceived as less breathable
and uncomfortable because it might promote perspiration
and skin rashes. 90% of the participants preferred soft and
smooth fabric as it provides better tactile comfort for their
sensitive skin:
I felt hot wearing it (the maternity support garment) when the
weather became hot and I felt itching with the sweating and the
material is not breathable enough. It is very uncomfortable…it’s like
my body is wrapped by something airtight…all the materials
(pointing to the maternity support garments) are very thick…and it
will cause bacteria to grow because the skin can’t breath…because
it’s easier for pregnant women to have (skin) infection...I must wear
cotton…and it has to be thin…this kind of material (polyes-
ter)…causes infection more easily I think…when you sweat, the
garment will become wet and sticks to the body making you feel
uncomfortable. (P3, housewife aged 30)
I need cotton because I already broke out into a lot of
rash…cotton absorbs sweat and is breathable…I don’t like
material which is elastic because it is not breathable and makes
me itchy…it is better if it (the material) can be softer… the edge is
smooth and won’t make me uncomfortable… (P5, housewife aged
35)
Eighty per cent of the participants felt that the tight-fit
abdominal panel would cause discomfort as the uterus grows.
One even expressed concern about the pressure over the
breasts which might cause discomfort:
This one (pointing to the abdominal panel of the vest H) seems to be
too tight…there seems to be very little stretch…if your belly becomes
bigger, then it (the abdominal panel) will be too tight and
uncomfortable. (P3, housewife aged 30)
 2009 The Authors. Journal compilation  2009 Blackwell Publishing Ltd, Journal of Clinical Nursing, 18, 2426–2435
Garment needs of pregnant women
It (the cradle G) presses the breasts…it’s uncomfortable…the edge of
the strap is sharp and the breasts are pressed down…the edge is too
tight. (P1, teacher aged 35)
Ease to put on and take off
All of the participants preferred the garment to be convenient
to put on and take off because their movement became
cumbersome with the enlarging abdomen:
This (the brief C) one is difficult to wear and the belly gets in the
way…it’s difficult even when I put on underwear…before I am
pregnant, I can just stand and wear it easily, now I have to sit on a
chair first and then put it on slowly…(P3, housewife aged 30)
This (the cradle G) is not very good (pause) I have to lift up my legs
(pause) it’s quite hard for me…it’s quite inconvenient that we need to
put it (the cradle G) on from the bottom. (P6, housewife aged 30)
Aesthetics
Seventy per cent of the participants favoured a simple style
rather than something ‘odd’ with complicated looking like
the cradle G. 80% of them preferred garments that look
good. One participant said that fashionable is the most
important element and two participants thought that sporty
style looks good. Adjustable features were preferred for better
fitting and convenience:
I like the simple style…the seamless style is much better and it is
trendy now…That one (the belt E) is flat should be better…it’s more
smooth under clothing…it’s better to have an adjustable strap to
accommodate all stages of pregnancy! (P5, housewife aged 35)
…this (the brief D) one is not adjustable…it’s not flexible or
convenient…this (the belt E) one is okay as it is adjustable..it should
fit the shape of the belly… (P7, clinic assistant aged 37)
Very strange…it (the cradle G) goes around the waist tightly as well
as the shoulders…it makes you feel that your body is tied up…this
(the cradle G) one is no good…I think this (the vest H) one is better, it
(the vest H) looks like sports wear, yoga clothes…It’s better to look
good and be simple (in style)...fashionable is the most important
element. (P3, housewife aged 30)
Forty per cent of the participants preferred the maternity
support garment to resemble an undergarment. One partic-
ipant pointed out that wearing a maternity support garment
that resembled the panty or vest was convenient because she
did not need to wear two garments as underwear. For the
accessories, the preference varied. Some participants liked
ornaments but others did not because the laces have no
support function and may cause skin irritation:
2431
SSM Ho et al.

The vest looks good, I can wear it (the vest H) instead of wearing Table 2 Functional and aesthetical values of maternity support
underwear…the ribbons and laces add no value and it is noticeable garments
under the outer garment. (P5, housewife aged 35) Functional values Aesthetic values
I don’t like the laces (of the brief B) as I get skin irritation easily. The Provide back pain relief Provide a simple
style is okay yes… I like the shiny material more…I prefer the basic and appealing style
seams than to the lace seams. (P9, clerk aged 29) Provide optimal support Provide favourite
to the abdomen colours
Sixty per cent of the participants liked the garment to be Provide optimal support Provide resemblance
invisible under the outerwear, well-fitted to the body contour to the lower back to an undergarment
and that no pressure marks were left on the skin after Diminish excessive pressure Minimise bulkiness
on the abdomen of garment
removal of garment (40%). The preference of invisibility of
Provide good air circulation Minimise visibility
the garment seemed not only relate to the aesthetic outlook, to the skin of garment
but also with the desire of being viewed as ‘normal’: Diminish moisture on the skin
Diminish irritation on the skin
..it’s not pretty…the crossing over makes it (the belt F) bulky at the Diminish pressure on the skin
back and it (the belt F) will be noticeable…I want a smooth body Facilitate ease in dressing
shape…it (the maternity support garment) should not leave any and undressing
marks on the body. (P4, housewife aged 34) Facilitate convenience
for toileting
The style is okay because it’s (the vest H) just like the underwear,
people won’t notice that you are wearing it (a special garment). (P3,
housewife aged 30) I think that usually the maternity support garments do not look as
nice as the normal underwear…but the function is more important…I
Almost all the participants have commented on the colours
will choose the one that has a better function than the one that has a
and had their own preferences. The most preferred choice
better appearance. (P10, manager aged 36)
was skin colour or light colour for example, white, pale pink
and pale yellow for both aesthetic and practical reasons. The shape (of the cradle G) looks too strange and it’s not
One participant liked white because it feels clean to wear acceptable!…(the interviewer asked the participant that even if the
and it is easier to bleach whereas another participant garment is very useful in relieving back pain, the participant answered
preferred a darker colour because it does not easily get that) it doesn’t look good…I won’t wear it. (P2, nurse aged 34)
soiled:
Close to the completion of the interview, the participants
Skin or pink colour is okay because they will not be shown through were asked to rank the order of precedence when using or
even if I wear thin layered clothing…I think the skin colour is easier buying a maternity support garment. Different women had
for mix-and-match. (P2, nurse aged 34) different opinions (Fig. 2). While 70% of the participants
ranked the function as the first or second priorities, many
White feels clean and it is easier for bleaching and washing. Other
others perceived that ease to put on and take off (100%),
colours cannot be bleached. (P6, housewife aged 30)
comfort (90%), water absorbent and heat transfer properties
The skin colour and black are okay…I prefer the darker colours of the fabric (80%) and non-itchiness (70%) were crucial.
because it won’t get dirty easily. (P10, manager aged 36) When compared to the functional values, aesthetics in terms
of colour and design (20%) became less significant.

Functional and aesthetical needs

Based on the interview data, the expressed values of
maternity support garments could be summarised into
functional and aesthetical aspects (Table 2). Some partici-
pants believed that aesthetics value was secondary when
compared with the functional value of maternity support
garments. However, others commented that unless the pain
was severe enough to require such garments, otherwise they
would prefer tolerating the pain rather than wearing the
medical garment that looks strange:
Discussion
The results confirmed that women’s physiological and psy-
chological changes during pregnancy influenced their clothing
preferences on both functional and aesthetical values. The
principal findings of this study are five main themes of
pregnant women’s needs, concerns and problems when using
maternity support garment. They are effective function,
safety, skin comfort, aesthetic and ease to put on and take
off. The findings were largely consistent with previous studies

2432  2009 The Authors. Journal compilation  2009 Blackwell Publishing Ltd, Journal of Clinical Nursing, 18, 2426–2435
Midwifery and women’s health Garment needs of pregnant women

healthcare professionals in providing evidence-based advice

Percentage (%) of participants

120 5th rank

4th rank to assist patients in making well informed treatment decisions
100 3rd rank
2nd rank
to improve the quality of care.
80 1st rank

60
Effective function
40
Perceived effectiveness in the pain relief and support function
20
of maternity support garment largely affected the decision
0 making process of the participants in this study in buying
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commercially-available maternity support belt, only a small

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percentage (30%) of the participants in this study were

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compliant to the garment therapy as they reported some

M

Garment characteristics
Figure 2 Participants’ responses in ranking the order of precedence
when using or buying maternity support garments.
examining medical garments for overall satisfaction and
compliance (Johnson et al. 1994, Myers et al. 1995, O’Hare
1997, Williams et al. 1998).
A notable finding is that all participants who have used
the maternity support garment for the relief of LBP were
self-prescribed instead of seeking advice from healthcare
professionals. This practice is congruent with self-care
behaviour in response to musculoskeletal pain and its
interference on the performance of daily activities
(Dannecker et al. 2008). Since over-the-counter analgesics
are contraindicated during pregnancy and pregnant women
are wary of taking even recommended medications (Carr
2003), the maternity support garment is a convenient and
easily accessible alternative.
The factors that had the largest influence over the decision
to use maternity support garments were advice from friends,
relatives and maternity fashion store personnel. Evans et al.
(2007) reported similar findings that as a result of lack of
complementary and alternative medicine information from
health professionals, patients acquired ‘alternative’ informa-
tion sources and treatment options through the network of
trusted family, friends and acquaintances. It implies that
healthcare professionals should play a role in guiding patients
to make better informed choices.
Relevance of clinical practice
The five main themes of garment needs are relevant to the
clinical practice in that these recommendations will facilitate
perceived benefit from the treatment. It raises the concern
whether this perceived benefit is a placebo effect or it has
genuine therapeutic value, which needs to be investigated in
future studies.
Safety
Some participants expressed their concern for the restric-
tiveness of the abdominal panel with the perception that
the tension may be harmful as it elicited increased ‘kicking’
movements from the foetus. The concern for safety may
reflect pregnant women’s anxiety and fear regarding
their own health and their babies (Colman & Colman
1990). It is important that pregnant women have compa-
rable information about risks and benefits of the treatment
options to weigh. With advice from the healthcare profes-
sionals, they can make appropriate treatment decisions
suitable for their individual needs. Future studies into any
adverse effects in the use maternity support garments are
necessary.
Skin comfort
The compliance of therapy was usually affected by skin
discomfort due to excessive heat, itchiness, excessive pressure
and inconvenience of adjustment. The greater need of
pregnant women for skin comfort can be explained by their
physiological changes during pregnancy including excessive
perspiration, elevated body temperature and increased skin
sensitivity (Cherry & Moss 2004). The fabric played a very
important role in maternity support garments not only to
promote skin comfort. Ho et al. (2008b), using objective
fabric tests, found that the fibre contents and breathability of

 2009 The Authors. Journal compilation  2009 Blackwell Publishing Ltd, Journal of Clinical Nursing, 18, 2426–2435 2433
SSM Ho et al.
material including porosity and thickness were the major
determinants for thermophysiological comfort. In the same
study, the pregnant women also preferred soft, smooth and
breathable cotton fabrics.
Ease to put on and take off
Most of the participants preferred a simple and convenient
ergonomic design that facilitates dressing and undressing and
for toilet use as pregnant women experience frequency of
urine particularly during the first and the third trimesters. It is
plausible as pregnant women experience movement limita-
tions and postural imbalance (Gilleard et al. 2002), which
affects the daily activities such as getting dressed and
undressed (Nicholls & Grieve 1992). Complicated garment
application that requires forward bending and balancing not
only imposes the risk of fall but also was perceived as difficult
to wear. Future study on the motion analysis of pregnant
women in using maternity support garments will provide
more in-depth knowledge about the biomechanics of how the
garment supports the body and facilities the wearer’s daily
activities.
Aesthetics
Many participants desired for aesthetic appearance when
wearing the maternity support garment whereas some
participants had less concern since the garment is covered
by the outerwear. This was reflected by their preference in
garment attributes including ‘looks good’ and fashionable,
invisibility of garment, well-fitted and favourite colours.
Previous studies also found that the style that ‘look good’ was
important to pregnant women (Chan 2000, Johnson et al.
2004) and that the maternity support garment that appeared
odd, ‘medical-looking’ and old fashioned was disliked (Yu &
Wong 2001, Johnson et al. 2004).
The strong desire for aesthetic appearance in clothing
among some pregnant women may be partly explained by the
women’s negative attitudes towards the images of their
bodies as they experience dramatic changes in the body
weight and shape during pregnancy. Some women used
negative terminology to describe their pregnant bodies as ‘fat’
‘ugly’, ‘frumpy’, ‘bloated’, ‘weird’ and referred to being less
attractive (Johnson et al. 2004). Recent studies found that
clothing may play a role in the enhancement of self concept
(Sweeney & Zionts 1989) and that women who were more
dissatisfied with their bodies were more likely to engage in
clothing-related appearance-management behaviours such as
wearing apparel to camouflage their bodies and avoiding
revealing (Trautmann et al. 2007). An interesting finding is
2434  2009 The Authors. Journal compilation  2009 Blackwell Publishing Ltd, Journal of Clinical Nursing, 18, 2426–2435
that some pregnant women seem to exhibit similar behaviour
to help in boosting their self-images which needs to be
confirmed in future studies.
Functional and aesthetical needs
Consistent with previous studies, the function of therapeutic
garment is perceived as one of the primary factors that
influences women in using or purchasing maternity support
garment (Myers et al. 1995, Chan 2000, Yu & Wong 2001).
Other functional values such as convenient for putting on and
taking off and providing skin comfort with non-itchy,
breathable and moisture absorbent materials are the key
factors that affect the compliance of wearing maternity
support garment. For some individual preferences, the
availability of colours and aesthetic design will also be of
importance.
Conclusion
This study identified the needs, concerns and problems in
the use of maternity support garment. Five main themes of
specific ergonomic needs were found by in-depth interviews
with pregnant women. They include the effectiveness of
function, safety, skin comfort, ease to put on and take off
and aesthetics of the garment. The implications for practice
are that nurses need to be aware of their patients’ needs in
using maternity support garments in the management of
LBP during pregnancy and to provide evidence-based
advice to their patients enabling them to make an informed
choice when selecting an optimal and appropriate mater-
nity support garment. Also, a better understanding in the
desirable features and the problems associated with mater-
nity support garments can help researchers and clinicians
deal with compliance issues of therapeutic garments. This
study was limited to the interviews of a small sample of
Asian women. New directions for future research on fabric
mechanics, biomechanics and body image are recom-
mended.
Acknowledgement
The funding from the Competitive Earmarked Research
Grant BQ779 during preparation of this paper is gratefully
acknowledged.
Contributions
Study design: SH, WY, JC; data collection and analysis: SH
and manuscript preparation: SH, WY, TL, DC, JC, YL.
Midwifery and women’s health
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