{"id":50118,"date":"2021-04-22T15:52:16","date_gmt":"2021-04-22T14:52:16","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=50118"},"modified":"2021-05-06T12:51:59","modified_gmt":"2021-05-06T11:51:59","slug":"humanising-obstetric-care-in-operating-theatres","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2021\/04\/22\/humanising-obstetric-care-in-operating-theatres\/","title":{"rendered":"Humanising obstetric care in operating theatres"},"content":{"rendered":"

Around four out of ten pregnant women in the UK give birth in the operating theatre. Few are prepared for delivery in this forbidding, high tech environment and the experience can be traumatic. Emma Evans, consultant anaesthetist<\/span>, <\/b>and <\/span>Monika Kupper, member of the St George\u2019s Hospital Maternity Voices Partnership, describe “New Beginnings,” a co-designed initiative to humanise obstetric care in operating theatres.<\/span><\/em><\/p>\n

\"\"<\/a>Emma Evans: consultant anaesthetist\u00a0<\/b><\/p>\n

Repeated conversations with women who described being fearful about being disconnected from their anticipated birth plan, and facing delivery in an operating theatre environment with (perceived) rigid staff hierarchies, raised my awareness of how stressful this is for some patients. It prompted me to think about ways to improve the environment informed by the experience of women and staff with knowledge of maternity care in this setting.<\/span><\/p>\n

In preparation, I attended a course on experience based co-design (EBCD) run by The Point of Care Foundation (PoCF), founded by Glenn Roberts, creator of the EBCD toolkit. It was an eye opener into how patient stories can change the perspective of clinical staff, reignite passion for their work, and motivate them to make sensible patient centred changes.<\/span><\/p>\n

It was clear that a formal initiative needed an inter-professional working group. I therefore approached colleagues with experience of implementing quality improvement initiatives, and members of the theatre staff, and used various informal and formal staff forums to invite discussion. I also worked with our Maternity Voices Partnership (MVP) to get patient input.\u00a0<\/span><\/p>\n

The initiative was launched in February 2018 and ran formally until September 2019. We broadly followed the EBCD toolkit. Funding was obtained for an introduction to EBCD methodology and mentoring by PoCF trainers. Discussions and one to one interviews with 27 medical, nursing, and midwifery colleagues and 15 patients were conducted in varied locations including offices, theatres, coffee rooms and homes, and then thematically analysed to inform joint events where key co-design themes were identified Once changes had been agreed on, sign off was obtained from the Trust Executive team.\u00a0<\/span><\/p>\n

Light bulb moments<\/b>\u00a0<\/b><\/p>\n

Practical sessions putting staff in women\u2019s shoes by lying on operating tables or being positioned in stirrups, enabled them to see their daily working environment through patients eyes, and see their professional role in a different light. This motivated them to engage in change. Pairing peer staff interviewees also reduced anxiety around expressing opinions and showing filmed patient interviews to clinical staff during quiet shifts broadened staff engagement.\u00a0<\/span><\/p>\n

NHS Horizons \u201cSchool for Change\u201d programme, proved a lever for change too. The school offers anyone who works in healthcare, at whatever level, clinical or non-clinical, the opportunity to take their desire to see change happen and make it a reality. The programme\u2019s emphasis on behaviours and moving forward despite uncertainty really enabled me to see how the iterative process and failing fast was a strength.\u00a0<\/span><\/p>\n

\"\"<\/a>Monika Kupper: patient advocate and co-chair<\/b> of the Maternity Voices Partnership<\/b><\/p>\n

A Maternity Voices Partnership (MVP) is an NHS working group of women, birthing people and their families, commissioners, and maternity service staff collaborating to review and develop local maternity care. It is led by an independent lay chair to ensure service users are well represented.<\/span><\/p>\n

I have been involved with the MVP since the birth of my second daughter and I was keen to support Emma as I knew from experience how daunting theatre birth can be and that nothing would change unless we worked on this together.\u00a0<\/span><\/p>\n

I am a documentary film maker and my main role in “New Beginnings” was to advise on how to edit the filmed interviews. Transcription of films and subsequent editing is labour intensive (and consumed much of the projects grant money) but eye witness accounts, and people\u2019s stories, which can be emotive and almost overwhelming to watch, are a good way to change hearts and minds. We agreed it was important to showcase how some women are emotionally scarred\u201d by their experience.\u00a0<\/span><\/p>\n

One mentioned the humiliation of walking half dressed into the operating room and then being asked to take off her pants in front of everyone and having to hand them to her husband. \u201cWhat little dignity I had left, went out the window,\u2019 she said. \u2018My husband had post traumatic stress disorder as a result of this experience and couldn\u2019t watch anything to do with hospitals on TV for months afterwards.\u201d\u00a0<\/span><\/p>\n

Watching these interviews made it evident how small inexpensive changes to the environment could make a huge difference<\/span><\/p>\n

Challenges<\/b><\/p>\n

Data protection (GDPR) regulations restrictions precluded using a patient database so we had to recruit our patient participants via clinics and social media sites. As a result we were not able to get a truly representational input from the full spectrum of our ethnically diverse patient population. The social networks that <\/span>the MVP use are mainly self selecting by geography and language. In future projects the midwifery teams who have the most contact with parents should be actively involved in recruitment.<\/span><\/p>\n

Key changes instigated:<\/b><\/p>\n

Improving antenatal information about operative birth<\/i><\/b><\/p>\n