1. Tailoring a Birth Plan for Women who have Experienced a Traumatic Birth Shaare Zedek Medical Center Jerusalem 1 Judith Kidouchim CNM, BA Pnina Mor –CNM PhD

2. Birth Plan Goals Prevent a second traumatic experience Prevent a second traumatic experience Prevent recurrence of the previous birth’s traumatic experience Prevent recurrence of the previous birth’s traumatic experience Strive for a remedial experience Strive for a remedial experience Achieve Empowerment Achieve Empowerment Coordinate expectations Coordinate expectations Forestall differences or misunderstandings Forestall differences or misunderstandings Give the Parturient the feeling of self control Give the Parturient the feeling of self control Avoid non-professional birth plans Avoid non-professional birth plans 2

3. Shaare Zedek Tailored a Birth Plan based on a Debriefing Project

4. Definition: A debriefing is a one-time, semi-structured conversation with an individual who has just experienced a stressful or traumatic event. A debriefing is a one-time, semi-structured conversation with an individual who has just experienced a stressful or traumatic event.traumatic eventtraumatic event The purpose of debriefing is to reduce any possibility of psychological harm by allowing them to talk about their experience The purpose of debriefing is to reduce any possibility of psychological harm by allowing them to talk about their experience Debriefing

5. The Birth Plan is Based on a Debriefing Project The technique of debriefing is useful for women following a traumatic birth experience Debriefing gives the woman the opportunity to reflect on her traumatic experience 5

6. The Debriefing Project Goals Enable the woman to organize her thoughts Enable the woman to organize her thoughts Legitimate and Normalize the woman thoughts and feelings Legitimate and Normalize the woman thoughts and feelings Give Answers to unsolved Questions Give Answers to unsolved Questions Fill in the “Empty Spaces” in her experience Fill in the “Empty Spaces” in her experience Recommend for further help (Social worker, Psychologist…) Recommend for further help (Social worker, Psychologist…) Avoid P.T.S.D. Avoid P.T.S.D. Focus on the most important problems to tailor the Birth Plan 6

7. The Debriefing Project Time & Place 24 - 48 hours after birth 24 - 48 hours after birth Next to the woman’s bed in the Maternity Department Next to the woman’s bed in the Maternity Department 7

8. The Debriefing Project Principles Medical Confidentiality Medical Confidentiality Active Listening Active Listening As less intervention as possible As less intervention as possible Express Empathy to the woman Express Empathy to the woman Give her a feeling of Confidence Give her a feeling of Confidence Give a total Freedom of Expression Give a total Freedom of Expression 8

9. The Debriefing Project Steps 1. Itemize the details of the experience (without emotions) 2. Express viewpoint associated with each item 3. Discuss alternative options 4. Discuss what helped her during the Labor 5. Summarize the debriefing session 6. Obtain contact information 7. Follow up 9

10. The Shaare Zedek Debriefing Project Project Staff: 4 midwives Project Staff: 4 midwives Interviewees: 100 postpartum women Interviewees: 100 postpartum women Referrals by other midwives: Referrals by other midwives: 1. When subjective distress was sensed 2. When there was an objective obstetric or neonatal cause 10

11. The Debriefing Project Results 11 100 Women Interviewed 100 Women Interviewed From July 2011 to February 2013 From July 2011 to February 2013 Monthly average Interviews: 5 women Monthly average Interviews: 5 women

12. The Debriefing Project Results 12 Delivery type Distribution of the Interviewees Delivery type Distribution of the Interviewees 1. Cesarean Section 29% 2. Vacuum delivery 25% 3. First normal vaginal delivery 23% 4. Second and above normal V. delivery21% 5. Normal Delivery outside the Hospital2% Causes Distribution Causes Distribution 1. Objective, Obstetric or Neonatal causes59% 2. Subjective Distress was sensed41%

13. The Debriefing Project Results 13 Reaction to the debriefing proposal: Reaction to the debriefing proposal: –68 women were very pleased with the opportunity to “tell their story” –26 were interested in the debriefing process and agreed to participate –6 initially evaded discussing their traumatic experience, but ultimately participated.

14. The Debriefing Project Results Itemize the details of the experience 95 women were very focused & itemized the facts in chronological order

15. Disappointment Helplessness Fear Anger Stress Guilt feelings Dependency Empowerment The Debriefing Project Results

16. 16 What should be improved for a better What should be improved for a better experience? experience? –Additional Staff Responsivity –Detailed Explanations –Communication: Technical issues related to the delivery room –Better Pain options What Helped her during the Labor? –Midwifery care –Emotional support

17. Summary of the Debriefing Session 17 Acknowledgement Essentiality Gratitude Referral Empathy/Understanding Midwife Interviewee

18. The Debriefing Project Follow-up 18 The follow-up was done several months later. The follow-up was done several months later. Reactions: (73 were reached): Reactions: (73 were reached): –Happy to hear the debriefing midwife calling  feeling of concern –Retold the details of their experience –Satisfaction and thankfulness –Few expressed negative feelings –Few asked for more explanations

19. Lessons Learned from the Debriefing Experience 19 The need for: The need for: –Thorough account of the labor experience –Opportunity to “talk” –Positive reinforcement

20.  Tailor an Individual Birth Plan 20 Personalize the Birth Plan according to the specific needs and experience. Personalize the Birth Plan according to the specific needs and experience. Discuss Discuss –The delivery room settings (dimmed lights, music etc.) –Pain relief options –Delivery positions –Medical requirements Help the woman to realize her dream Help the woman to realize her dream Document personalized birth plan with a copy for the staff Document personalized birth plan with a copy for the staff

21. 21 Thank You Acknowledgements: Prof A. Samueloff Chairman of Obstetrics & Maternal Medicine SZMC Hava Chacham Head Nurse Labor & Delivery Department SZMC Gali Weiss Deputy Director General, Head Nurse SZMC Midwifery Staff Labor & Delivery Department SZMC