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

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

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

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

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

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

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

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

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

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

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

12. The Debriefing Project Results
Delivery type Distribution of the Interviewees
Cesarean Section %
Vacuum delivery %
First normal vaginal delivery 23%
Second and above normal V. delivery 21%
Normal Delivery outside the Hospital 2%
Causes Distribution
Objective, Obstetric or Neonatal causes 59%
Subjective Distress was sensed 41%

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

16. The Debriefing Project Results
What should be improved for a better
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
Acknowledgement
Essentiality
Gratitude
Referral
Empathy/Understanding
Midwife
Interviewee

18. The Debriefing Project Follow-up
The follow-up was done several months later.
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
The need for:
Thorough account of the labor experience
Opportunity to “talk”
Positive reinforcement

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

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
Thank You