Study currently being undertaken (with interim findings submitted to BMJ) shows screening for PTSD symptoms 6-8 weeks postnatally identifies significant number of women. PTSD is associated with severe maternal morbidity but if these women felt in control throughout the rate is more similar to those experiencing normal birth and healthy baby
14 statement altogether, these are editedNB not just for maternity so this applies to women who may be seriously ill elsewhere in care
All good except last – needs addressing before 2013 survey carried out1!
What women and midwives want 26 february 2013
What women and midwives want Our lives and future in your hands Belinda Phipps NCT
“It ranks as number 1 in my great moments”“The way a woman gives birth can affect thewhole of the rest of her life - how can that not matter - unless the woman herself doesn‟t matter”
“It‟s something you never forget and it does mark a huge transition in your life” “Incredibly important” “Nothing can compare to the experience ofgiving birth and holding your child for the firsttime. It definitely altered my relationship with my partner - for the better”
“Life changing - more meaningful than all other experiences”“Birth experiences strike at the very heart and soul of you, they touch new emotions not experienced before and bring a whole new perspective to life”
The Potential of Birth• Empowering• Affirming• Identity changing• Courage giving• Advocate creating• Healing
Post-traumatic stress disorder• „feeling in control during the labour and delivery and knowing what to expect were important protective factors against the development of PTSD‟ (Lyon, 1998)• Czarnocka and Slade (2000) found that „women with symptoms of PTSD were more likely to feel that they had little control during the labour, to have higher ratings of trait anxiety, and greater fear during the labour‟
Safety is …• A midwife you know and trust• An NHS you trust• Being listened to and taken seriously• Good teamwork• Feeling consulted and involved and supported to decide• Affirmation• Explanation• A comfortable and comforting and clean place to be• Being and feeling cared about and cared for• Confidence you can cope
Safety is not…• Being left alone in labour or other times when frightened• Being told off or threatened• Professionals arguing with each other and contradicting each other• Being told your baby will die unless..• Being unable to ask any question you want without feeling silly
The ‘patient experience’• 1. Patients are treated with dignity, kindness, compassion, courtesy, respect, understanding and honesty.• 2. … staff …have demonstrated competency in communication skills.• 6. Patients are actively involved in shared decision making and supported to make fully informed choices about investigations, treatment and care• 7. Patients are made aware that they have the right to choose, accept or decline treatment and these decisions are respected and supported.• 11. Patients experience continuity of care delivered, whenever possible, by the same healthcare professional or team throughout an episode of care.• 12. Patients experience co-ordinated care with clear and accurate information exchange between relevant health … professionals.• 14. Patients are made aware of who to contact, how to contact them and when to make contact about their ongoing healthcare needs.NICE guideline QS15. Quality standard for patient experience in adult NHS services. NICE 2012.
Care Quality Commission Maternity Survey 2007/2010Question 2007 2010Women who got the pain relief they wanted 64% 65%Women with confidence and trust in the staff caring for them 68% 73%Women whose birth partner was made welcome by the staff? (not asked) 84%Women left alone by midwives or doctors at a time when it worried them? 26% 22%Women who were spoken to in a way they could understand during 82% 84%labourWomen involved in decisions about their care during labour? 70% 71%Women with legs in stirrups at the birth 27% 30%
Fulfilment is …• A midwife you know and trust• An NHS you trust• Being listened to and taken seriously• Good teamwork• Feeling consulted and involved and supported to decide• Affirmation• Explanation• A comfortable and comforting and clean place to be• Being and feeling cared about and cared for• Confidence you can cope
Fulfilment is not…• Being left alone in labour or other times when frightened• Being told off or threatened• Professionals arguing with each other and contradicting each other• Being told your baby will die unless..• Being unable to ask any question you want without feeling silly
In order to have this I must do this need action safety A Main stream In order to have this CONFLICTaim To be a good parent B In order to have this I must do this fulfilment Less common A need action
Midwifery 2020“Women and their partners want a safe transition toparenthood and they want the experience to be positiveand life enhancing. Quality maternity services should bedefined by the ability to do both.”“Midwives should have a visible place in a community setting where women can choose to access them as the firstpoint of contact.”“There are two key roles for midwives that are important if we are to achieve our vision: one is that midwives arethe lead professional for women with no complications, and the other is as the coordinator of care for allwomen.”“Each woman and her partner need a midwife they know and trust to coordinate their physical and emotional carethrough pregnancy and until the end of the postnatal period.”
In order to have this I must do this need action Provide high A Focus on one quality care person In order to have thisaim Provide the best care for B everyone In order to have this I must do this Provide some care to many Spend some people time with A everyone need action
She came to me and calmly said we were justgoing to chill out together, she asked why I wasscared of hospitals and was the only person whoactually listened to my fears. She actually saidvery little but her whole presence spokevolumes, if that makes sense?. She advocatedfor me and truly.