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

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

Shaare Zedek Tailored a Birth Plan based on a Debriefing Project

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

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

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

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

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

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

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

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

The Debriefing Project Results Delivery type Distribution of the Interviewees Cesarean Section 29% Vacuum delivery 25% 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%

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.

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

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

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

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

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

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

 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

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