Providence Nursing Institute Clinical Academy 2016.06 Providence Clinical Academy Providence Nursing Institute Clinical Academy Perinatal Curriculum Last Reviewed 2016.06

What has your experience been with c/s patients? 2016.06 Providence Clinical Academy What has your experience been with c/s patients? Pain management: What do you know about pain management specific to cesarean section recovery? What gaps do you still have? Unexpected C/S: What have your experiences been caring for families who experience an unexpected C/S? What do you say? How do families process? What influences these processes? How well do they understand what happened? Does their interpretation match the RN/LIP reports? Maternal point of view/coping? Father of the baby – point of view/coping? Response from family and friends? Have you found yourself doing different or the same postpartum care?

Post-traumatic stress disorder 2016.06 Providence Clinical Academy Post-traumatic stress disorder Approximately 1-6% of women experience post-traumatic stress disorder (PTSD) following childbirth Symptoms may include: Intrusive re-experiencing including flashbacks or nightmares Avoidance of stimuli Persistent increased arousal Anxiety and panic attacks Feeling a sense of unreality and detachment Feelings of fear, grief and depression Physical response General information on PTSD From the CDC: http://www.cdc.gov/masstrauma/factsheets/public/coping.pdf Avoidance of stimuli associated with the event, including thoughts, feelings, people, places and details of the event Persistent increased arousal (irritability, difficulty sleeping, hypervigilance, exaggerated startle response) Physical Response: nausea, vomiting, dizziness etc. http://www.cdc.gov/masstrauma/factsheets/public/coping.pd

Providence Clinical Academy 2016.06 Providence Clinical Academy How they might see it… Next few slides depict artwork created by women coping with their C/S experience Warning to look away if they may be disturbed by images

Providence Clinical Academy 2016.06 Providence Clinical Academy http://themandalajourney.com/author/amybirthingbody/page/7/ Artwork: “First Kiss” http://themandalajourney.com/author/amybirthingbody/page/7/

Providence Clinical Academy 2016.06 Providence Clinical Academy “Small Talk” “a picture about the meaningless smalltalk that was held in the operation room-wether or not the yellow tape around the trees near the hospital mean that they will be cut down or not.” https://cesareanart.wordpress.com/ https://cesareanart.wordpress.com/

Providence Clinical Academy 2016.06 Providence Clinical Academy “Spinal Anesthesia” https://cesareanart.wordpress.com/ https://cesareanart.wordpress.com/

Providence Clinical Academy 2016.06 Providence Clinical Academy “Smile, you have a healthy baby” https://cesareanart.wordpress.com/ Searching the internet for women’s experiences with C/S, there seems to be a lot of talk about how the medical community can sometimes make women feel like nothing else should matter except that they ended up with a healthy baby. https://cesareanart.wordpress.com/

Providence Clinical Academy 2016.06 Providence Clinical Academy http://spiriteddoula.blogspot.com/2010/04/healing-from-traumatic-birth.html http://spiriteddoula.blogspot.com/2010/04/healing-from-traumatic-birth.html

Providence Clinical Academy 2016.06 Providence Clinical Academy http://spiriteddoula.blogspot.com/2010/04/healing-from-traumatic-birth.html http://spiriteddoula.blogspot.com/2010/04/healing-from-traumatic-birth.html

Providence Clinical Academy 2016.06 Providence Clinical Academy “The deed is done” https://cesareanart.wordpress.com/ https://cesareanart.wordpress.com/

Providence Clinical Academy 2016.06 Providence Clinical Academy http://themandalajourney.com/author/amybirthingbody/page/7/ Artwork: entitled “Incision” “I thought and I thought for several days about how I could put into image form how I felt about my personal birth experiences. I didn’t think I could give it justice because there is just so many aspects that deserve attention in the process of this kind of birth. Courage is definitely one. Pain. Blood. Cutting… Fear. Love. And so on… I stayed with it and eventually “Incision” seemed to almost complete itself.” http://themandalajourney.com/author/amybirthingbody/page/7/

Providence Clinical Academy 2016.06 Providence Clinical Academy Positive

Providence Clinical Academy 2016.06 Providence Clinical Academy How can you help? What do we do with the knowledge that C/S can affect women and families in such various ways? What shouldn’t you say? What can you say? Resources http://pattch.org Group conversation What shouldn’t you say? I had a c/s and it was fine/great/awesome – don’t assume your experience will be someone else’s At least you have a healthy baby OR the only thing that matters is healthy baby/healthy mom Why aren’t you happy your baby is here? What can you say? How are you feeling? What can I do to help? Your feelings are valid

Providence Clinical Academy 2016.06 Providence Clinical Academy Unexpected C/S Talk through the experience and offer clarification Validate how they feel Revisit their birth plan Give choices/control when possible Early and sustained contact with the newborn Maternal pain management Maintain presence of support person(s) Continuity of caregivers How can we facilitate coping and attachment? Validate how they feel Avoid “talking them out of” what they think they experienced. Offer an empathetic ear; sometimes sitting and listening is all people need Revisit their birth plan Point out what went according to plan Coordinate their PP experience to incorporate whatever remains on their birth plan Examples: Skin to skin, breastfeeding, providing newborn care Maternal pain management: Mom’s recovery from major surgery need their pain controlled in such a way that they can be alert and participate in newborn care and education Allowing support person’s to stays with the couplet and continuity of caregivers have both been well documented in the research to reduce anxiety and improve patient satisfaction scores (Perinatal Nursing, 4th ed, page 421)