Monday, February 11, 2013

Communication, pregnancy & labour - women

The way we communicate with women:

I was saddened today by again listening to a woman retell her traumatic first birth from two years ago: it is really disheartening that our health system is letting these women down by not providing the right care. Something really needs to change about the culture and language used within maternity services and the paternalistic attitudes of our midwives and obstetricians; It really is all in the way that messages are communicated to the women:
I am sure we all have a story to share, I recently experienced this first hand as an observer: the woman attends hospital and is 6cm dilated on arrival, she requests an epidural. 

Doctor “I want to do a vaginal examination first
Woman “I really want the epidural first, then you can do an internal examination”
Doctor “I must do a vaginal examination first, now, you might be fully dilated
Woman “I don’t care I want an epidural now please
Doctor “but don’t you understand it is important for me to do one now
Woman’s husband in a cross tone “did you not hear my wife she wants an epidural first then you can do your examination”
Doctor “alright then I will call the anesthetist but he may not come for an hour or so”

This process had already taken an hour; this woman did not get her epidural for an hour and a half.
After a long labour, now fully dilated and a failed vacuum it was determined by the doctor that a caesarean section was required. There was no fetal distress – he had called another more senior obstetrician for trial forceps in theatre.  When the senior obstetrician arrived the woman was upset, she had worked damn hard, she was tired now crying and when the obstetrician introduced himself to her, she looked at him and pleaded..she said ....

Please try everything before having to do a caesarean section; it really is the last thing I want’. 

The doctors response was “I will do whatever I need to do, that will be best for the baby, and if that means a caesarean section, well, so be it”. He then went on to say “ a friend of mine did a small research study on women who are fully dilated after failed vacuum and the outcome is much better for the baby if you go straight to c/section’. ‘Now let’s get on with this to theatre now’.

The woman and husband were shattered on so many levels; they surrendered to what was to come:

My point is not whether the woman required a caesarean section or not, it was the manner in which the obstetrician had spoken to her.  There was no explanation, no informed choice, there was no empathy, and there was no consideration for what she was feeling, it was pure unadulterated power pure and simple. 
The obstetrician could have said “I am so sorry that this has been such a long hard journey; I will do my best to assist you, however I must let you know that a caesarean section is quite possibly on the cards, but I will assess the situation in theatre and keep you fully informed, explaining the situation to you and we can make the decision when I know the full picture”.

More consideration is needed when communicating with women that enables informed decision making – clear explanations as to the clinical picture therefore empowering women and their partners: More often than not when the clinical picture is spelt out in clear simple language, women will do what is necessary because they understand the situation and they are making the decision.

As health professionals we need to constantly think about the way we communicate with women.... think about the language you use, don’t be paternalistic be empowering – give an accurate explanation of the clinical picture and accept the decision that is given, not the one you want:
Remember the old saying ‘you get more flies with honey than vinegar’ – so true

1 comment:

daphne said...

this is exactly what happens in the everyday life for the pregnant women, they need to be handled and spoken to carefully, especially in times like this. anyways, check out this unn website,

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