Effective Communication in Obstetric Emergencies - Essay Example

?Running Head:  Effective Communication in Obstetric Emergencies Effective Communication in Obstetric Emergencies [Institute’s TABLE OF CONTENTS TABLE OF CONTENTS 2 Introduction 3 Role of Midwife in Obstetric Emergencies as an Effective Communicator 4 Lack of Effective Communication in Obstetric Emergencies 5 Issues Preventing Effective Communication 5 Post Traumatic Stress Disorder on Women in Childbirth 7 Consensus of Post Partum Hemorrhage in Obstetric Emergencies 7 Debriefing of Post partum during and after the Delivery 9 Proposition for Midwives for Best Practices in Emergencies Care 10 Conclusion 10 References 11 Introduction Maternal deaths are an important factor in the lack of communications due to obstetric complications. The failure to operate and seek effective healthcare, receiving the appropriate medical and life seeking interventions can lead to unwanted maternal and childbirth deaths. The reduced mortality rate indicates that skilled and proficient midwifes and nurses can assist in childbirth especially caesarian section. The incompetent midwifery and lack of awareness can also contribute to the inadequate maternal facilities to the mother and the baby (Aljunid & Zwi, pp. 426-36, 1996). In many countries, specifically the Middle East and South Asian countries like India, Nepal, and Srilanka have low mortality rate that contributes to women preferring to give deliver in private or home by unofficial nurses or midwifery. The lack of awareness and proper maternal education can even result in serious healthcare problems to the mother and the child (Walsh, pp. 1-5, 2001). The intensive prenatal care facilitation in obstetric emergencies is highly regulated factor and there should be specific paramedical facilities available to manage such interventions such as forced or unwanted abortions complications, prolonged labor deliver, blood transfusion, and cesarean section. According to the estimates, 585,000 women die due to lack of effective communication by the skilled attendants and midwifery in pregnancy and labor complications (WHO, pp. 20-42, 1996). The functional referral system of transporting midwifery services across the rural areas for stabilizing the obstetric emergencies and early diagnosis of complication in labor or pregnancies can resolve the mortality issues (O'Driscoll, pp. 39-41, 1994). The training of traditional birth attendants (TBAs) and midwives can effectively contribute to the immense action in the state of emergency as professional health armors to the delivering woman (Foord, pp. 10-29, 1995). Role of Midwife in Obstetric Emergencies as an Effective Communicator A person who has specific training and skills to work with the paramedical staff in obstetric emergencies during pregnancy and labor is termed as midwife. They have responsibility to provide utmost care to the newborn infants and detection of complications in case of emergent labor, eradicate the barrier in communication between the patient and the medical staff, and educate the mother for any preventive measures in case of any complications (ICM, pp. 56-79, 2005). The midwifery is a significant key player in reducing the risk of maternal death and immediate postpartum period. The appropriate facilitation of midwifery education and training, referral system, and positive support system to maternity care have regulated the expertise areas of midwifery profession in effective and immediate actions during the labor and pregnancy emergencies (Hogan et al., pp. 1609-23, 2010). The striking death toll for maternal death is due to in effective life saving techniques particularly in hemorrhage, obstructed labor, unsafe caesarian section, and abortions. The skilled midwives can provide utmost diligent care in the absence of a medical practitioner particularly in rural areas or private births. It could also accommodate to sufficient medical environmental care to the mother and the baby before and after the labor (Ronsmans & Graham, pp. 1189-1200, 2006). The literature revealed that lack of anesthesia training among the nurses and midwives could lead to discomfort communication in the labor and delivery as they spend hours with the patient in the labor. The in appropriate decision making in patient’s care and medical interventions during the obstetric emergencies is also a key portion that needs to be take in hand and developed to reduce the faulty labor as it results in misunderstanding and unsafe delivery collaborations (WHO, pp. 40-51, 2005). Lack of Effective Communication in Obstetric Emergencies The communication barrier is a dangerous feature of increase in maternal mortality rate and by ensuring effective management and delivery care by skilled midwives and attendants, the obstetric emergencies can be dealt swiftly and accurately saving lives of million over the globe. A trained midwife or proficient health practitioner should be locomotive by referral system and attend the patient in time and should be aware for any complication in the labor and post partum period. The referral system in such emergencies can reduce the barrier of communication in complications such as hemorrhage and obstructed labor. The midwife should be able to recognize and act immediately to any dangerous or trouble sign in labor. The transportation to remote areas and especially rural should be accommodated immediately as many births complications arises due to lack of swift transportation to the hospitals. The families and the immediate caretaker of the patient should be educated and aware of any consequences due to lack of care in delivery and should provoke to act immediate in order to save life incase of delay of Para maternal staff emergencies (Hofberg et al., pp. 83-85, 2000). Issues Preventing Effective Communication The important issues that brings lapse in the steady flow of communication between the patient and the midwives are discussed as follows: 1. Disruptive Interpersonal Skills: A therapeutic relationship should exist between the midwife and the patient for an effective and steady flow of communication eradicating all the barriers. Appropriate speaking and listening skills are desired by using the correct words to address any serious or minor issue to the patient and also making them understand the importance of the sanctity of the issue and timings (McKay- Moffat, 2003). It has been noted that sometimes the misinterpretation of the information by the family to the mater can also cause severe traumatic stress and lack of privacy to the mother (Iqbal, 2004). 2. Time Constraint Management: Another important issue is the time constraint in and out of labour and during the delivery saga. Most important time constraints occurs while seeking a delay in maternal care, receiving the right and appropriate care for any pregnancy complexities and lack of transportation to reach the maternity care or hospitals. The midwives and nurses are prone to communicate effectively during this time with the mother and also making her relief from stress at that vital moment. 3. Fear of losing: The fear of loosing in the mother is a high degree alert during the labour and it is also followed by post traumatic stress disorder, which also sometimes affects the relationship of mother with the baby in future. The depression and stress also adds to the fear of loosing the baby and gives more signalling effect due to ineffective communication with the midwife or nurse. There are signs that the patient is reluctant or out of severe horror of pain cannot communicate effectively with the midwifery and communicate non-verbally, such as body language or sign language or shirk of pain for any complications (Bick, 2003). 4. Lack of information flow: The lack of information is a big snake between the patient and the midwife. It is noted that the due to insufficient information about the patient’s maternal history and pregnancy complication, incorrect treatment and care can lead to a serious loss of life. The information can be passed to the close relationship of the patient such as partner, or close family relative to assist in the labour but the main constraint is the proximity of understanding the situation and lack of education and awareness to the obstetric issues can lead to disrupts and aggressive behaviour which can also break the flow of information between the patient and the midwife in such emergencies. Post Traumatic Stress Disorder on Women in Childbirth The literature indicated that 2% to 3% women is likely to suffer from post-traumatic stress disorder during or as resultant of childbirth that have a long term effects on their relationship with their partners and the baby. The traumatic stress effects the women physically, mentally, socially, and distained relationship with their surrounding and association of sexual dysfunctional behavior (Ballard et al., pp. 525-528, 1995). It has deep effect on the motherly bond of mother and the child as serious loss of fear and anxiety that has a lasting effect on the child as well. The postnatal stress can also harmfully affect their relationship with their partners and their social accord. The lacks of effective care and communication in delivering the baby also has a serious impact on the mother on her emotional capabilities. They are vulnerable and have a tendency to outburst the physical pain and not accepting the child due to her misbalance in emotional stability bond with the child. The immediate effects and the long term effects both are serious and affect her surrounding as whole. The immediate and skilled proficient midwife and nurses attended can play a significant role in the reduction of posttraumatic stress and by improving their practices they can identify the factors responsible and act according to the patient’s capabilities and maternal history (Allen, pp. 107-131, 1998). Consensus of Post Partum Hemorrhage in Obstetric Emergencies The post partum hemorrhage is a killer snake among women in obstetric emergencies in western and third world countries. According to statistics, two third of the women are affected by severe hemorrhage in labor due to lack of effective communication and training by the attendants and midwives. The midwives provided skilled and trained could prevent the post partum hemorrhage by appropriate diagnoses for any unfavorable or mysterious bleeding and emergency care. The identification and prevention by the midwives can lead to saving precious lives and making it easier for the gynecologists in emergencies. Midwives should be aware of the risk factors associated with the post partum hemorrhage especially in the antenatal period and placental abruption. The risk factors and the measures to prevent those risks for the safety of baby and the mother is important which in turn should highly assessed by the trained midwives. The effective communication is considerable for emergency deliveries or poor uneducated mothers who are not aware with the menace of hemorrhage and does not have admittance to antenatal care or any referral system according to their social and psychological accord (Guiver, pp. 1-5, 2004). Identification of the risk is important but it is useless if the midwives on spot reluctantly or carelessly avoid the appropriate actions. A strong relationship between the mother and the midwives is end to develope if the required information of the woman’s pregnancy and complications are stimulated to communicate effectively. This could resolve any misunderstanding and conflicts and the midwives could act swiftly for any possible prevention intervention for the mother and the baby (Goebel, pp. 221-6, 2004).The midwives are an effective communicator if they encourage frankness between their patients and offer alternative liberation for pain and suitable medical environmental care. Irrespective of technology, the education, and training is essential to recognize the signs of earlier stages of postpartum hemorrhage and report those changes in case of severe emergencies. The hemorrhage has a prospective to root nervous breakdown or loss of consciousness during in and out of labor. There should be a sufficient amount of blood transfusion or life saving equipment and knowledge to operate them in case of emergencies. The emergencies require precise and accurate flow of communication between the midwife and the obstetricians and swift feedback is required in either ambulances services or paramedics depending on the severity of the emergencies (Ayers, pp. 1-3, 2004). Debriefing of Post partum during and after the Delivery The debriefing of post partum is vital as it regards the amount of information to share with the emergency team members. It also build the effective relationship between the patients and scrutinize professional growth and learning for the paramedic and midwives that could result in better job satisfaction and completion (Czarnocka et al., pp. 35-51, 2000). The debriefing process is subjected to controversy associated to the ineffectiveness of the midwifery in determining the proximity of the complex deliveries and the flow of information to the patient and its close family. The recent development in debriefing women during the delivery can be life saving drug. There are constraints associated with the debriefing of the women in labour as sometimes the patient is highly affected by traumatic stress from the past relationship and birth experience, which could only add potential harm. In such cases the person in waiting or partner can be debriefed for any possible complexity in the emergency (Alexander, 1998). Researches also indicated that debriefing the women is an important tool for obstetric emergencies as it gives a positive incline towards safe delivery as the intervention decreased the anxiety and acute depression level during the delivery of the baby. The factor associated with the debriefing of the patient is the amount and quality of service provided to her before and after the delivery of the intervention process (Small & Toomey, 2006). The limited information and training can ruin the debriefing intervention before the delivery and this also vary according the age and ethnic origin of the patient. The debriefing may help to understand the pre birth circumstances and the complex issues to the mother but it does not account for clinical effectiveness (Ayers et al., 2006, p157). Proposition for Midwives for Best Practices in Emergencies Care The suggestions to adopt best practices in obstetric emergencies are as follows: 1. Appropriate training and maternal education is required in order to assist and act immediately for any severe emergency care especially in poor or uneducated community where the risk of mortality is high. 2. Improvements in interpersonal skills are requisite between the patient and the midwives for a clear view of the complications in the labor and pregnancy. 3. Appropriate training is required for facilitating the operation of live saving drugs and equipments on the patients. 4. The wide awareness of need and expansion of midwifery services can help the masses for loss of precious lives by diligent precautions adopted (Bailham et al., 159-168, 2003) 5. The campaigns and awareness by midwives in rural and unfortunate areas can not only save time and lives but will also help the families and community of the mother to act according in case of any troublesome signs of pregnancy. Conclusion The effectiveness of midwives and maternal services is important during the obstetric emergencies. The complete information is not permeable at a point but is preferred in portions to the patient according to her complexity. The post-traumatic stress disorder is important issues that can lead to severe consequences. It need to be, address and measured accordingly by debriefing the patient before the delivery intervention. References Alexander, J. 1998. “Confusing debriefing and defusing postnatally: The need for clarity of terms, purpose, and value.” Midwifery. Volume 14, pp. 122-124. Aljunid S. M., Zwi A. B. 1996. “Differences in public and private health services in a rural district of Malaysia.” Medical Journal of Malaysia. Volume 514, pp. 426-36. Allen, S. 1998. “A qualitative analysis of the process, mediating variables and impact of traumatic child birth.” Journal of Reproductive and Infant Psychology. Volume 16, pp. 107-131. 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