Teaching resources

Introduction

In this section, you will find resources that have been produced for teaching and learning. We have written seven summaries which summarise, and illustrate with clips, what we believe are the key learning messages from our interviews with patients who have experienced a near miss. They are intended as a resource for clinicians across the care pathways of these women and their families, including midwives, obstetricians, nurses, anaesthetists, intensive care specialists, health visitors and general practitioners.
 
Below are the key learning points from each of the summaries. You can find a fuller description and clips if you click through to each summary.
 
  • Personal touchefroindividual stafcan make a real differencthowomen antheir partnercopwitthemergency anrecovery
  • Transferwithithhospital can bdifficuland are made easiefowomeby:

               - Considerinbottheir critical carneeds anneeds as a new parent

               - Usof a singlroowherpossible

  • Reviewintheir noteand/or a discussiowittheiconsultant afteanevencan helwomen maksensowhat happened
  • WomefinGsupporoncthey ardischargevaluablthelthemreturtnormal life
  • Explanationsoftenrepeated, owhat is happening arhelpful twomen antheir partners at alstageothemergencanrecovery
 
  • Even when very ill, women want to be a mother to their new baby
  • Many women face challenges in seeing their new baby, and it would be helpful to develop protocols ahead of time for women who require high dependency or intensive care to facilitate the baby being allowed to visit the mother or vice versa
  • Where it is not possible for women to see or be with their baby, they really appreciate being kept in touch with the baby’s progress through:

             - photos

             - regular verbal or written updates such as a diary of the baby’s day

             - direct contact with the paediatrician when the baby is ill

  • Missing a baby’s “firsts” is something women really notice; if at all possible they want to be there for important milestones such as the first feed.
 
  • Women who have suffered a near miss feel different from other new mothers. They feel more supported when information about their condition has been handed over between staff and the team in the new setting show they are fully aware of what they have experienced.
  • Transfer from intensive care, while a positive step, can be difficult. Although there appears no idea solution to step-down care'

            - women who go to a high dependency area alongside a labour ward find this helpful

            - if women are in high dependency care for an extended period,

              policies which allow visits from the wider family, e.g. grandparents, are appreciated

  • Similarly, women can find transfer to the postnatal ward challenging:

            - if possible, a side-room is the most comfortable place for women who have experienced

              a near-miss to be cared for

            - if side–rooms are not available, a clear explanation of the reason for this is helpful

            - some women will experience significant problems with caring for themselves and their

              new baby in a side-room and will need extra help

  • Personal support and empathy from individual staff members makes a real difference to how women cope with transfer and recovery.

4. Information and understanding

  • Women and their partners appreciate staff giving clear explanations in non-medical language at all stages before, during and after the emergency'

           - where conditions are diagnosed in the non-emergency situation antenatally, knowing

             what might happen helps women and their partners prepare and cope better afterwards

           - during the emergency, repeated reassurance is appreciated

           - being listened to and able to ask questions after the emergency is important for women

             to come to terms with what has happened

  • Partners/fathers can feel forgotten during and after the emergency:

             - frequent updates from any member of staff help them to feel less anxious

               and isolated   

            - having another family member with them for support can help 

  • Knowing that staff have learned from a woman’s near-miss is reassuring for her
 
  • All the partners/fathers we spoke to have been deeply affected by their partner’s life threatening experiences, for some it has a profound impact on their long-term mental health
  • In situations where an emergency delivery might be anticipated, such as when a women has placenta praevia, explanation of what might happen really helps partners prepare and cope subsequently.
  • Frequent updates during the emergency help partners/fathers feel less isolated and anxious
  • Personal touches of support from individual staff make a real difference to how partner’s cope
  • Partners remember more about events than the woman who is ill, but still appreciate repeated explanations
  • Partners/fathers can find seeing their partner in high dependency or intensive care very traumatic, and may need support from staff and family members to'

              -   enable them to visit their partner

              -   understand that the situation is not hopeless' their partner may recover

              -   come to terms with what has happened

  • Long-term mental health problems in partners/fathers after a near-miss experience may have a big impact financially, practically and emotionally and families may need additional support in this event.
  • Partners/fathers who experience mental health symptoms do not necessarily seek help, although they do feel that counselling, if offered, could be beneficial
 
  • Women who had a follow-up review at the hospital found this a positive experience to help their understanding and recovery
  • Where follow up was not offered women felt abandoned and were left with questions
  • Women noted a number of things that were particularly helpful elements of the follow up review:

             - seeing and talking through their notes

             - answering questions about future pregnancies

             - sensitivity about the place where the review was conducted' returning to the

               antenatal clinic or labour ward or even hospital could be upsetting

             - flexible timing of the follow-up review' some women were not ready for this until

               several months or even years after the event

             - an offer of counselling was helpful to some

  • The follow-up programme with intensive care unit staff that some women were involved with was considered a good model
  • Women’s relationships with their partners are often put under severe strain, and additional support may be required in this context
  • Parenting advice can be important, since:

             - existing children can be severely affected by nearly losing a parent

             - building a relationship with the new baby following a near-miss event can be

               challenging even when the baby does not require neonatal unit care

  • Issues around future fertility and family size can be complex:

             - some women require support to come to terms with a loss of future fertility

             - for others, the worry about the possibility of a near-miss event in a future pregnancy

               leads to a decision not to have further children and robust contraceptive advice can

               be important in these circumstances 

  • Mental health impacts for both mothers and fathers may require long-term management
  • Help may not be sought for long-term mental health issues; actively offering counselling may therefore be beneficial
  • Mental health and other impacts can lead to significant changes in career or life paths which place an additional burden on parents
  • Many women reported that they would have welcomed more support in the community. In particular'

             - access to mother and toddler or other parent’s groups where other women had

                similarly “abnormal” birth experiences

             - GP and Health Visitor support for first time mothers to help with feelings of isolation

 

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