Teaching resources

Good practice that makes a big difference

Key Learning Points
  • Personal touches from individual staff can make a real difference to how women and their partners cope with the emergency and recovery
  • Transfers within the hospital can be difficult and are made easier for women by:
considering both their critical needs and needs as a new parent
use of a single room where possible
  • Reviewing their notes and/or a discussion with their consultant after an event can help women make sense of what happened
  • Women find GP support once they are discharged valuable to help them return to normal life
  • Explanations, often repeated, of what is happening are helpful to women and their partners at all stages of the emergency and recovery.
We interviewed women who experienced life-threatening emergencies during or shortly after pregnancy, and some partners/fathers. Across the care pathway, women and their partners identified a number of straightforward examples of good practice that made a big impact on how they experienced and recovered from these severe morbidities.
 
In the emergency
Women’s experiences of the emergency varied greatly. Women and their partners understood that during the emergency, the focus of medical staff was to save their lives and the life of their baby. However, a number of them gave us examples of thoughtfulness from professional staff that made a real difference to how they felt at the time.
 
Jo was pregnant with her first child. When she started to bleed at home, she called an ambulance. As soon as she arrived at the hospital, emergency staff put a Doppler to her bump to reassure her the baby was OK. Jo’s experiences also highlight the difficulties women may have consenting to emergency interventions in these situations.
 
A number of women noticed that small personal touches from individual doctors and midwives had a big impact on how they coped.
Julie was admitted to hospital with pre-eclampsia. She felt very reassured by the care and attention the midwife gave her overnight, but contrasts this with her very different experience of the postnatal ward.
Paula developed amniotic fluid embolism after giving birth to her daughter. She was very happy with the care she received, but explains how important it was to her that her daughter was dressed in clothes that she had brought in with her. In the confusion of the emergency this didn’t happen, and thinking about it still upsets her, even now that her daughter is three years old.
Fathers are often left wondering what is happening to their wife/partner while staff are fighting to save her life. We were given examples of small acts of kindness that helped them cope during the anxious waiting period. Michael’s son was delivered early after his wife developed HELLP syndrome.
 
Transfer in the hospital
Being transferred out of surgery or critical care to less acute areas of the hospital was often a difficult time for women. Paula had amniotic fluid embolism and highlighted how she had needs not only relating to being critically ill, but also to her role as a new mother. 
There were important examples given where the sensitivity of staff eased the transfer. Several women described being offered their own room for a night or two, so that they could be private as they started to recover from their near miss.
Follow up
Some women wanted to meet with doctors to understand more about what had happened during the emergency, to piece together the missing bits. Others found it helpful to go through their notes. It helped them understand and come to terms with their experience.
Post-natal support
The support that women were offered after they were discharged from hospital varied greatly. Women who were given support by their GPs valued it as they recovered and tried to get back to normal life.
Some women did not feel the postnatal support was as good as it could have been.
 
Clare developed a DVT after having her second child. She was given incorrect information about whether she could continue to breastfeed while taking warfarin.
Sophie was discharged from hospital after having a pulmonary embolism and a post-partum haemorrhage.
Communication and understanding
Good communication with health professionals, during the emergency or afterwards, helped women and their partners understand what was happening to them, and make sense of the experience afterwards.
Both Alex and Kerry had placenta praevia. Their contrasting experiences highlight how good communication was important in helping them understand the risks of their condition.

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