Academic literature on the topic 'Obstetric Patient satisfaction'

While neuraxial analgesia is considered the gold standard for labour analgesia, breakthrough pain can occur and can significantly impair maternal satisfaction. The early identification of breakthrough pain, for example, during epidural delivery suite rounds, is not only important for adequate maternal analgesia, but also in anticipation of using the epidural catheter for other potential obstetric interventions. Identifying patients at high risk for experiencing breakthrough pain enables the anaesthesia provider to adjust their anaesthetic plan. In case breakthrough pain does occur, it should b

The obstetric anaesthetist’s clinical practice is concerned with the safety of not one, but two intricately interwoven individuals, and much of this takes place in the presence of a third party—partner, friend or relative. Pregnancy and birth are natural and normal processes in the lives of most people. In this context, communication might be expected to be a matter of common sense and somewhat intuitive. How we communicate with women is a pivotal factor in determining their experience and, although recognized as such by many within the midwifery community , this is perhaps less so by doctors. Advances in medicine and changes in society over the last 100 years have resulted in a safer but, socially and technologically, a more complex experience for both women and their babies. Communication in childbirth originally occurred between women caring for each other, but this subsequently became dominated by an authoritarian medical machine, which has left some women feeling vulnerable and ‘processed’. Recognition of the importance and value of patient rights and satisfaction has been responsible for a cultural shift in many maternity units. However, the medicalization of childbirth continues to take over even when labour is proceeding normally. Anaesthetists are perfectly positioned as providers of analgesia and anaesthesia, within a multidisciplinary team, to communicate with women in a way that empowers them and supports their autonomy. Women become highly focused on the pregnancy and labour as the evidence looms ever larger in front of them. Pregnancy and childbirth usually represent a challenging psychological and physiological experience. This focus of attention on the pregnancy makes women highly suggestible to subconscious communications. For this reason, messages received can function as powerful determinants of how women perceive their pregnancy, and respond during childbirth. Central nervous system (CNS) changes occur that reduce anaesthesia requirements during pregnancy and increase hypnotizability, dissociation, daydreaming and an ability to use imagery to experience labour in a fulfilling way. There is a range of emotional responses to pregnancy. For some, there is joy and excitement, while for others there is no excitement—just fear and anxiety. Overlaying this, there may be pre-existing generalized anxiety, social concerns, obstetric problems and other complications.

Women may choose to deliver their baby in different places, e.g. obstetric-led units, midwife-led units, or at home, depending on their risk assessment and the mother’s own wishes. The way they manage their pain during labour will depend on where they deliver; however, it is essential that they are fully informed about the available options. This chapter explores the evidence base for both non-pharmacological and pharmacological options, e.g. complementary therapies, water immersion, TENS, inhalational analgesia, and systemic opioids. The use of patient-controlled analgesia (PCA) with ultra-short acting opioids, e.g. remifentanil, has been shown to be safe when used in a monitored environment and has high maternal satisfaction scores. The typical regimens and safe monitoring conditions for PCA remifentanil use are described.

Good communication skills form a fundamental principle of the patient- centred clinical consultation. The new Part 3 of the MRCOG, assesses candidates based on their ability to apply the core clinical skills in the context of real- life scenarios. It assesses five core skills domains, with three relating to communication skills; i) Communicating with patients and their families, ii) Communicating with colleagues and iii) Information gathering. Communication skills in the Part 3 clinical assessment can be assessed in many forms: … ● Exploring patient symptoms or concerns (information gathering) ● Explaining a diagnosis, investigation or treatment (information giving) ● Involving the patient in a decision (shared decision making) ● Health promoting activities ● Obtaining informed consent for a procedure ● Breaking bad news ● Communicating with relatives ● Communicating with other members of the health care team … In order to provide patient- centred care, doctors must treat their patients as partners, involving them in the decision making regarding their care and instilling in them a sense of responsibility for their own health. When the patient feels that they are part of the team it increases their satisfaction with care, increases treatment adherence and improves clinical outcomes. It is these skills that are assessed in clinical assessment tasks involving communication. Clinical assessment candidates are often assessed in two communication domains; Process and Content. In order to do well in the information gathering stations, you must be aware of the differential diagnoses that may arise with various presentations and how to explore each one independently and as a collection. When it comes to information giving or shared decision marking, candidates need to be familiar with the most recent Royal College of Obstetrics and Gynaecology guidelines and know how to interpret their meaning to the patient and their families. The Calgary- Cambridge Model is one of the most recognized communication theories in medical education (Kurtz, 1996). This theory can be adapted to fit into most clinical scenarios. Using the Calgary- Cambridge Model, you should be able to obtain the majority of the points related to process.