Pregnancy and birth are physiologic processes, unique for each woman, that usually proceed normally. Most women have normal conception, fetal growth, labor, and birth and require minimal-to-no intervention in the process. Women and their families hold different views about childbearing based on their knowledge, experiences, belief systems, culture, and social and family backgrounds.
As representatives of professional societies whose members care for pregnant and laboring women, we agree that patient-centered and safe care of the mother and child enhance quality and is our primary priority. Optimal maternal health outcomes can best be achieved in an atmosphere of effective communication, shared decision-making, teamwork, and data-driven quality improvement initiatives.
“Patient-centered” means that health care providers, and the system they practice within, accept that the values, culture, choices, and preferences of a woman and her family are relevant within the context of promoting optimal health outcomes. The overarching principles involved include treating all childbearing women with kindness, respect, dignity, and cultural sensitivity throughout their maternity care experiences. Patient-centered care is enhanced when women are provided supportive resources such as education and skilled attendants. Specifically, patient-centered care requires balancing maternal-child safety and well-being with the woman’s needs and desires.
Communication
The childbirth experience is dynamic and includes not only the woman and her family, but a host of other members of the health care team. Effective communication between the caregiver and the laboring woman and her family, as well as among the members of the care team, is critical to ensuring safety. Each team member should possess the skills necessary to promote effective communication, and should be aware of the concepts and skills involved in leadership, situational awareness, and mutual support.
Attention to language, communication, and care practices can create a climate of confidence as well as enhance the women’s childbearing experience. Effective communication is patient-centered, timely, direct, and specific, and occurs between the woman, her family, and members of the care team. Body language, nonverbal cues, courtesy, and prior experiences with team members can all strongly affect the content and effectiveness of any communication. A number of factors influence communication:
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Listening skills, which are as essential as speaking skills.
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A woman’s ability to cope with pain, discomfort, or anxiety, as well as her family members’ and providers’ responses to her coping strategies.
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Fatigue, sleep deprivation, and sleep inertia (being awakened from sleep).
Structured systems may help to optimize communication about and response to rapid changes in patient status. There are a number of effective strategies that can be applied to maternity care:
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Communication tools such as Situation-Background-Assessment-Recommendation.
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Training in principles of crew resource management.
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Drills and simulations.
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Debriefings and case reviews.
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Organized board rounds, huddles, structured handoffs, and bedside rounds.
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Checklists and standard order sets.
Shared decision-making
Patient-centered care recognizes that each woman brings unique knowledge regarding herself and her body to pregnancy, labor, birth, and mothering. Shared decision-making, a process by which a woman and her care team interact as partners to make decisions that are fully informed, based on the best available evidence, consistent with personal values, and mutually acted upon, is another key communication strategy. The choices a woman makes during the course of one pregnancy can affect her entire life course; therefore, information about the effect that care choices may have on a woman’s future should be discussed. Decisions about interventions should incorporate the woman’s personal values and preferences and should be made only after she has had enough information to make an informed choice, in partnership with her care team. Shared decision-making can increase patient engagement and reduce risk with resultant improved outcomes, satisfaction, and treatment adherence.
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