Trial of a Guideline for Adverse Maternal Events

Many factors may play a role in a woman's psychological well-being during the childbearing years, and some factors can influence a woman's ability to care for herself and her baby. Birth trauma is one event that may contribute to maternal mental illness. Birth trauma is defined as occurrence of any event in the labor and birth process that involves an actual or threatened injury or death to the mother or infant. This pilot project aimed to address the significant gap in assessment and referral of women who experience an adverse birth-related event during an in-patient maternity stay. An inter-disciplinary hospital team established a screening guideline, or "safety bundle," for perinatal hospital staff that would guide assessment, support and referral of hospitalized perinatal women who experienced birth-related trauma. Three registered nurses were trained to use a screening guideline to identify and refer women with birth trauma or an adverse maternal event to a response team for consultation and evaluation. Four response team members (social worker, chaplain and two nurse managers) received an orientation to the screening guideline. At the end of a one-month trial, all seven participants gave feedback on the use of the guideline in a focus group. Recorded, transcribed and inductively coded data were categorized into themes, which revealed important areas for guideline improvement. Themes highlighted barriers to implementation which included, 1) lack of staffing for a timely response from social workers and chaplains, and lack of available translators; 2) deficits in technology, including the use of computer translation for a crisis, lack of clear documentation of risks and events in the medical record system, lack of clarity in the paging system and a need for a standard order for RNs to initiate the response team, and 3) a need for improved communication about management for traumatic events that appeared during postpartum. The piloted guideline revealed important barriers that need to be addressed before wider implementation. Increased staff for assisting patients in crisis is needed and the chain of communication for a timely response was indicated. With minimal revisions, the guideline can be an effective tool to address a previously neglected area of women's health. Additional research is necessary to analyze clinical outcomes and improvements to interdisciplinary collaboration following guideline implementation.