Patient centered labour care to improve maternal and neonatal outcomes.pptx

Patient centered care is the most recent concept of modern health care system. It is based on the concept that "patient and family should be also involved in the management decisions of the patient. it also emphasize individualized care depending on individual patient requirements. Incorporating this in to Obstetric care will help improve patient care in this field. The most important area in obstetrics that need patient centered care is the labour ward care.
This presentation is based on how we can incorporate patient centered care in to labour ward management, its advantages and its drawbacks as well as challenges we face in developing countries when trying to incorporate these novel concepts.

1. Patient centered labour care to improve maternal and perinatal outcomes Dr Chandana Jayasundara Senior Lecturer and Head of Department Dept of Obstetrics and Gynaecology University of Colombo Honorary Consultant Obstetrician and Gynaecologist De Soysa Hospital for Women, Colombo .

2. What is patient centered labour care The Definition:- “ providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions”    It is recognized as a key dimension of the quality of maternity care that increases client satisfaction in an institutional delivery This approach has proven to improve maternal satisfaction in labour as well as combat the high maternal morbidity and neonatal morbidity

3. Why are maternal and perinatal outcomes important? Health indicators They reflect the quality of health care service, better outcome indicate effective health care systems. Economic impact Poor outcomes can lead to higher health care costs and loss of productivity Social stability H ealthy mothers and babies contribute to a more stable and productive society Preventive care insight They highlight areas needing intervention in labour care Policy development Data can shape health policies and resource allocation.

4. Ancient: religious and cultural beliefs heavily influenced the practices, labour was primarily managed by midwifes/birth attendants. Historical context of labour care 19 th Century: Introduction of hospitals for childbirths (Lying in homes) and this lead to more medical interventions. 20 th century: Rise in Obstetrics as a medical practice and reduction in maternal morbidity and mortality. Late 20-early 21 century: shifts towards more musicalized births. Pain relief, CTG, Caesarean section, evidence based care ect . Late 21 st to current: increase in PCLC, attempt to reduce unnnecesary CS and other medical interventions, increase in labour companionship.

5. Current state of statistics in Sri Lanka Each year about 2000 babies die during the newborn period, another 2000 is lost as still births and about 110 mothers die at or around child birth in our country : (UNFPA Sri Lanka ) The government has established a large network of healthcare facilities, including maternity hospitals, obstetric units, and primary healthcare centers, to provide care to pregnant women and newborns. In Sri Lanka, the government has implemented various initiatives to increase patient-centered care, such as integrating patient feedback systems into the health system and improving communication between healthcare providers and patients.

6. Principles of PCC Key Domains of PCLC Respect for patient preference Emotional support Involvement of family Continuity and transition Access to optimal care Physical support Information and education Coordinated and integrated care

7. How to adapt it to labour ward setting Respect patient preference: Listen actively!!!!! Information and education: Emotional support: continuous companionship, comfort measures. Collaborative care: interdisciplinary team management, patient involvement. Physical comfort: pain management options, comfortable environment. Family involvement: prepare the husband, companionship. Continuity of care: ensure close communication between care providers, post natal transition. Holistic approach: ensure proper mental wellbeing. Safety and security: always do safe practice, adhere to guidelines, individualized monitoring.

8. Respect patient preferences Prenatal planning: discus the birth plan, ensure patient understand the plan on intervensions . Active listening: listen to preferences, validate their choices. Respect patents preferences on interventions, pain management. Post birth plans and wishes. Information and education Informed concent , clear communication . Shared decision making. Continuous update the progress, educate on pain management. Newborn care guidanace and breast feeding support Family involvement in care for the woman It will increase the comfort It will ensure her empowerment It will enhance the bonding between father mother and the baby

9. Continuity of care Consistent care providers antenatally , intrapartum and during postnatal period Personalized care vplans on each and every parient Clear and continuous Communication Support system involving the family as well Post partum follow-up Holistic approach Address not only physical but also emotional, social and phsychological aspect of to ensure comprehensive support Safety and security Standardized protocols in labour care Emergency preparedness Qualified and skilled staff Ongoing training Monitoring and technology Hygiene and infection control Patient privacy (Video, photography) Data protection Emotional safety (respectful care and emotional support )

10. Evidence based benefits Reduce delivery interventions : Women receiving patient-centered care had reduced rates of cesarean sections and instrument-assisted deliveries. Hodnett , E.D., Gates, S., Hofmeyr , G.J., Sakala , C. (2013). Continuous support for women during childbirth. Cochrane Database Syst Rev. Enhance satisfaction and experience: Women reported higher levels of satisfaction with their childbirth experience when provided with patient-centered care. Betrán , A.P., Torloni , M.R., Zhang, J.J., Gülmezoglu , A.M., WHO Working Group on Caesarean Section. (2016). WHO statement on caesarean section rates. BJOG. Improved mental helath : Reduction in postpartum depression and anxiety rates. Shorey , S., Yang, Y.J., Ang , E. (2018). The Impact of a Postnatal Psychoeducation Intervention on Perinatal Post-Traumatic Stress Disorder: a qualitative study. BMC Pregnancy and Childbirth.

11. Shortens the length of labour : Shorter durations for both the first and second stages of labor were observed. Sandall , J., Soltani , H., Gates, S., Shennan , A., Devane , D. (2013). Midwife-led continuity models versus other models of care for childbearing women . Cochrane Database Syst Rev. Better Pain Management: More effective pain management techniques and greater use of non-pharmacological methods. Hodnett , E.D. (2002). Pain and women's satisfaction with the experience of childbirth: A systematic review. Am J Obstet Gynecol. Lower Admission Rates to Neonatal Intensive Care Units ( NICU): Continuity and personalized care reduced NICU admissions. Gülmezoglu , A.M., Bizik , D., Kidson -Gerber, G., Aprill , E. (2015). Patient-centered labour care and neonatal outcomes: A randomized trial. Lancet.

12. Results The highest overall effect without subgroup divisions was the improvement reported in the 5-minute Apgar score < 7, with an effect size of 1.52 (95% Confidence Interval (CI) 1.05, 2.20).  Familiar labor companions were better at reducing tocophobia , with an effect size of 1.73 (95% CI 1.49, 2.42), compared to unfamiliar companions, with an effect size of 1.34 (95% CI 1.14, 1.58).  Untrained labor companions were the better choice in reducing tocophobia and the cesarean section rate compared to trained companions . A significant subgroup difference (<0.1) was found in relation to the duration of labor, cesarean section rate, oxytocin for labor induction, analgesic usage, and tocophobia in the subgroup analysis of geographical regions.

13. Barriers for implementation Resource constrains: Limited financial resources hinder the ability to invest in necessary infrastructure, technology, and staff training Staff Shortages: There is a lack of trained healthcare personnel, particularly in rural areas, leading to overworked staff who may not provide individualized care . Cultural Norms and Practices: Traditional healthcare practices and societal norms may conflict with aspects of patient-centered care, making it challenging to implement change (Obstetricians preferences and beliefs) Education and Awareness: Both patients and healthcare providers may lack awareness about the benefits of patient-centered care, leading to resistance against new practices.

14. Infrastructure and Facilities: Many hospitals lack the necessary infrastructure, such as private rooms, adequate sanitation, and modern medical equipment, to support individualized care . Policy and Leadership Support: There might be insufficient support or advocacy from healthcare leaders and policymakers to prioritize patient-centered approaches . (Obstetricians preferences and beliefs) Communication Barriers: Language and literacy barriers can impede effective communication between patients and healthcare providers, crucial for patient-centered care . (situation in DSHW) Access to Information: Limited access to health information and digital resources can prevent patients from being well-informed about their care options and rights.

15. The way forward Invest in infrastructure Allocate more funds to improve hospital facilities and equipment Ensure availability of private rooms and better sanitation facilities

16. Training and development: specialized training programs for health care providers implementation of CPD activities and workshop by SLCOG, PNSSL, FHB. Cultural Sensitivity Programs: - Incorporate cultural competency training to respect and integrate traditional practices where possible. - Engage community leaders to advocate for patient-centered care. Awareness Campaigns: - Launch awareness campaigns to educate patients and families about the benefits of patient-centered care. - Use mass media and social media platforms for outreach. Policy Support and Leadership Advocacy: - Advocate for policies that prioritize patient-centered care at the governmental and institutional levels. - Foster leadership that champions patient-centered practices.

17. Improving Communication: - Provide interpreters and translators to overcome language barriers. - Use visual aids and simple, clear language for communication. Community and Patient Engagement: - Establish patient advisory councils to offer input on healthcare services. - Regularly collect and act on patient feedback to improve care processes. Access to Education and Information**: - Develop educational materials and programs to inform patients about their rights and care choices. - Increase access to digital health resources and telehealth services. Capacity Building: - Address staff shortages by offering incentives for healthcare workers to work in rural areas. - Introduce scholarship programs for medical and nursing education in underserved regions.

18. Utilizing Technology: - Invest in telemedicine and health IT systems to enhance patient engagement and streamline care processes. - Use mobile health initiatives to reach out and monitor patients remotely.

19. PCMC in DSHW Impact of multifaceted quality improvement interventions on experience of care, provision of care and obstetric outcomes: A quazi experimental study conducted in Sri Lanka M Rishard et al . Key findings Women’s overall satisfaction with maternity care was assessed using a 1–10 Likert scale, with median scores of 81.4%, post-intervention. Our comparative analysis revealed shifts in satisfaction levels following the implementation of PCMC interventions. Prof unit DSHW is the pioneering unit to introduce labour companionship in to the S ri Lankan labour ward setup

20. Future directions Research opportunities: Areas that need further investigation. Eg Trained Vs Untrained companion, Perception of the labour companion. Potential for longitudinal studies. Healthcare innovations Emerging trends and technologies. Potential interventions shaped by patient feedback (Audio recorded data retrieval without interviewer intervention. (ACASI)

21. Key takeaways Empowering women Promote informed decision making and respect women's choices and preferences during labour . Invidualized care plans Comfort and emotional support This include the staff , the labour companionship and the family members. Effective pain management Inclusive communications with laboring women

22. Cultural sensitive practices Safe and clean environment in the labour wards Regular monitoring and feedback. Continued training of the health care team Team work Equal access to high quality care. Use of new technology Family centered care