Presence of a Family Member During Childbirth

Abeer Manea, Aisha Saeed, Asma Aldosari, Nasra Alalawi, Yara Allaban
November 26, 2017
 Outline
Issue of Concern with Evidence
1
Why Family/Men
to change are not Allowed in Labor
2 Easy
Rooms
colors, photos and Text

3 Impcat on Patient, Family and

Healthcare System

4 Impact on Safety and Quality

5 Plan to Change (Theory)

6 History before Change

 Outline
Qatar National Vision 2030
7

Legal
Easyand Ethical colors,
to change Implications
photos and Text
8

Budget
9

10 Questions

6
What Is Labor Support ?
Labor support is a term for the caring work or social
support that is provided to women during labor and birth
(p. 405).

(Payant, Davies, Graham, Peterson, & Clinch, 2008)

Main Problem & Evidence
In the womens hospital family members are not allowed to attend either vaginal or cesarean
childbirth.
Evidence:
- Mothers reported feelings of fear, and anxiety during labor.
- Healthcare providers treat fathers and family members as not-patient and not-visitor, which
may lead to feelings of exclusion, fear, and frustration.
- It has been shown that fathers tend to feel useless, powerless and not entirely accepted by
health care workers

(Tarlazzi, Chiari, Naldi, Parma & M Jack, 2015).

(Krepia, Psychogiou, Sakellari, Tsiligiri & Julkunen, 2013)
Why Family Members and Men are not Allowed in
Labor Rooms
Unsupportive policies and attitudes

Perceptions that companion presence increase the risk of infection.

Concerns regarding being preoccupied with companion rather than the

woman in labor.

Healthcare professionals fears about being evaluated by companion

Feeling insecure in undertaking techniques in the presence of other

people.

Health care providers' education, prior to the establishment of

humanization labor attitude.

Worries about misconceptions of invasive procedures.

(Abushaikha & Massah, 2013)
 Practice Change & Reasons to Implement the Change
Impact on Patient, Family and Healthcare System

- Fathers reported increased in - Family member/friends act as

discomfort while waiting the ideal supporter for the
outside and receiving little mother, and his presence and
information about how labor is support is very helpful and
processing and potential comforting for her.
complications.

- The presence of the father, or a

close relative/friend, attending - According Maria & Santana (
the baby delivery, has been 2013), according to fathers,
shown to be even more having been present during
beneficial to the mother than childbirth has changed their
the medical care provided in views of women.
the labor room

(Krepia, Psychogiou, Sakellari, Tsiligiri & Julkunen, 2013)

 Practice Change & Reasons to Implement the Change
Impact on Patient, Family and Healthcare System

- Women will feel less anxious, - Father reported having feelings

more secure, and relaxed of pride, happiness,
satisfaction, love and strong
bounding with there wife.

- Attending labor room with

women will help men in their - May help in reduce the length
transition to parenthood. of the birth process

- fathers presence during birth - Sharing the experience with the

has been described as a mother is a positive thing for
positive experience. both the mother and her
partner.

(Krepia, Psychogiou, Sakellari, Tsiligiri & Julkunen, 2013)

 Impact on Safety and Quality
Communication
Timely
Direct Patient-centered care/ Family centered care
Specific
Shared-making decision
Consider women preferences
Teamwork
Professional obstetric team involve family members during labor
To support and help healthcare providers
Quality measurements
Name Here
Checklists
Programmer
Survey
Using evidence based protocols (Journal of Obstetric, Gynecologic, & Neonatal Nursing, 2012)
(World Health Organization, 2015)
(World Health Organization, 2015)
Lewins Change Model

Unfreeze

Change

Freeze

(Manchester et al., 2014)

 Unfreeze Creating readiness for
organizational change

Goal: To accept that the hospital needs to change

Contact the nursing director in the Womens Hospital.
- Complete a survey to measure patient satisfaction in labor room (three months) from womens
hospital, Alwakra and Alkor.
- Provide statistics to the staff.
Provide literature review about the best practice Evidence-based practice.
Survey that should be completed by all doctors and nurses to identify the percentage against change.

(Manchester et al., 2014)

 The History Before The Change
Giving birth is Women work.
In USA around 1930-1948, 95% of women delivered their babies at the hospitals instead of homes.
In 1950s no one was allowed to be present in labor rooms.

"In the delivery room, white with bright lights, you will be taken from a hospital trolley to the
delivery table. The nurses will be standing by with the doctor and with their gentle help and
encouragement, aided by the science they have studied so long, your baby will be born.

But where is the father/family?

In 1970s, doctors allowed men to be present.

(Lwanga, Atuyambe, Sempewo, Lumala, & Byaruhanga, 2017)

Qatar National Vision 2030

Economic Development

Social Development

Human Development

Environmental Development

(Tan, Al-Khalaqi, & Al-Kulaifi, 2014)

 Change
Involve 50 women in their 21 weeks (5 months ) in the change trial
Consent form
Identify the companion for the women
Educational sessions will be provided (4 sessions, 1 per month, for 1 hour)
Interview with women and their companion after child birth
Analysis of data, effectiveness of the change will be measured according to participants
satisfaction which will be measured by using Likert scale from 1-5.
- 1, strongly dissatisfied
- 2, Dissatisfied
- 3, Ok
- 4, Satisfied
- 5, strongly satisfied
(Manchester et al., 2014)
 Interventions and Rational
Promote involvement of companion throughout pregnancy
Engagement of the husband from the beginning positively affect mens feeling and satisfaction with
the birth experience.
Creating birth plans to improve family-centered experience.
Birth plan acted as a communication tool.
Allowed partners or family member to understand womens preference and expectation.
Enhanced knowledge regarding birth, options, and hospital policies.

Increased autonomy and decision-making.

(Smyth, Spence, & Murray, 2015)

(Aragon et al., 2013)
(Oliverira et al., 2014)
 Interventions and Rational

Doula: non-medical person who assists a woman before, during, and after
birth

Develop educational sessions including prenatal classes to foster the support

provided by the companion to the woman.

Relaxation techniques and pain relief during childbirth.

The stages of labor, and the interventions during this period.

The role of the professionals who care for the women during childbirth.

(Smyth, Spence, & Murray, 2015)

(Aragon et al., 2013)
(Oliverira et al., 2014)
https://www.youtube.com/watch?v=5SDOtGEvmLk
 Interventions and Rational
Comparison between men who attended and did not attended prenatal classes.

Attended prenatal classes Did not attend prenatal classes

77% had a very positive experience at 42% had a positive experience at the birth of
their baby.
the birth of their baby.

65% felt they were good supporters. 40% felt they were good supporters

(Smyth, Spence, & Murray, 2015)

(Aragon et al., 2013)
(Oliverira et al., 2014)
 Freeze
Goal: sustain the change

Identify individuals against change

Continue education for the staff and women and their companion (Right to have family or partner
support)
Unpronounced inspection
Create a reward system
Feedback system

(Manchester et al., 2014)

 Monitoring the Implementation
https://courses.lumenlearning.com/boundless-management/chapter/managing-change-for-employees/
 Barriers to Change
Fathers presence has been reported as a stressful experience for fathers, with caesarean delivery being a
more traumatic and anxiety producing experience.
The most common negative feeling reported is related to the difficulty many men experience in seeing their
partner in pain.
However, they are usually afraid of this moment, and may give various excuses to avoid experiencing it, such
as fear, dislike hospital environment, blood phobia, and lack of time for professional reasons. Taking all
this into consideration.
Lack of financial support

(Krepia, Psychogiou, Sakellari, Tsiligiri & Julkunen, 2013)

Legal and Ethical Implications
Women do not have the capacity to give consent while laboring.
The overall responsibilities of caregivers to those in their care. Key ethical
principles shared by all three of these groups include:
- promoting the well-being of the patient/client
- practicing informed consent
- respecting the patient's/client's right to privacy
Lack of support from the nursing staff, there should be someone to support her
(family, friend, or husband).

(Longworth & Kingdon, 2011)

(Draper & Lves, 2013)
Legal and Ethical Implications
Family and Men Involvement in Antenatal Care and Labor

Family Men (Fathers)

Patients right The patient right to choose a Have an interest in
(Autonomy) family member to be involve shaping their future
(Not causing harm) parental
responsibilities.
Engagement The father/family can be involved in some antenatal
services with providing specific skills during labor. To
help the doctor and nurses.

(Longworth & Kingdon, 2011)

(Draper & Lves, 2013)
 Budget
Classes: booking rooms will be provided by Hamad Medical Corporation
Presenters (Psychosocial, nurse)
- Hiring someone for salary of 1500 QR per session
- Paper and brochures
- Snakes
- Standard percuations for the companion

Total needs:
- Salaries: 12,000 QR
- Snakes: Marriott Marquis (3500 QR) total of (14000 QR)
- Papers and brochures: 5000 QR
- Standard percuations: will be provided by HMC

Total: 31,000 QR
Thank You
Any Questions
 References
Abushaikha, L., & Massah, R. (2013). Perceptions of barriers to paternal presence and contribution during childbirth: An exploratory study from
Syria. Birth: Issues in Perinatal Care, 40(1), 61-66. doi:10.1111/birt.12030
Aragon, M., Chhoa, E., Dayan, R., Kluftinger, A., Lohn, Z., & Buhler, K. (2013). Perspectives of expectant women and health care providers on birth
plans. Journal of Obstetrics & Gynaecology Canada, 35(11), 979-985. doi: 10.1016/S1701-2163(15)30785-4.
Brggemann, O., Ebsen, E., Oliveira, M., Gorayeb, M., & Ebele, R. (2014). Reasons which lead the health services not to allow the presence of the
birth companion: Nurses' discourses. Texto & Contexto-Enfermagem, 23(2), 270-277. doi: 10.1590/0104-07072014002860013
Draper, H., & Ives, J. (2013). Men's involvement in antenatal care and labour: Rethinking a medical model. Midwifery, 29(7), 723-729.
Krepia, D, Psychogiou, M, Sakellari, E, Tsiligiri, M & Julkunen, K. (2013). Greek fathers experiences from their wifes/partners labour and delivery:
A qualitative approach. International Journal of Nursing Practice, 470477.
Longworth, H. L., & Kingdon, C. K. (2011). Fathers in the birth room: What are they expecting and experiencing? A phenomenological study.
Midwifery, 27(5), 588-594.
Lwanga, H., Atuyambe, L., Sempewo, H., Lumala, A., & Byaruhanga, R. B. (2017). An exploratory study of men's companionship, perceptions and
experiences during pregnancy and delivery in Uganda. BMC Pregnancy & Childbirth, 171-8. doi:10.1186/s12884-017-1385-6
Manchester, J., Gray-Miceli, D. L., Metcalf, J. A., Paolini, C. A., Napier, A. H., Coogle, C. L., & Owens, M. G. (2014). Facilitating Lewin's change
model with collaborative evaluation in promoting evidence based practices of health professionals. Evaluation and program planning, 47, 82-90.
Oliveira, A., Damasceno, A., Moraes, J., Moreira, K., Teles, L., & Gomes, L. (2014). Technology used by companions in labor and childbirth: a
descriptive study. Online Brazilian Journal Of Nursing, 13(1), 36-45. doi:10.5935/1676-4285.20144254
 References
Payant, L., Davies, B., Graham, I., Peterson, W., & Clinch, J. (2008). Nurses' intentions to provide continuous labor support to women. JOGNN:

Journal Of Obstetric, Gynecologic & Neonatal Nursing, 37(4), 405-414. doi:10.1111/j.1552-6909.2008.00257.x

Quality Patient Care in Labor and Delivery: A Call to Action. (2012). JOGNN: Journal of Obstetric, Gynecologic & Neonatal Nursing, 41(1), 151-153.

doi:10.1111/j.1552-6909.2011.01317.x

Smyth, S., Spence, D., & Murray, K. (2015). Does antenatal education prepare fathers for their role as birth partners and for parenthood?. British

Journal of Midwifery, 23(5), 336-342. doi.org/10.12968/bjom.2015.23.5.336

Tan, T., Al-Khalaqi, A., & Al-Khulaifi, N. (2014). Qatar National Vision 2030. Sustainable Development: An Appraisal from the Gulf Region, 19, 65.

Tarlazzi, E, Chiari, P, Naldi, E, Parma, D & M Jack, S. (2015). Italian fathers experiences of labour pain. British Journal of Midwifery, 180-194

World Health Organization. (2015). Before birth: WHO safe childbirth checklist.