Enabling birth choices in theatre: how comfortable do staff really feel?

L. Cutler1, E. Evans2

1Department of Anaesthesia, Imperial College Healthcare NHS Trust

2Department of Anaesthesia, St George’s University Hospitals NHS Foundation Trust

Background

In 2018, New Beginnings, an experience based co designed project aimed at improving mothers' experience of operative birth, introduced a co-designed improvement called GRAPES (Gender, Reveal, Ambience, Partner, Extras, Skin to skin) to reflect mothers' desires to personalise the theatre checklist philosophy and to encapsulate their original birth plans. Post pandemic, we evaluated the staff comfort levels in enabling birth choices whilst delivering safe care.

Methods

In December 2021, we surveyed obstetric theatre teams. Questions covered the main components of birth choices rated against elective and emergency settings using a Likart scale from 1 to 5; 5 =very comfortable and 1=very uncomfortable. 

A final question asked how long they had worked in obstetrics to evaluate the impact on ratings.

Results
N=44 :23 Midwives, 12 Anaesthetists, 5 Obstetricians, 3 Scrub nurses,
1 Healthcare assistant
The highest rated aspect was music: 82% were very comfortable
during elective section versus 27% during an emergency; the median
emergency rating was 3.
The aspect with lowest rating and also greatest disparity between
elective and emergency births was dimming lights : 41% respondents
felt very comfortable during an elective section versus just 18% for an
emergency.
The least disparity in rating was to dropping screens at delivery and
having baby skin to skin; median score was 5.
The clinical experience of respondents correlated with higher ratings
in all aspects of GRAPES in an emergency context.

Discussion
GRAPES is the new normal of operative birth experience
at St George’s.
Cl
inical experience correlates directly with ratings in all aspects of GRAPES personalisation and could imply an increasing
willingness to deviate from the established routine.
The disparity in elective versus emergency ratings supports the need for a more clinical focus on care during emergencies
and less emphasis on the patient's birth choices.Ratings on interventions to adapt the sensory theatre environment proved
to be particularly divisive and this aspect could be perceived as less tangible contributors to birth experience than practic al
features like skin to skin or cutting the cord.
Fulfilling birth choices during operative delivery can be challenging, particularly in an emergency and with a less experienc
ed
healthcare worker. Ultimately, there will always be a balance between enabling birth choices and staff feeling comfortable
delivering high quality clinical care. A culture of supporting both equally is imperative in maintaining clinical and
psychological safety within maternity teams.