Ockenden’s Postnatal Anaesthetic Clinic at a Tertiary Centre: Surveying Clinician Experience,
Training and Opportunities to Improve Birth Trauma
Kwan, Zara; Wilgamuwa, Harshana; Rao, Chandana; Sadeghi, Abtin
Queen Charlotte's and Chelsea Hospital
Introduction
•The Ockenden report noted that many women with obstetric anaesthetic complications did not have adequate opportunity to discuss peripartum experiences, complications or poor care with clinicians. Therefore, one recommendation from the report was for outpatient postnatal anaesthetic follow-up.
•Current data suggests of women giving birth, 4.7% develop post traumatic stress disorder (PTSD) and 12.3% develop post traumatic stress symptoms (PTSS). [1]
•As consultants who have run a dedicated clinic at a tertiary maternity unit for over a year, we identified an opportunity to share new patient insights and explore themes from anaesthesia that may contribute to birth trauma.
Methods
We sent a retrospective survey to clinic leads within our national network with a six-question survey looking into: patient benefit, insights gained, presence of trainees from the clinic, prior training in managing birth trauma and the clinician experience of running this service. Participants were informed of data use.
Results
•We had responses from 10/15 leads in our network.
•90% described gaining new insights into patient experience, emphasising the distress caused by ineffective labour analgesia and ensuring explanation of time critical medical decisions. Leads also noted a higher-than-expected number of patients with neuropraxia.
•70% described being "somewhat drained" afterwards. Comments included difficulty with ongoing referrals and helplessness in response to suboptimal care due to maternity services under pressure and staff shortages.
Discussion
•Shared themes in birth trauma across centres support the value of postnatal anaesthetic follow-up clinics in understanding patient experience and improving care. Offering important learning to improve communication and patient-centred care
•Key issues included ineffective labour analgesia, poor understanding of urgent decisions, and the emotional impact of conversion to general anaesthesia.
•They were also emotionally demanding, highlighting the need for clear signposting, expectation management and clinician support.
•A two-clinician model may help reduce emotional burden and support debriefing after difficult consultations.
•Trainee involvement may be valuable, but should be considered case by case given the sensitivity of these consultations.
•Most clinicians reported no formal training in birth trauma debriefing or recognising PTSD.
•The 2024 All-Party Parliamentary Group[2] advocated mandatory trauma-informed care training for all anaesthetists, which we strongly support.
References
1.C Heyne, M. Kazmierczak, R. Souday, Prevalence and risk factors of birth-related posttraumatic stress among parents: A comparative systematic review and meta-analysis, Clinical Psychology Review , June 2022 Volume 94 102157 https://doi.org/10.1016/j.cpr.2022.102157
2. All-Party Parliamentary Group on Birth Trauma, Listen to Mums: Ending the Postcode Lottery on Perinatal Care, 2024 (https://www.theo-clarke.org.uk/files/2024-05/Birth%20Trauma%20Inquiry%20Report%20for%20Publication_May13_2024.pdf)
