Obstetric Nurses’ Workshop

Integrating Coaching and Hands-on Support into L&D Nursing; A Pathway to Patient-Centered Care and a Safe Vaginal birth

This nurses’ workshop integrates coaching strategies and hands-on labor support techniques into L&D Nursing as a pathway to patient-centered care and safe vaginal childbirth. It’s aligned with the vaginal birth initiative, and with the reforms in maternal care in the direction of eliciting patient’s autonomy in Labor and Delivery. It’s a one day workshop,  CE Approved (8 credit hours) by the California BRN.

Nurses’ feedback: 

Here are some of the things nurses said when I asked: “What are you taking out from the workshop’?
  • “The mirroring, definitely. I will never again enter the room and greet a new patient without observing and matching her body position, her breath work, or her pace. It makes so much sense now after the imposture exercise.” 

 

  • “The coaching questions were so valuable. I can’t wait to ask every patient time and again “How can I best support you right now? It’s such a simple way to understand her personal needs.

 

  •  “It was an important lesson for me to recognize how fast and irresistibly we are all responding to a patient’s request for an epidural by running to get the anesthesiologist. We can’t assume that the mother knows the dramatic difference in her birth experience after taking epidural.  And you are right, it might just be her way of asking for our support…saying that she is in pain. We need to take the time to provide her with the right support and information, suggest a coping position or apply massage…she might be able to avoid it.”

 

  • I love having the verbal coaching as a tool to give the power back to my patient; to help her own the birth. It’s a relief to be able to ask her: “Which steps did you take in order to achieve this birth plan?” and make her understand that I can’t be the only one accountable for her desired birth.”

 

  • The workshop is so relevant.  In 15 years of practice, I never had the chance to practice all the valuable techniques to support a woman in labor. Especially the many tools to help a posterior baby rotate.  I think we should have a bi-monthly refresher workshop with you because I can’t imagine any of us remember all of them. 

 

  • Thank you for giving us the tools to work with the doulas. you really help bridge doulas and nurses. I loved how you were open to working with challenging scenarios we shared even when we were frustrated with doulas. 

 

What can you expect to learn in this nurses’ workshop?

  • The origins and the changes in the role definition of the obstetric nurse in light of the different approaches to maternal care.
  • Introduction to the modern Coaching profession: The origins, principles, strategies and structure of the coaching process as a pathway to patient-centered care.
  • Integrating coaching questions and leadership strategies costumed to maternal care. 
  • Resolving  particular challenges you encounter at your workplace –  using the coaching strategies to navigate through scenarios you ancuonter at your hospital. 
  • Hands-on modalities of care: Positioning, massaging, vocalization, visualization, hydrotherapy, rebozo techniques and more. 
  • Acknowledging new aspects of childbirth beyond Pain and Fear.

 

Teaching Methods: 

  • PowerPoint presentations
  • Textual Study
  • Video Clips
  • Dynamic exercises
  • Reflective discussions
  • Practicing hands-on labor support techniques

 

Objectives: 

  • Raise nurses’ confidence in their ability to establish patient-centered relationships by introducing the different types of relationships and their expressions in L&D: Teaching, mentoring, authoritative relationships, therapy, coaching, and partnering.
  • Increase nurses’ knowledge about changes in philosophy and assigned tasks of maternal care figures throughout the history of obstetric medicine and obstetric nursing, in order for nurses to see the current value of the patient-centered approach and coaching skills in patient empowerment.
  • Understand and embrace coaching relationships as a pathway to patient-centered maternal care, and develop concrete tools and strategies which will be used by nurses to facilitate an informed consent, encourage patient autonomy, increase patient confidence and thus facilitate vaginal childbirth.
  • Introduce the basic principles, terminology, and strategies of the modern coaching professions in order for nurses to integrate these into clinical practice.
  • Understand and embrace coaching relationships as a pathway to patient-centered maternal care, and develop concrete tools and strategies which will be used by nurses r to facilitate informed consent, encourage patient autonomy, increase patient confidence and thus facilitate vaginal childbirth.
  • Practice a wealth of coping techniques for labor which nurses can trust and rely on while leading their patients towards a healthy vaginal and safe birth. 
  • Develop a new culture in maternal care where the practice of obstetric nurses is flexible to be adjusted in accordance with the patient’s belief system about childbirth pain, her motivations, coping skills and strengths, and is inspired by these.  

 


How does the workshop relate to the current directions and needs in maternal care? 

In recent years several organizations, including ACOG, the WHO, and CMQCC, have worked hard to reduce cesarean rates in the USA, and support the vaginal birth initiative. The coaching approach taught in this CE approved workshop suggests that this change can not be achieved by implementing new clinical policies, but rather should be found in establishing a new type of relationship in L&D. This new type of relationship is the basic principle of the coaching professions and is called client-centered relationships. It assumes that the client is an expert in her own lives, and therefore has all the answers and that the role of the coach is to help the client get in touch with her belief system and strengths in order to help the client overcome her internal resistance. This type of relationships is aligned with the sought transition of the medical system from providing standardized and Evidence-Based Care provided by authoritative experts towards a maternal care which is individualized and is respectful of patient’s autonomy.

“In the interest of increased accountability and quality in health care in recent decades, policymakers, professionals, and consumers have sought to standardize service provision. Yet in maternity care, in particular, the resulting spread of evidence-based clinical guidelines and care protocols remains at odds with an alternative humanistic discourse stressing the importance of individualizing women’s care…

…Proponents of Natural Birth accuse mainstream obstetric discourse of focusing too much on the measurable mechanics of labor and on managing the risk of them going awry but not understanding the complexity of processes involved. They argue that the medical management of risk often creates new risk, and further, that established Western birthing systems (practices, environment, cultures) actively discourage the physiological processes of childbirth. Rather than birth necessarily being a medical event managed through objective scientific knowledge and technology, it is seen as an embodied social, psychological and spiritual process, one which requires supportive relationships, personal knowledge, and understanding. “ (Reiger K. and Morton C., Standardizing or Individualizing? A Critical Analysis of the “Discursive Imaginaries” Shaping Maternity Care Reform,  International Journal of Childbirth, Volume 2, Number 3, 2012, pp. 173-186(14))

This nurses’ workshop is a paradigm shift. It is the perfect answer to the current crisis in obstetric nursing as describer by Theresa Morris in her book Health Care in Crisis; Hospitals, Nurses, and the Consequences of Policy Change. Morris maintains that what is most important in delivering quality care to patients is the amount of interaction time spent with patients, yet finding that time is a real challenge in this new environment.

This workshop provides Labor and Delivery nurses strategies from NLP and coaching, as well as hands-on labor techniques , to promote patient’s autonomy, and to establish the supportive relationships  and understanding between a nurse and her patient.