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Psyche and Support during Childbirth and Postpartum (Nursing)

by Jacquelyn McMillian-Bohler

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      Slides The Five Ps of Labor Nursing.pdf
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      Slides Five Ps of Labor Psyche and Support during Childbirth and Postpartum Nursing.pdf
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    00:00 Now we're on our fifth and final P, the psyche of the pregnant patient. Sometimes we don't pay enough attention to the psyche. The mind is powerful and it really will provide comfort and direction when you're feeling discomfort and sometimes very confused about all the things that are going on. The nurse has a responsibility to really assist the patient and monitor and see how they're doing and check in with them because not being in a good frame can really slow, stole, and even stop a labor and being positive and hopeful and feeling supported can actually work like the best medication to help the baby come out. So, psyche and what it means is important so let's talk about what that includes. So psyche refers to supporting the pregnant patient and their sort of psychological process and how they adapt to labor. There are some elements that we want to think about in terms of education because talking to the client about what's going to happen and preparing them for what they're going to feel and who's going to be in the room and what they're going to be doing makes a big difference. Thinking about how we build trust is going to be really important. Now I want to add another P to this conversation. We want to think about pronouns. So often we get caught up in "Well this is a woman, a woman has a baby. This is a mother." I want to encourage you to think bigger than that because everybody who's pregnant and everybody who has a baby does not identify as a woman or a female or a mother. So we have to be careful to ask the patient which pronouns they use, not which ones they would prefer because that implies choice. We want to say "Which ones do you use?" So asking them questions like that using the names that they prefer helps to establish trust which is key to building psyche. Also making sure that you don't surprise go ins, that when you come in the room you knock, that you make sure they're covered that before any examinations are done that a request is made to do so because any effort to not do that really erodes the trust and really sets off a bad relationship between the client and the provider, and it makes people afraid and fear is one of the things that actually can really have detrimental outcomes to both the experience of birth and the actual delivery. So we want to build trust. Education is part of that. We also want to make sure we've explored the culture. What is the patient's knowledge about labor and what are they expecting? And is there anything from their home culture that they want to incorporate into the labor process? Asking that question goes a long way in establishing comfort and support. Again, education.

    02:43 What to expect? What does that mean to be 3 centimeters dilated? How many centimeters do you have to be before it's time to start pushing? So these are thing we can't take for granted that the clients know, we want to slow down and talk about it. There have actually been studies done and we know that having a support person in the room with you while you're laboring can actually increase the experience, the positivity of the experience and actually decrease the chances of needing a Caesarean delivery. So just being present, it's not always about talking. Sometimes it's just about being there. So making sure that you're there or their support person is able to be there so they're not alone. Giving the client control. So making sure that when there are choices to be made, the client is involved. This is a well client who is perfectly healthy, they're just having a baby so we always want to give choices when there are choices there to give because the client really should be making the call, we're there to facilitate the birth. And then understanding their motivation. Why do they want to have a baby? Do they want to have a baby? Are they excited about this process or maybe they're not? So we have to understand the motivation of the client in order to really be in that space with them and provide quality, supportive, and compassionate care. Thinking about education a little bit more. We want to know what's happened before they come in to labor. Maybe the client has attended childbirth classes or maybe they haven't. If they haven't gone, then we have a lot of education to do. And if they have gone, maybe it was a long time ago. Maybe like some of us in class right now, they weren't paying very much attention. So we want to assess and ask and fill in the blanks and make sure that they have the education they need to feel safe in the environment.

    04:30 During labor, again, we want to offer anticipatory guidance, we want to talk about the assessments. When they're going to happen? When are we going to check the cervix? When are we going to come in and do any other procedures that need to be done ? We want to talk about that. So there are no surprises. And during their procedure, we want to keep talking. Sometimes what I've seen is providers will explain the procedure then they'll start doing the procedure and they don't say anything else and that's very scary for someone under a ____. Thinking about support. Remember, having a support person really does increase the chances that a client will not need or maybe need less pain medication in labor, that they're going to be more likely to experience a vaginal birth and they're going to be more likely to be pleased with the outcome. We have actually seen studies where our patients don't feel support and they liken the experience to being assaulted. So think about that as you engage in dialogue with the client and think about the kind of support that we as nurses need to be prepared to give. Creating an environment is really key to what we do as nurses and these are some kind of reminders in creating that client-centered environment you want to keep in mind. Culture we talked about. What does that look like for them? How can we create a safe environment for them? Not for us, but for the patient.

    05:51 Giving the patient autonomy, being able to make choices, ask questions, and feel comfortable in doing so and communication. Communication, communication. Are we talking out and about what to expect, what we're doing, what we're thinking? We give a lot of body language with our eyes and our face and what we're doing and if we don't tell the client it just makes them afraid and it makes them not trust us. We're the most trusted profession, we have to earn it.


    About the Lecture

    The lecture Psyche and Support during Childbirth and Postpartum (Nursing) by Jacquelyn McMillian-Bohler is from the course The 5 Ps of Labor (Nursing).


    Included Quiz Questions

    1. "Good morning. My name is nurse Sarah, and I use for myself the pronouns she or her. Which pronoun do you use for yourself?"
    2. "Good morning; my name is nurse Becky. I would like to keep all your valuables and give them back to you after delivery."
    3. "Good morning Mrs. Smith; my name is nurse Annie. I would like you to know that I'm here to listen if you have any family problems."
    4. "Good morning, Mrs. Ford. I want to see your husband or a family member and talk about your condition."
    1. All answers are correct.
    2. The nurse has a responsibility to assist the client, monitor, and see how they're doing, including their psychological state.
    3. It is essential to know the pregnant clients' knowledge about labor, their expectations, and if there's anything from their home culture that they want to incorporate into the labor process.
    4. The nurse is knowledgeable that the pregnant client has to be involved when there are choices to be made.
    5. Understanding the motivation of the pregnant client provides quality, supportive and compassionate care.
    1. The nurse doesn't need to assess the pregnant patient's knowledge about childbirth and labor, especially when the nurse knows the patient has attended childbirth classes before labor.
    2. With continuous support, pregnant clients in labor are more likely to need less pain medication.
    3. With continuous support, pregnant clients in labor are more likely to experience a vaginal birth.
    4. The nurse needs to assess the pregnant patient's knowledge about childbirth and labor even though the nurse knows the patient has attended childbirth classes before labor.

    Author of lecture Psyche and Support during Childbirth and Postpartum (Nursing)

     Jacquelyn McMillian-Bohler

    Jacquelyn McMillian-Bohler


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