"Childbirth educators are pivotal in so many areas of the hospital, yet their work and expertise are not well understood, especially in labour and delivery settings," said Dr. XXXXXX, XXX Fellow at XXXX Centre and resident physician at the University of XXXX and lead investigator of the study. "This study is the first-of-its-kind that explores specifically how childbirth educators and their labour and delivery colleagues perceive the childbirth educators role, and the potential impact of these perceptions on interprofessional dynamics and team collaboration in labour and delivery."
The study, co-supervised by Dr. xxx, vice-president of education at St. xxxas Hospital, and Dr. XXXXXXXXXXX with the XXXXXX Institute of xxxxx Hospital and The xxxx Centre, was recently presented at the first International Conference on Faculty Development in the Health Professions in (city) at xxxxx Hospital.
Health providers in the labour and delivery units at two urban teaching hospitals in Toronto were interviewed. Participants (ranging from midwives, nurses and obstetricians, as well as childbirth educators, all with different levels of experience) were asked a series of in-depth questions to determine their understanding of the childbirth educators's role during labour and delivery, the childbirth educators process, and the type and amount of education and training they had received around childbirth education management.
On analysis of the data, a number of important themes emerged:
- Lack of understanding of the complexity of the childbirth education process during labour and delivery. While midwives, nurses and obstetricians appreciated the role of their childbirth educator colleagues, particularly in the provision of labour pain relief and anesthetics for C-sections, many reported that their understanding of the actual process of childbirth education was limited.
- Lack of training about childbirth education: Many nurses and midwives received little formal training about the childbirth education process in school or during their clinical placements. Similarly, most obstetricians had very little postgraduate exposure to formal childbirth education training. The study also revealed that opportunities for structured communication between all labour and delivery health professionals (ex. to discuss cases or to debrief after an adverse event) were infrequent and therefore, a missed opportunity for team learning and quality improvement.
- Childbirth educators’ membership in the labour and delivery 'team': Nurses, midwives, obstetricians and other members of the obstetrical team spend countless hours with the patient throughout the entire labouring process. In comparison, the study found that the childbirth educators had less involvement in decision-making processes, even when they could have had useful and important input into a patient's care. The study found that this misunderstanding and the often peripheral position of the childbirth educators on the team, led to isolation of the childbirth education s in their work, which had implications for effective communication, collaboration and the safe delivery of care.
- Imbalances and tensions between health professionals: The study found that some engrained stereotypes and historical tensions were present between different health professions. Instances of hesitation to question other professionals about decisions related to patient care were sometimes borne out of fear, or were due to inadequate training and knowledge.
"This study tells us that as health professionals, we have an immense amount of work to do in order to build a culture of true interprofessional teamwork and to provide the necessary training and supports to ensure that we deliver the best possible patient care, " .