Conscientization for practice: The design and delivery of an immersive educational programme to sensitise maternity professionals to the potential for traumatic birth experiences amongst disadvantaged and vulnerable women.

Abstract

Birth is an important time in a woman’s life. While the journey into motherhood can be a transformational and liminal experience, unfortunately, this is not the case for every woman. It is estimated that approximately 30 % of women experience childbirth as a traumatic event, with up to 4% of women in community samples developing Post Traumatic Stress Disorder (PTSD) following childbirth. It is also highlighted that women who are vulnerable and disadvantaged, due to complex life situations such as poor mental health, poverty and social isolation, are more likely to experience birth trauma and PTSD onset. Recent research highlights that women’s subjective experience of birth is one of the most important factors in determining birth trauma, and that negative interactions with health care professionals are a key contributor to its development. The aim of this study was to develop and evaluate a training programme for maternity care providers to raise awareness of birth trauma amongst disadvantaged
and vulnerable women. A critical pedagogical approach was adopted so that the design of the programme would aid reflection, critical thinking and conscientization.
This study includes a meta-ethnographic review, empirical interviews and the design and delivery of a tailored educational programme within an NHS Trust. Firstly, a meta-ethnography was undertaken to explore disadvantaged and vulnerable women’s negative experiences of maternity care in high income countries. Noblit & Hare’s (1988) meta- ethnographic approach was used and four themes were identified through the synthesis of eighteen studies; ‘Depersonalisation’ ‘Dehumanisation’, ‘Them & us’ and ‘No care in the care’. Secondly, ten local disadvantaged and vulnerable women in North West of England were recruited and interviewed, exploring their negative experiences of birth. A framework analysis was used to interpret the data, identifying key triggers for birth trauma, focused on interpersonal interactions with maternity healthcare professionals. These findings were then compared against studies included in the meta-ethnography. Following these stages an innovative educational programme focused on birth trauma and PTSD was developed and evaluated. Key findings from the meta- ethnography and the empirical interviews informed the content of a filmed childbirth scenario that was embedded within a critical pedagogical framework. The scenario was delivered to participants’ using virtual reality (VR) technology, forming part of a 90- minute educational programme, in which maternity professionals view the scenario from a first-person perspective. Other elements of the education programme involved providing statistical evidence on birth trauma and PTSD, a presentation of qualitative data collected during empirical phases, critical reflections and the development of actionable practice points to change/influence care practice, for self and others. Ten maternity professionals participated in the evaluation, with pre/post questionnaires and a follow-up session used to assess participants attitudes, knowledge and experiences prior, during and following attendance. Findings suggest the immersive educational programme increased participants understanding and knowledge of birth trauma and PTSD, with the use of VR as a tool for knowledge translation found to enhance critical reflection and facilitate praxis. While further research to test the efficacy of the educational programme on women’s
birth experiences is needed, simulated first person realities, embedded within a critical pedagogical framework, offer a unique and innovative approach to addressing interpersonal care in maternity and wider health-related contexts of care.