Your Pregnancy Matters
'We will hear you': The power of patient stories in pregnancy care
August 27, 2019
Medical school prepared me for a range of emergency situations. Maternal-fetal medicine doctors (MFMs) are trained to think critically, act swiftly, and control chaos, particularly during a high-risk pregnancy.
But what happens after the patient leaves the hospital? What happens when we aren't there?
I don’t believe many providers consider this scenario nearly enough. It's not that we don't care – quite the opposite. We want the best outcomes for our patients and work hard to make that happen.
But providers must find the delicate balance between empathy and effectiveness. We can’t become overly emotional, especially during an emergency situation. Yet, if we suppress all our emotions, we risk coming off as medical robots. It’s important to remember, that every micromoment with patients, every single encounter can affect their psychological and physical health long after they leave our care.
For many providers like me, patient stories are among the most impactful reminders of why this balance is so important. So, I invited patient advocate Ashley Byrnes to share her harrowing story with my colleagues at Clements University Hospital. Ashley nearly died from postpartum hemorrhage at another hospital in 2017. She was diagnosed with post-traumatic stress disorder (PTSD) and experienced emotional distress because of the experience.
Hearing Ashley and her husband, Bryan, describe the lasting effects of her providers' words and actions greatly affected all of us. Three of my colleagues were moved to share their takeaways from Ashley's story and to offer insights into how our care team can better collaborate to reduce the risk of emotional trauma in our patients who have obstetric emergencies.
"Every micromoment with patients, every encounter can potentially affect their psychological and physical health long after they leave our care."
'There's a fine line between being effective and alarming.'
Morgan Mattay, bedside obstetric nurse
As I listened to Ashley's story, my first instinct was to feel defensive. We'd never treat our patients the way those providers did, dismissing her simply as an overwhelmed new mom.
Then it hit me. Situations like that happen more than we might think during obstetric emergencies like postpartum hemorrhage. We get caught up in responding to the crisis, and we sometimes put aside explaining the situation to the patient and her family. We use medical terminology and rush around the room because that's our job – but we must be aware that there's a fine line between being effective providers and being alarming to patients.
As providers, we must choose our words carefully. Every patient is someone's mother, daughter, or partner. Ashley said she first heard the word "hemorrhage" to describe her condition when she was being rushed into the trauma center. That made me think I should start using – and explaining – medical terms to my patients before emergencies happen.
I'm all for preparing my patients with information. But, as we do so, we must recognize that our interactions carry weight long after they're discharged from our care.
Related reading: PTSD after pregnancy: When a doctor becomes a patient
'Seeing and hearing the whole picture was profound.'
Martin Hechanova, M.D.
In an obstetric emergency, I immediately go into lifesaving mode. I'm "in the zone," like an athlete in a high-pressure event – you tend to block out factors that don't directly affect the immediate objective.
Athletes might ignore a roaring crowd. But for an obstetrician, that means we sometimes fail to recognize a concerned loved one like Bryan. He described sitting in the corner of the trauma room, watching nurses and doctors rush in and surround his wife – his newborn son's mother – shouting orders. He said that no one took a moment to tell him what was going on.
Ashely's story alone is powerful – but seeing and hearing the whole picture was a profound reminder of how important it is to proactively educate patients and their family members.
Education is a major part of our obstetric practice. Many of our providers are also professors. For example, I teach a lecture series to UT Southwestern medical students about abnormal uterine bleeding, which made Ashley's story doubly impactful.
Every day, our obstetricians huddle at least twice with our multidisciplinary nursing staff. We assign each patient a hemorrhage risk score and discuss what could happen before, during, and after delivery. The goal is to prepare our team for every scenario and to help them educate patients on risk factors.
Education is key. Women should feel empowered to ask how prepared their delivery hospital of choice is to manage obstetric emergencies. Hospitals have varied levels of resources, such as access to blood centers, 24/7 availability of anesthesiologists, and other critical factors. While many pregnant patients will not need emergency Ob/Gyn care, it can be comforting for women with high-risk pregnancies – and their doctors – to proactively learn this information.
Related reading: How much bleeding after delivery is normal?
'We will hear you – we will listen.'
Jessica McNeil, nurse educator
How can we better support our patients? What can we do to improve communication? These questions raced through my mind as I listened to Ashley's story.
As a nurse educator and a member of a healthcare team, we all want what patients want: a good outcome, a healthy mom and baby. Our patients are not just a number. We don't forget you after discharge. But at the same time, we have many patients who need care.
It's a provider's duty to follow lifesaving processes – call the blood bank, assemble the trauma team, attach the monitors and insert the IVs. However, we must always remember that part of our duty is caring for each patient's emotional health, too. Every interaction, no matter how seemingly trivial, can affect her in that moment and for years to come.
I encourage patients and family members to speak up when they're worried, scared, or confused. If you don't get an answer or aren't happy with the answer you get, ask someone else. You know yourself or your partner better than any provider ever will. We want to give you everything you need to feel confident in your care. Ask us if we don't bring it up first. We will hear you – we will listen.
A few closing thoughts
Seeing Ashley and Bryan, with baby Carter in tow, was a reminder our team can't hear enough. We must prioritize following up with patients after discharge to answer lingering questions and make sure they understand all that happened to them.
We must honor what we learn from every situation.
My hope is that all of us who manage obstetric emergencies – and those who provide regular care every day – remember to acknowledge the long-term implications of how we interact with patients and families.
As an academic medical center, our providers have a unique opportunity to spend time getting to know our patients – not just their individual medical needs, but often their hopes, goals, and dreams. We're invested in their care and well-being as people, not just as patients. And when obstetric emergencies happen, we'll be here to support them and their families every step of the way.