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Birthing my way: Why patient-centred care must catch up with medical technology
Many hospitals are still designed with not a single thought to incorporation of patient and family-friendly spaces.
What you need to know:
- As medical technology advances at lightning speed, patient and family-centred care continues to lag behind. Despite innovations that make care safer and more efficient, many health facilities still fail to prioritise dignity, privacy and family involvement.
- Drawing from surgical practice and maternity care, true healing happens when patients and families are active partners in care. Birth, in particular, demonstrates the power of shared decision-making and emotional connection.
The rate at which medical technologies and products are evolving is mind-boggling. As healthcare practitioners, we are in a permanent race to keep up with the never-ending transitions in care provision to stay relevant. To do otherwise would be suicidal.
This reminds me of an episode a few years ago, walking into the operating room for surgery at one in the night due to unavoidable delays. The patient was eventually wheeled into surgery and as I was scrubbing in, the scrub nurse asked me if I would like to use the Ligasure diathermy scissors in the surgery.
As I shook the sleep cobwebs off my fuzzy brain, I informed the nurse that we were doing open surgery, not laparoscopic, which was where we use the ligasure laparoscopic scissors. He smiled gently and informed me that we did indeed have the same for open surgery. I was so excited to have access to technological equipment that made the surgery easier, safer and faster, right up until I saw the cost of this fancy single-use disposable piece of equipment!
A recent tour of the Dr Kalebi Labs left me smiling to myself at how far laboratory diagnostics have come; from drab rooms at the end of the corridor with uninspiring, stained work benches and chemical smells; to brightly lit modern open spaces with full automated functions, plush adjacent working spaces, with artificial intelligence-assisted technologies making the processes more efficient, and costs way lower for the patients!
In the space of all these fancy new advancements in technology, the one thing that is not modernising fast enough, to keep in tandem with the improvement in care, is the most important of all: keeping the patient at the centre of it all. Patient and Family-Centred Care (PFCC) remains a foreign concept to many healthcare providers, both at institutional and individual staff member level.
Many hospitals are still designed with not a single thought to incorporation of patient and family-friendly spaces. The waiting bays for patients do not accommodate the family members accompanying the sick. The wards are worse, designed to fit in as many beds as possible, with no privacy, and absolutely no consideration for space for family; hence the perpetuation of the colonial concept of strict visiting hours. There are no family lounges where relatives can sit and receive the terrible news of the demise of their loved ones in privacy.
It is not all doom and gloom though. In the past few years, there has been amazing modification to maternity care, with state-of-the-art birthing suites equipped with fancy modern technologies, and heaps of space to keep mother and baby together throughout the whole delivery process; surrounded by family.
According to the Institute of Patient and Family-Centred Care, PFCC is an approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among healthcare professionals, patients, and their families. It emphasises collaboration with people of all ages, at all levels of care, and in all healthcare settings, assuring that healthcare is responsive to priorities, preferences, and values of patients and their families.
In PFCC, the patient defines their “family”, and determines how they will participate in care and decision-making. This perspective is based on the recognition that patients and families are essential allies for health care quality and safety; taking into account that healthcare provision in the health facility constitutes only a small portion of the overall health needs of an individual and community, with the larger aspect of care taking place away from the institutions.
Read: Why giving birth at home was our worst nightmare: Horror tales of women turned away by hospitals
In maternity care, the journey is a whole year-long engagement between the provider and the pregnant woman, punctuated by a short two- to four-day stay in hospital to welcome into the world the little one responsible for this engagement. Taking the cue from my patients and their families, we plan, not just for medical birth pan, but also for the social aspect of the care process.
In the fast-changing world of the Gen-Z generation, what does this look like? Cara* gave me a run for my money through her birth process. Her first pregnancy was filled with fear and anxiety. At about 29 weeks, Cara’s cervix was shortening and opening way before baby was due. She spent the next six weeks in bed, on medications to try and keep the baby in there for a while longer. The baby gave us up to 35 weeks before she made her way into the world. It was extremely stressful for the new parents when the baby was in the newborn intensive care unit.
In this last pregnancy, we had gone ahead to address her risks by performing cervical cerclage, a procedure to insert a stitch in the cervix and tie it tight to prevent premature opening before the baby was due. Despite this, the baby still insisted on coming earlier than expected, denying dad an opportunity to be present at the birth.
Cara went into labour at 36 weeks. We tried to knock it off but after three days, it was obvious we would not win. When I told Cara that the cervical cerclage had to come off and that this would likely result in a short labour, with imminent delivery, she did the most unexpected thing! She got off the delivery couch and walked to her ensuite bathroom. She took a shower and took a minute to do her makeup, down to the eyelash extensions!
Her rationale was simple; she wanted to experience immediate skin to skin contact with her baby, so she needed to be as clean as possible. Additionally, she had to be beautiful for her baby. She did not think it wise for her baby to meet his mom when she did not look her best!
Once it was time for the baby to come, Cara’s sister had one simple job, to bring Cara’s husband into the room through a video call. He may not have been physically present, but he was there for Cara through it all. He would encourage her through the contractions, remind her to breathe deeply after, and cheered her on when she was bearing down.
Read: The magic of childbirth
From different continents, the two shed happy tears together when their son was delivered and immediately laid on Cara’s bare chest, all gooey and wet, to count down the golden minute before clamping and cutting the umbilical cord. The grateful father took a minute to say a prayer of thanksgiving, dedicating his newborn son to God as per their beliefs and values; something he had done for their daughter too a few years ago.
The couple continued to bond over their new miracle while the paediatrician looked the baby over and I delivered the placenta and completed the third stage of labour. In the couple’s own words, their experience was all they ever wanted; an opportunity to do this together, even when thousands of miles apart.
Healthcare will remain heavily medical, but taking it to the next level will only work with PFCC at the centre of it all. Shared decision-making, and a fine sprinkling of a little bit of home and family ensures entrenchment of patient dignity, better outcomes and shorter hospital stays. It also does go a long way in blunting, even just a little bit, of the pain of loss for family, when outpatients have to leave this world.
*Name changed to protect identity.
The writer is an obstetric/gynaecologist practising in Nairobi.
