Managing Guests on the Labor Deck Requires Clear Communication Consistently, Firmness When Necessary, and Calmness Always
Christopher E. Swide MD
The labor and delivery suite is one of the few places in the hospital where family and friends are almost universally present during procedures that are fraught with risk (the other being the induction of pediatric patients with the parent present). The obstetric anesthesiologist must have not only the clinical skills to deal with the medical management of parturients but also the social and communication skills to manage guests. In the obstetrics environment, the patient’s family and friends are often in the immediate vicinity. They can be distracting to care providers and may become stressed themselves by witnessing emergency care procedures. Unlike other chapters in this book that address anesthetic emergencies, this chapter focuses on methods for handling the potential repercussions of managing anesthetic emergencies in the presence of guests.
Every anesthesia provider must develop a practice model concerning guests. It is important that this model meet the needs of all “clients” (mothers-to-be, family and guests, the baby, the obstetrician, and the labor and delivery nurses) as well as his or her own needs. Fortunately, there is help available in handling these situations:
Follow institution policies. Hospital policies govern who can be in the delivery room or operating room (OR), and include processes of limiting access for medical cause as determined by the obstetric and anesthesia providers.
Communicate with the labor nurses. The nurses taking care of the patient often have a good understanding of the relationship dynamics of the patient’s family and friends. Thus, the nurses can provide excellent advice on how to best broach the subject of presence during procedures. It is also important that the nurses, physicians, and other providers on the unit make a unified decision.
Communicate with the obstetric provider. The obstetric provider can be invaluable in helping the patient and her guests understand that the people she selected to be present at her delivery may be asked to leave the room if the care management plan necessitates it.
Communicate with the patient. Discuss the potential of asking guests to leave the room if necessary during a procedure as part of the basic patient interview. It is the author’s practice to always discuss this and to make sure the guests know that it is in the best interest of the patient.
Always remain calm and professional. Even in the midst of a real emergency or with an angry patient or guest, this is an important rule. If you must ask a guest to leave, try to frame it in terms of being able to best help the mom and the baby, rather than making it a contest of wills or control struggle.
Use the institution’s patient advocate. Patient advocates are trained professionals who are invaluable in dealing with stressed and angry patients, family members, and health care providers. These advocates can be used if the previous strategies are ineffective. This step almost always works to avoid utilization of the last step, which is activation of the security team.
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