Topic 2- Treatment

Situation: I went on to the Obstetric ward at King Edward Memorial Hospital to give Post Natal Education to patient. Patient A is a 31 year old women who has just given birth to her first baby the day before. The baby was born by spontaneous vaginal delivery, where patient A sustained stitches for an episiotomy. The labour was not long and the baby's birth weight was 7 pound 9 oz.
There was no other complications or history to report on. The husband was also in the room at the time I saw the patient.

Task: My role was to provide post natal education to patient A, prior to her discharge.

Action: I began my introducing myself and my tutor to the patient and finding out if it was a suitable time to have a discussion. My postnatal education began with a discussion on how they were going and how her stitches and perineum felt. I then continued to discuss the role and function of the pelvic floor, how to perform a pelvic floor contraction and gave her an exercise prescription. I then when on to talking about bladder function, finding out about any previous bladder problems, discussing what is normal frequency and fluid intake. After that I discussed with the patient about bladder, I chose to move on to talking about the patient's tummy muscles. I explained the role of the tummy muscles, checked for a diastasis and taught Transversus Abdominis exercises. I briefly explained the problems problems that can occur with the breasts and explained how physiotherapy can help if problems arise.
I then when on to discuss exercise with the patient. I enquired about previous exercise levels, explained what has happened to the tummy muscles and pelvic floor and why we recommend no high impact activities for at least 6-8 weeks. Educated her that walking is great and to begin gradually and progress the time she walks for. I also explained the Post Natal exercise classes that are run at the hospital in outpatients. I then discussed activities of daily living and posture and informed her how to access help and gave her pamphlets to read later for further advice.

Results: I was successfully able to educate this first time mother and father about a variety of points to consider post natally. I found a good time of day where the patient was alert would be able to take in a good portion of my education. Having the husband there worked to my advantage as he would be able to remind the patient of points I have raised when they are discharged home.

Evaluation: I believe I did a reasonably good job for my first post natal education. I was able to discuss a variety or areas in with a reasonable amount of detail. There were a few points I missed, for example not to do sit ups, about baby slings, maybe delegating jobs etc. There were also a few areas where I believe I could have been more specific and use examples to aid further understanding by the patient. When discussing the Pelvic floor, I asked the patient if she had ever heard of the pelvic floor and asked if she understood their location and function. When she replied yes, I did not continue to explain, but in retrospect I believe I should have gone through that detail anyway, just in case her understanding was completely wrong. But for my first try, I think I did a good job and gave her a decent level of education but there are ways I could improve.

Strategies: The strategies I believe will help me to perform a more thorough post natal education. I think further study in this area would help, along with verbally practising with the other student. I think the more practice I get the better my education will be. I understand that I need to be more specific, especially in the area of activities of daily living and posture. I discussed feeding, lifting, bathing, and change tables, however I believe I did not give the patient enough alternative options that she can apply at home. For example, changing the bath at a friends house in kneeling. I also could have discussed baby slings, prams, and car capsules, however I believe I didn't know enough about these areas. That is where further study and exposure will come into play.

All in all though, I believe I did a good job for my first post natal education, but there was definately room for improvement.