Personalising birth, with empowerment and transversal vision

Abstract

Introduction : Four years ago Martorell Hospital began changing its strategies relating to assisting birth, labour, post-partum and breastfeeding. The reasons for doing this included scientific evidence and the demand by users and are aimed at improving the level of care by personalising childbirth. These changes are not always enough because people want to share a special moment with us but, in many cases and for various reasons are choosing another hospital. Objective : Personalising childbirth assistance, post-partum support, breastfeeding and adapting the clinical practice. Materials and methods : Below are a series of actions that are being done to help positively influence the population: the presentation of our professional services to users, this gives them to opportunity to speak directly to parents through talks, guided tours to see the facilities and to evaluate them and the application of a Birth Plan (document worked with reference to the ASSIR). Protocols have been modified and done through a process of re-engineering (Normal Part Assistance, Perinatal Bereavement, skin to skin, breastfeeding, post-partum support and early discharge). We have made a major effort to individualize care, offering workshops for mothers breastfeeding during their hospital stay, from giving out high quality leaflets with post-partum information, including warning signs for the mother and baby, mail contact for questions, 24 hour phone number for an on call midwife and breastfeeding support until they visit the CAP. We have created partnerships with local organisations and agencies participating in the community (networking). We have been exhibiting in groups organised by councils and working international events such as the World Breastfeeding Week with all the councils health catchment area. We have promoted the service externally by participating in local fairs to present the portfolio of services, we have organized a photography competition towards breastfeeding. We have taken part in radio and television and local newspaper interviews and we have published articles digitally to try to influence the people in the local area. We have also obtained official accreditation (Maternal Milk Bank of Catalonia) and we are working towards others (Part natural / BFHI). Results : After performing the actions described above we have increased user satisfaction. This has included collecting 20 acknowledgements during the last quarter of 2014, the healthcare indicator for normal vaginal / instrumental / caesarean deliveries have improved from previous years, in 2010 collected in the annual midwifery service normal vaginal deliveries were 53% and 64% in 2014. The instrumental deliveries have gone from 23.8% in 2010 to 14.8% in 2014. Caesareans were 23% in 2010 and 20.6% in 2014. The breastfeeding rates remain high for the first month of life, favouring a reduction of breast / formula mixed. In 2010, according to the memoirs of Paediatrics and valuing shared history (primary care) there were 86.54% of mothers breastfeeding exclusively, decreasing 55.14% in the month of life. In comparison the 2014 figures are the highest with 91.10% exclusively breastfeeding in the first month of life and maintaining 83.18%. Since then there have now been 27 mothers recorded as breast milk donors. Conclusions : Transversal work with local authorities and municipalities, ASSIR, groups of indigenous mothers and mothers groups of immigrants have boosted the confidence of users in the hospital. Breastfeeding has generated a corporate celebration, the World Breastfeeding Week, where institutional events have been promoted, consolidating us as a referral hospital in the area with influence and positioning ourselves after this, as all leaders in Catalonia in number of donors selected. This, together with good healthcare indicators make us objectify and save a qualitative improvement in the reduction of the number of births, encouraging us to continue working in this direction and provide us with a comprehensive and continuous progression.