Delivering compassionate care
Renata Boreham explores her actions trying to enable nurses, midwives, doctors and medical students to deliver compassionate care through voluntary workshops in Sri Lanka
Renata Boreham is a registered midwife with over 15 years of clinical practice and a former midwifery lecturer at Oxford Brookes University. She has been in Sri Lanka since 2019. Renata used Borton’s (1970) model of reflection to explore her actions when attempting to enable health professionals to deliver a higher level of compassionate care through voluntary workshops. She chose this model for its generalisable framework, primarily designed to be used within education.
What? I was invited to spend a shift on a labour ward in a semi-government/private maternity hospitals in Colombo to observe the health professionals on Monday 8 November 2021. My first impression was of a sterile, top-to-bottom white tiled rectangular room with two small windows. There were four birthing beds with curtains between them and one woman was lying on a bed with a monitoring machine (cardiotocography).The place looked clean, seemed organised and all equipment was labelled in metal cupboards. Approximately 10 staff members in full personal protective equipment were circulating, talking loudly and some were using their mobiles.Two medical students were present.There was a small table with four chairs.The radio was on quietly and there were bright lights. A door was open to the sluice, another door was closed and led straight into the corridor and the final door was open into the birthing room for patients who were COVID-19 positive.This room had two beds, no curtain and a plastic transparent divider between the room and the corridor.
Renata Boreham Registered midwife
A woman was brought into the labour ward for induction. I was with her during her birth, as she laboured quickly once her water was broken. I held her hands, massaged her gently, smiled at her and told her positive birthing affirmations to help her breathe through her strong contractions. She had very little understanding of English. She held me and afterwards, asked the nurses to translate to me that she was grateful for the support.
What did other people do? There seemed to be little communication between women and staff.The staff members were busy with many tasks, people were walking around without any consideration for women’s privacy, chatting and laughing with one other.Women’s genitalia were exposed for all to see. I observed some discussion with women prior to tasks (from nursing or medical professionals). Infection control protocol prior to any aseptic procedure seemed to be followed. Birthing women were left mostly alone, without an explanation of the birth process or what will happen. Some nurses were using touch and talking to women. Food and drink were offered to some patients at intervals. A bed pan was given to each woman every 2–3 hours, with a complete absence of privacy while they used them. Examinations were performed by the senior registrar in front of everyone (with up to 10 people standing around the bed).
What was my reaction? The labour room seemed clean and well organised. I was pleased to see that nurses and doctors followed infection control rules when doing tasks, using sterile instruments and clean materials. Aseptic techniques were adhered to and clean gloves were used appropriately.
All women were lying on their back or left lateral once they arrived, with their legs in lithotomy for the second stage. Women giving birth vaginally for the first and second time were given a compulsory episiotomy, using infiltration of local anaesthesia.This is different to UK practice, as the National Institute for Health and Care Excellence (2021) guidelines suggest no routine episiotomy unless clinically indicated. Perineal suturing was done by the registrar within 1 hour of birth if possible, following aseptic technique using local anaesthesia.
Both women present were on continuous cardiotocography monitoring, no Pinard or Sonicaid was seen being used, with a cannula in and fluids running.
I found it upsetting that staff showed little compassion, empathy and understanding to birthing women and lacked awareness of the physiology of normal birth.There was no privacy for labouring and birthing women.
What is the purpose of returning? I wanted to use this observational shift as grounding knowledge for a workshop. I also intended to use it to identify points in practice that could be changed, using minimal resources to enhance patient care and women’s birth experiences.
So what? So what did I feel at that time? I felt that nurses (institution midwives) had good knowledge of processes and were skilled nursing practitioners. However, they had minimal knowledge of holistic approaches and the normal birth process (the mechanism of labour, hormones and a woman’s emotional wellbeing) and evidence-based practice was not always followed. All women were treated the same with no emphasis on privacy and dignity.
British Journal of Midwifery, April 2022, Vol 30, No 4