2.2.f Debriefs

Debriefs are a concise exchange of information, after a clinical event, to discuss team processes. Critical Incident Debriefing was developed as an intervention to reduce traumatic reactions for people following disturbing incidents. Traditionally, labour and births have only been debriefed if a critical incident or poor outcome occurred. If critical incidents do occur, birth debriefs are crucial. A growing number of individuals are making the case for Normal Birth Debriefs to occur after every birth, regardless of the outcome.When debriefs are used as strategies for feedback and learning, they improve team functioning and improve people's satisfaction with care (3). A debrief can involve two individuals, a team member and the client, or include other team members and the support people, or occur just among team members. 

The purpose of each type of debrief is similar. Open discussion questions are used and each person provides an opinion about “What went well?” and “What can be improved upon?”  When a client is present, the debrief prioritizes listening to the person’s overall experience of care, as well as the emotional and life impacts of individual decisions. The care provider(s) can then offer their own reactions within this context. Debriefings are not a clinical review of the case. A scheduled chart review can occur later and it will focus on the outcome and care. 

Debriefing with the Birthing Person

Providing the birthing person an opportunity to review the birth story with a care provider in the immediate postnatal period has more than one purpose. For some people, a debrief can help them fill gaps in their memory of events and process their reactions to events. This is especially important when there is a disparity in what they expected and what occurred, such as mode of delivery.  For some people childbirth can be experienced as traumatic. Their perceptions can be affected by lack of information, knowledge and understanding; and a debrief may help them to transition to parenthood with a sense of clarity.

The literature supports the view that people themselves find debriefs helpful (3). Best practice for care providers is to listen empathically, identify and report any problems within the service or to staff involved. Both negative and positive feedback may help to change care and practice, on a practice level or institutional level. A debrief can also assist care providers to evaluate appropriate referrals to specialists, for example, counsellors or psychiatrists.  Most importantly, the focus of a debrief is to consider the best interest of the client, not the care provider.

Some care providers routinely incorporate a birth debrief into their postnatal care, and evidence suggests there is some benefit to doing so in the first 48 hours after birth (3). Some settings have a professionally trained facilitator from client services or social services conduct the birth debrief. Open-ended questions that do not presume a specific answer are most effective for eliciting person-centered feedback. Sample questions may include:

• Tell me how you are feeling about the birth? What is most important when think about how you will tell your birth story?
• Do you have any questions about the labor or birth?
• What were the high and low points of your labour and birth?
• What made you feel proud and happy, or disappointed and concerned?
• What gives you a sense of being well cared for?
• How could things have been different for you?
• What recommendations do you have for me or the staff?  Shall we review the notes together to help us remember your birth story?