5.2.d Assigned Characters for the Scenarios: Morning Group

Characters

Background

Assigned Person

Florence, the Client

All of Florence’s female relatives – including aunts, sisters, cousins, grandmothers – plan to be present during the birth. This is an important cultural ritual that Florence and Tom are deeply committed to. She really wants to birth at home, with her family, and have a physiologic birth. Her last labour and birth was normal. This pregnancy she appears to be having a much larger baby. Her SFH measurements have been 2 cm above the last 3 visits and the Estimated Fetal Weight on ultrasound is 4000gm at 38 weeks. The baby is suspected to be large. Midwives must consult for inappropriate uterine growth in pregnancy so a consult occurred with Riann, the local Doctor. Riann and Florence discussed the possible birth risks associated with large babies (such as need for cesarean section, assisted vaginal birth, shoulder dystocia, and postpartum hemorrhage). At the appointment Rianne said as Florence was leaving the room that perhaps planning a home birth wasn’t a good idea. At 38 weeks Florence was surprised to learn that the midwife, Tasmin would be out of town when she was due to have her baby. Riann, would be covering Tasmin’s call. Florence wants to be able to meet with Riann again to see how supportive she will be of her birth preferences. Florence is aware of the risks of a large baby but is not convinced the size estimates of this baby are accurate. She is choosing to plan a home birth.

Erika Mitchell

Riann, the Doctor

He/She is the doctor that provides GP/OB services in town. It is a small remote community with a small population. He/She will be covering call and caring or Tasmin’s caseload of clients while Tasmin is away in the city for continuing professional development. Riann is trained to provide home births. Riann and Tasmin have similar approaches to care and enjoy working together as side by side, solo practitioners that cover each other’s maternity clients when needed. There are times where Riann cannot offer home birth when he/she is needed on site at the hospital. He/She sometimes has to provide emergency assessments and care for her own patients. Riann is familiar with Florence’s case, since she was the consultant who discussed the risks associated with suspected large babies. Since the risk of birth complications and birth injury could be higher for Florence, Riann suggested that hospital birth might be a better option.

Crystal Herie

Tasmin, the Midwife

He/She has told Florence after her meeting with Riann that she will support Florence’s decision to give birth at home. Tasmin feels that the suspected large baby will “declare themselves in labour.” That is to say that labours will not progress as expected with large babies and when that occurs it is at that time that they could move into the hospital. Tasmin said to Florence that if she doesn’t progress as expected in labour, or in the pushing stage then they can move in at that time, before complications arise. Tasmin has heard about a last minute, but long awaited, continuing professional development opportunity off island and arranged for call coverage from Riann. Tasmin realizes that he/she needs to discuss Florence’s plan to birth at home with both Florence and Riann. He/She arranges to have a meeting with both of them to discuss the plan and facilitate a discussion between them. Tasmin thinks that he/she should include the nurse, Jodi, in the care planning since she is the maternity nurse who provides home birth back-up in their community. Tasmin arranges for all 4 of them to meet together so an agreement can be in place before he/she leaves.

Emily Baxter

Jodi, the Maternity Nurse

Jodi is an experienced maternity nurse who is competent in both home and hospital settings. He/She has been providing remote maternity and newborn nursing care for 20 years. He/She enjoys backing up both Tasmin and Riann in either setting and has a really good, collegial relationship with both of them. He/She feels strongly about clients being well informed in order to make their own decisions. He/She is a good facilitator and mediator. Jodi regularly leads “lunch & learns” on the unit to review emergency skills as part of her role as clinical educator. She regularly reviews management of shoulder dystocia and postpartum hemorrhage.

Brigitte Moran

Characters

Background

Assigned Person

Dr. Monica Gupta, the Pediatrician

Monica, enjoys working as part of an interprofessional team. When he/she is sharing responsibility and risk with interprofessional colleagues, he/she ensures his/her ideas and concerns are communicated to the client and then documented in the chart. Monica feels that providers shouldn’t ask for a second opinion about a care plan unless they are asking for a formal consultation, or in-person assessment of their patient. He/She prefers to be consulted formally so that he/she can have a conversation with the patient directly since he/she will ultimately be responsible if any complications occurs. She/he will not participate in any interprofessional shared decision making conversation unless she is being invited to participate in the care planning or care management as well.

Brigitte Moran

Karen, the Nurse 

Karen, enjoys working with midwives and finds that often the workload is distributed nicely between them. Because nurses and midwives share similar duties, she/he can often anticipate the management and care plans of the midwives that he/she works with. But the overlap in their roles and duties can create some confusion and when clarification is needed Karen will rely on his/her leaders, such as the charge nurse, to help clarify responsibilities and duties.

Jessica Knowles

Sereena, the Midwife

Sereena, prefers to work to his/her full scope of care. He/She thinks that he/she isn’t obligated to include others in care planning unless he/she is reaching the limits of their scope of practice. He/She is not required by the College to consult with a pediatrician for a baby whose fever appears to be responsive to therapy. The baby does not have a fever currently. If the baby developed a fever that is unresponsive to therapy, he/she will consult then. Sereena finds that when he/she asks others for their opinion about clinical care, he/she has a hard time resolving the differences in his/her own management with another’s management – especially if the managements are at odds with the client’s preferences or his/her own scope of practice.

Erika Mithchell

Chris, the Charge Nurse

Chris is new to this position at this hospital. He/She has just transferred from a nearby hospital that does not have any midwives who work within it. He/She is an excellent leader and collaborator and was well revered as a Charge Nurse at his/her former hospital. He/She does not know how midwives fit in with the medical staff which has caused some confusion about the processes for working with midwives.

Lindsay Wells

Mee, the Client

See the case description for Mee in Module 2 for background information about her values and beliefs.

Crystal Herie

Alang, the Client's husband

See the case description for Alang in Module 2 for background information about his values and beliefs.

Rebecca Vincent

Characters

Background

Assigned Person

Carol, the Primary Midwife

Carol went with Geeta to the hospital after the decision was made to transfer in from the home birth after not progressing in second stage. He/She arrives on the hospital floor a bit after Geeta so some care has already been provided by the hospital staff before Carol arrived. Carol is tired from being with Geeta in labour at home overnight. He/She gets short with words when he/she is tired and this sometimes creates conflict with the people he/she is working with. He/She has been working on improving his/her communication because of a recent conflict with one of the OR nurses.

Emily Baxter

Eleanor, the Charge Nurse

Eleanor is waiting for Carol to arrive to get a report so he/she can anticipate how to help and distribute the nursing staff. He/She received the phone call from Sasha (The Second Attendant at Geeta’s birth) saying that Carol would be transferring in non-urgently with Geeta. He/She did not get much a handover from Sasha so doesn’t know why they are transferring in. Eleanor is waiting around for Carol and the assigned nurse to give him/her a report. He/She has experience working with Carol. They have had some conflict in the past, usually because of ambiguity about scope and roles.

Jessica Knowles

Aleya, the assigned Nurse

Aleya is the assigned nurse to Geeta. He/She is new to working as a nurse and unclear about what a nurse’s role should be after home birth transfers. He/She is taking a history from Geeta about her present pregnancy and labour progress so far. He/She gets along well with everyone because he/she avoids conflict and confrontations.

Rebecca Vincent

Dr. Liz Chen, the Obstetrician

Liz is competent and very good at his/her job. He/She is usually very quick and efficient at work. He/She has very few words to exchange with people and gets along well with everyone by keeping to himself/herself. Liz has a very good understanding of how to lead a team but usually does not take on a leadership role unless required to.

Lindsay Wells

Geeta, the Client

Geeta has the support of her mother and her doula at her birth. Her partner is out of the country. She was planning a home birth and transferred into the hospital during her labour for no progress despite 1 hour of active pushing. She had an uncomfortable transfer in. She is getting tired and impatient when she arrives at the hospital. She wants a natural, low intervention birth.

Crystal Herie

Geeta’s mother, Parvati

Parvati initially appeared supportive of Geeta’s plan for a home birth but feels much more relieved now that they have arrived in the hospital. He/She does not like seeing Geeta in pain but has been managing to keep his/her anxiety to herself. He/She will support Geeta’s decisions even if he/she does not agree with them. Although Geeta asks for Parvati’s input about every decision, Parvati does not weigh in strongly unless he/she feels it will help Geeta with the pain Geet feels in labour. He/She defers to Geeta for most decision making with very little personal opinion unless it will help with the pain.

No One

Jillian, the Doula

Jillian is an experienced doula who is very supportive of Geeta. He/She has no role in Geeta’s decision making process. His/Her only role is to support Geeta with comfort measures in labour. Geeta will ask for his/her opinion but Jillian will not provide any recommendations. Deferring always to what the midwife says is best.

No One