Novel Application of the After-Action Review Technique for Therapeutic Debriefing After Unscheduled Cesarean Births

Objective While birth-related PTSD rates are rising, obstetric providers are ill-equipped to lead the trauma response. To address this need, we employed the After-Action Review method in semi-structured interviews with patients who recently underwent unanticipated cesarean deliveries. We performed qualitative analyses to determine if the AAR technique could (1) provide a therapeutic outlet to patients who experienced trauma and (2) elicit patient-derived quality improvement opportunities. Study Design Twenty patients and their support people were interviewed during the delivery admission, three months postpartum, and via anonymous survey. Two independent coders analyzed transcripts and themes were generated inductively. Results All surveyed patients found this process helpful, and 80% suggested an improvement, including educating patients about cesarean earlier and designating a specific staff member to support the patient during a cesarean or code. Five main themes emerged: (1) mental adaptation to new care plan (reported by 95%), (2) prioritizing safety of baby (85%), (3) external influences on birth expectations (70%), (4) importance of support from various team members (85%), and (5) balance between autonomy and desiring definitive recommendations (75% vs 30%). Interviewers found the technique easy to apply. Conclusion AAR provides a novel, effective, and reproducible mechanism for therapeutic debriefing and generating patient-centered opportunities to improve care within obstetrics