It's time to TRIAGE triage.
The definition of triage is to systematise, organise and prioritise. To evaluate a situation, to best, most effective end.
I've always wondered how a transient, brightly-lit, interruptive environment could be an appropriate first space for someone arriving at hospital in labour - a person who will be navigating huge, new feelings; in profound need of soothing and reassurance; and given the aim is to give birth without hitch, physiologically requiring some very specific things (calm, quiet, privacy) to support hormonal flow. Look at the pictures - how can the setting on the right meet the feelings on the left?
So if we assess the assessment tool, is it fit for purpose?
The corona crisis has heightened the mismatch. I was recently involved with three births where women who had declined a vaginal examination (in all three cases they turned out to be fully dilated so you can imagine how easy it was to assess them visually)were told if they didn't agree to having their cervix checked, they wouldn't be able to have their birth partners back.
I understand the logic - if we cant' confirm you are in labour, we can't let you through, and then you can't have your partner with you. But could the protagonists really just be locked in a protocol cul de sac?
Surely their hands shook in shame as those wobbled, tearful women agreed, and TRADED their right and choice, just so they could see a familiar face. Isn't it kind of abhorrent that blackmail like just gets overlooked as a necessary consequence of a care path?
Wouldn't it be wonderful if we could go back to the way it was for mothers in the nineties and noughts...where you got to hospital, you got welcomed into your quiet dark room, you settled in and got comfortable and when (AND ONLY WHEN) you felt safe and relaxed with your midwife, you'd get assessed. Usually by then, she'd know anyway what was happening, so midwives got to hone and attune their listening skills too.
To my mind, instead of last-minute gatekeeping on labour day, there should be a midwife appointment entirely devoted to WHAT TO EXPECT; WHAT DOES ACTIVE LABOUR FEEL LIKE; HOW TO MANAGE AT HOME; COMFORT AND COPING so that parents who want to have their baby in hospital are properly prepared; and a 24 hour reassurance line available to call when they want support and a bit of ordinary guidance to help them to know where they were and what they were feeling.
What are your thoughts? What was your experience of triage and do you think there could be a better more fit-for-purpose system ?