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

## TL;DR

This study explores using After-Action Review interviews to help patients who had unexpected cesarean births process trauma and suggest improvements in care.

## Contribution

The study introduces After-Action Review as a novel therapeutic debriefing method in obstetrics for trauma response and quality improvement.

## Key findings

- 80% of patients suggested improvements like earlier cesarean education and dedicated support staff.
- Five main themes emerged, including mental adaptation to new care plans and prioritizing baby's safety.
- Interviewers found the AAR technique easy to apply and effective for therapeutic debriefing.

## Abstract

While birth-related posttraumatic stress disorder (PTSD) rates are rising, obstetric providers are ill-equipped to lead the trauma response. To address this need, we employed the After-Action Review (AAR) method in semistructured 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.

Twenty patients and their support people were interviewed during the delivery admission, 3 months postpartum, and via an anonymous survey. Two independent coders analyzed transcripts and themes were generated inductively.

All surveyed patients found this process helpful, and 80% suggested an improvement, including educating patients about cesareans 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.

AAR provides a novel, effective, and reproducible mechanism for therapeutic debriefing and generating patient-centered opportunities to improve care within obstetrics.