As Occupational therapists, we use models and theoretical frameworks to guide us in our practice. These models tend to base themselves on human occupation which is split into different categories surrounding; the person, the environment and the occupation.
When we think of midwifery and the journey a birthing woman or person goes through, we would consider birthing as an occupation.
Therefore, we would suggest using a framework for understanding any potential barriers, identifying new relationships and preparing for the birth and thereafter.
‘What models essentially do is provide an organizing framework with which to think about practice in a systematic way, and to provide a discourse with which to discuss practice with others.’
The PEOP (Person Environment Occupational Performance) model by Baum and Bass 2005 is one of the many models that is used across occupational therapy. This particular model is good for clinical settings as the model aims to blend the biomedical approach with a more holistic one. PEOP bases itself on being top-down and client-centred with core occupation focused principles including wellbeing and quality of life. Some research has suggested however, that this is not indicative of a top-down approach and so you will need to consider the effect this may have in your practice.
The PEOP places the client in the centre, starting the process with their narrative, therefore focusing on the therapeutic relationship between the therapist and the client.
The PEOP framework provides the therapist with a clear visual process that combines the person, occupation and environment together, using barriers and enablers as the focus of intervention.
Example:
Jess is 28, she is a first time mum and has just gone into labour. She wants her partner, Lola, with her during the birth and is hoping to have a calm, relaxing environment. She has brought along some things to use in the room to help her relax; lavender oil, LED candles, music, soft comforters. She is hoping to move around the room during labour and make use of the exercise ball. Her partner is really keen to get involved in the delivery and wants to be part of the whole experience. Jess and Lola are looking forward to being a family after a few years of trying with IVF. They are still trying to agree on a name for the baby and Lola is using this as a way to distract Jess from being anxious about the birth. Jess is in a lot of pain and is only using gas and air.
Looking at the PEOP framework in relation to Jess, any potential enablers and barriers can be outlined in the sub-categories;
Jess (person):
Spiritual
Jess is soon to be a mother, she is also a partner, she believes in relaxation therapy
Physiological
Jess is experiencing a lot of pain, she is in labour
Neuro-behavioural
Jess is showing signs of anxiety but is coordinated
Cognitive
Jess is trying to focus on the contractions and is finding it hard to focus on anything else
Psychological
In pain, motivated, anxious, excited, nervous
Environment:
Social support
Partner
Economic systems
Partner has time off to help her at home once the baby is born
Culture and values
Part of the LGBTQIA+ community, family orientated
Built environment & technology
Hospital room, ball, private bathroom, dimmed lighting, candles, smells, music
Natural environment
Home with partner
Occupation:
Giving birth
Performance:
Active labour, a successful birth and positive birthing experience
Participation:
Partner involved in birth, no medical intervention, assistance of midwifes
The strengths and challenges Jess is experiencing aids us in designing an individualised plan or approach to providing the best care for her, which will include areas she regards as being important to her as well as addressing her wellbeing and quality of life.
As the birthing experience is unique to everyone, it is a good idea to use something like this framework to consider how you can individualise and personalise the care you provide, putting the service user in the centre.
Reflection:
How does midwifery models compare to this one?
Do you think you could use this model in practice?
Try and apply it to a case study and see if it makes you think about the birthing woman or person differently.
Further reading:
OT Journal about top down/bottom up approach
Medical website definition of PEOP
(Written by Beth Hart August 2020)
