Reducing Maternal Mortality: Effective Training In Emergency Cesarean Deliveries
Nobody wants to think of worst case scenarios in childbirth, least of all the laboring mother. But it’s something which medical professionals have to think about and keep thinking about until the baby is safely delivered. It’s one of the rare medical situations when you have two patients, both of which need constant monitoring. In childbirth, when things go wrong they can go very wrong indeed. In many countries, the percentage of babies born by cesarean section is as high as 25% but in most of these cases the decision to deliver the baby in the theatre will have been made well in advance of the mother going into labor, for a whole host of reasons. Around half of the cesareans performed in hospitals are not pre-planned though and the decision to operate is only made when the mother is in labor and things are not progressing as they should. It’s not hyperbole to say this is a life-and-death decision, with two lives potentially in danger.
Making The Call
Things can go wrong rapidly in any labor and midwives, nurses and doctors have to be aware of the signs that a baby is in distress. Sometimes, these signs are very obvious, such as a sudden bleed which could indicate a ruptured placenta. Often though it’s subtler than that and medical professionals have to use their judgement and experience to know when to call for an immediate transfer into the operating theatre.
Experience counts for a lot in obstetrics but how do you gain that experience whilst protecting patient safety? Shadowing senior staff can help, as can watching videos or reading case studies. However, one of the main defining features of emergency cesareans is that they’re unpredictable – if we knew in advance which woman was likely to get into difficulties in her labor we’d be booking the section date before it even got to that stage. Less experienced staff could easily be in the situation of shadowing colleagues for shift after shift, with nothing out of the ordinary happening.
Getting Into Theatre
Once the call is made to go for an emergency cesarean, there’s no time to be lost. There’s no chance for lengthy discussions with the mother, evaluating the pros and cons, referring to the textbooks or calling the consultant for a second opinion. Speed is of the essence to get that baby out as soon as possible.
An interesting study in a Scandinavian anesthetics journal highlighted the importance of interdisciplinary training in procedures for emergency sections. It’s not enough that the surgeons know what they’re doing; the scrub nurses, anesthetists, neo-natal nurses and midwives have to know exactly what they’re doing too, in order for the whole thing to run like a well-oiled life-saving machine. The advantages of interdisciplinary training are enormous but many hospitals are still running separate courses for each job role rather than taking the holistic approach.
Simulation and Training
Emergency cesarean sections aren’t the ideal scenario for training. When they happen, the focus is quite rightly on the mother and child, not on explaining to onlookers what’s happening and why. This is where simulation equipment, like the 3B Scientific C-Celia simulators, comes in. Celia’s an ultra-realistic abdominal simulator, allowing trainers to run medical professionals through dealing with everything from making the first incision to dealing with post-partum hemorrhage and medical complications. C-Celia is as realistic as simulators come, with amniotic fluid, realistic soft tissue and even twin babies to practice delivering multiples. Students can practice their suturing as often as they like and senior members of staff can roleplay complex life-threatening scenarios. Medical simulation training can cover situations that aren’t experienced often in real life but result in providing well-trained professionals who are extremely competent regardless of how complex or rare the situation is.