Death during pregnancy, childbirth, or shortly after childbirth is more common in the United States than in any industrialized country. It’s called “maternal death,” and it’s about three times more likely for black women than for white women.
To help save lives, a growing number of US hospitals are using simulated birth centers where medical teams can rehearse for life-threatening situations that can occur during labor and Birth. One place that does this is NYC Health + Hospitals/Elmhurst in Queens, New York, which delivers 180 babies in a typical month.
Elmhurst’s Mother and Baby Simulation Center features a custom-designed, colorful full-body mannequin, along with an infant mannequin. The center puts doctors, nurses, and other medical professionals in simulated – but realistic – obstetric emergencies such as maternal bleeding, dangerously high blood pressure, sudden cardiac arrest, and emergency cesarean delivery. They are also trained to deal with umbilical cord prolapse, when the umbilical cord drops through the mother’s cervix into the vagina in front of the baby, which can cut off the baby’s oxygen supply.
Elmhurst serves one of the most diverse communities in the country, with residents of more than 100 countries speaking more than 100 different languages in its surrounding neighborhoods, says Frederick Friedman, MD, NYC Health + Hospitals/Elmhurst’s OB/GYN Services.
“Our simulation team is very happy that the new model that we have to simulate OB multiples is a model of color, which is more realistic for our patients,” says Friedman.
At Elmhurst, some simulations are scheduled to prepare new residents for the most common emergency obstetrics. Others come as a surprise, just as a crisis can unfold in real life.
“We might run down the hallway with a ‘patient’ who has a prolapsed cord, requiring an emergency delivery — and that’s often a cesarean section,” says Friedman. We’ll shout, ‘Dangling the rope, sorting’, and see how fast we can assemble the team, and how long it takes. Anesthesiologist To prepare, when will we have a scrub nurse ready for surgery,” as if the “patient” mannequin is a real person.
This simulation focuses on high-risk situations that don’t happen often, such as severe cases Postpartum hemorrhage (bleeding) or a mother with bouts of eclampsia (high blood pressure), Friedman explains. “It is difficult to develop skills in an emergency that may only occur in 1% of cases, where a doctor or nurse can go years without confronting them.”
The chance for doctors, nurses, and other medical professionals to gain experience in obstetric emergencies is even less at hospitals with fewer crowded Elmhurst deliveries, says obstetric simulation expert Shad Deering, MD, professor of obstetrics and gynecology, a maternal specialist. Fetal Medicine, Associate Dean at Baylor College of Medicine, and Medical Director of Simulations at CHRISTUS Healthcare.
“If you only have 10 deliveries per month, and your risk of postpartum hemorrhage is about 5%, you can go several months to a year without having one,” Deering says. “Birth-related emergencies happen with enough frequency that we really need to prepare for them – but not enough, especially in low-volume settings, that teams get the preparations they need.”
Could training with even a more realistic mannequin and a simulated emergency improve the performance of the medical team when a real person is bleeding uncontrollably during childbirth?
A number of studies say yes. Simulation training offered on:
- Reducing injuries to children Shoulder dystociaTheir shoulders are affected by the bones of the mother’s pelvis during vaginal delivery.
- Shorten the time it takes to diagnose cord prolapse and improve its management.
- Reduce the time it takes to decide whether an emergency C-section is needed to deliver the baby.
“Obstetrics is one of the only places in medicine where we have two patients at the same time,” says Dearing, referring to the mother and baby. “This means that we have to balance very quickly and sharply the needs of both patients.”
“Because labor and delivery teams change so often, nurses and doctors may not have worked together so much before,” Dearing says. “We have a constantly rotating team where everyone has to understand their roles and responsibilities and be able to carry them out flawlessly at any moment, when everything is going well until everything suddenly happens.”
Not every hospital can have a large high-tech simulation lab with expensive and high-quality mannequins. Dering says they don’t necessarily need that kind of setup.
“In a fictional simulation lab, you can order blood products and they will just show up, which is totally unrealistic. But if you’re running a simulation in your normal L&D booth with a relatively inexpensive, mid-range mannequin, run, get your supplies, and come back just like you do In fact, Deering says. “We actually had a situation where we were running an emergency simulation in one room and then we were called to run the same real emergency nearby!”
Besides giving labor and delivery teams the opportunity to hone their skills in responding to emergencies, simulations can help identify specific issues within a hospital setting, such as access to certain supplies. Understanding how unconscious bias affects their care decisions is also part of the training.
“When we make simulations, we can build in situations that might help us identify where care inequalities are, so we can start to address them,” Dering says. So it’s not just about ‘Have you been given the right medication for bleeding?’ But also, “How well did you communicate with the patient and family, were there any potential cultural issues that you dealt with or did not address?”
As with the new model at Elmhurst Hospital, the new obstetric simulators now have more color options, so hospitals can choose from models with a range of skin tones. “We need these simulators to look like our patients, and now we can finally do that,” Deering says.
He says every hospital where babies are born should have a simulator available to prepare the medical team for emergencies, noting that low-cost mannequins are available for less than $3,000, accompanied by free resources available from the American College of Obstetrics and Gynecology (ACOG) and its “Practice of Obstetrics” initiative. for patients” to help make the most of simulation technology.
“To make a real difference in saving the lives of women and their children, and reducing disparities in care, simulation needs to be accessible and practiced regularly,” Dering says. “We want any maternity unit and delivery of any size in any hospital in the country so we can do that.”
(For more information on maternal deaths, listen to WebMD’s Discover Health podcast episode with Tonya Lewis Lee on her new Hulu documentary, After Trauma.)