by Sharon Jordan, Labour Ward Co-ordinator, North Bristol Trust.
I have been training midwives, obstetricians and anaesthetists in Neonatal Resuscitation for the last 11 years, and it is rewarding to see how confidence grows in a skill that is not practiced frequently.
As Labour Ward Co-ordinator you are often first on the scene to answer an emergency bell and initiate resuscitation of a compromised baby, but midwives only really gain practice in this area if the baby they deliver themselves is sick, and even then, may hand over the resuscitation to the help that has arrived, as they need to attend to the woman’s care, usually to manage the third stage of labour.
In the training sessions, role-play is used but the resuscitation is not carried out in ‘real time’. This enables the midwives to develop a deeper understanding of the physiological process in each step of the resuscitation. There is always an initial hesitation when a volunteer is requested to step forward to show how they would resuscitate a baby, but with time, and as participants overcome their embarrassment, they appreciate the opportunity to actively take part in the scenario, and practice their skills.
During the scenario participants develop and practice a structured approach to the skills required. They are encouraged to anticipate the problems that could be encountered with a view to maternal obstetric history. This may include growth retardation, antepartum haemorrhage, abruption, sepsis, a presumed compromised fetus in labour, maternal opiate intake, and so on. Key learning points also include the importance of calling for help early, and how crucial effective communication skills are when stating the problem to the neonatal team and the parents. Once the scenario is practiced as a group, each participant is in turn asked to practice airway management, and is individually assessed on their technique. Both community and hospital-based scenarios are practised, and the difficulties in the home situation debated; this is obviously a challenge for the midwife as they need to co-ordinate calling for paramedics with continuing resuscitation efforts. Failings observed during the drills usually include poor thermal care, failure to open the infant’s airway adequately, usually due to over-extension of the neck, loss of airway management when conducting simultaneous cardiac compressions, and performing cardiac compressions too slowly.
At the end of the session, personal experiences are discussed in a question and answer type forum, which acts as healthy debate, especially where specific problems have been encountered, such as airway management in undiagnosed cleft palate or Pierre-Robin syndrome.
In the UK, very few babies require assistance at birth, however, in developing countries, many babies die following delivery. On a recent trip to Bulawayo in Africa with the PROMPT team, the story was alarmingly different. With little or no formal training in obstetric emergencies, the midwives in the local maternity hospital were unsure of any resuscitation procedures for the neonate. If a baby was born with poor respiratory effort, the usual resuscitation method simply involves a vigorous rub on the babies back. With a limited supply of drugs and medical equipment, the neonatal death rate is high. The hospital we visited shared one resuscitaire between 16 delivery rooms, with three babies sharing a resuscitaire while their mothers were being sutured etc, leading to a high rate of cross infection.
Here, our training had to be adapted as the midwives are unable to call for help, as there is no neonatal team that can come to the delivery suite, and no bleep system in place. If senior help is required, the midwives have to run to find a doctor.
Whilst the UK has the luxury of training aids such as mannequins and simulation models, the hospitals in Sub-saharan Africa would be unable to access such aids. However, we were able to trial Laerdal’s® newly developed ‘Neo-Natalie’; an inflatable/water filled baby doll which can be purchased by developing countries at a fraction of the standard price.
Following the interactive lectures, drills and workshops, the African midwives were excited and grateful to learn the resuscitation procedures demonstrated, and the enthusiasm to teach their newly acquired skills to their colleagues was palpable.
This experience again reinforced that visual, hands-on learning and team training improves outcomes for mothers and babies.
Resuscitation of the newborn is a highly stressful situation for all involved. MIDIRS latest Practice Development Tool has been developed to support students’ and registered midwives’ knowledge and understanding of the actions that should be instigated.
Click here to read more.
Contributor: Sharon Jordan, Labour Ward Co-ordinator, North Bristol Trust
Photo Credit: MIDIRS