Simulation drill helps Valley Medical's Birth Center

Doctors, nurses and staff in Valley Medical’s Birth Center, Tuesday, participated in simulation training for emergencies a woman might face when delivering a baby.

More than 60 hospital staff went through the drills facilitated by The Doctors Company, a California-based, medical-malpractice insurance company. The training simulated three frequently experienced obstetrical emergencies: shoulder dystocia, neonatal resuscitation and postpartum hemorrhage.

Expensive mannequins, with motorized parts, fake blood, and sound effects helped the staff learn. The baby mannequin’s chest inflates to simulate breathing; it also changes color and cries depending on what happens in the exercise.

While some Valley staff did the hands-on drills in one Birth Center suite, another group of staff watched the action on monitors in another room. There were multiple sessions throughout the day. Valley staff received a didactic, or lecture covering the methodology of the simulation and extensive debrief sessions.

“It’s to get us working more as a team, articulate what our goals are and actively facilitate good teamwork,” said Tami Allen, Birth Center manager.

In 2012, Valley’s Birth Center had 4,300 deliveries. The renovated center opened in 2005 and has since expanded into the Northwest Pavilion of the hospital. Allen did not know how many obstetrical emergencies the Birth Center had last year, but the types of emergencies the training simulated are common and some are on the rise, according to the training facilitators.

Shoulder dystocia in delivery can be life-threatening and happens quite frequently, said Marion Constable. She is a nurse midwife and one of The Doctors Company consultants facilitating the simulations.

“If the baby’s not out in a five- to seven-minute framework, they can die,” she said. “It is a manageable emergency if you know the maneuvers to go through to get that shoulder unstuck under the pubic bone. It’s a skill; you’ve got to practice them.”

Constable likens obstetric teams to pit crews, who practice constantly and become very clear about their roles and responsibilities. She calls it “choreographing the crisis.”

“So they get ‘Dancing with the Stars’-perfect as far as their response to these emergencies,” Constable said.

Post-partum hemorrhage, or the extensive loss of blood during vaginal delivery, is another obstetric emergency on the rise because of the prevalence of obese women and also more C-sections being performed today.

“Obese women tend to have larger babies, which tends to increase your risk of shoulder dystocia," said Pamela Willis, a patient safety, risk manager for The Doctors Company. She was formerly a labor and delivery nurse and became an attorney in 2009.

“And also having a larger baby stretches the uterus more and makes it harder for the uterus to contract back down after delivery,” Willis said.

This in turn can cause hemorrhaging, she said.

Women who’ve had a previous C-section also face the possibility of hemorrhaging. In a following pregnancy, the placenta can become implanted around the C-section scar. It can actually grow through the wall of the uterus, the vessels of the placenta, said Willis.

Multiple C-section scars and implantation of the placenta on the uterus can lead to surgery to remove the placenta if it doesn’t come out, or even a hysterectomy.

“That’s one of the reasons (hemorrhaging) is on the rise because we have more C-sections now than we did 10 years ago,” she said.

Simulations for these three emergencies were conducted because they often occur together. First the baby’s shoulder becomes dislocated, then because of stress it needs to be resuscitated and sometimes the situation progresses into post-partum hemorrhage for the mom.

“The team here at Valley Medical, it’s not unusual for them to be faced with this cascade of events,” Constable said.

Simulation training is fairly new on-site at hospitals, involving the whole delivery team, training on its own equipment, the facilitators said.

“Simulation has been around for years and used by the aviation industry and the Navy, but used in medicine only in perhaps the last decade,” Constable said.

“The notion of bringing it into the hospital is pretty darn unique,” she said. “It gives you the opportunity to really analyze opportunities for improvement.”

After the training, Valley’s Birth Center staff plan to form an education committee and decide what to train on next and how often a year, said Allen.

“It’s more and more the standard of training,” she said of simulation. “You’re learning hands-on and anybody will learn better with hands-on.”