Two‐Provider Technique for Bimanual Uterine Compression to Control Postpartum Hemorrhage

Effect of an in-situ simulation workshop on home birth practice in Australia

PROBLEM

Interprofessional training programs for obstetric emergencies have been introduced for up-skilling birth unit staff in hospitals but not frequently used in training midwives and paramedicine staff for home birth emergency.

BACKGROUND

Practical Obstetric Multiprofessional Training (PROMPT) has previously been described in the home birth setting using in-situ simulation training of home births for midwifery and paramedicine staff.

AIM

The aim of this study was to evaluate the benefit of the home birth simulation in clinical practice and to explore how the simulation program prepared the midwives for a birth-related emergency in a publicly funded home birth program.

METHODS

Midwives conducting home births, the midwifery educator and the simulated woman in labour (n=9) attended an interview that explored how the midwives' learning through simulation affected their home birth clinical practice. The simulated woman and the facilitator who conducted the simulation for more than six years were also interviewed to comment on the observed change in performance in simulation. The interview transcripts were thematically analysed.

FINDINGS

The themes that were identified and agreed upon, were applying learning to clinical practice, learning in teams, valuing realism, facilitating simulation based education and managing variation.

DISCUSSION

In-situ nature of simulation with home birth midwives and paramedical staff facilitated learning transfer and team-based approach to practice. The careful simulation design provided a breadth of experience in emergencies.

CONCLUSION

Applying learning to prepare for clinical emergency situations changed the midwives' approach in managing home births. This provided evidence for a change in behaviour (Level 3 Kirkpatrick's framework) and transfer of learning, leading to changed protocols (Level 4a Kirkpatrick's framework).

Obstetric emergency simulation

Simulation for obstetric emergencies has progressed from being a good idea in theory to the level of an evidence-based intervention that can improve outcomes. Though not a stand-alone solution, the inclusion of simulation for training individuals and teams to react and perform correctly when obstetric emergencies occur is a critical part of a comprehensive strategy to improve outcomes for both the mother and baby. In this article, we will briefly review both the recent history of simulation for obstetric emergencies and then examine the most current evidence for specific emergencies.