Team training arrives in delivery room
Team training arrives in delivery room

By Alan Bavley Comments 0
Published: August 26, 2008

KANSAS CITY, Kan. — The simulation seemed all too real. A laboring woman groaned in pain: "Ow, ow. Make the baby come out.”

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Obstetrician Timothy Bennett helps health care assistant Joyce Marks, right, position her hands as she helps deliver a simulated baby from a birthing trainer mannequin at the University of Kansas Hospital. McClatchy-Tribune

The baby's head was already seeing daylight.

But its shoulder was stuck. Delivering this infant safely would take some careful maneuvers.

Doctors, nurses and residents crowded around the hospital bed. Each took a turn easing the baby out — over and over again.

It was a remarkable simulation, with a lifelike baby doll popping out of an anatomically correct model of a woman's pelvis.

And it's now part of a mandatory training program, the first of its kind in the nation, at the University of Kansas Hospital.

The medical equivalent of fire drills, the exercises are designed to save newborns and their mothers during potentially catastrophic emergencies.

"Everyone who works on obstetrics must take this or they won't be allowed to work obstetrics. Period. No exceptions,” said Carl Weiner, chairman of the university's department of obstetrics and gynecology.

"Even if they work in the nursery and only come to delivery to pick up a baby, they have to participate.”

About 100 university staff members — doctors, nurses, technicians and clerks — went through two days of classroom and hands-on training.

They learned methods to deal as a team with various obstetrical emergencies that can range from the shoulder dystocia that had the simulated baby stuck, to eclampsia, a condition in which the mother suffers convulsions or coma.

Each of these emergencies is relatively rare, but they account for many of the deaths and serious injuries of childbirth.

Many medical personnel have had little training working through these crises together.

"Even though in medicine we work in teams, we train independently and never practice as teams,” Weiner said.

Weiner is an enthusiastic advocate of PROMPT (Practical Obstetric Multi-Professional Training), a safety program developed in the United Kingdom.

Weiner has imported PROMPT for the University of Kansas and Americanized it to account for differences in terminology and medicines used here.

There is evidence PROMPT reduces birth complications, Weiner said.

Published studies conducted at a hospital in England found that after staff members took the PROMPT course, the number of injuries from shoulder dystocia was reduced by about 75 percent, and newborn brain injuries from lack of oxygen were cut in half.

"If you can do that, you are practicing medicine as it should be practiced,” Weiner said.

"We've seen so many training courses that do nothing. Here is something we know will improve outcomes.”

Weiner has heard from other hospitals and insurance companies interested in adopting the program. He expects insurers that pay the costs of birth injuries to take the lead.

McClatchy-Tribune Information Services