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| Dr Kumar |
While home births are a safe and appropriate choice for
healthy women with low-risk pregnancies, the small risk of an emergency
requires immediate and skilled management by midwives.
A home birth simulation workshop developed by Monash
University and Monash Health has shown to enhance the clinical skills of
midwives and paramedic staff to support home birth practice with hospital back
up.
Results of the world-first training program were published last
week in the Australian College of Midwives’ journal, Women and Birth.
When a publicly funded home birth program was introduced at
Casey Hospital in 2011, in collaboration with Monash Women’s at Monash Health, the
Department of Obstetrics and Gynaecology designed an in situ home birth
workshop to upskill midwives.
“With limited resources available to clinicians who aim to
enhance the management of home birth complications, we developed the home based
Practical Obstetric Multi-Professional Training (PROMPT) workshop,” said lead
study author Dr Arunaz Kumar, a Monash Senior Lecturer and an Obstetrician and
Gynaecologist at Monash Health.
“Midwives and emergency paramedic staff who participated in
the simulation workshops had to manage birth emergencies in real time with
limited availability of resources in a home based setting.”
To enhance the realism of the simulation, workshops were
delivered in a community home (in situ) and the equipment used for
training was the home birth kit used by midwives in a real home birth.
Workshop participants included home birth midwives,
paramedic staff from Mobile Intensive Care Ambulance (MICA) Victoria and an
obstetrician (available on phone).
“A
simulated patient, a birthing model for pelvic examination, and a SimBaby
newborn model were used in training scenarios that involved intrapartum,
postpartum or neonatal complications,” said Head, Department of Obstetrics and
Gynaecology at Monash University and Director, Obstetric Services at Monash
Health, Professor Euan Wallace.
“Workshop tasks required participants to identify and manage
the emergency and stabilise the mother or baby in real time, using the
equipment provided in the home birth kit.”
Most scenarios culminated with the transfer of the mother
and/or baby to the hospital in the ambulance.
“Our analysis, based on six workshops conducted from 2012 to
2014, assessed the participants’ perceptions of usefulness of a home birth
emergency training workshop,” said Dr Kumar.
“The workshops enabled participants to practice and reflect
on a simulated home birth, making direct links to real practice.”
Although technical skills were important, participants
reported value in the opportunity to communicate effectively with colleagues
and the support person at home, as well as being prepared with a back-up plan
if complications occurred.
Professor Wallace said it was important to optimise
psychological fidelity in the workshops such that participants needed to
communicate effectively and use available resources efficiently, as required in
real home birth practice where home birth emergencies occur.
“Even if the absolute numbers of women requesting home birth
are small, an effort should be made to ensure the safety of women with adequate
training, education and provision of a back-up support system,” added Professor
Wallace.
“The
joy of childbirth often goes hand in hand with its unpredictability,” said
study co-author and Professor of Midwifery at Monash University, Christine
East.
“We
have shown how midwives and paramedics working together to anticipate the
intricacies of such situations reinforce the safety of home birth and help
maintain this option for women.”
“Our study shows these workshops benefit midwives and
paramedic staff in enhancing their clinical skills and in training together as
a team, with a common objective of improving maternal and perinatal outcomes of
home birth,” said Dr Kumar.
Dr Kumar acknowledges the assistance and contributions of Ms
Colleen White, midwifery lead in this project.
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