There are some pearls of knowledge learned during midwifery school that I call on often during my day-to-day practice.
One of the best pieces of advice was to review the management steps of post-partum hemorrhage and shoulder dystocia on the way to every delivery.These two often unexpected but potentially catastrophic obstetric emergencies can be managed, but are often further complicated if the provider or the team panics.
Anyone who has ever been part of an obstetric emergency knows just how easy it can be to panic when it appears that a baby’s shoulders have gotten stuck or a mom is bleeding uncontrollably. Every second seems like an hour and once the emergency is recognized, the room often erupts in chaos.
It can be difficult to predict every shoulder dystocia or postpartum hemorrhage. Therefore the best preparation is practice so that the management of these emergencies becomes routine. But how can you practice for emergencies? Emergency drills.
Obstetric emergency drills are essential practice and preparation for every labor and delivery unit. It is a way to determine which resources and team members are essential to have at the ready, and also a way to determine areas of weakness in a system. Communication is key in emergencies, therefore it is essential to establish a concise way to share information when stress is high and time is at a premium.
Creating a simulation that is as realistic and serious as possible will help keep all team members focused. Having a time to debrief and have each person involved give constructive feedback and criticism may also provide an opportunity to identify areas that need improvement.
Recognizing the risk factors or preexisting conditions that can predispose a patient to a postpartum hemorrhage or shoulder dystocia is the very first step in preparing for, managing, or even preventing these emergencies. It is better to have gathered equipment, medications, and extra help and not need them then to be scrambling to find something in an emergency.
I still try to review the steps for managing common obstetric emergencies on my way to each delivery. If they are fresh in my mind, I’m more likely to stay calm, which may be one of the most important factors in successfully handling any emergency.
Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.