Effective training for obstetric emergencies

Local, multiprofessional training has been associated with improve­ments in the care administered during an emergency. However, not all training is effective. There are a multitude of training programmes aimed at improving perinatal care: some have demonstrated no im­provement in outcomes (42-44) and some have resulted in worse outcomes (45, 46).

National enquiries into maternal deaths regularly identify lack of team working and poor communication as key contributors to substandard care (1, 15). Isolated teamwork training does not ap­pear to be effective in intrapartum care (47, 48). In one study, where teamwork and communication skills were integrated throughout the clinical training, the most efficient teams administered magne­sium sulphate more quickly during the eclampsia drill (49). These teams were noted to state the emergency earlier, managed the task using structured closed-loop communication, and had significantly fewer exits from the room during the drill. Although high-fidelity simulation models are advantageous for learning techniques such as vaginal breech birth and shoulder dystocia management, the con­current use of patient actors during drills may improve the percep­tion of safety and communication (50).

Training staff within their own maternity unit enables owner­ship of their learning, allowing them to address specific issues and drive system changes. Specific unit-based tools such as emergency boxes and algorithms can be introduced during the training and embedded into clinical practice.

Training should be sustainable as well as effective. A recent long­term study of shoulder dystocia training in a single maternity unit showed that over 85% of staff were trained annually over 12 years (52). Moreover, the effect of training had improved over time, from a 70% reduction in permanent brachial plexus injury after 4 years of training, to a 100% reduction after 10 years. Sustaining training does require support from hospital management (obstetrics and midwifery) and dedicated staff to run the training. However, this should be associated with improved outcomes and a measurement system is required.

Effective multiprofessional training programmes for obstetric emergencies improve intrapartum care, significantly impacting the lives of women and their families and reducing the burden on health services. All maternity units should implement and sustain a local, evidence-based training programme for all of their staff to attend on an annual basis.