Training For When A Birth Isn’t “Routine’’
Owen Riley Cooper was refusing to make his entrance to the world.
In the BirthCenter of Genesis Medical Center, Davenport, where most births would be considered routine, Owen’s arrival was not routine. After several hours of active labor, it was decided that his mother, Tiffany, needed a c-section.
Because she could still feel pain in one area of her abdomen before the procedure, she was given general anesthesia. It was her first surgery.
The healthy, 8-pound, 9-ounce Owen was delivered with no issue. His mother, however, experienced a life-threatening complication. For unknown reasons, possibly asthma, Tiffany had no noticeable pulse and was not breathing following Owen’s delivery. CPR compressions were begun and she was intubated to assist when she began breathing again. An overhead call for a Rapid Response Team to BirthCenter surgical room brought doctors and nurses quickly from other departments.
For several minutes the compressions were continued until she began to respond.
Tiffany survived to become Owen’s mom. After a night in intensive care for testing and observation, she was returning to normal by the next morning and joined Owen in the BirthCenter.
“I don’t remember anything but wondered why my chest hurt,’’ Tiffany said the next morning when she was told about the compressions and the response from departments throughout the hospital.
The team that worked on Tiffany included two BirthCenter nurses – Lisa Andresen and Jessica Lienen – who have advanced training specifically for providing care to pregnant and postpartum patients who experience complications.
“You think of most births being routine but whenever a c-section is needed, there is higher risk. That is why always try to deliver without a c-section and try not to do a c-section unless it is absolutely necessary,’’ explained Kim Nimrick, RN, BSN, manager of the Genesis BirthCenter in Davenport. “Fortunately we have nurses who have trained for exactly this instance.’’
Currently, all labor and delivery nurses take Advanced Cardiac Life Support (ACLS) every two years. However, the training doesn’t address the unique anatomical and physiological structures of pregnant and postpartum patients. The obstetrics-based advanced cardiac life support education for obstetrics (ACLS-OB) includes modifications in training that ensure the safest care for mothers and babies in the event of cardiac emergencies.
Four Genesis nurses are now trained to teach the remaining Genesis labor and delivery nursing staff in ACLS-OB. The four trainers are RNs Julie Grothusen, Andresen, Anne Herrin and Lienen.
“During labor and delivery, we’re really caring for two patients – the mother and her unborn fetus. Research has shown the effectiveness of obstetrics-based advanced cardiac life support education to bring the best outcome for our patients,’’ said Kenneth Naylor, M.D., Medical Director of the Genesis BirthCenter in Davenport.
Genesis BirthCenter nurses can be certified in ACLS-OB using Noelle, a high-tech childbirth simulator available on-site in the BirthCenter. Noelle can be programmed to simulate emergency complications to help staff practice responding to high-risk deliveries.
ACLS-OB training addresses urgent medical situations such as maternal cardiopulmonary arrest, anesthesia complications, uterine placental emergencies and preeclampsia/eclampsia.
“We probably aren’t going to treat an 80-year-old man in the BirthCenter but that might be one of the scenarios in standard ACLS training,’’ Nimrick explained. “What we are much more likely to see is a pregnant woman or a mom who had just delivered who has complications. That is why training specific to OB makes us a better prepared department.
Increase In Higher Risk Births
“Nearly all of our births are routine without complications, but we are seeing more that we would consider to be higher risk births. We are looking at older mothers and conditions of obesity, diabetes and high blood pressure that all can complicate a birth.
“When a delivery isn’t progressing well, nurses are available with the training to respond to the specific needs of the pregnant and post-partum patients. In training, we have gone through the evidence-based simulations of scenarios when a birth isn’t routine.’’
Training for when a birth is complicated is one of many safety initiatives in place at Genesis to benefit patients.
The Genesis BirthCenters in Davenport and Silvis deliver safe, comfortable care in updated rooms and the security of an onsite Neonatal Intensive Care Unit staffed by neonatologists from the nationally respected University of Iowa Children’s Hospital.