How Safe is Childbirth?
CHA recognized for excellence in maternity services
Most people who have children don’t give much thought to risks. But childbirth is unpredictable, even when women are healthy, and health care providers need to be ready for the unexpected.
Due to public health efforts, fewer women across the globe are dying during childbirth. However, pregnancy-related deaths in the U.S. have been rising since the 1980’s. These rates are alarmingly higher for women of color, and 60 percent are considered preventable deaths.
To reduce pregnancy risks, Cambridge Health Alliance (CHA) adopted key elements of the California Maternal Quality Care Collaborative model, which is proven to reduce death during or after childbirth. “Our OB/GYN team worked very hard to put this system in place,” explained Dr. Kathleen Harney, CHA’s Chief of OB/GYN, “and we’re saving women’s lives.” This work is one of the reasons CHA was named one of the nation’s Best Maternity Hospitals in 2021 by Newsweek.
How the process works
Bleeding is the most common life-threatening risk of pregnancy. CHA has an entire team ready to act if there’s an emergency. “It’s more than bringing departments together – it’s about having a tool kit in place that we practice regularly,” said Dr. Harney.
“Everyone knows the plan and we’re always working to do better,” added director, maternal newborn services, Jennifer Pedley, MS, RNC-OB, NEA-BC. “Every point of contact was noted when the protocol was put in place. This included changing the code to ensure the entire OB/GYN rapid response team arrives quickly. We also set up a QBL (Quantitative Blood Loss) measurement, which required weighing every item in clinical areas as a baseline to compare against.”
In the past, providers made assumptions based on what they were seeing. “It’s a common response based on what people think they’re supposed to expect,” Dr. Harney explained. “Accurate measurements forced us out of that paradigm. And, we now identify patients at higher risk before there’s a problem, allowing us to be better prepared to respond quickly.”
Two carts are on the maternity floor – in Labor and Delivery and the maternity unit. These carts have everything providers need to respond to a hemorrhage. “We created detailed training to educate every team member about their role and then we started our drill program,” says Dr. Eva Patalas, CHA Pathologist. “The idea is to have our response become second nature for the real events. The protocol also includes debriefs after each event to determine how we can do better.”
Another part of the effort allows the Transfusion Medicine Service to ensure they have enough blood on hand based on the blood type of people delivering on the unit. “The idea was to make our response as simple as possible when facing a very complex and life-threatening situation,” added Dr. Patalas.
“Now other organizations are contacting us to learn more about our team approach and special training which makes CHA a very safe place to deliver babies,” said Dr. Harney.
Practice Makes Perfect
Melissa Abell-Bardsley, RN, CHA’s Clinical Nurse Educator, had placed the red Jello and other products to simulate blood in the plastic pelvis that was tucked next to the volunteer patient, who sat comfortably holding a baby doll. The patient’s companion pushed the nurse call button and the maternal hemorrhage drill began.
Within a minute, a nurse arrived to see what was needed and it didn’t take more than another to assess that the patient was in trouble. The baby was quickly passed to the companion and CODE OB was called. Less than another minute passed and the room filled with providers in addition to the hemorrhage cart. Dr. Latoya Jackson, designated as the event manager, began coordinating the emergency situation. Dr. Melissa Ethier, OBGYN, the lead provider, following protocols, transferred the hemorrhaging patient to the makeshift OR down the hall. Had it been a real emergency the transfer would have gone to the true OR. In a flurry of calm activity, providers from anesthesiology to nurses responded to the data and cues that Ms. Abell-Bardsley had planted on equipment. An IV line had already been attached to the patient before she was wheeled down the hall, surrounded by the team of providers. Blood was ordered from the lab, the QBL measurement was taken, and the team did everything they could to stabilize the patient. Again, within minutes, the lifesaving blood arrived from the lab and the patient was saved.
The drill was over in twenty minutes when it became clear that the patient was improving, and the debrief took equally as long. Just as important as the drill itself, the team analyzed every moment to determine what improvements could be made. In this scenario, the event was managed well and there were very few suggestions for improvement. Considering this was the team’s sixth drill over the past year, it seems practice makes perfect.
Main Photo: Dr. Latoya Jackson checking up on one of the many adorable babies safely born at CHA
This article was provided by Cambridge Health Alliance.