ICOE Guru’s Chops
Our Trainers’ Experience
ICOE Guru’s Chops
Our Trainers’ Experience
Tips and Tricks in Managing Obstetric Emergency
I have been an ICOE midwife trainer since 2009, yet each course never fail to allow me to learn through teaching. Through my observations, both local and regional midwife participants generally possess the basic knowledge in managing cord prolapse, but the common pitfall lies in teamwork coordination. Here are some tips that can help to
improve overall team management in an obstetric emergency:
1) A team leader’s role is vital in any obstetric emergency. It is the team leader’s responsibility to identify each team member’s strengths and weaknesses, thus assigning the most appropriate task to each member. A good leader also need to maintain situational awareness at all times in order to effectively manage the emergency at hand.
2) All members involve in the emergency should always communicate via ISBAR, to improve efficiency.
3) Debriefing is as important as successfully managing the emergency. We often forget to communicate with the patient during the event, which can create unnecessary anxiety and impair patient care. Team debriefing is also beneficial to ensure continuation of systematic teamwork when handling future obstetric emergency.
We can only hope that with simulation - training and constant drills we’d be able to provide optimal care for all pregnant women.
Regional ICOE Matters
It’s 3am in the morning and my alarm went off. I jumped out of bed and got ready to head to the ERL for KLIA. I will be off my clinic and work for the next 3 days for a regional ICOE. The entire trip was like a well-oiled machine, and this was a testament of the ICOE DNA: thorough planning and impeccable cooperation from the regional team.
What I remember most from this trip was the cord prolapse station. The participants were instructed to device a drill to be carried out at their own place of practice. In many regional ICOEs this station would usually require extra guidance or explanation. However one particular group was exceedingly innovative in using items that were only available at their area/province to simulate the situation. I was very impressed with their ability to grasp the task and execute the cord prolapse drill. The group leader displayed good leadership skills, being able to understand the instructions and guided the team towards one common goal.
The 3-day course was rewarding when analysis of the participants’ pre- and post-course skills test scores showed evident improvement, sweetened with positive feedback from participants and local trainers.
As with all regional courses, the trip back to Malaysia was late in the day. In the plane, most trainers were exhausted albeit the camaraderie, the new friendships formed and melancholy that the next day it’s back to work and the hustle bustle of life. For me, returning from a regional course always lift my spirits and inspires me to continue my passion in sharing the ICOE knowledge, in order to ensure safe deliveries every time, everywhere.
To my surprise, a few months following that regional course, I received a message via social media from one of the course participants, who shared her success in carrying out a cord prolapse drill at her workplace. In addition, a few days later they had a clinical case of cord prolapse in which their team managed to transfer the patient to a tertiary hospital in a safe manner, thus resulting in good outcomes for the mother and baby.
This is the main reason ICOE trainers persist in simulation-training, despite our sacrifices in personal time and energy. Some things are more worthwhile than monetary gains.
‘The mediocre teacher tells. The good teacher explains. The superior teacher demonstrates. The great teacher inspires.’ ― William Arthur Ward
Oh Nooo... Another Cord Prolapse?!
When we hear cord prolapse, very often we picture a team of doctors and midwives rushing around and later the patient rushed to the operating theatre in an awkward position. There’s usually a healthcare personnel who’ll be partially covered by a blanket, while crouching in between the patient’s legs. Compared to other obstetric emergencies, cord prolapse tend to be more dramatic.
In my past 15 years of service, I once experienced three cord prolapses within a two weeks’ span during my medical officer years. Having one is considered unfortunate, but three in a row was rather sensational and unforgettable.
I was working as the registrar in-charge of the first-stage labor unit in a Klang valley hospital where patients in latent phase of labour were admitted for close monitoring and offer of epidural service. All admissions had to be reviewed and assessed by the registrar. I recalled that when I examined a multigravid patient who was medically induced, there was a sudden fetal bradycardia on the CTG tracing. Simultaneously I felt the umbilical cord on vaginal examination! The adrenaline rush kicked me into prompt action by lifting the patient’s buttocks to elevate the fetal presenting part and rushed the patient for a crash Caesarean section. Thankfully both mother and baby did well. That was the first of three cord prolapses to follow.
The next two cases occured over the following two weeks. I became perplexed and curious as the incidence was becoming too frequent. After some investigation and reflection, I noticed that the events seemed to occur when a particular house officer was on duty. I later discovered that the house officer had been routinely pushing the fetal head upwards as she performed vaginal examinations on patients, in an attempt to drain the liquor. She assumed that it’d help the fetal head to better engage into the maternal pelvis. I immediately corrected her misconception and advised her to practice vaginal examinations under supervision. Our unit also began training new house officers on the correct way to perform vaginal examinations. We were then miraculously free from further cord prolapse for a whole year!
From this I learnt that:
1) Junior colleagues need continuous guidance and training
2) Drills can help build confidence in managing obstetric emergency
3) Obstetric emergency is always unpredictable so we must be prepared at all times!
