While home births are a safe and appropriate choice for healthy women with low-risk pregnancies, the small risk of an emergency requires immediate and skilled management by midwives.
A home birth simulation workshop developed by Monash University and Monash Health has shown to enhance the clinical skills of midwives and paramedic staff to support home birth practice with hospital back up.
Results of the world-first training program were published last week in the Australian College of Midwives’ journal, Women and Birth.
When a publicly funded home birth program was introduced at Casey Hospital in 2011, in collaboration with Monash Women’s at Monash Health, the Department of Obstetrics and Gynaecology designed an in situ home birth workshop to upskill midwives.
“With limited resources available to clinicians who aim to enhance the management of home birth complications, we developed the home based Practical Obstetric Multi-Professional Training (PROMPT) workshop,” said lead study author Dr Arunaz Kumar, a Monash Senior Lecturer and an Obstetrician and Gynaecologist at Monash Health.
“Midwives and emergency paramedic staff who participated in the simulation workshops had to manage birth emergencies in real time with limited availability of resources in a home based setting.”
To enhance the realism of the simulation, workshops were delivered in a community home (in situ) and the equipment used for training was the home birth kit used by midwives in a real home birth.
Workshop participants included home birth midwives, paramedic staff from Mobile Intensive Care Ambulance (MICA) Victoria and an obstetrician (available on phone).
“A simulated patient, a birthing model for pelvic examination, and a SimBabynewborn model were used in training scenarios that involved intrapartum, postpartum or neonatal complications,” said Head, Department of Obstetrics and Gynaecology at Monash University and Director, Obstetric Services at Monash Health, Professor Euan Wallace.
“Workshop tasks required participants to identify and manage the emergency and stabilise the mother or baby in real time, using the equipment provided in the home birth kit.”
Most scenarios culminated with the transfer of the mother and/or baby to the hospital in the ambulance.
“Our analysis, based on six workshops conducted from 2012 to 2014, assessed the participants’ perceptions of usefulness of a home birth emergency training workshop,” said Dr Kumar.
“The workshops enabled participants to practice and reflect on a simulated home birth, making direct links to real practice.”
Although technical skills were important, participants reported value in the opportunity to communicate effectively with colleagues and the support person at home, as well as being prepared with a back-up plan if complications occurred.
Professor Wallace said it was important to optimise psychological fidelity in the workshops such that participants needed to communicate effectively and use available resources efficiently, as required in real home birth practice where home birth emergencies occur.
“Even if the absolute numbers of women requesting home birth are small, an effort should be made to ensure the safety of women with adequate training, education and provision of a back-up support system,” added Professor Wallace.
“The joy of childbirth often goes hand in hand with its unpredictability,” said study co-author and Professor of Midwifery at Monash University, Christine East.
“We have shown how midwives and paramedics working together to anticipate the intricacies of such situations reinforce the safety of home birth and help maintain this option for women.”
“Our study shows these workshops benefit midwives and paramedic staff in enhancing their clinical skills and in training together as a team, with a common objective of improving maternal and perinatal outcomes of home birth,” said Dr Kumar.
Dr Kumar acknowledges the assistance and contributions of Ms Colleen White, midwifery lead in this project.