Skills for midwife led environments Jeanette Carter- Practice - - PowerPoint PPT Presentation

‘ Skills for midwife led environments’

Jeanette Carter- Practice Development Midwife Helen McDonnell- Community Team Lead Bernie Quigley – Community Midwife

The Background

• The annual homebirth rate at WHFT is 0.34%.
• The community midwives rely on homebirth for

their intrapartum exposure.

• Need to maintain skills and confidence in order to

promote and support homebirth.

• Mandatory training does not meet the bespoke

needs of the Community Midwife.

Ultimate Aim…..

To produce a tailor made study day that met the needs of the community team.

The Planning

• In 2016 four core trainers attended a bespoke 2 day RCM accredited

residential training course. The ASAP course (Appropriate Skills for Appropriate Places).

• The core team included the PDM, Consultant Midwife, Community

Team Lead and Community Midwife.

• The course programme focused on promoting the role of midwives in

the community and their ability to provide up to date evidenced based care.

• The overall focus was on the promotion of normality, risk assessment

and dealing with Obstetric Emergencies in the community

Outcomes from attending the course

• Networking opportunity- midwives

from all over the UK.

• Team building opportunity.
• Opportunity to reflect on how we

could replicate this at Warrington.

• ‘Real life’ opportunity to practice

emergencies in a realistic environment.

• Following completion the passion to

develop our own local training courses.

What next ?

• Motivated and raring to go !
• Questionnaire to determine

the community midwives needs.

• Reviewed procedures,

equipment and documentation for homebirth. We needed to ensure the ‘tools’ needed were readily available.

• Developed a bespoke training

day.

What did the midwives want ?

Training

• Management of obstetric emergencies in an a homebirth

environment.

• Separate training from general mandatory training sessions.
• Opportunity to train with their peers.

Homebirth equipment

• To formalise/standardise the paperwork completed by the midwife

at the 36/40 home visit appointment.

• To streamline the equipment delivered to the woman at home prior

to the homebirth.

• To review the emergency equipment carried by the community

midwives to a homebirth.

Training

• Where could this take place ? We wanted to replicate the home from home

environment we had experienced at Powys.

• Someone's home, hotel/B&B, the residence at Warrington?
• We decided to utilise the OT Flat with the support of the Occupational

Therapy Team. This was on-site, accessible, had a bathroom, stairs, bedroom/lounge and kitchen, ideal for simulation and free!

• The course was planned to be delivered in the evening, as the OT Flat was

used for patient assessments in the day time.

• Four days were planned to ensure small groups of midwives attended (5-6).

The Programme

Promoting Normality – Homebirth scenarios Record Keeping Risk assessment- Booking, 36 weeks and Intrapartum. Birth Place study findings- individual statistics for midwives Training updates- Waterbirth, Perineal suturing, Physiological third stage. Launch of new paperwork, equipment, safe transfer.

‘Real time’ scenarios.

• ‘Live’
• Simulated persons.
• Core emergency drills- (breech,

shoulder dystocia, cord prolapse, haemorrhage).

• Variety of environments- birth

pool, bathroom, lounge, floor, staircase.

• Waterbirth scenarios
• De-brief.
• Safe transfer.

What did the midwives think ?

Loved group exercises very realistic Realistic/relevant to our working environment (enjoyed the opportunity for peer review) Very relevant to our job in comparison to other training days. These drills within the practice setting. It really bridges the gap between theory and practice Scenarios especially designed for community Risk assessments for home delivery and statistics to give women. Loved it ! Relaxed atmosphere to enable discussion Feel more confident to deliver care at home confinement

Further developments

• New Homebirth bags in

liaison with the resuscitation department.

• Formalised ‘dry kit’.
• Formalised homebirth

risk assessment and associated paperwork.

Monitoring impact on practice

• Audit homebirth bookings
• Audit homebirth rate.
• Review transfer rates
• Review homebirth
• utcomes
• Audit compliance re: risk

assessment.

• Staff survey/questionnaire.
• Evaluate ‘friends and

family’.

What we hope to see !

CULTURE CHANGE!

Empowerment Confidence Risk assessment Equipment changes Promoting Normality

The future

• Changing model of care.
• Community midwives to

rotate to MLU.

• Training to involve

paramedic crews.

• Plan additional bespoke

days to incorporate community midwifery requirements.