Dying during pregnancy, delivery, or soon after having a baby is more common in the U.S. than in any industrialized nation. It’s called “maternal mortality,” and it’s nearly three times more likely for Black women than white women.
To help save lives, a growing number of U.S. hospitals are using obstetric simulation centers where medical teams can practice for life-threatening situations that can happen during labor and childbirth. One of the places doing this is NYC Health + Hospitals/Elmhurst in Queens, NY, which delivers 180 babies in a typical month.
Elmhurst’s Mother-Baby Simulation Center features a specially designed full-body mannequin of color, along with a mannequin infant. The center puts doctors, nurses, and other medical professionals through simulated – but realistic – obstetric emergencies such as maternal hemorrhage, dangerously high blood pressure, sudden cardiac arrest, and emergency C-section. They also train to handle cord prolapse, when the umbilical cord drops through the mom’s cervix into the vagina ahead of the baby, potentially cutting off the baby’s oxygen supply.
Elmhurst serves one of the most diverse communities in the country, with residents from over 100 countries speaking more than 100 different languages in its surrounding neighborhoods, says Frederick Friedman, MD, NYC Health + Hospitals/Elmhurst’s director of OB/GYN Services.
“Our simulation team is very happy that the new mannequin we have to simulate OB complications is a mannequin of color, which is more realistic for our patient population,” Friedman says.
Practicing for a Crisis
At Elmhurst, some simulations are scheduled to prepare new resident physicians for the most common obstetric emergencies. Others come as a surprise, just as a real life crisis can unfold.
“We might come running down the hallway with a ‘patient’ who has a cord prolapse, requiring emergency delivery — that’s almost always a C-section,” Friedman says. “We’ll yell, ‘Cord prolapse, triage,’ and see how fast we can get the team assembled, how long it takes the anesthesiologist to prepare, how soon we have a scrub nurse ready for surgery,” as if the mannequin “patient” is a real person.
These simulations focus on high-risk situations that don’t happen often, such as severe postpartum bleeding (hemorrhage) or a mother who is having seizures from eclampsia (high blood pressure), Friedman explains. “It’s hard to develop skills in an emergency that might only occur in 1% of cases, where an individual doctor or nurse could go years without encountering it.”
The chance for doctors, nurses, and other medical professionals to gain experience with obstetric emergencies is even lower at hospitals that have fewer deliveries than the busy Elmhurst, says obstetric simulation expert Shad Deering, MD, an OB/GYN professor, specialist in maternal-fetal medicine, associate dean at Baylor College of Medicine, and medical director for simulation at CHRISTUS Healthcare System.
“If you’re doing only 10 deliveries a month, and the risk of postpartum hemorrhage is about 5%, you can go several months to a year without having one,” Deering says. “Obstetric emergencies happen with enough frequency that we really need to be prepared for them — but not enough, especially in lower-volume places, that the teams get the preparation they need.”
Can practicing with even the most realistic mannequin and simulated emergency situation really improve how a medical team performs when there’s a real person bleeding uncontrollably during delivery?
A number of studies say yes. Simulation training has been shown to:
Reduce injuries to babies that have shoulder dystocia, in which their shoulders are impacted by the mom’s pelvic bones during a vaginal delivery.Shorten the time it takes to diagnose cord prolapse and improve its management.Reduce the time from deciding that an emergency C-section is needed to delivering the baby.
“Obstetrics is one of the only places in medicine where we have two patients at the same time,” Deering says, referring to the mother and the baby. “This means that we have to very quickly and acutely balance the needs of both patients.”
“Since labor and delivery teams change often, nurses and doctors may not have worked together much before,” Deering says. “We have a constantly rotating team where everyone has to understand their roles and responsibilities and be able to execute them flawlessly at a moment’s notice, when everything is going great until suddenly everything is going wrong.”
Not every hospital can have a large, high-tech simulation lab with expensive, high-quality mannequins. But they don’t necessarily need that kind of a setup, Deering says.
“In a fancy simulation lab, you can ask for blood products and they just show up, which isn’t exactly realistic. But if you’re running a simulation in your regular L&D ward with a relatively inexpensive, mid-range mannequin, you have to run and get your supplies and come back just like you would in reality,” Deering says. “We’ve actually had a situation where we were running an emergency delivery simulation in one room and then were called in to manage the exact same real emergency next door!”
Besides giving labor and delivery teams the opportunity to hone their skills in responding to emergency situations, simulations can help identify specific problems within a hospital’s setup, like access to certain supplies. Understanding how unconscious bias may affect their care decisions is also part of the training.
“When we create simulations, we can build in situations that might help us identify where disparities in care may be, so that we can start to address them,” Deering says. “So it’s not just about ‘Did you give the right medication for hemorrhage?’ but also, ‘How well did you communicate with the patient and family, were there any potential cultural issues you did or didn’t address?'”
As with the new mannequin at Elmhurst Hospital, new obstetric simulators now have more color options, so that hospitals can choose from mannequins with a range of skin tones. “We need these simulators to look like our patients, and now we’re finally able to do that,” Deering says.
He says that every hospital where babies are delivered should have a simulator available to prepare the medical team for emergencies, noting that lower-cost mannequins are available for under $3,000, accompanied by free resources available from the American College of Obstetrics and Gynecology (ACOG) and its “Practicing for Patients” initiative to help make the most of simulation technology.
“To make a real difference in saving the lives of women and their babies, and reduce disparities in care, simulation has to be accessible to everyone and practiced on a regular basis,” Deering says. “We want any size labor and delivery unit in any hospital in the country to be able to do this.”
(For more on maternal mortality, listen to WebMD’s Health Discovered podcast episode with Tonya Lewis Lee on her new Hulu documentary, Aftershock.)
Congress Under Pressure: Colorado Officials Push for Cannabis Banking Reform
With the end of Congress’ session just around the corner, marijuana advocates, stakeholders and lawmakers continue to push for marijuana banking policy change.
This time, Colorado Gov. Jared Polis (D) joined forces with Lt. Gov. Dianne Primavera (D), Attorney General Phil Weiser (D), Treasurer Dave Young (D) and Department of Public Safety (DPS) Executive Director Stan Hilkey in urging congressional leaders to revisit the issue, reported Marijuana Moment.
In a letter sent on Monday to both House and Senate leaders, Colorado officials focused on the impact which a bipartisan marijuana banking bill will have in terms of public safety and industry equity,
“The lack of safe banking and financial services for the cannabis industry in the State of Colorado has become a dire public safety issue for highly regulated cannabis businesses operating in compliance with state …
Original Post: benzinga.com
New Data Shows Weed Legalization a Boon for Real Estate, New Jobs and Tax Revenue
A new report from the Federal Reserve Bank shed light on the economic impact marijuana legalization has had in recent years, reported Marijuana Moment. Policy changes on the state level have resulted in increased commercial real estate demand, as well as a surge in tax revenues while creating more jobs.
According to an analysis from the Kansas City arm of the Central Bank, which collected data from several states under its jurisdiction, the Tenth Federal Reserve District, the cannabis industry has become one of the main economic sectors positioned to grow substantially in the coming period.
“Overall, the marijuana industry has had a significant effect on the economies of Tenth District states in the initial years after legalization,” the report said. “The emergence of the industry has …
Will Missouri Legalize Cannabis? Amendment 3 Suffers Another Attack This Time by State NAACP
Cannabis legalization efforts in Missouri are under attack once again, this time by The Missouri State Conference of the NAACP.
The Missouri NAACP, breaking with chapters in the St. Louis area is urging its members to vote against Amendment 3 on the Nov. 8 ballot, reported the Saint Louis Post-Dispatch.
The group announced Thursday that it believes recreational marijuana legalization, as it is proposed under Amendment 3, would prevent minorities from entering the cannabis industry.
“Marijuana possession should not be a constitutional crime. Additionally, for years now, Black people, other minorities, and people who have been criminalized by marijuana laws in the past have been unable to enter the medical marijuana market,” the Missouri NAACP wrote. “That is not right. In an effort to prevent the permanent exclusion of minorities from the cannabis industry in the state of Missouri, the NAACP calls upon every voter to reject the criminalization of marijuana possession, de facto racist regulation of the cannabis market, and the wool being pulled over our eyes by the supporters of Amendment 3.”
Under Amendment 3, the first “comprehensive” cannabis business licenses would be provided to existing medical marijuana companies.
The state’s chapter highlighted that the amendment “does not increase the number of available full market licenses” and claims that giving “micro” business licenses to disadvantaged groups makes a “very limited” program.
According to Nimrod “Rod” Chapel Jr., president of the Missouri NAACP, members agreed last week …
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