“No patient should die of PPH just for the lack of training!” Experiences from multi-professional simulation training on postpartum hemorrhage in northern Tanzania: a qualitative study

Abstract

BackgroundPostpartum hemorrhage (PPH) is a major cause of maternal morbidity and mortality. In Tanzania, PPH causes 25% of maternal deaths. Skilled attendance is crucial to saving the lives of mothers and their newborns during childbirth.This study is a follow-up after multi-professional simulation training on PPH in northern Tanzania. The purpose was to enhance understanding and gain knowledge of important learning features and outcomes related to multi-professional simulation training on PPH.MethodsThe study had a descriptive and exploratory design. After the second annual simulation training at two hospitals in northern Tanzania, ten focus group discussions comprising 42 nurse midwives, doctors, and medical attendants, were carried out. A semi-structured interview guide was used during the discussions, which were audio-taped for qualitative content analysis of manifest content.ResultsThe most important findings from the focus group discussions were the importance of team training as learning feature, and the perception of improved ability to use a teamwork approach to PPH. Regardless of profession and job tasks, the informants expressed enhanced self-efficacy and reduced perception of stress. The informants perceived that improved competence enabled them to provide efficient PPH management for improved maternal health. They recommended simulation training to be continued and disseminated.ConclusionLearning features, such as training in teams, skills training, and realistic repeated scenarios with consecutive debriefing for reflective learning, including a systems approach to human error, were crucial for enhanced teamwork. Informants’ confidence levels increased, their stress levels decreased, and they were confident that they offered better maternal services after training.

Initial management of primary postpartum hemorrhage: a survey

“…Several guidelines include actions to preserve body temperature [12,27,28] as part of a strategy-oriented to treat PPH but others do not [29,30] Because of the proven influence of body temperature on coagulation cascade, efforts to maintain adequate temperature are essential. As hypothermia impairs coagulation, fluids should be warmed, and the patient kept warm with active warming devices or warmed blankets [25].…”

“…Not surprisingly, almost all respondents referred to the use of uterotonics (94, 95% CI: 92-97); this was often the first action mentioned and one in which respondents took time to explain the use of different drugs and a sequential plan for their use. Uterine tamponade resources, mainly the Bakri balloon, was mentioned by 29% of those surveyed (95% CI: [24][25][26][27][28][29][30][31][32][33][34][35], and 60% (95% CI: 54-66) referred to instruments for exploration and hemostatic clamping.…”

Skills training for operative vaginal birth

“…There is a substantial body of evidence supporting the use of simulation-based training within obstetrics. Simulation training has been associated with increases in knowledge and skills [27,41], improved teamwork and communication [42,43], improved situational awareness and improved care delivery [44,45].…”

Novel use for the abdominal tourniquet in the management of postpartum haemorrhage

“…This includes the active management of the third stage of labour, such as administration of oxytocin to the mother soon after childbirth, controlled cord traction, delayed clamping of the cord and uterine massage. 1 Unfortunately, in the resource-limited environment (RLE), access to immediate medical or obstetric care by skilled personnel may be limited. Furthermore, there may be a significant delay in transfer to definitive care.…”