Kadlec Personnel Train on Mannequin for Difficult Births
By Michelle Dupler, Herald staff writer
RICHLAND -- In a matter of seconds, what seems a normal birth can become a mother's nightmare with a simple phrase uttered by the doctor delivering her baby: "We've got shoulders."
It's a phrase designed to sound innocuous, but to trained medical personnel, it tells them something has gone wrong and the baby's shoulder is stuck in the birth canal behind the mother's pubic bone. The medical term is shoulder dystocia.
Most of the time, the baby can be rotated or repositioned using one of several options, then the birth proceeds more or less as normal within a minute or two.
But in some cases, the birth becomes more complicated and the baby can be injured, suffer nerve or brain damage or even die.
It's those kinds of cases that lead to lawsuits by traumatized parents, but Swedish Medical Center's Gossman Center Simulation Team and Physicians Insurance are hoping practice drills using a lifelike birthing mannequin can improve outcomes for patients and their newborns, and reduce the possibility of litigation.
They brought the mannequin -- called Noelle -- to Kadlec Regional Medical Center in Richland on Wednesday to give the staff in the hospital's Birth Center a chance to polish their teamwork and communication.
"It is the most valuable training there is for a number of reasons," said Celia Smith, Continuing Medical Education director for Physicians Insurance. "Physicians and nurses hardly ever train together. There is no better practice than training together."
The training puts obstetricians, obstetric nurses and technicians -- all of the people who would be involved in a delivery -- in a room with the mannequin, which simulates a woman's abdomen, pelvis and upper thighs, and a live person who acts the role of the mother giving birth.
On Wednesday, Leslee Goetz, a Swedish clinical nurse specialist, played the mother -- down to screwing up her face in concentration and groaning with pain as she simulated labor.
While she was pretending to deliver a baby, she actually was manipulating an infant doll through the mannequin's plastic birth canal.
When it became apparent the "baby" was stuck, the hospital team leapt into action. The doctor tried different measures designed to ease the baby through the vaginal opening while someone called out the time once every 30 seconds.
A doctor typically should be able to correct a shoulder dystocia in two or three minutes. If it takes longer, then it's time for an immediate Caesarean section, said Dale Reisner, medical field specialist for Swedish.
In a debriefing after the simulation, the Kadlec team said the exercise highlighted how important communication is when responding to an emergency birth complication, not only with each other, but also the mother, who is in pain and scared for her baby.
But it also showed how well they already worked together, staff members said.
"It was good to drill it and reinforce necessary steps," said Dr. Rich Lorenzo.