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The Continuum of Care

Training for the Fourth Trimester

Prior to giving birth, women who have become accustomed to regular exams with their doctor where they can ask questions, gather information, and gain reassurance may feel overwhelmed. Following the birth of a baby, women typically have one follow-up visit with their doctor at the six-week mark, but more than half of women say they don’t receive enough information at this appointment.1

With so many physical, emotional, and lifestyle changes happening at once, it can be difficult for a woman to notice when something is going terribly wrong. That is why the American College of Obstetricians and Gynecologists (ACOG) recommends that professionals closely assess:2

  • Mood and emotional well-being
  • Infant care and feeding
  • Sleep and fatigue
  • Physical recovery from birth
  • Chronic disease management
  • Health maintenance

After giving birth, the mother and infant are no longer treated in tandem; rather, their care becomes individualized with separate care teams. But, poor preconception and prenatal care can affect both patients’ healthcare long after birth.

New mothers need ongoing care during the ‘fourth trimester’…Our goal is for every new family to have a comprehensive care plan and a care team that supports the mother’s strengths and addresses her multiple, intersecting needs following birth.

Alison Stuebe, M.D., Committee Opinion, American College of Obstetricians and Gynecologists (ACOG) *

Acute issues for the mother are often associated with underlying medical conditions like heart disease, high blood pressure, diabetes, depression, substance abuse and obesity.3 And, an infant’s cognitive and physical development can be heavily influenced by the health, nutrition, and behaviors of the mother. Because of this mother-child connection, early recognition of abnormalities in either patient is crucial to the health of both.

Simulation can aid in a healthcare provider’s ability to recognize cause for alarm. High-fidelity simulation, specifically, provides learners with the opportunity to observe a patient and witness physiological changes in real-time. This can be something as simple as a spike in blood pressure for the new mother, or cyanosis on the infant. In simulation, these symptoms can be replicated on command to create realism in the scenario.

With nearly 4 million women giving birth each year in the U.S., an estimated 50,000 women are affected by life-threatening delivery complications.5 This means that most births will go according to “the plan”, but what about those that don’t? The significance of simulation training lies in these low-frequency, high-acuity events.

A study by the National Council of State Boards of Nursing (NCSBN) concluded that simulation is such a powerful learning method that it can substitute up to 50% of the traditional clinical experience.4 Compared with didactic learning, learners gain a much more realistic expectation of how to manage a crisis.

[Simulation] is a more realistic representation of the time. When you talk through it, you don’t have that element of how long something takes.

Kendra Flanagan, RN, Labor & Delivery, Eliza Coffee Memorial Hospital **

Healthcare professionals are the source of information, protection, and guidance for new mothers. Using simulation in training can ensure that they feel confident in their ability to educate, diagnose, and treat a woman at any stage of the continuum of care. 

References

  1. The American College of Obstetricians and Gynecologists. (2018). Optimizing postpartum care. Retrieved from https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Optimizing-Postpartum-Care
  2. The American College of Obstetricians and Gynecologists. (2018). ACOG redesigns postpartum care. Retrieved from https://www.acog.org/About-ACOG/News-Room/News-Releases/2018/ACOG-Redesigns-Postpartum-Care
  3. Rupe, H. (2017). The time after childbirth is more dangerous than you think. Web MD. Retrieved from https://blogs.webmd.com/womens-health/2017/11/the-time-after-childbirth-is-more-dangerous-than-you-think-what-to-watch-for.html
  4. National Council of State Boards of Nursing. (2012). Simulation study. Retrieved from https://www.ncsbn.org/685.htm
  5. Centers for Disease Control & Prevention. (2017). Severe maternal morbidity in the United States. Retrieved from https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html

* The American College of Obstetricians and Gynecologists. (2018). See reference #2.

** Edwards, J. (2017). Nurses benefit from simulation lab training. Times Daily. Retrieved from http://www.timesdaily.com/news/education/artquest-summer-classes-set-for-july/article_6451f76c-b38b-5542-a9b3-58b7198853e2.html#tncms-source=article-nav-prev