ESMOE-EOST: Birth at home

Birth at home
Scenario 2
MATERIALS TO BE READY AND AVAILABLE BEFORE STARTING THE SESSION:
General Equipment
• Baby • Sphygmomanometer
• Blank clinical notes sheet • Stethoscope
• Clock • Dry towels
• Cord clamp, scissors, gloves
Drugs and supplies • Pulse oximeter if available
• Syringes and needles • A supplemental oxygen source.
• IV giving sets and IV pole o If cylinders are used, check that they have adequate
• Test tubes for taking blood samples oxygen
• Ringer’s Lactate o Flow meter and air oxygen blender
o Tubing
Learning materials • Ambu bag and mask
• Flip charts • Oxygen mask and tubing
• Radiant heater

CALL FOR • Responsible

HELP! TEAM LEADER for key
DISCOVERER (Most senior appropriate procedures
SBAR person)
approach
• Quick diagnosis
• Basic management LOUD INSTRUCTIONS, role allocations
of patient
and distribution of functions
to $
(Mostly 1 to 3
helpers available) HELPER 1 HELPER 2 HELPER 3

Functions:
Equipment & Apprise family
Interventions Monitoring
documents Comfort patient

For all of the steps, please demonstrate what you would do.
Explain what you are doing as you do it and why you are doing it.
 ESMOE-EOST: Birth at home

B = Before / A = After B A
Information provided and Key reactions/responses expected from participants
questions asked
Scenario. Me M arrives at hospital after giving birth at home. She was waiting for the ambulance when she delivered and was assisted by
her neighbour. Me M and her baby are brought to hospital by the paramedic. Baby is wrapped in a silk scarf. She brought the placenta with
in a plastic packet.
What will you do?
1. Mother: Shake and Shout Shake and Shout Alert
2. Call a CAB Circulation: Pulse 78bpm, BP 115/80 mmHg
Airway: Talking normally
Breathing: RR 16, does not appear distressed
3. Baby Dry the baby and remove all wet wrappings
The baby is noted to be limp and not crying.
Note the time
4. ABC Airway: Gently suck the airway
Call for help
Breathing: The baby is not breathing. Give 2 B&M breaths and reassess. Still not breathing Give B&M for
30 seconds and reassess
Call for help
The doctor/ senior sister and two other nurses arrive (What must be done now?)
Circulation There is a pulse of >100 palpable at the umbilical cord.
You notice the baby is cold and blue
Take the baby to a radiant heater and continue bag and mask ventilation with O2
One team member briefly explains to mother why the baby is taken away
You take the temperature and it measures 29°C
Continue bagging with B&M while ensuring baby is dry. Make sure the head is covered as it represents a
significant part of the baby’s surface area
Measure the glucose 3,4 mmol/L
Warm towels and place baby on warm towels
Continue B&M ventilation until baby is 36°C before declaring baby as not responding to ventilation.
Once baby responds, keep baby warm, ensure breastfeeding is established
More information(What must be done now?)
3. Big 5, Forgotten 4, Core 1 CNS alert
(Secondary survey)
CVS Pulse normal and heart sounds normal
Respiratory RR 12 bpm
Gastrointestinal No jaundice, no hepatosplenomegaly
Renal Passes 80ml of urine for urine dipstix analysis: leucocytes
Immunological HIV positive. Takes one tablet per day for HIV since booking at 20 weeks
Haematological Hb 9,0 g/dL, no bleeding
Endocrine Glucose 4,5 mmol/L. Opts for EBF
Musculoskeletal Calves soft, not swollen or tender
Core one: Placenta examined and complete
Uterus well contracted, no vaginal bleeding, no vaginal tears
4. Diagnosis Hypothermic (cold) baby
5. Further management Perform routine newborn procedures: Vitamin K, Chloromycetin eye ointment, newborn immunizations
and Road to Health Card.
CLINICAL SCORE = TOTAL NUMBER OF TICKS ABOVE
CLINICAL SCORE: Assessment, diagnosis, monitoring and emergency management 29 29
 ESMOE-EOST: Birth at home

B = Before / A = After B A
Information provided and Key reactions/responses expected from participants
questions asked
DISCUSSION QUESTIONS
1. What are the risks to the mother of • Haemorrhage: retained placenta, atonic uterus, genital tract tears
giving birth before arrival at hospital? • Infection from lack of aseptic technique
• Emotional trauma
2. What are the neonatal risks of birth • Asphyxia
before arrival • Birth trauma
• Hypoxia
• Hypothermia
• Hypoglycaemia
• Tetanus and neonatal sepsis from lack of aseptic technique
3. Why is it important to warm the baby? • Cold babies have a higher O2 consumption
• Hypothermia can lead to acidosis, hypoglycaemia, poor respiratory effort and cardiac arrest
4. What are good ways to keep a neonate • Close windows and doors to minimise draft
warm? • Dry baby with a towel
• Wrap in warm towel
• Place underneath radiant heater
• Place on warm bag
• Place in a plastic packet (ensure head is exposed) if <1000g BEFORE drying and place under a
radiant heater

EXECUTION OF DRILL SCORE: Before (B) After (A)

A. Activation/Communication skills
1. Appropriate equipment brought (emergency trolley)
2. Discoverer exchanges information with team leader and helpers using SBAR approach
3. Team leader assigns essential roles to helpers (care for the woman, calling a doctor, etc.)
4. Team leader addresses team members by name
5. All observations are communicated clearly and loudly
6. Communication done correctly: instruction
repeat instruction
inform team when instruction is completed
7. The delegated helper informs the patient and family of what is happening and what will be done for the woman
B. Response/Team work
8. Team responds appropriately to team leaders’ instructions
9. Team members cooperate with each other
10. The team determines the disposition of the patient (transfer, plan for further management)
C. Sign out/Documentation
11. Person allocated to do documentation
12. Care (actions) completely documented (timing of intervention and administration of drugs)
D. Sequence of activities
13. Activities performed in the correct order of priority
EXECUTION OF DRILL SCORE (A-D above) 13 13
EXECUTION OF DRILL SCORE (A-D above): Number of boxes ticked
TOTAL SCORE (CLINICAL SCORE + EXECUTION OF DRILL SCORE)
Out of a possible score of 43 43
DISCUSSION POINTS
1. Remember to replace drugs etc (on emergency trolley) 4. The environment should be quiet. Only instructions and
2. Equipment to be cleaned and sterilised appropriately feedback allowed
3. During drill there are no arguments or in-between discussions of opinions on 5. Observations are given clearly and loudly
how something should be done. Only the necessary actions are performed 6. Importance of the correct sequence of events
as swiftly and efficiently as possible 7. Documentation
 ESMOE-EOST: Birth at home

Date: 11111111111. Name of health facility:

111111................................

Name(s) of evaluator(s): Signature(s):

1111111111111111111...1
11111111111111111111

1111111111111111111...1
11111111111111111111

SCORE: BEFORE AFTER

NOTES AND FOLLOW-UP

ATTENDANCE

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