Simulation Training for Blood Loss Recognition During Waterbirth

The occurrance of waterbirth (WB) in labor and delivery (L&D) units across the U.S. is a new mode of delivery for many delivering providers. As a result, providers lack experience in evaluating blood loss in water. Proper training and tools to accurately identify blood loss in water are needed for timely management of postpartum hemorrhage (PPH). The purpose of this project was to develop a visual blood loss scale and practical learning approach to delivering providers in evaluating blood loss in water during WB. The objectives of this project were to 1) develop a visual blood loss scale and a simulation training scenario session that addressed the identification of blood loss in a WB tub; 2) pilot the simulation scenario using the blood loss scale with nurse midwifery students in a tub with similar capacity to the birthing tub in the project hospital L&D unit; 3) evaluate the project by pre and post simulation questionnaires from the participants to assess knowledge gained and to recognize weaknesses of the simulation or areas for improvement; and 4) disseminate the project results through presentation to the project hospital L&D unit educator and through a poster presentation at a regional American College of Nurse Midwives (ACNM) meeting in April, 2016. Review of the literature indicates that WB delivery has increased in popularity and consumer demand due to its multiple benefits during labor and delivery. Studies have demonstrated that women achieve greater satisfaction with their delivery, experience effective pain control, and receive fewer medical interventions with similar neonatal and maternal outcomes when delivering in water. Simulation is a method of instruction that research studies have found to be highly effective in learning new skills, allowing for better decision making and bridging gaps in knowledge through practical application in a no‐risk environment. Implementation and evaluation of this project included development, scheduling and implementation of the simulation scenarios, and recruitment of volunteers after obtaining IRB approval and feedback from content experts. After successful completion of the simulation pilot and receipt of feedback from the participants, the project was evaluated and presented to the project hospital L&D nurse educator and was also presented via poster presentation at a regional ACNM meeting in April, 2016. As a result of this simulation exercise, the visual blood loss scale was found to be helpful, as were the simulation scenarios, despite the unrealistic appearance of simulated blood in water. Women have expressed the desire for WB and this demand has resulted in the initiation of waterbirth deliveries in the project hospital. Simulation training may be effective for improving provider skill level and confidence in evaluating blood loss in water. This method of instruction and the use of the visual blood loss scale may assist providers to provide safe care to their patients who choose WB delivery. Future studies are necessary to determine the actual effectiveness of simulation and the visual blood loss scale in improving outcomes among women who choose to birth in water.