Dawn Mangine

    The United States is the only developed country in the world where the rate of maternal death is rising. From 1987 to 2015 (the latest year for which numbers are available), the number of reported pregnancy-related deaths has steadily increased from 7.2 per 100,000 live births to 17.2 deaths per 100,000 live births.1

    Reporting by NPR and ProPublica reveals some key findings about maternal care in hospital settings:

    • Hospital protocols for dealing with potentially fatal complications vary so widely from hospital to hospital that treatable complications can quickly turn lethal.
    • Even hospitals that are well-prepared for complications in newborn infants can be “woefully unprepared” for a maternal emergency.
    • Only six percent of block grants for maternal and child health go to care for the health of mothers.
    • In the United States, some healthcare professionals entering the field of maternal-fetal medicine complete their education without entering or spending time in a labor-delivery unit.2

    The Role of Simulation in Obstetrics

    According to the National Institutes of Health, studies reveals that poor teamwork and ineffective communication are the most important contributing factors to adverse events in obstetrics. They encourage the development of “high-reliability organizations” by using simulation to transform institutions, OB departments, and maternal-fetal medicine divisions. 3

    Obstetric simulation focuses on three areas:

    • Skill acquisition
    • Interval training
    • In-situ drills

    Skill acquisition education focuses on trainees, such as nursing students or residents, and usually targets a particular complication. Interval training refreshes skills and updates providers on new techniques and recommendations. In-situ drills often incorporate interprofessional education (IPE) and occur in a real setting (rather than a simulation lab). They provide the opportunity for healthcare providers to practice teamwork and can identify system issues that may impact patient safety. 4

    “Simulation should be an integral part of our journey towards high reliability, with the ultimate goal of improving patient safety and quality of care in obstetrics.” 5

    The California Maternal Quality Care Collaborative (CMQCC), formed in 2006 found two well-known complications could be survived when treated properly: hemorrhage and preeclampsia. The keys were prevention through early recognition, teamwork, and well-rehearsed treatments.

    Use Simulation to Prepare OB Students - Lucy Manikin

    Maria Hellen Rodriguez, the medical director of maternal-fetal medicine at Pomona Valley Hospital Medical Center near Los Angeles, has incorporated in-situ training into the program. She asserts that creating muscle memory to address worse-case scenarios is key to saving mothers.6 CMQCC has created toolkits that include carts, checklists, equipment, and medication needed to tackle an emergency complication in labor and delivery. They run scenarios with manikins and standardized patients. From 2006 to 2013, the maternal death rate in California dropped 55 percent.

    Many obstetric tools, simulators, and manikins exist for the simulation classroom, and advancements in this technology are improving every day. Task trainers allow for practicing non-complicated deliveries, episiotomies, and fetal monitoring. Advanced manikins give students access to practice more challenging scenarios and learn what to do in an obstetric emergency. See the Pocket Nurse site for all the simulation solutions.


    1. “Pregnancy Mortality Surveillance System,” Reproductive Health, CDC https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-mortality-surveillance-system.htm

    2. Montagne, R., Martin, N. “U.S. Has the Worst Rate of Maternal Deaths in the Developed World,” NPR and ProPublica. https://www.npr.org/2017/05/12/528098789/u-s-has-the-worst-rate-of-maternal-deaths-in-the-developed-world

    3. Goffman, D., Colleen, L. Bernstein, PS. "Simulation in maternal-fetal medicine: making a case for the need.", PubMed, NCBI, NIH. https://www.ncbi.nlm.nih.gov/pubmed/23721767

    4. Deering, S. M.D. "Using Simulation Technology to reduce maternal morbidity." Contemporary OB/GYN. https://www.contemporaryobgyn.net/surgery/using-simulation-technology-improve-maternal-morbidity

    5. Goffman et al. PubMed, NIH.

    6. Montagne, R. "To Keep Women from Dying in Childbirth, Look to California." NPR. https://www.npr.org/2018/07/29/632702896/to-keep-women-from-dying-in-childbirth-look-to-california