A model of birth asphyxia in a precocial small animal species (Acomys cahirinus): Effects on microglia, oligodendrocytes and myelination at 1 and 7 days post-partum

Background: In 2005, the RCOG’s “Why Mothers Die” report showed that substandard care was a factor in nearly 70% of maternal deaths from direct causes, and nearly 40% of maternal deaths from indirect causes1. The failure of communication between medical and midwifery staff was an important dynamic in these grim statistics. Similarly in Queensland, a major review2 reported the cogent need for maternity carers to have ‘highly developed communication skills’, and for carer teams to have clearly defined roles and responsibilities. The review also noted that obstetricians and midwives appeared unable to find ‘a common ground for care provision’, and recommended that future carers ‘learn to work together’ through dedicated education and training. Aim: In response to the above, the multidisciplinary MaCRM program was developed and has successfully trained midwives and obstetricians using crisis resource management (CRM) principles. This presentation will describe the program and the results of recent evaluations by participants in both the short- and longer-term. Methods: Participants initially refresh their knowledge about a number of crises (e.g. maternal collapse, massive obstetric haemorrhage, shoulder dystocia and cord prolapse). The following day, participants work as a team to manage emergencies in 5 different scenarios. Scenario-based training encourages high-order thinking: learners and teachers have to deal with real-world situations and are forced to think critically about them, and to make informed decisions by correctly interpreting all parts of the scenario at hand3. CRM training enables groups from unrelated disciplines to act as a co-ordinated team, through emphasis on: clear/directed communication; the roles of leaders and followers; situational awareness; when to call for help; and using all available human and technical resources at hand. Evaluation of MaCRM has 3 elements: 1) a pre-program survey relating to participants’ level of experience, knowledge, and skills in the areas covered by MaCRM, and self-reported behavioural characteristics; 2) an immediate evaluation of the program at its completion, and 3) one month later, a repeat of the pre-program survey and semi-structured interview to determine what effect if any, MaCRM had on the handling of crises by participants. It is envisaged that a State-wide impact evaluation will be carried out when there is a sufficiently high number of participants for a difference in outcomes to be observed. Results:The learning objectives of the MaCRM programs to date have been met, as evidenced by both midwives and obstetricians indicating their use of CRM principles (e.g. better communication, teamwork, calling for help early) when dealing with emergencies, and a higher level of confidence in their ability to deal with these. Additionally, participants have benefited from the opportunity to refresh their skills (e.g. handling a breech, APH, PPH).Conclusions: The MaCRM program has enormous potential to save lives of mothers and babies through the up-skilling of both midwives and obstetricians, and especially through training them to work as an effective team in the face of any emergency in the birthing suite.