Importance of Simulation in Obstetric Instruction and Care

by Anastasia Klipa

5/19/21



Black and white image of the profile of a pregnant woman

Within the past few decades, astounding advancements in technology and healthcare have been made. From noninvasive surgical procedures never before possible, to developing the Covid-19 vaccine at record speed, these advancements in modern medicine have undoubtedly played a role in increasing life expectancy and quality of life (STFC). However, the following statistic sheds light upon one healthcare trend that has yet to improve: The CDC reports that since the Pregnancy Mortality Surveillance System was implemented, “...the number of reported pregnancy-related deaths in the United States steadily increased from 7.2 deaths per 100,000 live births in 1987 to 17.3 deaths per 100,000 live births in 2017 (the latest available year of data).” In a report published by the American Journal of Managed Care, the U.S. ranks worst among 10 other developed nations in terms of maternal care. Additionally, the report stated that maternal deaths in the United States have been on the rise since 2000, and of the approximate 700 pregnancy-related deaths occurring each year, two-thirds of these deaths are considered to be preventable.

As many innovations are currently in development with the goal of bettering the future of healthcare, decreasing the U.S. maternal mortality rate should be a focus for many, especially when it comes to simulation. Several studies have found that including simulation in obstetric instruction has been proven to be effective in reducing complications that can lead to maternal morbidity or death, such as umbilical cord prolapse, postpartum hemorrhage, and incidence of third- and fourth-degree lacerations in forceps deliveries (Contemporary OB/GYN). There has also been evidence that points to simulation improving practical skills, teamwork, and communication, which can have drastic effects in improving maternal care, as it is reported that miscommunication plays a factor in over 70% of harmful or deadly events during delivery (Contemporary OB/GYN).

Not only does simulation have the power to improve technical outcomes during deliveries, and therefore improve maternal mortality rate, but simulation can also be used to tackle the racial disparities that plague the already devastating data behind maternal mortality rates. During 2014–2017 (latest available year of data), the CDC reported the following data for pregnancy-related mortality ratios:

As demonstrated by the data, the proportion of pregnancy-related deaths was staggeringly higher among Non-Hispanic Black women than any other group in the United States, which highlights the disparities present within our healthcare systems, such as “access to care, quality of care, prevalence of chronic diseases, structural racism, and implicit biases'' (CDC). With proper initiative and instruction, simulation could be a valuable tool in diminishing and eradicating these life-threatening disparities, as “research shows that [cultural competency] is best learned over time and should involve a self-reflection process,” a process that occurs during simulation training and subsequent debriefing sessions (Laerdal). Additionally, “A bi-national study showed that nursing students improved in their cultural awareness after participating in a simulation experience” (Laerdal). Therefore, there is evidence that supports that simulation is beneficial to increasing cultural competence and awareness among students, which can have a direct positive impact in helping improve disproportionate maternal mortality rates. However, a study published by Clinical Simulation in Nursing about racial diversity in simulation products observed that of the manikins accounted for in the study, 94% were White while only 6% were Black. This is a limiting factor in providing adequate diversity training in simulation scenarios. The simulation community should increase its efforts to include a wide range of skin tones and incorporate a diverse set of cultural phenomenons within their simulation training and scenarios. These important inclusions can lead to decreasing pregnancy related deaths as well as minimizing disparities, proving simulation’s power to transform and decrease maternal mortality rates in the United States.

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