Improving Maternal and Neonatal Outcomes in China
By Jessica Geerling, MD, Anesthesia, Critical Care and Pain Medicine
In China, the cesarean delivery rate is more than 46 percent. At the same time, labor analgesia varies widely, with less than one percent of women receiving pain relief anesthesia during delivery.
In June 2013, a team from BIDMC joined the No Pain Labor and Delivery: Global Health Initiative (NPLD-GHI). We flew halfway across the world to help introduce safe analgesia for laboring women in China.
More than 50 anesthesiologists, obstetricians and labor and delivery nurses from 11 medical centers and hospitals across the U.S. set out and together, we worked in four different hospitals in China.
The BIDMC team led by Yunping Li, MD, Anesthesia, Critical Care and Pain Medicine included myself, Margaret Chory, MD, Obstetrics/Gynecology; Chanel Harding, RN, Labor and Delivery; and Laurel Wilmore, RN, Labor and Delivery.
The goal of our trip was to help increase the neuraxial analgesia rate, reduce the high cesarean section rate and improve the safety of mothers, fetuses and newborns. A large part of this program was educational, including multidisciplinary interactions in real clinical settings.
Our team was stationed at the First Affiliated Hospital of Chongqing Medical University for a week. We participated in bedside instruction, helped create bilingual clinical guidelines, reviewed goals and objectives daily, performed simulation drills, held a childbirth class and more.
Chory worked with the local obstetricians to increase acceptance of this new practice. Discussions were held daily regarding the latest literature and practice, and we were able to help coordinate a new practice consisting of patient evaluation upon arrival to labor and delivery by the anesthesiologist.
By the end of the week, the local anesthesiologists were placing 8-10 epidurals per day and the patients all had wonderful things to say about their experience delivering with analgesia.
With the new guidelines came new expectations, and Wilmore and Harding helped the Chongqing nurses adjust to consistently monitoring vital signs, while learning how to quickly identify any side effects or complications that may be associated with neuraxial analgesia.
One day of our trip was also spent simulating emergency cesarean deliveries in order to facilitate communication and increase the efficiency of all team members.
On the final day in Chongqing, our team held a symposium to discuss topics such as options for labor analgesia, safety systems for a labor and delivery floor, intrauterine fetal resuscitation and management of severe preeclampsia. The lectures were well received by more than 300 attendees.
We had a great time in China, enjoyed teaching, traveling and of course, the delicious food!