Photo Credit: Wouter Adriaensen & Thomas More University
As reported in Het Nieuwsblad (English: The Newspaper), Thomas More University in Mechelen, Belgium is the first Flemish university to use Gaumard’s SUPER TORY® S2220 simulator to help midwifery students receive neonatal resuscitation training. The curriculum incorporates neonatal care and resuscitation training to help midwifery students develop the skills needed to effectively respond to these emergency events.
Midwifery students lack clinical experiences
Respiratory distress is one of the most common medical emergencies experienced by neonates within the first few days of life. According to the American Academy of Pediatrics, approximately 10% of neonates need help breathing at birth, with up to 1% requiring extensive resuscitation. Current clinical guidelines emphasize immediate intervention to reduce respiratory morbidity and death. Moreover, specialized skills are needed to provide proper care due to neonate anatomy and physiology.
One recognized method to ensure the health of the neonate is to have a clinician who is experienced in neonatal resuscitation present at each delivery. Midwives could help fill this role, as the CDC/National Center for Health Statistics reports that “the risk of experiencing an infant death was 19% lower for births attended by certified nurse-midwives”.
However, opportunities for midwifery students to respond to emergency events like neonatal respiratory distress are rare in traditional learning environments. Students cannot take an active role in patient care when emergencies occur since they are novices. Therefore, midwifery students tend to miss opportunities to manage emergency events hands-on.
Adults learn best through a hands-on approach where they actively apply their skills and knowledge and learn through experience. From an ethical perspective, it is understandable that midwifery students would not practice on a real patient since errors could jeopardize the safety of the neonate. Nevertheless, without opportunities to practice, some midwifery students will enter the workforce with experience gaps that could adversely affect patient care.
Improving neonatal resuscitation training with simulation
One way to address the experience gap in midwifery student training is by incorporating simulation into the midwifery curriculum. A 2020 study published in the journal Nurse Education in Practice demonstrates that simulation is an effective learning strategy for undergraduate midwifery programs, improving student knowledge, confidence, and skills post the simulated event.
Simulation-based training allows students to engage in hands-on clinical experiences where they reflect on and think critically about their actions. Students use the knowledge they have gained in the classroom and apply it to the care of a simulated patient, translating theory into practice as they would during clinical training hours.
However, simulation-based training is not opportunistic learning like clinical training hours. Educators can systematically map out various patient encounters so students gain experience providing care for even rare events that could be missed during clinical training hours. Thus, midwifery students avoid gaps in their training, acquiring and mastering the necessary skills to provide safe and effective care to real patients.
This is especially important in neonatal resuscitation training due to infants’ unique anatomy and physiology requiring specialized knowledge and training to ensure a successful outcome. Therefore, novices can practice on a simulator first, receive feedback, and not risk harming a real patient as they work to improve their performance.
Since a high fidelity simulator like SUPER TORY can be operated wirelessly from a tablet by an educator, they can control the baby’s breathing, heart rate, movements, crying sounds, and skin appearance, including cyanosis, jaundice, etc., representing an infant in distress. SUPER TORY’s vitals and physical symptoms will respond to the students’ interventions, so they experience the consequences of their actions in real-time.
This results in simulation-based training promoting higher-level thinking and learning since it requires students to reason, problem-solve, and usefully deploy their knowledge based on their understanding. As a result, simulation helps bridge the gap in training and prepare students for the realities of neonatal patient care.
Applying simulation to the midwifery curriculum
High-fidelity birthing simulators like Gaumard’s VICTORIA® S2200 have been used at Thomas More University for several years as an effective strategy for teaching, evaluating, and maintaining clinical skills at all levels of midwifery education. SUPER TORY was introduced into the curriculum to help train a new generation of midwives equipped with the knowledge and skills to respond to low-frequency, high-risk events like neonatal respiratory distress.
Midwives only have a minute from the time of birth to evaluate the newborn and help them start breathing. As such, the midwifery students will practice the steps taken to assess a newborn and follow current neonatal resuscitation guidelines to practice life-saving techniques on SUPER TORY. The simulation can recreate the stress inherent during this time-sensitive event, allowing students to learn how to cope and work effectively.
Since SUPER TORY supports using real medical devices, the midwifery students also gain experience working with the tools they will use in the clinical environment. Thus, learners can enter the workforce with practical knowledge, reducing device use errors linked to provider inexperience.
“[SUPER TORY] is indispensable for the practical simulation education that we offer,” explains Violet Vervloet, one of the midwifery educators working at the university’s simulation center. “Hopefully, our students don’t have to resuscitate a newborn too often in real life, but if they do, TORY allows our students to become familiar with different techniques in a realistic but safe environment so they can effectively apply that knowledge and skill during acute situations.”
Although only the midwifery students at Thomas More University will practice with SUPER TORY, the university plans to expand the training program to local hospitals. This will allow existing neonatal nurses and doctors to participate in skill maintenance programs and ensure that clinicians in the region maintain high proficiency in neonatal resuscitation skills even if they do not frequently occur at their facility.
 Haider, Nighat, et al. ” Frequency, causes and outcome of neonates with respiratory distress admitted to Neonatal Intensive Care Unit, National Institute of Child Health, Karachi.” Journal of the Pakistan Medical Association, vol. 65, no. 7, 2015, pp. 771-775.
 American Academy of Pediatrics and American Heart Association. Neonatal Resuscitation Textbook, 6th Edition. American Academy of Pediatrics, 2011.
 “New Study Shows Lower Mortality Rates for Infants Delivered By Certified Nurse Midwives.” CDC, 19 May, 1998, https://www.cdc.gov/nchs/pressroom/98news/midwife.htm.
 Fleet, Julie, et al. “Simulation in midwifery education: A descriptive explorative study exploring students’ knowledge, confidence and skills in the care of the preterm neonate.” Nurse Education in Practice, vol. 42, no. 1, 2020, pp. 1-32.
 Lathrop, Anthony, et al. “Simulation-Based Learning for Midwives: Background and Pilot Implementation.” Journal of Midwifery & Women’s Health, vol. 52, no. 5, 2007, pp. 492-498.
 “Helping Babies Breathe.” Healthy Newborn Network, 2021, https://www.healthynewbornnetwork.org/partner/helping-babies-breathe/.