Mississippi moms and babies are dying. This training teaches first responders how to save their lives.
Published 11:29 am Monday, December 19, 2022
Matt Greer of Brookhaven was driving home from his shift at the Mississippi Center for Emergency Services, where he works as a flight nurse, when he got a call from his younger sister. A few days earlier, she had given birth to a healthy baby girl after an uncomplicated pregnancy. Now, she told him she had a headache.
He asked her to check her blood pressure: 140/90.
For most patients, that reading isn’t concerning. For a pregnant or postpartum woman, however, it’s an indication of preeclampsia. Greer told her to go to the hospital and eventually she did, getting treatment to prevent seizure and stroke.
But Greer thinks things might have gone very differently had he not completed a new training run by the Mississippi Center for Emergency Services just a few weeks before his sister called.
The STORK Program equips first responders and medical professionals without specialized obstetrics training – including emergency room doctors and nurses – to handle pregnancy and delivery complications like hypertension and hemorrhage. Doctors at the University of Mississippi Medical Center recognized that in a rural state with dwindling options for obstetrical care, women are likely to deliver outside of dedicated labor and delivery wards, and to need care from people who don’t see pregnant patients every day. So they created the STORK training.
Greer has years of experience as a nurse, and his sister is a nurse, too. But without STORK, he would not have known how to interpret her blood pressure reading.
“I would have blown it off,” he said. “Without that fresh on my mind … I would have said, ‘that’s not too bad. You’ll be alright.’”
Chronic health conditions like obesity and diabetes plus poor access to prenatal care contribute to Mississippi’s worst-in-the-nation outcomes for moms and babies, and can’t be treated during a single interaction with a health care provider. But potentially lethal hypertension and hemorrhage are not complicated to manage – if a provider knows what to watch for and what to do.
And even inside hospitals, that can be a big “if.”
“Obstetrics is most people’s kryptonite,” said Dr. Rachael Morris, associate professor of maternal fetal medicine at UMMC, who created and leads the training. “Unless you’re an obstetrician, even a well-trained E.R. physician or mid-level provider is going to tell you that you bring a pregnant lady into my E.R., and everyone’s going to freak out.”
The STORK Program’s half-day training includes lectures and simulations to change that dynamic. (STORK stands for Stabilizing OB and Neonatal Patients, Training for OB/Neonatal Emergencies, Outcome Improvements, Resource Sharing, and Kind Care for Vulnerable Families.) The training is funded with a grant from the W.K. Kellogg Foundation, which also allows participants to receive a bag of supplies they can use during deliveries. The program is run by MCES, a division of UMMC that houses critical care transport services – including helicopter teams – and the state’s communications system for hospitals and first responders, Mississippi MED-COM.
“In Mississippi, infant and maternal mortality rates for people of color are among the highest in the nation and many families have to travel considerable distance to access care, creating obstetric emergencies,” said Wesley Prater, Kellogg Foundation program officer. “Our support of UMMC ensures providers across the state have the proper training to stabilize mothers and babies who need critical care.”
So far, about 150 people from around the state – a mix of registered nurses, physicians, medical residents, firefighters and paramedics – have completed the training over 11 classes since it launched in June. The team has 18 more trainings on the calendar.
With the state likely to tally an additional 5,000 births annually thanks to the abortion ban that took effect in July, obstetric services in the state are actually shrinking. The labor and delivery ward at Greenwood-Leflore Hospital closed in the fall. The Delta lost its only neonatal intensive care unit this summer. The NICU at Merit Health Central, which serves predominantly Black and low-income Jackson neighborhoods, also closed.
Already, more than half of the state’s counties are maternity care deserts: No labor and delivery ward. No OB-GYNs. No certified nurse midwives.
Women in rural areas face long drives to the nearest labor and delivery ward. Sometimes, that means they can’t make it there at all. Instead, they may give birth in an emergency room, at home while waiting for first responders to show up, or on the side of the road.
The STORK program staff hope training participants will be able to handle those situations effectively, saving lives along the way.
“These patients are going to be coming into really small hospitals and delivering or having problems,” said Dr. Tara Lewis, assistant professor of emergency medicine at UMMC and a former labor and delivery nurse.
Lewis joined the program to help tailor it to the needs of emergency room staff in small, rural hospitals.
“If providers don’t know how to make the diagnosis of what problem is going on, then they’re not going to know how to take care of them.”
“You look like a really good uterus,” Morris told a burly Flowood firefighter and paramedic who had joined three of his colleagues to attend a STORK training at MCES on a recent Wednesday morning.
She had just given a presentation on managing hypertension and hemorrhage, and now it was time to demonstrate how to assist during a delivery.
The paramedic held a rubber baby as Morris demonstrated how a baby’s head will generally turn to one side as it leaves the birth canal, and how to use a finger to gently loosen the umbilical cord if it has looped around the neck.
In addition to the Flowood firefighters, attendees included a pediatric emergency room nurse at UMMC, a women’s health nurse in Meridian, and an emergency room nurse at Magee General Hospital who has assisted with three deliveries in the last year alone.
“That’s a lot considering it’s a small hospital with no labor and delivery resources,” she said.
There are regular STORK trainings at MCES open to people from all over the state. But the free training is also conducted at hospitals, so participants don’t have to travel and can see how to apply what they learn where they work.
After Morris finished her presentation, Emily Wells, a nurse practitioner and member of UMMC’s neonate transport team, explained how to care for newborns in the moments after birth. Since Jan. 1 of this year, the team has transported 390 babies to higher levels of care, and participated in 20 emergency room deliveries.
She described the recent delivery of a “rest stop baby,” who was born in a Toyota Camry en route to a hospital during a cold snap.
“Cold babies die,” she said, so the team had cranked up the heat inside the car and done everything they could to keep the baby warm.
In a hospital, the baby would be placed in an incubator. But in a pinch, any kind of plastic bag – maybe one that had been used to hold supplies now in use – could be placed around the baby’s body to conserve heat.
A woman had just delivered a baby at 26 weeks in her car, and now both had made it to the emergency room of their small-town hospital. She had delivered the placenta, too, but was still bleeding.
What should happen next? Half of the training participants gathered around their patient – a life-size mannequin lying on a hospital bed shouting “I’m bleeding” – and discussed what to do.
“At 26 weeks, I think the placenta abrupted,” Morris explained.
Blood trickled from the mannequin’s vagina, soaking a pad underneath her body. This was an important lesson, Leslie Cannon, now an educator with STORK after 25 years as a labor and delivery nurse, pointed out: In patients who aren’t pregnant, life-threatening hemorrhage often looks like a dramatic gush.
“Hemorrhage postpartum, it’s this trickle,” she said. “It’s a huge deal, because that trickle just keeps going.”
That’s important to keep in mind especially because it’s often not obvious when a woman is at serious risk because of bleeding.
“A young, healthy pregnant lady is going to look really good — until she’s about dead,” Morris had warned of hemorrhaging patients.
The students administered tranexamic acid to slow the bleeding.
As Morris had explained during her lecture, a student reached an arm into the uterus to sweep for pieces of retained placenta, which can cause life-threatening bleeding. (“It’s not a comfortable thing to do,” Morris warned.) Another student massaged the mannequin’s belly to cause the uterus to contract.
Eventually, the trickle slowed and stopped. Morris estimated the patient had lost a liter of blood.
Before everyone left, Morris and Wells gave out their cell phone numbers. Kace Ragan, project manager for STORK, explained that participants get supply bags that include QR codes they can scan to request refills — as long as the grant funding holds out — and report their experiences during deliveries.
Morris urged the attendees to text or call her with questions any time. Morris treats some of the most challenging pregnancies in the state and serves as obstetric COVID director at UMMC, meaning she’s spent the last two years witnessing devastating loss.
And yet, she told the training participants, she has “the luxury” of working in a hospital with plenty of resources and specialized training.
“Y’all are in the trenches doing things that I have to do, too, but with so much less,” she said.