Dr Sharmila Solanki, Senior Consultant – Obstetrics and Gynaecology, Manipal Hospital, Gurugram highlights the need for multidisciplinary approach for better maternal care
According to WHO data, more than 130 million births each year, results in death of 303,000 mothers, 2.6 million in stillbirth, and another 2.7 million in a new born death within the first 28 days. The majority of these deaths occur in low-resource settings and most could have been prevented. The aim of multidisciplinary care aims that professional from a range of disciplines work together to deliver comprehensive care that addresses as many of the patient’s needs as possible like the mother’s physical, emotional, social, and spiritual needs. A multidisciplinary team that focuses on and treats the obstetric (OB) patient with a holistic health approach.
The multidisciplinary team meets to develop an approach to maternal care to improve patient safety and increasing maternal satisfaction during the hospital stay. Multidisciplinary team care is comprised of a patient and multiple health professionals from several different disciplines. Health professionals who participate in a multidisciplinary team, care, collaborate and communicate together to address as many aspects of a patient’s care as possible A pregnant woman might be having other comorbidities like diabetes mellitus and heart problems, hence need a multidisciplinary approach with super-specialists.
Obstetrics is the most dynamic and unpredictable branch of medicine. Any seemingly simple delivery case can any moment turn into a nightmare. Any labouring patient can have any complication needing specialized care in a tertiary centre. She and her partner receive prenatal counselling and following spontaneous conception are closely managed by a multidisciplinary team involving fetomaternal obstetricians, anesthetists, cardiologists, geneticists, and endocrinologists in tertiary referral hospitals throughout her pregnancy as is indicated according to her needs for the patient management.
Reports of an increase in preventable medical errors in recent years have prompted the healthcare delivery system to design and execute patient safety measures. Now is an excellent time to consider a multidisciplinary, integrated approach to health-care delivery.
Integrated multidisciplinary medical care may provide cost-effective quality care with the patient-centric approach. Management in the aviation industry, this team training approach has been applied in the labour and delivery area and some cases resulted in fewer adverse outcomes, and thereby a decrease in malpractice claims.
For a delivering patient, having an in-house blood bank and 24 into 7 services available at the centre is a boon. Atonic PPH, Placenta previa, and accrete can be life-threatening and have a high risk of morbidity for mother and infant. The incidence of placenta accrete has increased significantly during the last 30 years.
The round-the-clock availability of anesthetists so that emergency cesarean section can be taken up immediately whenever indicated. It also facilitates the process of painless delivery under epidural analgesia.
For taking care of a new born who may be in distress supervision of a specialist neonatologist and Neonatal Intensive Care Unit (NICU) facilities are of utmost importance. The value of few minutes to the Golden one hour immediately after birth need not be overemphasized because if the baby is not properly taken care of during this time there may be oxygen deficiency in brain cells leading to permanent brain damage and its consequences like retarded milestones and cerebral palsy. Any unpredictable complications like fits (if blood pressure is high) cerebral thrombosis, pulmonary embolism, or amniotic fluid embolism can occur in any labouring patient.
The patient can be well managed by continuous monitoring equipment, as all the facilities like 24 hours ICU with intensivists, super specialists & other supporting services like round-the- clock Lab services are available. An opinion by other specialists Like endocrinologists, neuro-physician, pulmonologists, and cardiologists can be provided under one roof. Any imaging facilities like ultrasound, CT scan MRI facilities available round the Clock come a long way in saving a life.
To conclude utilising concepts of ethical and moral care coupled with interprofessional coordination, communication, collaboration, and flexibility among multiple disciplines led to a positive outcome for mother and new born. It can minimize maternal and neonatal morbidity and provide a safe environment for the woman, family, and the care team.
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