By Mary Wilson Trider and Heather Garnett
In October 2012 the Ottawa Valley Midwives expressed an interest in acting in the role of First Assist at Caesarean sections for midwife clientele who deliver their babies at Almonte General Hospital (AGH).
A First Assist in the Operating Room (OR) works with the surgeon, in this case an obstetrician, through all stages of the surgery, providing assistance with exposure, controlling blood loss, safe delivery of the infant and closure or suturing of the incision.
First Assists must have a thorough understanding of anatomy, sterile technique, the instruments used in the operating room and the flow or sequence of the Caesarean section procedure.
First Assist is an expanded role that was added to the scope of practice for midwives in Ontario in 2008 to improve the continuity of care for patients and to respond to the increasing number of births and decreasing number of care providers across the province.
AGH enthusiastically supported the expansion of the midwives’ scope of practice, as it contributes to safe, high-quality care for the patients in our regional Obstetrics program.
The midwives completed an on-line course through the University of Philadelphia in January 2013 that included six learning modules. Upon successful completion of the on-line modules the midwives are required to complete three phases of practical OR training at AGH including:
Phase 1: Surgical Sterilization in the OR. This phase of the practical training was supported by AGH OR Nurse Kate McDermott, who provided education on sterile technique and instrumentation.
Phase 2: OR training for the role of Second Assist. The midwives completed this phase of the practical training by scrubbing in and assuming the role as Second Assist for two Caesarean sections under the leadership of our Obstetricians, with support from the physician in the First Assist role.
Phase 3: As next step, the midwives will complete training for the role as First Assist under the leadership of an Obstetrician, while having a Second Assist present to provide support. The Obstetrician will determine when each midwife has attained competency in the role as First Assist.
We are grateful for the interest and enthusiasm of our midwives in taking on a new role and for the support of the other members of the Obstetrical Unit Team—obstetricians, family physicians and nurses—to implement this progressive approach to caring for patients who require a caesarean section.
Mary Wilson Trider is President and CEO of Almonte General Hospital and Heather Garnett is Vice President, Patient/Resident Services and Chief Nursing Executive.