Nursing

It is essential for parturients requiring level 2 or 3 care to have their nursing needs met by staff who are trained and competent in critical care; midwives normally provide nursing care on the DU. Current midwifery training in the UK concentrates on normal pregnancy and labour, and does not require a general nursing background. Further training is therefore needed if midwives are to attain the knowledge, skills and competencies required to care for critically ill parturients. Several different courses with varying levels of practical experience are currently available, many now being university based. A useful framework for the skills and competencies required can be adapted from the DOH document ‘Competencies for Recognising and Responding to Acutely Ill Patients in Hospital’ and the ‘National Competency Framework for Adult Critical Care Nurses’.

Recognition of critical illness is often poor, as highlighted in a number of Confidential Enquiries. Midwives benefit from undertaking ‘acute illness management’ training to pick up patient deterioration before overt maternal collapse; there are a number of these courses throughout the UK. This involves lectures and scenarios and then a competency assessment.

A combination of critical care nurses and midwives with enhanced competencies to care for level 2 women has been shown to work well in some units with both the critical care nurses and the midwives find that the combination of the two plays to their strengths.

All the critical care nurses have an induction programme; this includes lectures, sessions in clinics and simulation. The course is open to midwives who are gaining enhanced competencies to look after level 2 women and covers all aspects of maternal physiology, pathophysiology and common emergency scenarios (see Chapter 26).

Medical

Obstetricians in units providing level 2 critical care will need additional training in care of the critically ill as this is not currently included in speciality training. A number of general courses are available, though none specific to obstetricians or maternal critical care. This may be an area for development, using adaptations of existing intensive care courses, and core competencies in intensive care medicine as a framework.

Dedicated 24-hour anaesthetic cover from anaesthetists with a minimum of Step 1 intensive care competencies should be available for units providing critical care.

UK anaesthetic training includes a significant amount of intensive care at present, though most consultant obstetric anaesthetists do not have regular sessions in critical care. As maternal critical care evolves there is scope for consultants to have a dual role in both general critical care and maternity and this may also be an area for development.