Special Delivery

The Obstetric Rapid Response Team is helping Nina Williams save time and lives.

By Venita Jenkins and Jennifer Glatt

If emergency drills collide with actual emergencies, it may be just another day on the job for Nina Williams. According to her, “the baby determines when it’s coming.”

Williams, a nursing lecturer in the College of Health and Human Services and a part-time staff nurse in the labor and delivery unit at New Hanover Regional Medical Center, is familiar with obstetric emergencies. She has delivered babies in the emergency department from mothers in cardiac arrest, or experiencing seizures, stroke or uterine rupture. She has delivered more than her fair share of babies in a hospital parking lot.

Williams, who is passionate about decreasing mortality and maternal morbidity rates, realized that her team needed better structure to meet the needs of those emergencies. “One maternal death is too many,” Williams stated simply.

National statistics show 700 women die from pregnancy-related complications each year in the U.S. – and three in five pregnancy-related deaths could have been prevented, according to the Center for Disease Control. Thirty-six percent of pregnancy-related deaths occur during delivery and up to one week afterward. “If we can save one mother, one baby, then we have already improved what we have seen in the last four or five years.”

Babies born in less-than-ideal environments can easily get hypothermia, necessitating a stay in the NICU. Hypothermia causes compromised respiratory systems, “and then it’s a snowball effect” of progressively worse issues, explained Williams. Adequate care in the early moments of birth ensures a healthy start.

Williams found that the typical response to emergencies was “feast or famine.” “We would either have 10 people leaving the unit, then no one was left on the floor to watch patients, or we had only one person go to the code,” she said. “We never had a plan.” Even delivering babies in the emergency department wasn’t ideal, as the distance from Labor and Delivery to the Emergency Department was more than half a mile on foot, and specific supplies were not readily available. Getting a supply cart from one location to the other proved cumbersome.

Combining her experience and ingenuity, Williams created a mobile code team and a supply kit in an easily transportable backpack. The creation of the team and Code-OB bag was the result of a Ph.D. sustainability project Williams completed in order to obtain a Doctor of Nursing Practice in Leadership degree at Gardner-Webb University. The backpack is an EMS/ firefighter bag outfitted with blankets, caps, IVs and medications. Members of New Hanover County Hospital’s newly formed Obstetric Rapid Response Team underwent extensive training and took part in impromptu drills, day and night. Williams implemented the project in February 2019, and within a few weeks, the team was put to the test.

“A code was called for a delivery in front of the hospital. The response time was greatly improved getting to the patient, which led to fewer complications for both the mother and the baby,” said Williams.

Team members are assigned roles similar to football offensive players: the charge nurse is the “quarterback” and the registered nurses are the “running back,” “center” and “wide receiver.” Each offensive player is responsible for certain tasks after the team receives an emergency code. The quarterback oversees all obstetric emergency codes, the running back carries the emergency backpack kit and assists with IV and medications, the center assists physicians with care of patients and the wide receiver documents all code activities.

“The response team makes a very chaotic situation less chaotic,” said Ashley Riley, a labor and delivery registered nurse. Additional nursing staff are assigned as back-up team members to cover patients when the emergency team is responding to a code.

“Globally, every minute a woman dies from complications related to pregnancy or childbirth,” said Charlie Hardy, dean of the College of Health and Human Services. “The United States continues to rank poorly compared to other countries. Nina Williams’ project has the potential to give health care providers the training they need to quickly, confidently and competently treat their patients, reduce extensive financial impact for both the family and the health care system, and most importantly, save lives.”

Williams is exploring the possibility of production of the Code-OB bag, already stocked with the necessary supplies for immediate use in hospitals throughout the country. Several hospitals in North Carolina have reached out to Williams to provide training to their staff. She also presented her project at the Sigma Theta Tau Nursing Research Conference in Calgary, Alberta, Canada, in July 2019; Williams’ goal is to take the program abroad.

“I don’t care to make a profit off this; I just want to make it readily available,” Williams said. “This project is going to lead mothers and infants to a safer place.”

Posted January 7, 2020

Read more articles from the Fall/Winter 2019 issue of UNCW Magazine here!