EmOC course outline


Course description

Although most pregnancies and births are uneventful, approximately 15% of all pregnant women develop a potentially life-threatening complication that calls for skilled care and some will require a major obstetrical intervention to survive. The main causes of maternal death and disability are complications arising from hemorrhage, unsafe abortion, eclampsia, sepsis and obstructed labor. This training course is, therefore, designed to train doctors, midwives, and/or nurses with midwifery skills who, as team members, will provide basic and comprehensive EmOC at health centers and hospitals to avert maternal death and disability.

The course builds on each participant’s past knowledge and takes advantage of his/her high motivation to accomplish the learning tasks in the minimum time. Training emphasizes doing, not just knowing, and uses competency-based evaluation of performance.

Course Content

• Management of shock
• Adult resuscitation
• Post-abortion care clinical skills
• Post-abortion care family planning skills
• Clean and safe childbirth
• Breech delivery
• Episiotomy and repair
• Repair of cervical tears
• Vacuum extraction
• Compression of the abdominal aorta
• Manual removal of placenta
• Newborn resuscitation
• Postpartum physical examination and care
• Newborn examination
• Endotracheal intubation*
• Caesarean section*
• Salpingectomy (ectopic pregnancy)*
• Laparotomy (ruptured uterus)*
• Postpartum hysterectomy.*

* Applies only to staff able to perform surgery

Course goals

• Influence in a positive way the attitudes of the participant towards teamwork and his/her abilities to manage and provide emergency obstetric services
• Provide the participant with the knowledge and clinical skills needed to respond appropriately to obstetric emergencies
• Provide the participant with the decision-making skills needed to respond appropriately to obstetric emergencies
• Provide the participant with the interpersonal communication skills needed to respect the right of women to life, health, privacy, and dignity.
Learning objectives
By the end of this course, participants will be able to:
• Describe basic and comprehensive EmOC and the team approach to the provision of care in relation to reducing maternal mortality
• Describe the ethical issues related to EmOC, including feeling a sense of urgency, accountability for one’s actions, respect for human life, and recognition and respect for the right of women to life, health, privacy and dignity
• Use interpersonal communication techniques that facilitate the development of a caring and trusting relationship with the woman when providing EmOC
• Use recommended IP practices for all aspects of EmOC
• Describe the process of rapid initial assessment and management of a woman who presents with a problem
• Identify the presenting symptoms and signs of shock and describe immediate and specific management
• Describe the principles and procedure of blood transfusion, including recognition and management of transfusion reactions
• Perform adult resuscitation
• Identify the presenting symptoms and signs, determine the probable diagnosis and use simplified management protocols for vaginal bleeding in early and later pregnancy
• Perform MVA for incomplete abortion
• Identify the presenting symptoms and signs, determine the probable diagnosis and use simplified management protocols for pregnancy-induced hypertension
• Identify and manage cord prolapse
• Provide care during labor, childbirth and the postpartum period
• Demonstrate use of the partograph to monitor progress in labor, recognize unsatisfactory progress in a timely manner and respond appropriately
• Demonstrate clean and safe childbirth, including active management of the third stage of labor and examination of the placenta and birth canal after the birth
• Perform and repair an episiotomy
• Identify and repair cervical tears
• Perform a breech delivery
• Perform a vacuum extraction
• Identify the presenting symptoms and signs, determine the probable diagnosis and use simplified management protocols for vaginal bleeding after childbirth
• Perform bi-manual compression of the uterus
• Perform abdominal aortic compression
• Perform manual removal of the placenta
• Identify the presenting symptoms and signs, determine the probable diagnosis and use simplified management protocols for fever during and after childbirth
• Describe normal newborn care
• Perform basic newborn resuscitation using a self-inflating bag and mask
• Describe anaesthesia and pain management associated with obstetric emergencies
• Describe pre- and post-operative care for women who require obstetric surgery
• Perform endotracheal intubation*
• Perform a Caesarean section*
• Perform a laparotomy for ectopic pregnancy and ruptured uterus*
• Perform a postpartum hysterectomy*
• Describe the procedure for performing a craniotomy*
• Describe the process for conducting a maternal death review and explain how the results should be used
• Describe the steps involved in setting up EmOC services and managing them on a day-to-day basis.

Training/learning methods
• Illustrated lectures and group discussions
• Case studies
• Role-plays
• Simulated practice with anatomic models
• Simulations for clinical decision-making
• Guided clinical activities (providing care and performing procedures for women who experience obstetric emergencies).

Participant selection criteria

Participants for this course must be:
Practicing clinicians (doctors, clinical officers, midwives and/or nurses with midwifery skills) who work at a facility where EmOC is being provided or planned actively involved in the provision of labor and childbirth care at the beginning of the course and committed to continuing their involvement on completion of the course, including the provision of EmOC selected from health facilities capable of providing consistent institutional support for EmOC (i.e., supplies, equipment, supervision, linkages with referral facilities) supported by their supervisors or managers in order to achieve improved job performance after completing the course.

In particular, participants should be prepared to communicate with super visors or managers about the course and seek endorsement for training, encouragement for attendance and participation, and involvement in the transfer of new knowledge and skills to their job.

Course duration

The course is composed of 15 classroom sessions (one week), followed by two weeks of supervised clinical skills practice and a six week to three-month self-directed practicum. It is important to note that course duration may need to be revised depending on participants’ experience and progress in learning new knowledge and skills. For example, if participants do not develop skills competency by the end of the course, it may be necessary to extend supervised clinical skills practice and/or the self-directed practicum. Alternatively, it may also be necessary to extend the classroom component of the course.