How Simulation Training Is Making Childbirth Safer—One Practice Scenario at a Time

Simulation-based training allows obstetric teams to practice rare, life-threatening childbirth emergencies in a safe, controlled environment before encountering them with actual patients. At Cleveland Clinic, over 900 healthcare professionals from 10 different clinical backgrounds have participated in more than 100 interprofessional simulation trainings since 2022, practicing scenarios that most caregivers may never encounter in their entire careers.

Why Practice Rare Emergencies Before They Happen?

Some obstetric emergencies are so uncommon that most doctors will never see them in real life. Amniotic fluid embolism (AFE)—a life-threatening condition where amniotic fluid enters the mother's bloodstream—occurs just once in every 40,000 deliveries in the United States. An obstetrician performing 100 deliveries annually has less than a 9% chance of encountering one over a 35-year career. Yet when an AFE happens, preparation is critical.

"We're able to practice these rare events so that the first time we're trying to manage them isn't with a real patient, it's with a manikin in a safe, controlled environment," explains Dr. Erin Higgins, Director of Simulation for Cleveland Clinic's Obstetrics & Gynecology Institute. This approach transforms how teams respond when emergencies do occur.

What Conditions Do Obstetric Teams Practice?

High-fidelity pregnancy manikins allow teams to identify and respond to multiple serious conditions, including:

• Amniotic Fluid Embolism: A rare but life-threatening condition where amniotic fluid enters maternal circulation during labor or delivery.
• Severe Postpartum Hemorrhage: Excessive bleeding after delivery that requires rapid team coordination and intervention.
• Pre-eclampsia and Eclampsia: Pregnancy-related high blood pressure conditions that can become dangerous without prompt treatment.
• Resuscitative Hysterotomy: An emergency surgical procedure (formerly called perimortem C-sections) performed during cardiac arrest to save both mother and baby.

Why Teamwork Matters More Than You Might Think

One key insight from obstetric simulation training is that technical skills alone aren't enough. On a labor and delivery unit, managing emergencies requires seamless communication across multiple professions. Cleveland Clinic's simulation programs include doctors, nurses, midwives, physician assistants, nurse practitioners, clinical-clerical associates, blood bank staff, and anesthesia providers—the entire team that responds when a crisis occurs.

This multidisciplinary approach reveals how different team members communicate and coordinate. Simulation sessions often take place directly on hospital units (called "in-situ" training), which allows teams to identify potential problems with medication storage, equipment supplies, and workflow before a real emergency tests these systems.

How Does the Learning Actually Happen?

Many people assume the hands-on scenario is where the real learning occurs, but simulation experts know better. Dr. Higgins structures each session with three components: a pre-brief to orient learners, the hands-on scenario practice, and a formal post-simulation debrief. The debrief is intentionally long—simulation standards recommend it be two to three times the length of the practice scenario itself.

"Where we see the learning develop is really during the discussion afterward," Dr. Higgins explains. During the debrief, teams dive deeper into the decisions they made, discuss what worked and what didn't, and reinforce that every caregiver is empowered to speak up if they see a safety concern. This psychological safety is essential—simulation is a place to make mistakes on a manikin, not on patients.

The approach reflects a principle adopted by high-reliability organizations: "if you see something, say something." Any team member can activate a code and get the people and resources needed, and caregivers are encouraged to voice concerns without fear of shame or ridicule.

Making Simulation Training Actually Work

Not all simulation training is created equal. Dr. Higgins emphasizes that quality simulation-based education requires much more than realistic manikins—it requires the entire experience to be psychologically safe and aligned with best practices. Old-school medical training approaches that relied on shame or "gotcha" moments don't work in simulation environments.

Instead, Cleveland Clinic embraces a foundational principle from Harvard's Center for Medical Simulation: "The Basic Assumption© holds that everybody here is intelligent and capable, cares about doing their best and wants to improve." This creates an environment where learners feel comfortable trying new approaches and making mistakes without fear of being humiliated.

Since 2022, Cleveland Clinic's Simulation and Advanced Skills Center—which is fully accredited by three simulation accreditation bodies—has completed 5,687 events involving more than 75,000 learners. Obstetric teams at Cleveland Clinic are required to participate in simulation training every two years, ensuring that preparation for rare emergencies remains current and that new team members receive the same rigorous training.

As childbirth becomes safer through better preparation and teamwork, simulation training represents a shift in how healthcare systems approach quality and safety. By practicing rare emergencies before they happen, obstetric teams can respond with confidence and coordination when real patients need them most.