“There are not a lot of mid­wives in remote loca­tions and so remote area nurs­es (RANs) often have to step up and look after preg­nant women, new mums and their babies out­side their nor­mal scope of prac­tice,” says Leonie.

“One of our major goals at CRANAplus is to pro­vide sup­port to these remote nurs­es, by pro­vid­ing them with the skills, tools and infor­ma­tion they need to be con­fi­dent in their assess­ment and col­lab­o­ra­tive care of the peri­par­tum woman.”

Along with her col­league Aman­da For­ti, Leonie coor­di­nates more than 30 MEC and MIDUS cours­es through­out the year across Australia. 

The pair have spear­head­ed recent course updates, such as more inter­ac­tive, hands-on learn­ing in the MEC course and addi­tion­al course and pre-course learn­ing material.

“We cov­er emer­gency and co-mor­bid­i­ty sit­u­a­tions in mater­ni­ty, but also the nor­mal aspects of ante and post­na­tal care,” Leonie explains, ​“such as the skills to con­duct a thor­ough assess­ment for preg­nant women, under­stand­ing the nor­mal preg­nan­cy, birth and post­na­tal period.

“This is often ​‘bread and but­ter’ for these RANs in con­sul­ta­tion with their local mater­ni­ty care providers, and, impor­tant­ly, then enables the RANs to iden­ti­fy vari­a­tions from nor­mal, and to esca­late care in a time­ly manner.”

One such vari­a­tion is sep­sis. As defined by the Sep­sis Alliance, sep­sis is the ​‘body’s over­whelm­ing and life-threat­en­ing response to infec­tion that can lead to tis­sue dam­age, organ fail­ure, and death… Sep­sis can lead
to severe sep­sis and sep­tic shock.’

Sep­sis is now a major focus in CRANAplus’ recent­ly updat­ed MEC and MIDUS cours­es. Ear­ly recog­ni­tion and com­mence­ment of treat­ment are vital; dou­bly so in a low-resource remote set­ting where
help is fur­ther away.

“It’s all very well for the nurse to have the skills to assess and con­sult, but pro­vid­ing treat­ment in the first hour and get­ting the patient to the hos­pi­tal are also key pri­or­i­ties,” Leonie says.

“As per the sep­sis guide­lines and path­ways, we encour­age nurs­es to always con­sid­er sep­sis as a pos­si­bil­i­ty in any pre­sen­ta­tion, and to keep at the front and cen­tre of their mind: ​‘Could this be sepsis?’

“In mater­ni­ty care, one of the things preg­nant women can present with may appear to be pneu­mo­nia or a uri­nary tract infec­tion. With a post­na­tal patient, it could be mas­ti­tis, a wound, or retained prod­ucts – but always, ​‘Could this be sepsis?’”

Leonie says there is an excel­lent array of resources and infor­ma­tion avail­able online to help clin­i­cians iden­ti­fy and man­age sep­sis (refer to the box below). 

“On each course, we may have 24 par­tic­i­pants, all from remote com­mu­ni­ties, and each sit­u­a­tion can be dif­fer­ent,” says Leonie. 

“These par­tic­i­pants are our peers, and they are often very, very expe­ri­enced nurs­es and mid­wives, who need to trans­late what needs to be done into their own settings. 

“The more gener­ic ques­tions we share are so impor­tant. Ques­tions like: ​‘Do I have a birthing box?’ ​‘What drugs do we have on hand?’ ​‘Are they in date?’ ​‘Who is in charge of check­ing these resources?’

“When our course par­tic­i­pants go back to work, we encour­age them to review their local pro­to­cols, equip­ment and resources. 

“We’ve had par­tic­i­pants report that, on check­ing, they’ve dis­cov­ered drugs that are well out of date, and birthing kits that need re-ster­il­is­ing or refreshing.

“This course gives par­tic­i­pants the oppor­tu­ni­ty to pause for thought, to think about their pro­to­cols and their birthing kits, neona­tal resus equip­ment, oth­er equip­ment and resources for mater­ni­ty care, and how they will pre­pare for and respond to the pre­sen­ta­tion of a peri­par­tum woman.”