During surgical procedures, a swab count should be performed before the abdomen is closed, so that any discrepancy can be investigated by a thorough search of the abdomen and theatre before the abdomen is closed. Sometimes, the swab (or instrument) has gone with the placenta or baby so the search should include these.
Training in scrubbing and theatre practice covers swab counts. A lack of knowledge or confidence can lead to poor decision-making and put patients in danger of poor outcomes. It is possible that staff may have doubts but lack the confidence to speak up. Encouraging and empowering people to speak up is valuable in this respect. All theatre practitioners must have the confidence to express any doubt about a correct swab or instrument count in a timely manner, to ensure a successful remedial action.
Educational and training resources relevant to labour ward management are:
- perinatal mortality/morbidity meeting
- case review meetings
- CTG review meetings
- obstetric emergencies training meetings.