Respect for the primiparous OVD in anticipation of possible complications.
Participants discussed respect for the primiparous OVD and the potential difficulties and complications that may occur.
I think the most difficult deliveries are OT or OP in primigravidas when the presenting part is at the spines” [HST5]
“A primip who doesn’t know how to push is worrying .” [HST3]
“Doing an operative vaginal delivery on a primip with caput would probably make me uncomfortable and I suppose affect my confidence as well, (because) you know when it’s a situation where you’re under pressure and the patient hasn’t pushed before, you’ve got a higher chance of failing and more chance of bad perineal tears too, so that will affect my confidence as well.” [HST2]
“…If it’s a primip with high head and caput you won’t achieve success with ventouse” [Consultant]
Wish for senior midwifery support .
The wish for senior midwifery support was universal. A senior midwife who is supportive and has plenty of experience in dealing with obstetric emergencies (including OVDs) was crucial in both confidence and competence of participants.
“Support, knowing that you have somebody there over your shoulder if you need them and support from the midwifery staffing,…that if the midwifery team are supportive and experienced its more likely to be smoother and in terms of engaging a woman and working together that’s probably the key actually.” [BST3]
“…midwifery staff here are very supportive and encouraging, and even if it’s a difficult delivery and they’re there encouraging you, encouraging the woman, and supporting you it can make what can be a potentially very difficult situation, much easier and as a consequence of that when the woman feels that everyone is on the same page and supportive from every angle it manages their expectations a little bit more and reduced their (and my) anxiety .” [HST5]
“It does, because you need a patient who is cooperative and well informed, you need midwives who know their job and trust you and if I’m called to do an instrumental and I know the midwife is competent that reassures me.” [Consultant]
Trainees felt uncomfortable if the accompanying midwife was inexperienced or unsupportive.
“….whenever the patient is very distressed and if the midwives are junior or very stressed as well if there is not a calm atmosphere that makes me quite stressed out .” [HST1]