Wish for more training in Forceps OVD
More junior trainees (HST year 3 and under) expressed the need for more training with the use of forceps.
For kiwis yes, for forceps probably not” [BST3] when asked if they felt there was adequate teaching/ training available for OVDs in the current training set up in Ireland.
“Need more training in forceps, coz I’m pretty happy with ventouse, with forceps not so much I’m still struggling with them.” [HST2]
Self-doubt amongst female trainees in their ability to successfully perform an operative vaginal delivery .
Most female trainees, independent of their grade, expressed the feeling of self-doubt in their skills and clinical judgement, whereas male trainees and all consultants said they confident and comfortable with performing operative vaginal deliveries.
When describing their general feeling while performing an operative vaginal delivery, most female trainees used the terms “nervous”, “apprehensive”, “anxious”, “unease” and “worried”.
“I would usually not be anxious, but I will always expect the worst. When I go in I would be confident in my demeanour outwardly, but inwardly I will be aware that something could go wrong very easily very quickly.” [HST3]
“… just to try and feel prepared, expecting the worst, like you feel prepared and you’re able to cope and manage worst case scenario. So, I guess anticipation of the worst.” [HST1]
“I would be nervous just to make sure that everything goes right. I would probably be thinking in my head of the method, just to make sure that I know what I’m doing, why I’m doing it, what steps I have to take and what to do if they don’t work, so if I needed help, there might be someone there to help me and I know who to call and also so that everyone on the labour ward knows I’m there doing the instrumental delivery” [BST3]
“…feeling of fear that everything will be ok, that it will be successful; feeling of hope that it will be fine; feeling of uncertainty, am I making the right decision?” [HST2]
Furthermore, these trainees expressed that self-doubt to some extent is healthy and essential for being a safe practitioner – so more of healthy respect for the procedure and anticipation of problems.
“I suppose it depends on the circumstances of the delivery but whether it’s going to be a delivery that I anticipate to be difficult or straight forward I will always be a little bit apprehensive because the more you do vaginal deliveries the more you come to a conclusion that while there is a science to obstetrics, there’s an art to it too, and I think it’s always healthy to have a certain amount of self-doubt and anticipation that sometimes things aren’t going to go your way and be ready for that…” [HST4]
Consultants mostly used the terms “confident”, “comfortable ” and “hopeful” to describe their general feeling when performing an OVD. Almost all the consultants explained this to having plenty of experience in performing OVDs and knowing when it is indicated and when it shouldn’t be attempted.
Most male trainees didn’t express self-doubt, instead showed confidence and stated they would be focussed on the clinical situation.
“…so if I think the indication is valid and if I assess the patient and I think it's suitable I would be happy to go ahead and feel confident to do it.” [HST5 (male)].
I’m generally focussed on the clinical situation and feel pretty confident.
[HST 3 (Male)].
I feel confident because I will assess the patient to ensure she is suitable for an OVD, make sure she needs it and I know how to place and use the instruments” [BST3 (male)].
[Methods and Results Word Count – 2,550]