Introduction
Operative vaginal delivery (OVD) is an important skill for
obstetricians. It is the most common emergency intervention in
obstetrics1, can reduce the risks associated with
second stage caesarean section2 and is more likely
than second stage caesarean to result in higher rate of spontaneous
vaginal delivery in subsequent pregnancies3.
Regardless of the type of instrument used, mid cavity and rotational
deliveries require a high degree of skill4. The Royal
College of Obstetricians and Gynaecologists (RCOG) recommends that the
person performing an operative vaginal delivery should demonstrate
“adequate knowledge experience and skill to use the instruments
and manage the complications should they arise ”5.
The total time available for training before performing these procedures
independently has markedly reduced in the recent
years6. While there is a lot of data available on
technical and non-technical factors (such as operator experience,
patient factors and type of instrument used) 6-10affecting the outcome of OVDs in terms of success of the procedure,
maternal and fetal morbidity, little work has been done to investigate
the factors that make obstetricians feel confident and competent when
performing such a procedure. Confidence and competence has been studied
in general medical specialities11-15, in the area of
emergency care in Obstetrics16 and has been recorded
as part of other studies in OVD6-9, 17-18.
Lack of training has been identified as the single most important factor
contributing to low confidence when using a particular type of
instrument for an operative vaginal delivery6. Higher
number of OVDs performed as the primary operator did affect operator
confidence in the non-technical skills, but not in technical
skills7. The second study7 used a
questionnaire and therefore was limited in analysis of possible hidden
themes.
The purpose of the study was to identify the factors that affect
confidence and competence of obstetricians in performing operative
vaginal deliveries. Our hypothesis was that a qualitative research
method would provide a rich approach where themes would be developed
that the participants themselves identify as important. Identification
of such factors ultimately could help improve training and potentially
maternal, fetal and neonatal outcomes.