Factors Affecting Confidence and Competence of Doctors in performing
Operative Vaginal Births: a Qualitative study.
Design: Qualitative research Setting: Two University Hospitals and one
District Hospital in Ireland Population: Participants interviewed ranged
from first year trainees to consultant obstetricians. Methods:
Interviews using open ended questions. Interviews were recorded on audio
and later transcribed. Main outcome measures: Thematic analysis was
performed until saturation. Results: 35 obstetricians were interviewed.
The median number of years of experience was 5 years (range 3-20 years).
The median number of OVD was 200 (range 20-1000+). Vacuum was the
preferred choice amongst junior trainees. Preference shifted to forceps
with increasing clinical experience. Seven clear themes emerged. Three
themes were common to all participants: firstly, that all clinicians
reported respect for the primiparous OVD in anticipation of possible
complications, secondly the wish for senior midwifery support and
finally the importance of clinical experience and exposure. Four themes
were common to trainees only. Female clinicians in training reported
significant self-doubt in their ability to perform an OVD and had
concerns about causing harm. Clinicians in training wished to be trained
by consultants during their first year on the labour ward. Experience
was important. The final theme was a wish for more training in forceps
OVD by clinicians in training. Conclusion: This qualitative study
identified factors that can be used to design education and training in
OVD in order to improve care for the woman and baby.