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]