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 arise5. 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.