PLD.53 Using clinical experience to elicit the components of a skilled and safe operative delivery

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Reduced working hours and increased caesarean delivery rates have resulted in less exposure to intricate deliveries by obstetrics trainees. Though trainees may not be exposed to these deliveries as part of their training, conversely they may be expected to be proficient in them once starting independent clinical practice.

This study aims to identify the verbal and non-verbal components of three intricate deliveries – Kiellands, non-rotational and assisted breech.

Labour and delivery nursing staff were asked to identify those clinicians who they considered to be particularly skilled in intricate deliveries. Those identified consistently were invited to participate in the study. With written consent participants were then videoed performing each type of delivery on a model in order to identify the verbal and non-verbal components of the delivery. Two clinicians reviewed videos. The initial summary was then circulated to all participants for their approval.

Themes identified included the need for careful assessment of suitability, the role of the multidisciplinary team, need for careful and appropriate communication with the parents, the technique of delivery itself and postpartum care and documentation. Overall the clinicians balanced respect for the “elegant technique” of intricate deliveries with careful assessment and when to stop should safety criteria not be met.

There is still a role for intricate deliveries in modern obstetric practice, and a need for good quality holistic training programs on how best to perform such deliveries. By identifying verbal and non-verbal components of skilled deliveries these can then be translated into an useful educational tool.

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