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Introduction/Background: Recently the data of the third Euro-Perinatal European Perinatal Health Report 1 were launched, which again showed a relatively high perinatal mortality rate in the Netherlands compared to other European countries. Due to this high perinatal mortality rate, a nationwide research program on pregnancy and birth of the Netherlands Organization for Health Research and Development (ZonMw) was developed. The pilot study described in this abstract is part of this program and consists of simulation-based team training concerning different health professionals involved in obstetric care. Our country has an unique obstetric system with a high percentage home deliveries (21%): primary care, represented by independent midwives, provides care to women with low risk pregnancies and secondary care, represented by hospital midwives and gynecologists, is responsible for high risk pregnancies. Low risk women can deliver either at home or in primary care hospital setting. Up to 70% of women will be referred from primary to secondary care implicating multiple medical handovers. Dutch audits concluded that in the entire chain of obstetric care process management could be improved. Dutch data showed that 85.2 % of perinatal mortality is caused by one or more of so called BIG 4 disorders: preterm delivery, small for gestational age (SGA), congenital anomaly and low Apgar score. Studies have shown that obstetric team training improves perinatal outcome 2 and that simulation based obstetric team training implementing Crew Resource Management (CRM) improves team performance 3 . In addition, the use of concepts of deliberate practice (DP) is superior in improving medical skills.

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