Experience and confidence in vaginal breech and twin deliveries among obstetric trainees and new specialists in Australia and New Zealand

Abstract

Background: The number of vaginal breech and twin deliveries may be insufficient for adequate training. Objective: To determine whether advanced trainees and new Fellows in obstetrics are gaining adequate experience and confidence in vaginal breech and twin deliveries. Methods: An online survey was emailed to registered Royal Australia and New Zealand College of Obstetrics and Gynaecology (RANZCOG) advanced trainees and new Fellows (Years 1-5). This survey asked about their experience, confidence and whether they intend to perform vaginal breech and twin deliveries as specialists. Results: The survey was sent to 703 advanced trainees (162) and Fellows (541) and answered by 217 (31.7%). Experience and confidence in vaginal breech and twin deliveries increased with the number of procedures performed (P < 0.001) in both groups and were significantly higher among Fellows. Despite the level of experience, 100% of respondents felt confident in managing vaginal twin deliveries with or without supervision, whereas 14.9% of respondents did not feel confident in managing vaginal breech deliveries. Intention to offer these procedures in their practice depended on confidence levels, and there was a significant difference between twins and breech. Overall, 87.3% of respondents intended to offer vaginal twin deliveries in their practice, while only 32.7% intended to offer vaginal breech deliveries. Conclusion: Confidence in complex vaginal deliveries increases with increasing number of procedures performed and a significant proportion of trainees and Fellows consider they do not have sufficient experience. The association between confidence and intention to offer these procedures is stronger in twins than in breech deliveries.

How often will midwives and obstetricians experience obstetric emergencies or high-risk deliveries: a national cross-sectional study

“…34 35 Furthermore, among trainees who did not intend to offer vaginal breech deliveries and vaginal twin deliveries, in 46% and 67%, the argument was that they did not have sufficient experience to manage these complex vaginal deliveries. 35 A common feature of the events studied was that the time interval between emergencies or high-risk deliveries depended on the healthcare professional group, indicating that some groups can acquire the skills based primarily on clinical experience alone. However, alternative educational pathways should be provided for other groups.…”

“… 34 35 Furthermore, among trainees who did not intend to offer vaginal breech deliveries and vaginal twin deliveries, in 46% and 67%, the argument was that they did not have sufficient experience to manage these complex vaginal deliveries. 35 …”

20-year trend in Caesarean section rates in primiparous women in a regional obstetric unit in Hong Kong

“…The JUMODA study confirmed that planned CS (compared with planned vaginal delivery) for twins could be associated with increased composite neonatal mortality and morbidity, particularly when delivery was before 37 weeks 44 . Nevertheless, there is a strong preference among mothers with twin pregnancies for planned CS, which is likely to be compounded by the clinician's lack of confidence in conducting complex vaginal deliveries 45 . The high CS rate for twin pregnancies is unlikely to be reduced in the future.…”

Learning Breech Birth in an Upright Position Is Influenced by Preexisting Experience—A FRABAT Prospective Cohort Study

“…Since clinical expertise and teaching competency for vaginal breech delivery are generally dwindling, it is of high importance to promote the training of obstetricians in this clinical skill around the world. The quality and frequency of teaching how to deliver a baby out of breech presentation is improvable [ 17 , 18 ]. To amplify teaching of the management of vaginal breech delivery in an upright position, it is necessary to study delivery outcomes and learning curves of newly trained obstetricians and to take a closer look on the preexisting knowledge and training.…”