High-fidelity simulation on shoulder dystocia management in Greek Midwives: the SAFE study (2022)

Type of publication:
Conference abstract

*Papoutsis D.; Klazoglou P.; Valasoulis G.

BJOG: An International Journal of Obstetrics and Gynaecology. Conference: Royal College of Obstetricians and Gynaecologists World Congress, RCOG 2022. London United Kingdom. 129(Supplement 1) (pp 128), 2022. Date of Publication: June 2022.

Objective: The SAFE study is funded from the Hellenic Foundation for Research and Innovation and its primary objective is to explore and quantify how the knowledge and skills on shoulder dystocia management of Greek Midwives may improve following high-fidelity simulation. Design(s): A high-fidelity simulator that consisted of a pelvic model and a computerised neonatal mannequin with a built in force-monitoring system was utilised for the purposes of shoulder dystocia management in a one-day workshop. Registered midwives were invited to participate in groups of five in a 90-min training session during the workshop. Method(s): The training session consisted of a 30-minute initial assessment, a 30-minute theoretical and hands-on training from the instructor, and a 30-minute final assessment of participants. The outcomes measured involved the performance of maneuvers, the force applied on the neonatal head, the level of communication skills and self-reported confidence. These outcomes were recorded at the start and end of the training session. The checklist of performance involved 20 items in accordance with the RCOG guideline on shoulder dystocia. The force applied on the neonatal head was recorded with the force-monitoring system of the simulator. The communication skills and the self reported confidence of participants were measured on a numerical scale. The pre-and after-training scores of all four outcomes were compared and statistical analysis was applied. Result(s): There were n = 6 one-day workshops with 81 midwives participating in total (October-November 2021). Their mean age was 30.6 +/- 11.1 years old (median:25 years). Prior to training, only 6/81 (7.4%) managed to successfully deliver the impacted shoulder (defined as successful delivery of the posterior arm), with this increasing to 77/81 (95%) after training. The force applied to the neonatal head was similar pre-and after-training (pre:102.20 +/- 38.1 Newtons vs after: 102.13 +/- 27.7 Newtons), with a convergence of the outliers to the mean value. Performance scores (scale:0- 20) improved significantly almost three-fold (pre:5.75 +/- 3.8 vs after:15.63 +/- 2.5), and the self-reported confidence of participants (scale:0-10) increased almost two-fold (pre:3.2 +/- 1.9 vs after: 7.8 +/- 1.4). The communication skills of the participants (scale:0-5) also improved (pre: 2.90 +/- 1.1 vs after: 4.78 +/- 0.5). Those with the most improvement in their confidence were the participants with less clinical experience (r = ?0.329, p = 0.03). Conclusion(s): High-fidelity simulation on the management of shoulder dystocia at childbirth, even after a single training session, can significantly improve the performance score of maneuvers, the levels of confidence and the communication skills of Midwives.

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