Instrumental delivery should be promoted to reduce the rate of caesarean section in the second stage of labour say experts in The Obstetrician & Gynaecologist (TOG) today.
Caesarean section rates have risen globally over the years, however, the rates of instrumental vaginal deliveries have declined. Reasons for this decline include reduction in training hours, lack of senior supervision and fear of litigation.
Appropriate use of instrumental delivery could reduce risks associated with caesarean section, associated complications in current and future pregnancies and the costs of obstetric care. It may also result in higher success rates of spontaneous vaginal delivery in subsequent pregnancies.
The paper emphasises the need to provide practical training using simulators and mannequins and the importance of maintaining these skills. This practical training is not routinely available meaning many junior doctors are less prepared than a competent operator when performing forceps delivery. Simulator training enables the practitioner to learn how to achieve the appropriate force with the help of computer-assisted visual feedback.
Consultant Obstetrician and Gynaecologist, Prabbha Sinha, from Conquest Hospital in St Leonard’s On Sea and lead author on the paper said:
“Emergency caesarean sections carry the risk of severe obstetric morbidity however if conducted properly instrumental deliveries can be safe and make it easier to give birth again vaginally. Use of the Kielland forceps, for example, can minimise the risk of second-stage caesarean section and its complications, however the technique needs to be practiced.
“Enhanced practical training is required for all junior doctors using simulators to maximise expertise prior to clinical application. It is essential that trainees perform these procedures under the direct supervision of a trained and experienced obstetrician.”
TOG’s Editor –in-Chief, Jason Waugh said:
“This paper outlines factors to take into account when conducting an instrumental delivery, such as documenting events, knowing the precise position of the baby and being an experienced operator. It also highlights the need for further training for junior doctors in this area.
“Caesarean section rates are increasing and it is important to note instrumental delivery is another effective option which may improve outcomes of future deliveries.”
Ends
To speak to Prabbha Sinha or Jason Waugh please call 020 7772 6357 or email nweston@rcog.org.uk
Notes
The Obstetrician & Gynaecologist (TOG) is published quarterly and is the Royal College of Obstetricians and Gynaecologists’ (RCOG) medical journal for continuing professional development. TOG is an editorially independent, peer reviewed journal aimed at providing health professions with updated information about scientific, medical and clinical developments in the specialty of obstetrics and gynaecology.
Reference
Sinha P, Dutta A, Langford K. Instrumental delivery: how to meet the need for improvements in training. The Obstetrician & Gynaecologist 2010;12:265–271.
