Qualitative analysis by interviews and video recordings to establish the components of a skilled low-cavity non-rotational vacuum delivery

R Bahl, D J Murphy, B Strachan
BJOG: An International Journal of Obstetrics and Gynaecology 2009, 116 (2): 319-26

OBJECTIVES: The objectives of this study were to define the components of a skilled low-cavity non-rotational vacuum delivery (occiput anterior, vertex at station +2 or below and less than 45-degree rotation from midline) and to facilitate the transfer of skills from expert to trainee obstetricians.

DESIGN: Qualitative study using interviews and video recordings.

SETTING: Two university teaching hospitals (St Michael's Hospital, Bristol, and Ninewell's Hospital, Dundee).

PARTICIPANTS: Ten obstetricians and eight midwives identified as experts in conducting or supporting operative vaginal deliveries.

METHODS: Semi-structured interviews were carried out using routine clinical scenarios. The experts were also video recorded conducting low-cavity vacuum deliveries in a simulation setting. The interviews and video recordings were transcribed verbatim and analysed using thematic coding. The anonymised data were independently coded by three researchers and compared for consistency of interpretation. The experts reviewed the coded interviews and video data for respondent validation and clarification. The themes that emerged following the final coding were used to formulate a list of skills.

MAIN OUTCOME MEASURES: Key technical skills of a low-cavity non-rotational delivery.

RESULTS: The final list included detailed technical skills required for conducting a low-cavity vacuum delivery. The combination of semi-structured interviews and simulation videos allowed the formulation of a comprehensive skills tool for future evaluation.

CONCLUSION: This explicitly defined skills list could aid trainees understanding of the technique of low-cavity vacuum delivery. This is an important first step in evaluating clinical competence in intrapartum procedures.

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