title: Can formal education and training improve the outcome of instrumental delivery?
abstract: OBJECTIVE
  The primary objective was to examine the effect of formal education and training on instrumental delivery with respect to its success rate and associated neonatal and maternal morbidity. The secondary objective was to determine factors that could influence the success rate of instrumental delivery.
  
  
  METHODS
  Prospective case-control study with historical controls set in a teaching hospital in Sheffield. The prospective group included all women who had instrumental deliveries between 1 November 1999 and 29 February 2000. The control group included all women who delivered between 1 February 1997 and 1 February 1998. An educational package involving formal postgraduate training and self-directed learning were introduced in the time period between the prospective and the control groups. Medical notes were reviewed in the historical controls. For both the control and prospective groups, the following patient characteristics were recorded: maternal age, parity, whether or not onset of labour was induced, use of oxytocin in the second stage of labour, delay in the second stage, operator grade, vaginal findings at delivery and the use of epidural analgesia.
  
  
  RESULTS
  The overall failure rate was not different in the prospective group (16%) compared with the control group (18.5%). However, the introduction of an educational package was associated with significant decrease in maternal morbidity associated with cervical, severe labial and high vaginal tears (Odds Ratio (OR) 0.29, CI 0.09-0.97) and neonatal morbidity associated with admission to SCBU (OR 0.72, CI 0.02-0.60), severe neonatal scalp injury (OR 0.14, CI 0.02-0.98) and facial injuries (OR 0.02, CI 0.01-0.04). The factors identified to affect the success of instrumental deliveries were: OP and OT positions of the baby at delivery (OR 0.28, CI 0.17-0.44) and inexperienced operators (OR 0.11, CI 0.02-0.58).
  
  
  CONCLUSIONS
  In this study, formal education and training of medical staff did not influence the success rate of instrumental delivery but was associated with improved safety for both mother and baby.
authors.affiliation: The Jessop Wing, University Section of Reproduction and Developmental Medicine, Tree Root Walk, Sheffield S10 2SF, UK.
authors.forename: Y C
authors.initials: YC
authors.lastname: Cheong
authors.forename: H
authors.initials: H
authors.lastname: Abdullahi
authors.forename: H
authors.initials: H
authors.lastname: Lashen
authors.forename: F M
authors.initials: FM
authors.lastname: Fairlie
mesh_terms: D001003:Anal Canal / Q000293:injuries; D015360:Analgesia, Epidural; D001720:Birth Injuries / Q000453:epidemiology; D002584:Cervix Uteri / Q000293:injuries; D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000379:methods*; D004503:Education, Medical, Graduate; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007751:Labor, Induced; D009017:Morbidity; D009772:Obstetrical Forceps; D009774:Obstetrics / Q000193:education* / Q000295:instrumentation*; D010121:Oxytocin / Q000008:administration & dosage; D011247:Pregnancy; D016896:Treatment Outcome; D014621:Vagina / Q000293:injuries
chemical_list: D010121:Oxytocin