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ROBuST: RCOG Operative Birth Simulation Training
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Book description

Training in safe operative birth is a key priority in obstetrics. Around one in five women are dissatisfied with their labour and birth, especially operative birth, often because of poor communication or inadequate technical skills. This can lead to sexual dysfunction and aversion to further pregnancy, as well as increases in complaints and litigation. This book accompanies the Royal College of Obstetricians and Gynaecologists' Operative Birth Simulation Training (ROBuST) course, and will be an essential resource for all obstetricians and maternity care providers. Internationally recognised contributors discuss all aspects of operative birth including: vacuum and forceps-assisted birth; Caesarean section at full dilatation; safe and effective practice of Kielland's forceps; essential non-technical skills; teamwork; and medico-legal aspects. A simple-to-use flowchart is included to guide the reader through the essential steps for a successful operative vaginal birth. Each chapter identifies the key learning points and provides step-by-step instructions for performing each technique.


'A comprehensive and very well written manual for trainees accompanying a course with the same name on the topic at the Royal College of Obstetricians and Gynaecologists … very useful, also for experienced obstetricians. All of the required aspects are covered in a clear and concise text by the 29 contributors, amply illustrated.'

Source: Acta Obstetricia et Gynecologica Scandinavica

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  • Chapter 7 - Caesarean section at full dilatation
    pp 95-109
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    Nowadays, concerns regarding operative vaginal birth (OVB) that need to be addressed at a national and institutional level in many countries. This chapter presents general notes on vacuum extraction and forceps to assist vaginal birth. The varying circumstances of practice between countries and hospitals within countries mean that, unless a trainee has opportunities to be trained in a variety of hospitals and regions, it is unlikely that the goals of the RCOG Green-top Guideline on operative vaginal delivery will be attained. One of the purposes of this book, and the ROBuST training course that accompanies it, is to ensure that trainees have the opportunity to develop skills in both methods of OVB. In the developing countries where operative obstetric skills have been maintained, OVB is carried out when there are concerns in terms of 'fit'. Skills training workshops in emergency and newborn care are many and varied too.
  • Chapter 8 - Medico-legal matters
    pp 110-125
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    Operative vaginal births (OVB) have an important role to play in modern obstetric care. OVB should be offered only when the benefits outweigh the potential risks, taking account of both maternal and neonatal perspectives. A systematic clinical assessment, effective communication and expertise in the intended procedure are prerequisites for OVB. OVBs are classified primarily by the station and position of the fetal head. OVB are performed when birth needs to be expedited and may be indicated for conditions of the fetus or the mother or both. Suspected fetal compromise, as revealed by a suspicious or pathological fetal heart rate pattern on cardiotocography (CTG), is also a common indication for OVB. Careful patient assessment, observing the rules of safe obstetric practice and working within the appropriate clinical indications for OVBs should ensure that the benefits of recommending OVB outweigh the risks.
  • Chapter 9 - Analgesia and anaesthesia for operative vaginal birth
    pp 126-137
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    This chapter explains the importance of non-technical skills in obstetric practice. It describes the non-technical skills useful when conducting operative vaginal birth (OVB). Non-technical skills have been studied in surgical, anaesthetic and acute medicine domains using methodology from the aviation industry. OVB merits non-technical skills unique to this very intimate and emotive time for the mother and her birth partner. A three-tier behavioural system is used to classify non-technical skills. The first level has five major categories of these skills. When conducting an OVB, the main categories to be considered are: situational awareness, decision making, team work and communication, professional relationships with the woman, and maintaining professional behaviour. The social and interpersonal skills not only contribute to patient safety but also can lead to a lasting impression on the mother. Therefore, the value of these should not be underestimated and need to be carefully built into teaching and formative assessments.


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