Understanding factors influencing team functionality at operative vaginal birth through multidisciplinary perspectives.

Abstract

Background: Poor outcomes associated with Operative Vaginal Birth (OVB) demonstrate similar themes of breakdown in team communication, loss of situational awareness, lack of escalation, and inadequate safety systems. To date, there is limited qualitative inquiry into the factors impacting team functionality at OVB. This study aims to evaluate factors influencing team functionality at OVB through maternity care provider perspectives. Method(s): This mixed methods study involved four maternity sites in Melbourne, Australia. Surveys sent to Midwifery, Obstetric and Paediatric staff, invited quantitative and qualitative appraisal of team functionality at OVB using Likert-style and free-text questions respectively. Semi-structured interviews further explored themes in survey responses. Responses to Likert survey questions were compared between staff roles using Pearson's chi-squared tests. Free-text survey responses and interviews transcripts underwent thematic analysis. Finding(s): We received 100 survey responses from obstetric (n=41), midwifery (n=52) and paediatric (n=7) staff, including senior (n=49) and junior (n=51) roles. Overall, 99% thought team communication could improve and 82% had witnessed practices outside protocol. Midwifery or paediatric staff were more likely to rate communication as low or very low quality compared to obstetric staff (29% vs. 5%, p=0.010). Reporting being extremely or very confident to escalate concerns was less likely in midwifery or paediatric staff compared to obstetric staff (12% vs.49%, p=0.003) and junior versus senior staff (10% vs. 44%, p=0.008). Five overarching themes impacted on team functionality at OVB; (1) Calibre of communication, (2) Preparation and risk assessment, (3) Leadership and interpersonal dynamics, (4) Variation in practice, (5) Transfer from Birth Unit to Operating Theatre. Implications for practice: Care providers perspectives of team functionality at OVB differed, particularly related to the quality of communication and empowerment to escalate. Explicit training in behavioural skills, alongside clinical skills, should be considered to improve team functionality and outcomes for women and families.Copyright © 2024