Comparing clinician-applied loads for routine, difficult, and shoulder dystocia deliveries

Area of Science:

• Obstetrics and Gynecology
• Medical Simulation
• Biomechanics

Background:

• Vaginal delivery involves significant forces applied by clinicians.
• Understanding these forces is crucial for patient safety and optimizing delivery techniques.
• Current methods for assessing clinician-applied forces during delivery are limited.

Purpose of the Study:

• To quantify and compare clinician-applied forces, moments, and rates during simulated vaginal deliveries.
• To investigate the relationship between delivery difficulty and applied loads.
• To evaluate the utility of a birthing model for training clinicians in force perception.

Main Methods:

• Development of a novel birthing model and microcomputer data acquisition system.
• Measurement of extraction forces, moments, and rates in 39 simulated vaginal delivery experiments.
• Categorization of deliveries into routine, difficult, and shoulder dystocia scenarios.

Main Results:

• Clinicians applied significantly higher forces and neck-bending moments in difficult (122 N, 697 N-cm) and shoulder dystocia (163 N, 700 N-cm) deliveries compared to routine deliveries (84 N, 473 N-cm).
• Force levels exceeding 100 N were common in difficult and shoulder dystocia deliveries (74% and 82%).
• No association was found between applied force/moment parameters and clinician gender or experience.

Conclusions:

• Laboratory simulation of shoulder dystocia is effective for measuring extraction forces and neck-bending moments.
• Birthing models can serve as valuable tools for training clinicians in the perception of force, moment, and rate during delivery.
• Findings highlight the significant forces involved in complicated deliveries and the potential for simulation-based training to improve outcomes.