Improving the physical and psychological safety of operative vaginal birth

This thesis explores strategies to improve the physical and psychological safety of operative vaginal birth (OVB) through the development and evaluation of a multidisciplinary safety bundle. A systematic review assessed ultrasound measures of descent in predicting OVB outcomes, while mixed-methods research examined team functioning and decision-making. A safety bundle—comprising labour ultrasound, a team time-out, procedural checklist, and postnatal debriefing—was implemented, leading to safer clinical practices, fewer unsuccessful OVBs and reduced neonatal complications. Maternal birth experience of OVB was also explored, revealing the importance of communication, preparation and empowerment. The safety bundle is now being scaled across Victoria.