Fundamental Obstetric Procedures

  • Komal Bajaj
  • Michael Meguerdichian
Part of the Comprehensive Healthcare Simulation book series (CHS)


A variety of healthcare disciplines intersect during the care of a pregnant woman, especially during delivery. Simulation has been effectively utilized to train a wide range of health professionals on fundamental obstetric skills including cervical exams, assessment of fetal position, spontaneous vaginal delivery, and perineal laceration repair. Educators have used simulation equipment ranging from part-task trainers and full-body mannequins to organic materials such as different fruits or beef tongue, to train individuals or teams on core pregnancy-related procedures.


Obstetrics Simulation Birth Labor Perineal laceration 


  1. 1.
    Gupta N, Dragovic K, Trester R, Blankstein J. The changing scenario of obstetrics and gynecology residency training. J Grad Med Educ. 2015;7:401. Scholar
  2. 2.
    Higham J, Steer PJ. Gender gap in undergraduate experience and performance in obstetrics and gynaecology: analysis of clinical experience logs. Br Med J. 2004;328(7432):142–3. Scholar
  3. 3.
    Cooper S, Cant R, Porter J, et al. Simulation based learning in midwifery education: a systematic review. Women Birth. 2012;25(2):64–78. Scholar
  4. 4.
    Deering S, Auguste T, Lockrow E. Obstetric simulation for medical student, resident, and fellow education. Semin Perinatol. 2013;37:143. Scholar
  5. 5.
    Medical Simulation in Medical Education: Results of an AAMC Survey. 2011. Accessed 5 Apr 2017.
  6. 6.
    Pinar G, Knight CC, Gaioso VP, et al. International Archives of Nursing and Health Care. The effects of high fidelity simulation on nursing students’ perceptions and self-efficacy of obstetric skills. Int Libr Cit Int Arch Nurs Heal Care Pinar al Int Arch Nurs Heal Care. 2015;1(12).’_Perceptions_and_Self-Efficacy_of_Obstetric_Skills/links/5760023b08ae97c1231434de.pdf. Accessed 5 Apr 2017.
  7. 7.
    Fritz J, Walker DM, Cohen S, Angeles G, Lamadrid-Figueroa H. Can a simulation-based training program impact the use of evidence based routine practices at birth? Results of a hospital-based cluster randomized trial in Mexico. Scholar
  8. 8.
    Kumar A, Gilmour C, Nestel D, Aldridge R, MCLelland G, Wallace E. Can we teach core clinical obstetrics and gynaecology skills using low fidelity simulation in an interprofessional setting? Aust N Z J Obstet Gynaecol. 2014;54(6):589–92. Scholar
  9. 9.
    Cunningham FG. Williams obstetrics. New York: McGraw-Hill Education; 2008.Google Scholar
  10. 10.
    Gardberg M, Tuppurainen M. Persistent occiput posterior presentation – a clinical problem. Acta Obstet Gynecol Scand. 1994;73(1):45–47. Accessed 4 Apr 2017.CrossRefGoogle Scholar
  11. 11.
    Arias T, Tran A, Breaud J, Fournier JP, Bongain A, Delotte J. A prospective study into the benefits of simulation training in teaching obstetric vaginal examination. Int J Gynecol Obstet. 133:380. Scholar
  12. 12.
    Nitsche JF, Shumard KM, Fino NF, et al. Effectiveness of labor cervical examination simulation in medical student education. Obstet Gynecol. 2015;126(4 Supplement):13S–20S. Scholar
  13. 13.
    Huhn KA, Brost BC. Accuracy of simulated cervical dilation and effacement measurements among practitioners. Am J Obstet Gynecol. 2004;191(5):1797–9. Scholar
  14. 14.
    Shea KL, Rovera EJ. Vaginal examination simulation using citrus fruit to simulate cervical dilation and effacement. Cureus. 2015;7(9):e314. Scholar
  15. 15.
    Donkers K, Delong D. High-fidelity simulation use in preparation of physician assistant students for neonatal and obstetric care. Scholar
  16. 16.
    Diez-Goni N, Guillen S, Rodriguez-Diez MC, Pineda L, Alcazar JL. Use of the learning curve-cumulative summation test for Leopold maneuvers assessment in a simulator: a pilot study. Simul Healthc. 2015;10(5):277–82. Scholar
  17. 17.
    Deering SH, Hodor JG, Wylen M, Poggi S, Nielsen PE, Satin AJ. Additional training with an obstetric simulator improves medical student comfort with basic procedures. Simul Healthc J Soc Simul Healthc. 2006;1(1):32–4. Scholar
  18. 18.
    Reese TR, Deering SH, Kavanagh LB, Maurer DM. Perceived clinical skill degradation of Army family physicians after deployment. Fam Med. 2015;47(5):343–348. Accessed 5 Apr 2017.
  19. 19.
    Cooper M, Papanagnou D, Meguerdichian M, Bajaj K. Emergency obstetrics for the emergency medicine provider. MedEdPORTAL Publ. 2016;12.
  20. 20.
    Dayal AK, Fisher N, Magrane D, Goffman D, Bernstein PS, Katz NT. Simulation training improves medical students’ learning experiences when performing real vaginal deliveries. Simul Healthc. 2009;4(3):155–9. Scholar
  21. 21.
    Reynolds A, Ayres-de-Campos D, Bastos L, van Meurs W, Bernardes J. Impact of labor and delivery simulation classes in undergraduate medical learning. Med Educ Online. 2008;13:14. Scholar
  22. 22.
    Holmström SW, Downes K, Mayer JC, Learman LA. Simulation training in an obstetric clerkship: a randomized controlled trial. Obstet Gynecol. 2011;118(3):649–54. Scholar
  23. 23.
    Easter SR, Gardner R, Barrett J, Robinson JN, Carusi D. Simulation to improve trainee knowledge and comfort about twin vaginal birth. Obstet Gynecol. 2016;128(4):34S–9S. Scholar
  24. 24.
    Ion STEDIT, Downing D, Hargreaves O, et al. Healthcare simulation. 2016;(June):1–50.
  25. 25.
    Blondel B, Alexander S, Bjarnadóttir RI, et al. Variations in rates of severe perineal tears and episiotomies in 20 European countries: a study based on routine national data in Euro-Peristat Project. Acta Obstet Gynecol Scand. 2016;95(7):746–54. Scholar
  26. 26.
    Hirayama F, Koyanagi A, Mori R, Zhang J, Souza JP, Gülmezoglu AM. Prevalence and risk factors for third- and fourth-degree perineal lacerations during vaginal delivery: a multi-country study. BJOG Int J Obstet Gynaecol. 2012;119(3):340–7. Scholar
  27. 27.
    Ampt AJ, Ford JB. Ascertaining severe perineal trauma and associated risk factors by comparing birth data with multiple sources. Public Health Res Pract. 2015;2525(44).
  28. 28.
    Best C, Drutz HP, Alarab M. OBSTETRICS obstetric anal sphincter injuries: a survey of clinical practice among Canadian obstetricians. J Obstet Gynaecol Can. 2012;34(8):747–54. Scholar
  29. 29.
    Martinez A, Cassling C, Keller J. Objective structured assessment of technical skills to teach and study retention of fourth-degree laceration repair skills. J Grad Med Educ. 2015;7(1):32–5. Scholar
  30. 30.
    Patel M, LaSala C, Tulikangas P, O’Sullivan DM, Steinberg AC. Use of a beef tongue model and instructional video for teaching residents fourth-degree laceration repair. Int Urogynecol J. 2010;21(3):353–8. Scholar
  31. 31.
    Dancz CE, Sun V, Moon HB, Chen JH, Özel B. Comparison of 2 simulation models for teaching obstetric anal sphincter repair. Simul Healthc J Soc Simul Healthc. 2014;9(5):325–30. Scholar
  32. 32.
    Illston JD, Ballard AC, Ellington DR, Richter HE. Modified beef tongue model for fourth-degree laceration repair simulation. Obstet Gynecol. 2017;129(3):491–6. Scholar
  33. 33.
    Winkel AF, Lerner V, Zabar SR, Szyld D. A simple framework for assessing technical skills in a resident Observed Structured Clinical Examination (OSCE): vaginal laceration repair. J Surg Educ. 2012;70:10–4. Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.NYC Health + Hospitals Simulation CenterBronxUSA
  2. 2.Albert Einstein College of MedicineBronxUSA
  3. 3.Harlem Hospital Center, Emergency Department/H+H Simulation CenterNew YorkUSA

Personalised recommendations