Poster Session 1
Category: Operative Obstetrics
Poster Session 1
Minhazur R. Sarker, MD
Fellow Physician
Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego
San Diego, California, United States
Dana R. Canfield, MD
Maternal Fetal Medicine Fellow
Department of Obstetrics & Gynecology , University of Washington, Seattle, WA
Seattle, Washington, United States
Rachel L. Wiley, MD, MPH (she/her/hers)
Maternal Fetal Medicine Fellow
Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego
San Diego, California, United States
Yalda Afshar, MD, PhD (she/her/hers)
David Geffen School of Medicine at University of California, Los Angeles (UCLA)
Los Angeles, California, United States
Kelsey Rose, MD
David Geffen School of Medicine at University of California, Los Angeles (UCLA)
Los Angeles, California, United States
Scott Harvey, MD, MS
Department of Obstetrics, Gynecology and Reproductive Science, University of California San Diego
San Diego, California, United States
E. Nicole Teal, MD, MPH (she/her/hers)
Assistant Professor, Division of Maternal-Fetal Medicine
Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego
San Diego, California, United States
Obstetricians’ proficiency with operative vaginal delivery (OVD), and particularly forceps-assisted vaginal delivery (FAVD), has been declining over time. This study aims to characterize FAVD proficiency among maternal-fetal medicine (MFM) fellow physicians - a group of physicians obtaining additional training in obstetrics.
Study Design:
We conducted a cross-sectional survey of MFM fellows from January to June 2025. The survey was distributed primarily by email to fellows, program directors, and program coordinators. The primary outcome was fellow proficiency with FAVD after fellowship. Secondary outcomes included fellow proficiency with vacuum assisted vaginal delivery (VAVD), perceived barriers to OVD training, number of OVD performed, and comfort with not only performing but also teaching OVD. Institutional Review Board exemption was obtained prior to survey distribution.
Results:
Of the 411 fellows in training at study implementation, 162 (39.4%) responded with no differences in fellowship year or region among responders (Table 1). While 67 (41.4%) entered fellowship with proficiency in FAVD, 110 (67.9%) anticipate comfort with FAVD after training suggesting fellowship continues to train and/or solidify this skillset. During residency, 65.4% of respondents performed 10 or fewer FAVD and only 8.0% performed >20 FAVD while 49.4% of respondents performed 11-20 VAVD and 22.2% performed >20 VAVD (Table 2). In their current level of training, respondents more often felt comfortable teaching VAVD than FAVD (Table 2). The greatest perceived OVD training barriers were low volume, lack of attending proficiency, and too many trainees (Table 1). In the 2nd stage of labor, the preferred mode of delivery among respondents is OVD over cesarean delivery, even in an emergency (Table 2).
Conclusion:
Less than half of MFM fellows who participated in this study felt comfortable teaching FAVD. While MFM fellowship is expected to improve FAVD proficiency in a quarter of respondents, the declining rate of teaching capacity highlights an impending barrier to maintaining FAVD proficiency in the obstetric community.