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In skilled hands, assisted vaginal birth (AVB) remains the most efficient and effective method of expediting birth in the second stage of labour. It is associated with fewer adverse maternal and neonatal outcomes compared to second stage emergency caesarean section. In this chapter we will focus on the history and role of AVB as it currently stands. We will review relevant literature, examine important areas of practice and suggest a way forward that aims to maintain AVB at the heart of obstetric practice in the twenty-first century. The need for such focus is clear – complications in the second stage of labour (fetal compromise, obstructed labour, maternal exhaustion, or maternal medical conditions exacerbated by the act of pushing) remain a major cause of maternal and neonatal mortality and morbidity across the world. Such complications are responsible for 4 to 13% of maternal deaths in Africa, Asia, Latin America and the Caribbean. In 2013 obstructed labour alone accounted for 0.4 deaths per 100,000 women worldwide.
Maternity claims represent the highest value and second highest number of clinical negligence claims reported to NHS Resolution. The three most frequent categories of claim were those relating to management of labour (14.05%), caesarean section (13.24%) and cerebral palsy (10.65%). Two of these categories, namely cerebral palsy and management of labour, along with CTG interpretation, were also the most expensive and together accounted for approximately 70% of the total figure of £3.1 billion, paid out on or expected to be paid, for all maternity claims.
Assisted vaginal birth (AVB) remains a key aspect of respectful, effective care for women in labour. In trained hands, it is associated with better maternal and neonatal outcomes than the alternative of a caesarean section in late labour. Written to accompany the RCOG Assisted Birth Simulation Training (ROBuST) course, this book provides guidance on the only RCOG-approved, evidence-based techniques for when and how to perform AVB and complex caesarean sections. There are clear descriptions of techniques, plus photographs, diagrams and videos to improve learning. Internationally recognised contributors discuss all aspects of assisted birth, including vacuum and forceps-assisted birth; caesarean section at full dilatation; safe and effective practice of Kielland's forceps; and essential non-technical skills. This second edition includes chapters on providing care within the medico-legal context of modern obstetric practice and on exploring the worldwide trends in AVB. This remains a much-valued, and much-consulted, part of any accoucheur's library.
Training in safe operative birth is a key priority in obstetrics. Around one in five women are dissatisfied with their labour and birth, especially operative birth, often because of poor communication or inadequate technical skills. This can lead to sexual dysfunction and aversion to further pregnancy, as well as increases in complaints and litigation. This book accompanies the Royal College of Obstetricians and Gynaecologists' Operative Birth Simulation Training (ROBuST) course, and will be an essential resource for all obstetricians and maternity care providers. Internationally recognised contributors discuss all aspects of operative birth including: vacuum and forceps-assisted birth; Caesarean section at full dilatation; safe and effective practice of Kielland's forceps; essential non-technical skills; teamwork; and medico-legal aspects. A simple-to-use flowchart is included to guide the reader through the essential steps for a successful operative vaginal birth. Each chapter identifies the key learning points and provides step-by-step instructions for performing each technique.