At VMIA, we’re committed to improving safety and outcomes in maternity care. One of our most impactful initiatives is the Operative Vaginal Birth Safety Bundle, a collaborative project with Monash Health that has already demonstrated positive results. This award-winning program is now expanding across Victoria, bringing safer and more supportive care to thousands of women, their babies, and maternity staff.
What are operative vaginal births?
Operative vaginal births (OVBs) are births that require the use of forceps or vacuum. These procedures account for approximately 15% of all hospital births in Victoria, equating to around 12,000 births annually. While often necessary, OVBs can be complex, sometimes requiring advanced technical skills and decisive action in high-pressure situations. They also carry risks for both women and babies, particularly if complications arise.
At VMIA, we’ve prioritised improving outcomes for OVBs as part of our harm prevention strategy. These births make up 20% of our obstetric claims, highlighting the need for better safety measures. This focus aligns with recommendations from the Victorian Consultative Council on Obstetric and Paediatric Mortality and Morbidity and the Victorian Coroner, both of which have emphasised the importance of improving outcomes in this area.
How is VMIA helping support OVBs?
In 2022, Monash Health approached us with the idea to pilot a program that could reduce risks associated with OVBs. With our support, they developed the OVB Safety Bundle, a set of four key practices designed to improve safety, communication, and the overall birth experience.
These practices include:
- Bedside ultrasound before OVB
Conducting an ultrasound helps maternity care teams accurately determine the baby’s head position. This improves clinical decision-making and reduces the risk of complications for both women and babies. To conduct bedside ultrasound in the birth suite, clinicians use ultrasound equipment that’s light and portable. - A routine structured team time-out
Before starting an OVB, the team pauses for a 'time-out' to confirm the right team is present and aligned on a plan, including preparations for any complications. The woman is engaged in the time-out so that they and their support people understand the plan and are supported to lead decision-making in their care. - Safety checklist
The team then uses a safety checklist to guide the procedure and ensure adherence to best practice. - Birth experience pathway
A woman’s birth experience is a crucial indicator of their wellbeing and ongoing care needs. The pathway offers an opportunity to identify women who may need additional support post-birth and to link them with appropriate supports, for example, dedicated debriefing services and community-based services.
An evaluation of the pilot in late 2024 demonstrated positive results, including a 25% reduction in composite neonatal morbidity and a 48% reduction in neonatal birth trauma. These outcomes prompted Monash Health to embed the OVB Safety Bundle into their permanent clinical practice and establish a Centre of Excellence to support other maternity services in adopting the program. The initiative also won the Excellence in Women’s Health category at the 2024 Victorian Public Healthcare Awards, recognising its significant impact on maternity care.
“By bringing staff together, partnering with women during their birth, improving communication and improving escalation, we’ve created a safety culture.”
Prof Ryan Hodges
IBPS Information Session May 2025
The establishment of Monash Health’s Centre of Excellence marks a major milestone in the evolution of maternity care in Victoria. This Centre will play a pivotal role in training clinicians, sharing best practices, and supporting the rollout of the OVB Safety Bundle to other maternity services. By equipping clinicians with the tools and knowledge they need, the Centre is helping to create a safer, more consistent standard of care for women and their babies.
VMIA has provided additional funding to Monash Health in 2025 to develop training resources to support interested level 4-6 maternity services in the Victorian public health system to implement the bundle.
Incentivising Better Patient Safety (IBPS) program in 2025
To speed up its uptake, the OVB Safety Bundle will also become part of VMIA’s Incentivising Better Patient Safety (IBPS) program in 2025. IBPS rewards hospitals with cash refunds for training clinicians in key risk areas that impact medical indemnity claims.
The OVB Safety Bundle is more than just an innovative set of clinical practices - it provides optimal communication and decision-making conditions for health professionals in emergencies, and a tool to identify possible psychological injuries experienced by women during childbirth.
As we expand the program across Victoria, we’re not only improving safety for women and their babies, but also empowering clinicians with the skills and confidence to deliver exceptional care. Together, we’re building a safer, healthier future for Victorian families.
For more information, visit IBPS Program and OVB Safety Bundle.
(image courtesy of Monash Health)
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