DESCRIPTION OF TOPIC:
Background: Vacuum-assisted births (VAB) can be a safer alternative to cesarean sections in expediting delivery in the second stage. Training of midwives in the use of VAB can increase accessibility of VAB and can benefit in maintaining continuity and proficiency in the procedure in the ward over time. Objectives: To evaluate if training of midwives in the use of VAB can be achieved in a safe and sustainable manner in a rural hospital in Tanzania. Methods: Using the framework developed in the Safer Births Bundle of Care, midwives and doctors were trained in the use of VAB through simulation on a mannequin, biweekly team training, clinical mentorship, and continuous clinical feedback on their performance through debriefs after every VAB. The clinical data were continuously used as feedback to the ward to recognize areas of improvement in the biweekly team training. Clinical data on all VABs performed at the hospital were gathered and analyzed from March 2022 to January 2025. Results: A total of 103 VABs were performed by midwives and 89 by medical doctors. There was no significant difference in the need for resuscitation (38% vs. 35%), low Apgar score (34% vs. 41%), or adverse perinatal outcome (6.8% vs. 5.6%). Complications of vacuum were significantly lower in vacuums performed by midwives (16.2% vs. 33.7%). There was no significant difference in the decision-to-delivery interval (27.5 min vs. 23.7 min). Conclusions: Midwives can perform vacuum-assisted deliveries in a rural setting in Tanzania as safely and as timely as medical doctors. Education and training in the use of VAB should be provided for all midwives.

RELEVANCE TO MIDWIFERY:
Key message: Vacuum-assisted delivery can safely and timely be performed by midwives in a rural hospital in Tanzania. Education and training in the use of VAB should be provided for all midwives. Spanish - professional development (including three-minute presentation competition)