Evaluating the effect of two different training interventions on improving vaginal twin birth rates and provider confidence and knowledge levels: A pre- and post-intervention study

Objective: Despite the increasing trend in cesarean section rates in multiple pregnancies, vaginal delivery in twin pregnancies appears both possible and safe. Methods: This retrospective multicenter study compared outcomes before and after the implementation of a vaginal twin intervention in two Italian hospitals. In January 2021 in Pescara and in July 2022 in Florence, physicians with expertise in twin and breech vaginal birth started working in each center, and clinicians and midwives started quarterly training in these skills. The study period was divided into two equal time intervals and lasted 8 years in Pescara and 5 years in Florence. Providers were also surveyed about how the intervention affected their confidence, skill, and knowledge levels. Diamniotic pregnancies with two viable twins, ≥34 weeks of gestation, and cephalic presentation of the first twin were included. A total of 278 women were evaluated, split into pre-intervention (n = 131) and post-intervention (n = 147) periods. Results: Vaginal birth rates increased from 9.2% to 40.8% overall, with no negative effect on maternal or neonatal outcomes. Participating providers felt more skilled, knowledgeable, and confident and agreed that the training improved vaginal birth rates as well as their vaginal breech skills. Conclusion: In settings with a high background cesarean section rate, a rapid increase in the vaginal birth rate of twins is possible without adversely affecting maternal or neonatal outcomes, via either staff-wide training or specialist teams. Simulation and skills training can improve provider confidence, knowledge, and skill levels as well as impact clinical practice in the labor ward.