{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T05:38:35Z","timestamp":1792474715995,"version":"4.5.0"},"reference-count":42,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100025316","name":"Victorian Managed Insurance Authority","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100025316","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>We implemented a safety bundle for operative vaginal birth, including routine intrapartum ultrasound to assess fetal position, a structured team time\u2010out and procedural checklist, a birth experience survey and postnatal debrief pathway. This study assesses maternity staff experience of implementing this bundle.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>This mixed\u2010methods study involved four maternity hospitals in Australia. Surveys sent to maternity staff sought feedback on the bundle for 12\u2010months following implementation using Likert\u2010style and free\u2010text questions. Likert\u2010style responses were compared in the first and second 6\u2009months, as well as between obstetric and midwifery, and senior and junior clinical roles. Results from quantitative and qualitative analysis of survey data guided further in\u2010depth qualitative enquiry using semi\u2010structured interviews in a sequential convergent design.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      There were 117 survey responses from obstetric (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200927) and midwifery (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200990) staff, including senior (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200955) and junior (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200962) roles. In the second 6\u2009months, staff more often reported using the bundle \u201cAlways\u201d or \u201cMost of the time\u201d (90% vs. 69%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003), that the bundle improved accuracy of clinical assessment (85% vs. 69%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.018), communication with the woman (79% vs. 44%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002), woman's birth experience (73% vs. 42%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003), and 93% reported improved safety. Responses were similar between obstetric and midwifery staff, and junior and senior staff. Qualitative analysis identified improved safety culture with five underlying themes summarized by the acronym CALMER: clarity and transparency, agency and empowerment, learning and agility, mutuality and engagement, resourcing and feasibility.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Maternity staff perceived significant improvement in safety culture with the implementation of an operative vaginal birth safety bundle.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/birt.70138","type":"journal-article","created":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T04:48:15Z","timestamp":1792471695000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Staff Experience of Implementing a Safety Bundle for Operative Vaginal Birth: A Mixed Methods Study"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9051-4408","authenticated-orcid":false,"given":"Sasha M.","family":"Skinner","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Women's and Newborns Monash Health  Melbourne Victoria Australia"},{"name":"Department of Obstetrics and Gynaecology Monash University  Clayton Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0909-028X","authenticated-orcid":false,"given":"Arunaz","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Women's and Newborns Monash Health  Melbourne Victoria Australia"},{"name":"Department of Obstetrics and Gynaecology Monash University  Clayton Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleanor","family":"Kippen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Women's and Newborns Monash Health  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2263-3592","authenticated-orcid":false,"given":"Daniel L.","family":"Rolnik","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Women's and Newborns Monash Health  Melbourne Victoria Australia"},{"name":"Department of Obstetrics and Gynaecology Monash University  Clayton Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6688-713X","authenticated-orcid":false,"given":"Peter","family":"Neil","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Women's and Newborns Monash Health  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadine","family":"Murry","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Women's and Newborns Monash Health  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4110-3261","authenticated-orcid":false,"given":"Alison","family":"Dale","sequence":"additional","affiliation":[{"name":"Transformation Office Monash Health  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shai","family":"Bynon","sequence":"additional","affiliation":[{"name":"Transformation Office Monash Health  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8337-550X","authenticated-orcid":false,"given":"Ben W.","family":"Mol","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Monash University  Clayton Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan 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