Self-reported experience, confidence, and preparedness for operative vaginal delivery among obstetric trainees in Canada, the UK, and Ireland: an international cross-sectional survey

Abstract Background Assisted vaginal birth rates are declining while caesarean section (CS) rates continue to rise. Although sometimes indicated, CS is associated with maternal and neonatal morbidity. Declining operative vaginal delivery (OVD) rates limit trainee exposure to advanced and emergent obstetric procedures worldwide. Preparedness for complex intrapartum scenarios, including assisted vaginal and breech births, is critical. This study compares self-reported trainee experience, confidence, and training satisfaction across tertiary centres in Canada, the UK, and Ireland. Methods A cross-sectional survey (March–August 2025) assessed self-reported procedural exposure, confidence, anticipated future practice, and training satisfaction among obstetric trainees in Canada, the UK, and Ireland. Experience was self-reported using logbook data, participant estimation, or both and was not externally verified. Higher-volume exposure was defined using pragmatic, procedure-specific thresholds rather than validated competency standards. Analyses of procedural exposure, confidence, and composite indices were restricted to senior trainees (≥ ST3/PGY3/R3), and between-country comparisons were restricted to the UK, Canada, and Ireland. Results Ninety-five trainees completed all questions (UK 47, Canada 23, Ireland 10, Others 15), including 71 senior trainees. Median hands-on exposure was highest in the UK (9), followed by Ireland (8) and Canada (7). Higher-volume exposure was lowest in Canada (median 2 vs. 5 in the UK and Ireland; P < 0.001). Self-reported confidence mirrored this pattern, with median index scores of 3 in the UK, 2 in Canada, and 3 in Ireland (P = 0.007). Rotational vacuum delivery and pudendal nerve block demonstrated markedly lower exposure and self-reported confidence in Canada. Simulation exposure also differed significantly between countries. Country subgroups were small, particularly among senior trainees in Canada (n = 15) and Ireland (n = 9). Conclusions Differences in self-reported training exposure, confidence and perceived preparedness were evident across systems. As all measures were self-reported, these findings reflect trainee perceptions rather than objectively assessed procedural competence. Targeted, competency-based strategies, including structured clinical exposure and enhanced simulation, may help reduce variability in trainee-reported preparedness.