Virtual Reality Technology-Based Breech Birth Maneuver Training

Official title

The Effect of Virtual Reality Technology-Based Breech Birth Maneuver Training on the Knowledge and Skill Levels of Midwifery Students

Overview

Midwifery education is a comprehensive process aimed at equipping students with advanced theoretical knowledge, clinical decision-making abilities, and complex psychomotor skills necessary to promote and protect maternal and newborn health (ICM, 2024; Güden, 2025). National and international standards for midwifery education require graduates to achieve the clinical competence needed to manage antenatal, intrapartum, and postpartum care safely, effectively, and in accordance with evidence-based practice (ICM, 2024). Accordingly, one of the core components of the midwifery curriculum is to provide students with the knowledge, practical skills, and clinical judgment required to manage not only physiological childbirth but also high-risk pregnancies and obstetric emergencies (ICM, 2024). Breech presentation is a fetal presentation anomaly in which the fetus presents with the buttocks, knees, or feet at the birth canal and occurs in approximately 3% of all births (Atasayan \& Gürsoy, 2022). Because maternal and perinatal morbidity and mortality are significantly higher in breech births than in cephalic presentations, competence in the management of breech birth is essential for healthcare professionals providing obstetric care (Wängberg Nordborg et al., 2022). However, with the increasing global rates of cesarean delivery, opportunities to observe and perform vaginal breech birth maneuvers have become increasingly limited. Consequently, student midwives and clinicians have fewer opportunities to gain hands-on clinical experience in vaginal breech birth management, which may lead to insufficient preparedness, lower self-confidence, and reduced competence in managing this uncommon yet high-risk obstetric situation. Although breech birth is rarely encountered in clinical practice, it represents a high-risk obstetric emergency associated with substantial perinatal morbidity and mortality, leaving little room for error. The accurate and comprehensive acquisition of essential psychomotor skills required for the management of breech birth, including the Bracht, Mauriceau-Smellie-Veit, and Lövset maneuvers, directly influences neonatal outcomes and the likelihood of survival. In traditional midwifery education, these skills are generally taught through conventional simulation methods using partial or full-body mannequin models. Although traditional mannequin-based simulations contribute to the learning process, they have several important limitations, including restricted opportunities for repeated practice, low levels of interaction, insufficient realism, high costs, and the need for continuous physical resources (Saab et al., 2023). Furthermore, the limited occurrence of such high-risk cases in clinical settings and the ethical impossibility of allowing students to gain hands-on experience with real patients create significant barriers to transforming theoretical knowledge into clinical competence. Virtual Reality (VR) technology provides users with a 360-degree interactive environment, enabling the creation of highly realistic clinical simulations and introducing a new dimension to experiential learning processes. VR-based educational approaches allow students to repeatedly and independently practice high-risk clinical scenarios within a safe digital ecosystem without the risk of harming real patients (Fealy et al., 2019). The literature demonstrates that VR applications in health sciences education improve knowledge acquisition, accelerate psychomotor skill development, and positively influence self-efficacy and learner satisfaction (Cho \& Kim, 2024; Liu et al., 2023; Bracq et al., 2019). Recent studies have shown that VR-based simulations enhance knowledge retention and clinical skill development more effectively than traditional educational methods (Zambrano-Serrano et al., 2025). Furthermore, VR interventions have been reported to significantly improve midwifery students' fundamental clinical performance, self-confidence, and satisfaction levels in skills such as Leopold's maneuvers (Ahmed et al., 2025; Saied et al., 2025). Although the literature emphasizes the significant role of Virtual Reality (VR) technology in health education, randomized controlled studies directly addressing the simulation of "breech birth maneuvers" in midwifery education and methodologically evaluating the educational outcomes of these interventions remain limited. This study introduces an innovative approach by integrating one of the most critical high-risk birth management topics within the midwifery curriculum into digital education. Furthermore, it contributes to the field by applying an emerging technological method to a specific clinical area and providing a reproducible and standardized educational environment. This study was designed as a randomized controlled trial to determine the effect of virtual reality-based breech birth maneuver training on the knowledge levels and skill acquisition of midwifery students.

Interventions

• Other Virtual Reality
  Participants will receive breech birth maneuver training through a virtual reality-based simulation program. The intervention includes a realistic learning experience aimed at improving students' knowledge levels and skills related to breech birth management.
• Other Conventional Slide-Based Training
  Participants will receive breech birth maneuver training through a slide-based educational presentation. The intervention includes theoretical instruction on breech birth management and related maneuvers using conventional educational materials.

Primary outcome measures

• Knowledge score related to breech birth maneuvers [Time frame: Immediately after theoretical training]

Secondary outcome measures (1)

• Skill development regarding breech birth maneuvers [Time frame: One week after the training provided via theory and virtual reality]

Eligibility criteria

Inclusion criteria

• Volunteering to participate in the study,
• Having completed and successfully passed the "Childbirth and Postpartum Care" course,
• Having sufficient Turkish reading, writing, and speaking skills.

Exclusion criteria

• Being a first-, second-, or fourth-year midwifery student,
• Having a current or previous diagnosis of a psychiatric disorder,
• Having a diagnosis of vertigo or migraine,
• Having visual or hearing impairments.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Other

Study locations

Turkey (Türkiye) · 1 center

• Istanbul Medipol University — Istanbul

Publications

• Liu K, Zhang W, Li W, Wang T, Zheng Y. Effectiveness of virtual reality in nursing education: a systematic review and meta-analysis. BMC Med Educ. 2023 Sep 28;23(1):710. doi: 10.1186/s12909-023-04662-x. PMID 37770884
• Fealy S, Jones D, Hutton A, Graham K, McNeill L, Sweet L, Hazelton M. The integration of immersive virtual reality in tertiary nursing and midwifery education: A scoping review. Nurse Educ Today. 2019 Aug;79:14-19. doi: 10.1016/j.nedt.2019.05.002. Epub 2019 May 4. PMID 31078869

Identifiers

NCT: NCT07732998 · E-10840098-50.04-4717

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗