Virtual Reality Technology-Based Breech Birth Maneuver Training
The Effect of Virtual Reality Technology-Based Breech Birth Maneuver Training on the Knowledge and Skill Levels of Midwifery Students
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.
Study Overview
Status
Intervention / Treatment
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Iclal Ilknur Ozdemir
- Phone Number: +90 544 721 11 59
- Email: iclalozdemiirr@gmail.com
Study Locations
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-
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Istanbul, Turkey (Türkiye), 34810
- Istanbul Medipol University
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Contact:
- Iclal Ilknur Ozdemir
- Phone Number: +90 544 721 11 59
- Email: iclalozdemiirr@gmail.com
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Child
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
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.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Other
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
|---|---|
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Experimental: Virtual Reality group
Participants in this group will receive breech birth maneuver training through a virtual reality-based simulation platform designed to provide an interactive and immersive learning experience.
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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.
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Other: Control Group (Conventional Slide-Based Training Group)
Participants will receive breech birth maneuver training through a conventional slide-based educational method.
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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.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Knowledge score related to breech birth maneuvers
Time Frame: Immediately after theoretical training
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Participants' knowledge will be assessed using the Breech Birth Knowledge Form developed by the researcher specifically for this study.
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Immediately after theoretical training
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Skill development regarding breech birth maneuvers
Time Frame: One week after the training provided via theory and virtual reality
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The students' technical skills will be assessed using a study-specific OSATS (Objective Structured Assessment of Technical Skills) form developed by the researcher.
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One week after the training provided via theory and virtual reality
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Collaborators and Investigators
Sponsor
Publications and helpful links
General Publications
- 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.
- 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.
Study record dates
Study Major Dates
Study Start (Estimated)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
- E-10840098-50.04-4717
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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