Project Summary:
Second-stage cesarean delivery, performed when the fetal head is deeply engaged, is among the most technically challenging and high-risk obstetric procedures. In Wisconsin, about one in three second-stage cesarean deliveries is complicated by an impacted fetal head, leading to severe maternal and neonatal morbidity, such as hemorrhage, hysterectomy, and birth trauma. Workforce gaps including rural hospital closures, limited staffing, and fewer opportunities for advanced obstetric training further worsen disparities in maternal and neonatal outcomes. Despite the recognized complexity of this procedure, no standardized guidelines or simulation-based education currently exist to prepare teams, making this a critical workforce priority for Wisconsin. This project will implement and evaluate a RE AIM-guided, simulation-based, and video-assisted training model to standardize second-stage cesarean management at Froedtert Hospital and West Bend Hospital Birth Centers. The team will co-develop an evidence-based second-stage cesarean toolkit integrating technical, communication, and decision making frameworks tailored to each site’s resources. Through semi-annual multidisciplinary simulations and video-assisted performance feedback, the project will promote continuous skill development, reflection, and improvement. Guided by the RE AIM-framework, evaluation will assess reach, adoption, fidelity, and sustainability to ensure feasibility and scalability across Wisconsin hospitals. Integrating implementation science with simulation-based education will strengthen workforce readiness, improve teamwork, and reduce maternal and neonatal morbidity. Deliverables will include a second-stage cesarean toolkit, a reproducible simulation and feedback curriculum, and a statewide dissemination plan, positioning the project as a scalable model for equitable obstetric workforce development.