Perceptions of newly recruited midwives on clinical simulation-based training in obstetric emergencies: A qualitative study from northern Morocco

Abstract

Every day, hundreds of women worldwide die from preventable causes related to pregnancy and childbirth, mostly due to obstetric emergencies such as post-partum hemorrhage, eclampsia, and obstructed labor. These emergencies are major contributors to maternal morbidity and mortality, especially in low-resource settings. Midwives play an essential role in managing these critical situations, particularly in rural areas where access to emergency care remains limited. Clinical simulation training appears as an innovative and promising method to strengthen their skills and preparedness. This qualitative study explores the perceptions of newly recruited midwives working in rural areas of northern Morocco regarding simulation training for obstetric emergencies. In October 2024, three focus groups were conducted across rural maternity units in four northern provinces of Morocco, involving 11 newly recruited midwives. These discussions allowed gathering insights on engagement with clinical simulation-based training for obstetric emergencies, examining their experiences with simulation-based training, prioritized competency development, perceived strengths of the training modality, and the challenges faced, alongside recommendations to enhance its integration into educational programs. The data, transcribed and analyzed using NVivo, revealed five major themes and twelve subthemes, based on both literature and the discussions. The results show that simulation training is perceived as a powerful tool to boost confidence, improve technical and relational skills, ensure adherence to protocols, and encourage teamwork. Realistic scenarios and constructive feedback were particularly motivating. However, workload and limited time sometimes hinder full participation. The midwives recommend adapting the training by favoring smaller groups, a gradual increase in scenario complexity, selecting participants according to their professional context, and providing stronger educational support. This study highlights the importance of context-adapted simulation and protected training time, which are essential to empower rural midwives and thereby improve maternal and neonatal health.