Simulation training linked to fewer active-labor cesareans at Tanzanian hospital

A quasi-experimental pre–post study at Kilimanjaro Christian Medical Centre, Tanzania, assessed whether multiprofessional simulation training on prolonged labor and shared decision-making could reduce intrapartum cesarean sections. Training in January 2023 involved local faculty and 84 maternity staff. Researchers compared 1,159 women before training with 2,256 afterward, using data collected between May 2022 and September 2024. The primary outcome was the cesarean rate during active labor; secondary outcomes included labor duration and cesarean timing.

Active-labor cesarean rates fell from 7.4% before training to 2.7% afterward (p < 0.01). Overall cesarean rates were 54.5% and 51.6%, respectively, a nonsignificant difference (p = 0.11); most procedures occurred before labor or during the latent phase. Estimated median time until vaginal delivery increased from 330 minutes (95% CI, 310–350) to 435 minutes (95% CI, 426–443). The hazard ratio for cesarean section during the first 20 hours of active labor was 0.33 (95% CI, 0.24–0.46), relative to the preintervention period.

The findings suggest training may influence active-labor management, but do not establish a reduction in overall cesarean use. The single-center, nonrandomized pre–post design limits causal inference. Maternal and neonatal safety outcomes were not reported in the supplied abstract, limiting assessment of the clinical consequences of longer labor.