Virtual Reality Technology-Based Breech Birth Maneuver Training

Plain-language summary

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.

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