Foundations, evidence, and applications of translational simulation in obstetric anaesthesia: a narrative review.

Abstract

Obstetric anaesthetists work in high-acuity settings where maternal and fetal conditions can deteriorate rapidly, requiring coordinated action across teams and systems. Simulation-based education improves technical and non technical skills and protocol adherence but often focuses on individual or team performance rather than the wider clinical systems influencing safety. Translational simulation expands the role of simulation by directly examining processes, identifying safety threats, and co-designing system improvements with end users. This review describes the progression from education-focused simulation to team-based, in situ, system-oriented translational approaches. Although conventional simulation strengthens crisis management and communication, translational simulation emphasises system change, generating actionable recommendations to refine protocols, streamline workflows, and optimise clinical environments. In obstetrics, it has supported redesign of postpartum haemorrhage pathways, improved safety during service transitions, and informed planning of new maternity facilities. Using postpartum haemorrhage as an example, we illustrate how translational simulation can clarify activation criteria, define roles, and improve access to equipment and medications, thereby enhancing system resilience. Future priorities include implementing recommendations from translational simulation, involving consumers in simulation design, and exploring artificial intelligence to support system-level learning in maternity care.