Introduction/Background Recently the data of the third Euro-Perinatal European Perinatal Health Report1 were launched, which again showed a relatively high perinatal mortality rate in the Netherlands compared to other European countries. Due to this high perinatal mortality rate, a nationwide research program on pregnancy and birth of the Netherlands Organization for Health Research and Development (ZonMw) was developed. The pilot study described in this abstract is part of this program and consists of simulation-based team training concerning different health professionals involved in obstetric care. Our country has an unique obstetric system with a high percentage home deliveries (21%): primary care, represented by independent midwives, provides care to women with low risk pregnancies and secondary care, represented by hospital midwives and gynecologists, is responsible for high risk pregnancies. Low risk women can deliver either at home or in primary care hospital setting. Up to 70% of women will be referred from primary to secondary care implicating multiple medical handovers. Dutch audits concluded that in the entire chain of obstetric care process management could be improved. Dutch data showed that 85.2 % of perinatal mortality is caused by one or more of so called BIG 4 disorders: preterm delivery, small for gestational age (SGA), congenital anomaly and low Apgar score. Studies have shown that obstetric team training improves perinatal outcome 2 and that simulation based obstetric team training implementing Crew Resource Management (CRM) improves team performance3. In addition, the use of concepts of deliberate practice (DP) is superior in improving medical skills. Methods Prior to the training, obstetric health professionals were interviewed in focus groups. Relevant aspects were distilled and used for designing of the training. Training groups consisted of approximately 15 persons, representing the chain of obstetric care: ambulance providers, maternity nurses, community midwives, obstetric nurses, hospital midwives, residents and gynecologists. In total 77 health professionals were trained. Training focused on process management of the BIG 4. Elements of DP and CRM were implemented in the training. To strengthen the elements of DP, a syllabus concerning communication, CRM and medical knowledge was written and handed out prior to the training. To stimulate the motivation of the trainee a multiple choice exam prior to the training was performed. The training was provided in a medical simulation center. Four obstetric scenarios were trained: unexpected home delivery of fetus in breech presentation, extreme premature delivery starting at home, home delivery with fetal distress and unexpected SGA, unexpected resuscitation of newborn with unexpected congenital heart abnormality at home. Every scenario started with an introductory briefing video. Thereafter, the team moved to the simulation room where they managed the simulated patient (Noelle®, Gaumard, Miami, Florida). All scenarios were videotaped. After each scenario a debriefing with reviewing the video recordings was provided. All trainees performed an evaluation in which they scored (0-5) for 36 different items. The average overall score of the training was 4.15 (range 3.5-5). The concept and content of the scenarios were scored with 4.4 (range 3-5). The trainees experienced the video briefing as reinforcing the feeling of reality. All trainees considered the training as potential for improving communication and perinatal outcome. This pilot study will be used for the design of a trial concerning simulation-based training in a subregion of the Netherlands consisting of over one million inhabitants with an annual delivery rate of around 12.000. The objective of this study will be to improve perinatal outcome and team performance. Conclusion The evaluation of the pilot study by the trainees was very good. The results will be used to design a trial with simulation-based training concerning the entire chain of obstetric care in a subregion of the Netherlands.