Objective. To implement and evaluate a simulation-based training program. Design. Descriptive. Study period: June 2003June 2006. Setting. Obstetric Department, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. Population. Two training sessions were provided for all health professionals including doctors, midwives, auxiliary nurses, and 147 out 156 participants (94%) took part in the first training session and 192 out possible 201 (96%) took part in the second session. Methods. An intervention study of the impact of simulation-based training in management of postpartum bleeding, shoulder dystocia, basic neonatal resuscitation, and severe preeclampsia. Main outcome measures. Before, just after and 915 months following the training, data were collected on the confidence and stress levels relating to the carrying out of certain procedures. In addition, a written objective test on basic neonatal resuscitation was administered. Data on any changes in work-routines experienced by the participants were obtained by open-ended questions. Registry data from the Danish Medical Birth Registry and from the hospital administration were included in the analysis. Results. Ninety-two percent of all respondents had a positive attitude toward the training program. They considered management of shoulder dystocia, preeclampsia, and neonatal resuscitation less stresful and less unpleasant to perform after training. Confidence scores for all the trained skills improved significantly. A significant association was found between confidence in neonatal resuscitation and numbers of correct answers in the objective test. More than 90% found the training to have had a positive influence on their work. The need for organizational changes in the department became evident and necessary changes were implemented. Sick leave amongst midwives diminished significantly during the study period. Conclusions. A comprehensive evaluation of a mandatory simulation-based program, implemented in a obstetric department, demonstrated a positive impact at individual and organizational levels.