The ICOE started in September 2014 in Malaysia and has since been conducted in 12 countries in the region, training doctors, midwives and trainers. The doctors who participated were from a diverse range of experience, from consultants to trainees in maternity care. Midwives form an integral part of skilled birth attendants and there is a separate skills-based course for midwives.

The course was designed to be comprehensive, covering the various pertinent causes of maternal death. It also included the causes of poor outcomes and death in newborns. The introduction of ICOE training has resulted in improved skills in obstetric emergencies among doctors in Malaysia, international doctors and midwives in Malaysia.