Breech Clinics and Specialist Midwives Toolkit

We will launch our toolkit describing ‘how to build and OptiBreech service from the ground up’ at the British Intrapartum Care Society Conference 2022 in just over a week. When the conference goes live on 29 September, the toolkit will go live.

Download the Toolkit here.

Image: Kate Stringer

The toolkit brings together clinical and social science evidence in favour of delivering care for breech pregnancy and childbirth through a dedicated clinic and intrapartum care team, co-ordinated by a breech specialist midwife, working in collaboration with a breech lead obstetrician.

The majority of team roles includes tasks that are already performed by someone in your organisation. They key is to task-shift, so that all breech-relevant service leadership tasks are performed by the specialist(s). This increases their expertise, and their work increases skill and competence across your team.

This model addresses two known problems: individualised care and safety. Women want individualised care in line with national guidance, but the way services are usually delivered within the NHS makes this difficult. Clinics and specialists standardise practice, reducing biases in the direction of both caesarean section and vaginal birth. Women enjoy easier access to both planned vaginal breech birth and planned elective caesarean section. Specialists also drive up the safety and quality of care by helping research inform practice as quickly as possible and facilitating cultural change. They enable vaginal breech births to occur in a planned an organised manner, creating learning opportunities that make unplanned births safer.

The toolkit has been developed by: Shawn Walker (OptiBreech Chief Investigator), Phoebe Roberts (OptiBreech Patient and Public Involvement Lead for this project) and Harriet Boulding from the King’s Policy Institute.

The toolkit will be available HERE for download and includes:

Background information

  • What is the problem?
  • How does the OptiBreech approach offer a solution?
  • What is physiological breech birth?
  • What does OptiBreech ‘proficiency’ mean?
  • What is the evidence for this model of service delivery?

What you need to build a breech service

  • A dedicated breech clinic
  • A Breech Lead Obstetrician
  • A Breech Specialist Midwife (Band 7 or 8)

Breech specialist midwives

  • Roles and activities of a breech specialist midwife
  • Where does the money come from?
  • Personal characteristics and circumstances required
  • Compensation and support
  • Involvement in research and quality improvement

Training other team members

  • What training involves
  • Why is this way of training most effective clinically?
  • Why is this way of training most cost-effective?
  • Who does a breech clinic rotation
  • What about people who cannot be on-call?
  • Maximising economic efficiency

Other considerations

  • Role of the on-call obstetric team
  • External Cephalic Version (ECV) and other breech turning modalities
  • What about continuity for planned CS?

Approaches that do not appear to be effective

References

Appendix: Proficiency Achievement Record

This toolkit is funded by an ESRC Impact Acceleration Award, from the King’s College London Social Science Impact Fund. Shawn Walker is funded by a National Institute of Health Research (NIHR300582) Advanced Fellowship. 

Author: midwifeshawn

Midwife with a special interest in complex normality, especially breech.

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