Due to the minimal data available about physiological breech birth practice and breech birth teams in a UK setting, we will share our outcomes to support women’s decision-making about participation in the study. Outcomes are reported in blocks of 5 to preserve anonymity.

Women are eligible for participation in the OptiBreech 1 study if they have requested support for a vaginal breech birth, and the team are able to care for the woman within their current guideline and experience level. All of these women have been planning a vaginal breech birth with NHS care in the UK.

As of 5 November, 42 women have been recruited across 8 sites.

women having their first baby (nulliparous)2359%
women who have had a baby before (multiparous)1641%
MODE OF BIRTH (39 total completed births)
vaginal breech birth2051%
cesarean section in-labour (early and active labour)1128%
pre-labour caesarean section718%
cephalic (head-first) birth
(baby turned prior to labour)
forceps breech birth25%
TOTAL vaginal births2154%
admissions to the neonatal unit13%
stillbirth or neonatal death (within 28 days of birth)0
someone present throughout second stage who had completed physiological breech birth training18/2090%
someone present throughout second stage who met all proficiency criteria15/2075%
no intervention required3/2015%
maternal movement and effort were encouraged prior to hands-on intervention16/2080%
Less than 5 minutes elapsed between the birth of the pelvis and the birth of the head18/2090%
upright (kneeling, hands and knees, standing, squatting)15/2075%
supine (lying on the back, semi-sitting, lithotomy stirrups)5/2025%

How does this compare to a high-quality ECV pathway?

For this we look to the largest UK study of external cephalic version, conducted in Oxford (Melo et al, 2019). Overall, the outcomes for women in this gold standard care pathway, including all women, were:

total vaginal births43.6%1141/2614
spontaneous vaginal births (non-instrumental)33.1%866/2614
instrumental birth (forceps or suction cup)10.5%275/2614
pre-labour caesarean birth36.6%957/2614
in-labour caesarean birth18.5%484/2614
baby turned head-down prior to labour
following failed ECV
admission to SCBU3.6%95/2614
stillbirth or neonatal death0.19%5/2614

Following an attempt at ECV, for babies who remained cephalic (head-down) at delivery, the outcomes were:

spontaneous vaginal birth64%791/1234
pre-labour caesarean section1.1%13/1234
emergency caesarean section13.2%163/1234
instrumental delivery21.7%268/1234

It will be a long time until we are able to determine how our figures compare because the number of people in the study so far is very small. But these are the standards we will be referencing as we continually check to ensure the study is proceeding in a safe manner, and that it is worthwhile to continue.

Training Evaluation

Below, we also include the results of an evaluation of the training we use to ensure those attending breech births in this study meet the proficiency criteria – Physiological breech birth training: An evaluation of clinical practice changes after a one-day training program. This is important because some sites have indicated they can ensure someone who has completed training is present, but are not yet able to ensure someone who meets the full proficiency training can attend the birth. This can only be considered pilot data, but our results encourage us to continue with the research.

Results of vaginal breech births only. Conducted in 6 hospitals across the UK. No attempt was made to quantify the experience/proficiency of attendant, only their completion of training package.

Total = 90 vaginal breech birthsPBB trainee at the birth (n=21)No PBB trainee at the birth (n=69)
Birth Position
upright17/21 (81%)22/69 (32%)
supine4/21 (19%)47/69 (68%)
Maternal Severe Adverse Outcomes

5/69 (7%)
PPH > 1500 mL
(heavy bleeding following birth)
0/213/69 (4%)
3rd/4th degree tear0/212/69 (2%)
Intact11/21  (52%)27/69 (39%)
Episiotomy1/21 (5%)15/69 (22%)
Neonatal Severe Adverse Outcomes

5/69 (7%)
5 min Apgar < 4
(measure of baby’s condition immediately following birth, scale of 1-10)
0/214/69 (6%)
NICU > 4 days
(admission to the neonatal intensive care unit)
0/211/69 (1%)

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