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.
| TOTAL PARTICIPANTS | ||
| women having their first baby (nulliparous) | 23 | 59% |
| women who have had a baby before (multiparous) | 16 | 41% |
| MODE OF BIRTH (39 total completed births) | ||
| vaginal breech birth | 20 | 51% |
| cesarean section in-labour (early and active labour) | 11 | 28% |
| pre-labour caesarean section | 7 | 18% |
| cephalic (head-first) birth (baby turned prior to labour) | 1 | 3% |
| forceps breech birth | 2 | 5% |
| TOTAL vaginal births | 21 | 54% |
| ADVERSE OUTCOMES | ||
| admissions to the neonatal unit | 1 | 3% |
| stillbirth or neonatal death (within 28 days of birth) | 0 | |
| OPTIBREECH ATTENDANCE | ||
| someone present throughout second stage who had completed physiological breech birth training | 18/20 | 90% |
| someone present throughout second stage who met all proficiency criteria | 15/20 | 75% |
| VAGINAL BREECH BIRTHS | ||
| no intervention required | 3/20 | 15% |
| maternal movement and effort were encouraged prior to hands-on intervention | 16/20 | 80% |
| Less than 5 minutes elapsed between the birth of the pelvis and the birth of the head | 18/20 | 90% |
| MATERNAL BIRTH POSITION | ||
| upright (kneeling, hands and knees, standing, squatting) | 15/20 | 75% |
| supine (lying on the back, semi-sitting, lithotomy stirrups) | 5/20 | 25% |
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 births | 43.6% | 1141/2614 |
| spontaneous vaginal births (non-instrumental) | 33.1% | 866/2614 |
| instrumental birth (forceps or suction cup) | 10.5% | 275/2614 |
| pre-labour caesarean birth | 36.6% | 957/2614 |
| in-labour caesarean birth | 18.5% | 484/2614 |
| baby turned head-down prior to labour following failed ECV | 4% | 57/1334 |
| admission to SCBU | 3.6% | 95/2614 |
| stillbirth or neonatal death | 0.19% | 5/2614 |
Following an attempt at ECV, for babies who remained cephalic (head-down) at delivery, the outcomes were:
| spontaneous vaginal birth | 64% | 791/1234 |
| pre-labour caesarean section | 1.1% | 13/1234 |
| emergency caesarean section | 13.2% | 163/1234 |
| instrumental delivery | 21.7% | 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 births | PBB trainee at the birth (n=21) | No PBB trainee at the birth (n=69) |
| Birth Position | ||
| upright | 17/21 (81%) | 22/69 (32%) |
| supine | 4/21 (19%) | 47/69 (68%) |
| Maternal Severe Adverse Outcomes | 0/21 | 5/69 (7%) |
| PPH > 1500 mL (heavy bleeding following birth) | 0/21 | 3/69 (4%) |
| 3rd/4th degree tear | 0/21 | 2/69 (2%) |
| Perineum | ||
| Intact | 11/21 (52%) | 27/69 (39%) |
| Episiotomy | 1/21 (5%) | 15/69 (22%) |
| Neonatal Severe Adverse Outcomes | 0/21 | 5/69 (7%) |
| 5 min Apgar < 4 (measure of baby’s condition immediately following birth, scale of 1-10) | 0/21 | 4/69 (6%) |
| NICU > 4 days (admission to the neonatal intensive care unit) | 0/21 | 1/69 (1%) |
The OptiBreech Project 