Specialist midwives and clinics – inviting your views

Help us get it right, Wednesday 19th January 2022, 12:00-13:00. Are we accurately reflecting your views on breech specialist midwives and clinics?

We would like to invite women, birthing people and their families who have experienced a breech pregnancy at term to attend an online focus group discussion on Wednesday 19th January 2022, 12:00-13:00 to be conducted via Microsoft Teams.  Anyone with an interest and experience of breech pregnancy can participate.

The purpose of this meeting will be to get your perspective on the work we have been doing so far.

We have been working on analysing data from qualitative interviews held with OptiBreech 1 participants. To date, we have interviewed 15 women purposefully sampled to reflect various OptiBreech sites, mode of births, and outcomes. Our main objective was to understand what makes the OptiBreech intervention acceptable (or not) to women.

The key themes that we have found are:

  1. Access to skilled breech care: Vaginal breech birth as a viable and safe option is still unknown to many, and lack of specialists reduced equity of access. Women who were referred to a specialist at one of the OptiBreech sites or were already receiving care at a study site found it easy to access and participate in their care. Women who had to transfer care from another hospital or find an OptiBreech site themselves had a difficult time doing so, often requiring increased effort, multiple trips, time off work etc. 
  1. Balanced information: Women really appreciated being provided balanced information on the safety and risks of vaginal breech birth vs. caesarean section including possible complications and how to manage them. This enabled them to make autonomous informed decisions and increased self-efficacy and confidence, not only in themselves but also in the breech specialist midwife. Conversely, when women had to do this research themselves because they were not getting cohesive information from the healthcare professionals, this was seen as a burden and sometimes women were made to feel pressure to choose caesarean section as the ‘safe’ choice. 
  1. Shared responsibility: Women often felt emotional burden including feelings of stress, judgement, and guilt because of the choices they had made to have a vaginal breech birth, both from family and friends, as well as other healthcare professionals. Speaking with and being cared for by the OptiBreech specialist midwife helped ease this emotional burden and gave the women confidence in their choices.
  1. Team dynamics: We found that women had placed an enormous amount of trust and confidence in the breech specialist midwife which extended to the rest of the team, attributed to previous experience, skills and knowledge. Although women did not know all the members of the team, the trust and confidence was extended to them because of shared responsibility and training requirements needed by all OptiBreech team members.

We need your input on our findings and invite your opinions on whether these findings are relevant to you, if we have interpreted them correctly, or if we have missed any important factors in what makes OptiBreech an acceptable intervention. At the meeting we will present a short summary of our findings so far, and then have an open discussion to hear any thoughts, opinions, or questions you may have.

The meeting will be held on Wednesday 19th January 2022, 12:00-13:00 via Microsoft Teams.  

Join on your computer or mobile app  

Click here to join the meeting  

Breech-COS international study launches

Round 1 of the international multi-stakeholder Delphi study, Development of a Core Outcome Set for Effectiveness Studies of Breech Birth at Term (Breech-COS) is now open. We invite the involvement of anyone from the following stakeholder groups, who has experience of care for women having vaginal breech births:

QR code for Breech-COS Round 1
  • obstetrician
  • midwife
  • service users (you or your partner have had a breech-presenting baby within the last 5 years)
  • neonatologist
  • researcher
  • health services manager
  • healthcare commissioner
  • health economist
  • statistician
  • support group representative
  • other relevant roles

You can read more information about the research and participate using the link or the QR code below. You are welcome to share this post or forward to your stakeholder associates.

Participation Link: https://qualtrics.kcl.ac.uk/jfe/form/SV_b4uw2QJxcTC8oZM

This consensus-building activity follows on from our systematic review, including Patient and Public Involvement (PPI) activity, Development of a core outcome set for effectiveness studies of breech birth at term (Breech-COS): A systematic review on variations in outcome reporting.

Shawn Walker, on behalf of the OptiBreech team

OptiBreech 1: First Steps

Your Research & Development Office have given your site the green light! This post will outline your first steps now that you are starting in the OptiBreech 1 Study.

In accordance with the protocol at site set-up, all sites should:

  1. Provide the OptiBreech research team with a copy of your current guideline covering the management of breech presentation at term, including information provided to women.
  2. Provide us with materials used in mandatory training and any specialist site-specific training, or a brief description. For example, we are interested if your mandatory training uses an in-house package or is based on PROMPT or another training programme.
  3. Please answer: When a woman plans a vaginal breech birth, is it routine to put a plan in place to ensure she has experienced support at the birth, e.g. formal or informal on-call system? (Yes/No)
  4. Liaise with your research team to identify how you will deliver the anonymised data required in the protocol, outlined below.
  5. Make the OptiBreech training available to your staff members. The research team will provide further information on how to do this.

Next Steps

The above information outlines the minimum required for sites who are participating in OptiBreech 1. For sites who are also intending to offer OptiBreech support for planned or unplanned breech births, these are the next steps.

  1. Invite your colleagues to express an interest in delivering OptiBreech care by completing the consent form and survey. This is linked from the top of the Information for Professionals page. (password is available from the protocol or research team)
  1. All staff members supporting OptiBreech births need to have completed the OptiBreech Training, also available from the Information for Professionals page. (password is available from the protocol or research team)
  1. On-line participant Information Sheets and Consent Forms are all linked from the Information for Women and Birthing People page. (password is available from the protocol or research team — the research team are happy to run through this process with you whenever you like, so do not hesitate to be in touch)

Accruals

In this study, the following count as accruals:

  1. recruitment of women who are planning a vaginal breech birth with OptiBreech support;
  2. recruitment of women who have had an unplanned vaginal breech birth with support from the OptiBreech team;
  3. interviews with health care professionals who have been involved directly or indirectly with care for women recruited to the study.

Because of the importance of developing services slowly and carefully where vaginal breech births have been rare in the past couple of decades, we have enabled sites to access the enhanced training in exchange for anonymised, retrospective data only; however the return of this data will not count as an accrual. There is no minimum recruitment target, though we may seek to interview key staff about their feelings of readiness / willingness to support planned vaginal breech births or to develop a proficient team.