BICS2022 Conference

The OptiBreech Research and Public Involvement team share their work at the #BICS22 conference.

The OptiBreech Team enjoyed meeting each other in person for the first time at last week’s British Intrapartum Care Society Conference. And we won a prize! We are so grateful to the women who have participated in our research, the Principal Investigators who have made it all happen locally, and our Steering Committee. Here’s what we shared at the conference:

Dr Siddesh Shetty and Dr Shawn Walker

Is it feasible to test OptiBreech Care in a clinical trial?: results of the OptiBreech 1 study – Dr Shawn Walker, Tisha Dasgupta, Siân Davies, Sarah Hunter, Phoebe Roberts, Prof Jane Sandall, Prof Andrew Shennan. We shared the results from our first-stage study, OptiBreech 1. We are currently writing these up in publication format and will share as soon as that is ready. This presentation won the top oral abstract prize at the conference.

The roles and responsibilities of breech specialist midwives in the OptiBreech Care Trial feasibility study: a qualitative inventory Davies, Dasgupta, Natasha Bale, Alexandra Birch, Walker. Siân Davies shared a poster about the role of Breech Specialist Midwives, as described by midwives and obstetricians participating in OptiBreech 1.

Toolkit for implementing breech clinics and specialist midwives to support planned vaginal breech births – OptiBreech PPI Lead and Service User Representative Phoebe Roberts presented this poster. Read more about it here.

Ritika Roy and Cecelia Gray

Women seek ‘connected autonomy’ when they wish to plan a vaginal breech birth at term: a systematic review and meta-synthesis – Ritika Roy, Cecelia Gray, Charlene Prempeh, Walker. Medical students Roy and Gray presented the results of their 2021 King’s Undergraduate Research Fellowships. The results are ready for publication and will be shared in that format soon!

Not too fast not too slow: the legacy of time management in vaginal breech births Jacana Bresson, Walker. Midwifery student Bresson presented the results of her review of obstetric texts in the Royal College of Obstetricians and Gynaecologists and Wellcome Trust Libraries, funded by a 2022 King’s Undergraduate Research Fellowship.

Assessing feasibility of economic evaluation alongside a full trial for ‘OptiBreech Care’ with development and testing of a decision model to assess its long-term cost-effectiveness Dr Siddesh Shetty, Dr Shawn Walker, Prof Julia Fox-Rushby. The Health Economics team used this as an opportunity to gain feedback and peer review on the economic model developed.

Thanks also to the BICS Committee, who organise a wonderful, supportive, multi-disciplinary conference every time!

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. 

Reflections on International Day of the Midwife, 2022 — Breech Birth Network

Shawn talks about some of the challenges of improving the way we deliver care for mothers and their breech babies.

Yesterday was International Day of the Midwife. I saw but didn’t participate in the social media celebrations. Not because I wasn’t feeling it, but because my clinical academic midwife life was full to the brim. 931 more words

Reflections on International Day of the Midwife, 2022 — Breech Birth Network

Student midwife summer research opportunity

We are pleased to announce an opportunity for 2nd year undergraduate students to apply for a Wellcome Trust Biomedical Vacation Scholarship.

A successful applicant will be paid the London Living Wage for 35 hours per week, for seven weeks, beginning 11 July 2020. The project synopsis is:

Recent research suggests specialist services may improve maternal and neonatal outcomes in breech pregnancies, as well as women’s experiences of care. The aims of this research are to summarise the evidence base for these organisational interventions in a literature review, and to determine the prevalence of clinics, teams and specialist midwives dedicated to the care of women with a breech pregnancy in the United Kingdom. The results will be published as a report and used to establish a network of UK breech practitioners for the purposes of joint learning, collaboration and research. They will also inform the on-going work of the OptiBreech Trial.

Although the scholarship is based at King’s College London, applicants can apply from all over the UK. The work can be done remotely. Preference is given to applicants from non-Russell Group universities, from ethnic groups currently under-represented at King’s, mature students, and other groups whose interest in pursuing research the funders are particularly keen to encourage.

Please visit the Wellcome Trust Biomedical Vacation Scholarship page for more information and instructions on how to apply.


For King’s College London students only:

King’s Undergraduate Research Fund


Students can apply via King’s CareerConnect here.

Application opening date: Monday 28 March 2022

Application closing date: Sunday 24th April 2022, 23:59

The list of all projects from all faculties is available here

For more information, students can check the KURF websiteFAQs and Programme Regulations. Please note that one student can submit only one application. 

If you have any further questions, please contact kurf@kcl.ac.uk.    

— Shawn

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