PPI: Proposal Development Phase – Implementation of Bedside Resuscitation 

Nimisha Johnstone, @OptiBreech PPIE lead, shares women’s views of why it’s important we help babies to start breathing with the cord intact when needed. @NIHRinvolvement

In autumn/winter 2022, the OptiBreech research team spent time developing a research proposal for a study to investigate the implementation of bedside resuscitation for breech babies who require breathing assistance at birth. In my role as a PPI leader with the OptiBreech trial, I sought input from breech presenting mothers and birth workers through small group interviews. 

I am the mother of a baby who presented breech at the end of pregnancy. I planned a vaginal breech birth and agreed to allow my birth data to contribute to the OptiBreech study in 2021. Since then, I have become involved in enabling other mothers of breech-presenting babies to become involved in shaping the evolution of this research. 

Birth Experience

I spoke with 7 women with a breech presentation at term and 1 doula over video calls in groups of 2. We started by sharing our breech birth experiences and the themes of lack of choice and lack of confidence in birthing professionals echoed across all interviews. The need for support towards a physiological breech birth was not met in many of the experiences resulting in a lack of choice and feelings of coercion towards a c-section. They reported a confidence in their body’s own ability to birth breech, but a lack in the birthing professional’s ability to confidently support them.  

The mothers were aware of optimal cord clamping and the benefits, however, similar to the women in our OptiBreech studies, they had reported feeling let down because the cord was clamped immediately, despite stating their wishes on their birth plan. They also reported not being made informed as to why the cord was clamped immediately. 

Some of the mothers also reported their baby being taken to a resuscitation table out of sight without being informed. Seeing their baby on the resuscitation table led to feelings of self-doubt, guilt and questioning whether they had made the right choices. 

Is this research proposal important and relevant? 

The research proposal aims to answer two questions: 

  1.  What are the outcomes for mother and baby for term breech pregnancies within the services offering optibreech care?
  2.  And can bedside stabilisation and/or resuscitation following vaginal breech births be successfully implemented with provision of a bedside unit and staff training?

About 1:5 babies born after a vaginal breech birth need some help to start breathing, and about 1:10 are transferred to a neonatal intensive care unit after the birth. We feel we can reduce this to 1:5 (the UK national average for all births) if our specialist teams are able to provide help next to the mother. This will result in better long-term outcomes for the baby. Families have better experiences if they are not separated from babies, during resuscitation or after. Women in our OptiBreech studies have reported feeling let down because in most births where the baby appeared to need help, the cord was cut immediately, despite OptiBreech and UK Resuscitation Council guidance. 

All mothers strongly support the research proposal and believe optimal cord clamping and keeping the baby near to them immediately post-birth is hugely important. Some mothers reported feelings of confusion as to why this did not happen in their experience because they felt it was quite obvious that babies should be near their mother immediately post-birth, therefore were supportive of having a bedside unit so that they could always see their baby if they needed resuscitating. 

Mothers reported doing more research on neo-natal death rates resulting in them feeling less informed around the need for resuscitation. Sharing this scenario before birth would help to keep the mother informed around a potential post-birth scenario as well as the need to keep the mother informed in real-time should a resuscitation unit be needed. 


The importance of the use of language was highlighted, in particular the use of the word “resuscitation” did not resonate well with some of the mothers as it can lead to negative connotations such as not being able to breathe or death. There was an understanding that the resuscitation table is also used for clearing the lungs and or for simply checking the baby and therefore the word “resuscitation” should be carefully considered when speaking to mothers to avoid panic. “Transition” was one replacement word suggested, however, there were mixed responses to this word as some felt it wasn’t specific enough and needed explaining whereas others responded positively saying it’s a mid-way point. There will need to be further consideration around the use of language and the most appropriate terminology to use. 

Thank You

We ended the session by sharing our motivation for joining this PPI meeting and learnt that mothers wanted to be a part of the driving force behind normalising physiological breech birth, and to avoid other mothers and birthing people feeling like they have no other option. 

I would personally like to say a huge thank you to those who participated in this PPI meeting, it was a pleasure meeting each of you. We value your thoughts and comments to improve on the design of our study to better our research. 

Nimisha Johnstone