This week, the first woman planning a vaginal breech birth consented to participate in the OptiBreech 1 study.
What does this mean?
The woman requested to plan a vaginal breech birth, and met the criteria, so her care provider spoke to her about the OptiBreech 1 study. After accessing our Information for Women and Birthing People, the woman agreed to have her data contribute to our study. She completed the on-line consent form, and the professional who counselled her completed the consent confirmation form.
What’s going to happen next?
The local Breech Lead makes a plan for how they will provide care for this birth. Ideally, someone who meets all of the OptiBreech Proficiency Criteria will attend the birth. Where this is not possible, the team will do their best to have someone attend the birth who has completed OptiBreech training.
How will they do that?
In this setting, ensuring experienced support is straightforward. The hospital employs a Consultant Midwife with a special interest in breech birth. She meets all of the Proficiency Criteria, and part of her job role is to attend planned vaginal breech births. While she is not paid for additional time on call, her Head of Midwifery has authorised her to claim time back for any birth she attends outside of her normal working hours.
In order to make the service sustainable, the Consultant Midwife will support the clinical staff caring for the woman to gain experience. Her role is to provide an additional layer of OptiBreech support and safety. Where possible, she will seek to involve another member of the OptiBreech team. This is the group of colleagues who expressed an interest in providing OptiBreech care, through the OptiBreech Interest and Proficiency Survey.
What if the Consultant Midwife can’t make it to the birth?
The expectation is that, where possible, a member of the OptiBreech team will be present for all of second stage at a minimum. For planned breech births, there is usually at least a few hours warning, time enough to sort out who is available to attend. All women are informed that there is not an absolute guarantee, and assisted to think through what might happen if no skilled and experienced practitioner is available.
If the Consultant Midwife can’t make it, she will liaise with her colleagues to determine whether someone else on the OptiBreech team is available. If no other skilled and experienced member of staff who has completed OptiBreech training is available, the woman will be informed of this. She will be counselled by the consultant obstetrician on-call and decide if she would like to proceed with a vaginal breech birth or have a caesarean section, just as she would if she were planning a VBB outside of the study.
If this occurs, and nobody who has completed OptiBreech training is available to attend the birth, this will be recorded on the Case Report Form. The research team will be monitoring this closely so that we can give women an accurate idea of how well they can depend on their birth being attended by someone with OptiBreech training.
There is no ‘penalty’ if a participating site is not able to get someone with the OptiBreech training to the birth. Part of what our feasibility testing will determine is how often this occurs. Women in our PPI group expressed understanding that it may be hard for Trusts to guarantee attendance, especially in the early days, but that they appreciated the willingness to try.
What will happen during the birth?
The OptiBreech team member who attends will lead the birth but liaise closely with the on-call consultant obstetrician, as an additional layer of safety. The team will ensure that the Pro Forma is completed, documenting the care around the time of birth.
What will happen after the birth?
The local Principal Investigator will gather the data from the birth and enter it onto a Case Report Form. This will be securely returned to the research team.
If the woman has consented to a follow-up interview or long-term outcome collection, the research team will be in touch as appropriate.