Vaginal breech birth (VBB), where a baby is born bottom or feet first, is becoming increasingly accepted as a safe option for some women when supported by skilled professionals. However, there’s still uncertainty about what happens if labour needs to be started or “induced.” Because there isn’t much evidence about the risks and benefits of induction of labour (IOL) for breech babies, many clinicians remain cautious. This can limit women’s choices and could potentially lead to some women making unsafe decisions, especially when birth needs to be brought forward for medical reasons.
This webinar will share findings from a recent systematic review which looked at what is currently known about the safety of inducing labour for women with a breech baby at term. It compared outcomes with:
Women who went into labour spontaneously
Women who had a planned caesarean when earlier birth was advised
Women with a head-down (cephalic) baby who had labour induced
I’ll share what the research tells us, and where the gaps still are. We’ll open the conversation to explore what further research is needed, and how both women and professionals can work together to shape safer, more informed choices for breech birth in the future.
The term “women” is used here in relation to biological sex. We recognise and respect that people of diverse gender identities also give birth, and we aim to include and welcome everyone with lived experience of pregnancy and birth in this discussion.
Everyone is welcome, whether you’re a parent, birth worker, midwife, obstetrician, researcher, or simply interested in supporting informed decision making in maternity care.
The OptiBreech research study closes this month, but we hope to be back again in the future.
Thank you to everyone who has been in touch to ask how you can help make sure OptiBreech research carries on. We have been incredibly moved by your support. For those of you who would like to do something to make a difference, you can let these organisations know that you feel this should be a research priority:
After many months of hard work, the OptiBreech pilot and feasibility work is finally drawing to a close at the end of January. This is the planned closing date, defined by the length of our funding for pilot and feasibility work (Shawn’s NIHR Advanced Fellowship). In fact, with the support of the Trial Steering Committee, we kept the observational arm of the study open for several months longer than originally planned, in order to monitor outcomes for sites that were continuing to offer OptiBreech care.
You can access all of our publications on this site, and we will update with the remaining few we are working on.
Thank you for all of your support! We are especially grateful to all of the women and birthing people who have participated in our study and allowed us to collect data about their births.
Unfortunately, our applications for further funding were unsuccessful. That means that we cannot at this time proceed to a substantive / full trial. Therefore, we will stop collecting data for the moment, and try again this year. We’re grateful for the women and clinicians who helped to inform our project proposals, which included:
If you think, as we do, that we need to continue evaluating the outcomes of OptiBreech care to make vaginal breech birth safer and easier to access for all women, not just those privileged with resources and social support to surmount resistance to this choice — now is the time to share your views. The RCM is inviting views on Midwifery practice and maternity care in the UK. You can share what matters to you, whether this is breech or any other topic.
Most OptiBreech sites will continue to offer support for planned vaginal breech births. For those of you who have told us that you intend to try to start an OptiBreech service anyway, we will support you to the best of our ability. Below are some resources.
The second round of our consensus-building activity to establish a core outcome set for breech birth studies is now open. This will establish a standard set of outcomes and their definitions that ALL breech birth studies will collect, so that we can compare the results.
We have sent personal invitations to all previous participants but are also opening this round to new participants.
You can participate here. You are welcome to forward this post to anyone else who may be interested. The results will inform a consensus meeting discussion to take place in the spring. This will be open to the public and announced later this year.
We invite participants from the following stakeholder groups:
Service user (you or your partner has experienced a breech pregnancy)
midwife
obstetrician
neonatologist
paramedic
anaesthetist
health researchers
health service manager
healthcare commissioner
health economist
statistician
support group representative
Example of results from the first round on the outcomes of intrauterine death/stillbirth and cord clamping < 1 minute after birth.
In recent years we have seen the pervasive effects of health inequalities and inequities highlighted in the MBRRACE-UK reports. There has been discussion since then about ‘hard to reach groups’ and how we ensure all voices are shaping research and clinical practice. However, Dr Natalie Darko, an Associate Professor of Health Inequalities offers the perspective that actually it is more a case of research being incredibly difficult to access for a number of communities rather than those groups being hard to reach.
This is an incredibly pertinent consideration and something research teams really need reflect on when in the initial stages of designing research. We have seen a real emphasis on co-production and PPI informing projects but to truly address health disparities, it is critical to ensure underrepresented groups are included and their voices are shaping future work.
I recently met up with Victoria Walsh, chair of Wirral Maternity Voices Partnershipto discuss some of the OptiBreech Project’s upcoming work and develop an inclusive PPIE strategy. We reflected on how best to be able to engage with a number of communities who are often excluded to increase their participation. Considerations such as interpreters (in multiple languages and British Sign Language) for events (both online and in person) and translation of all participant-facing materials to address language barriers. Accessibility should be considered in terms of the physical, psychological, technological, and financial barriers to participation. Additionally, mistrust in services is often a key barrier for underrepresented groups being excluded from research and so therefore consideration of our position and power must also be central to our approach when engaging with these communities.
We are proud that in our pilot trial, 59% of participants came from non-British backgrounds and 29% were from black or brown populations. But we know there is always more to do to ensure everyone can participate in research. We look forward to continuing to work with Wirral MVP during the course of this year to be able to remove even more barriers to maintain the diversity of participation in OptiBreech research.
Siân Davies – OptiBreech Research Assistant and PPI Lead
A photograph of my not so little breech baby!
Useful References
Coe D, Bigirumurame T, Burgess M et al. Enablers and barriers to engaging under-served groups in research: Survey of the United Kingdom research professional’s views [version 1; peer review: awaiting peer review]. NIHR Open Res 2023, 3:37 (https://doi.org/10.3310/nihropenres.13434.1)
Looking to engage with research, develop your critical appraisal skills and sharpen your own writing? If you have academic research training, consider becoming involved in peer review.
In my role as Researcher in Residence at Imperial College London, I support clinical NMAHPPs (nurses, midwives, allied health professionals, healthcare scientists, pharmacy staff and psychologists) to develop careers in research. As part of this, I have begun recommending midwives with Masters or PhDs as peer reviewers, when I am asked to review an article that I know fits their clinical or methodological areas of interest. I also offer support through this process. This fairly simple activity seems to have really hit a chord with clinical midwives who are looking to become more research-active, so I want to share it with others who are supporting clinicians to engage with research.
How the peer review process works
First, let’s de-mystify how people become involved in peer review activity. When you submit an article for publication, this is all done on-line. As part of this process, you enter your personal details, including (this is important!) your areas of interest and expertise. Even if your article is not accepted for publication, your details are retained on the journal’s database. When an assistant editor does a search for peer reviewers with an interest in, say, ‘breastfeeding,’ if you have listed this as one of your areas of interest/expertise, your details will come up in the search results. They are likely to ask the ‘big names’ first, people who have published a lot in this area. But top academics get many more peer review applications than they can accept. So, eventually, you will get asked to peer review in your area. Of course, if you have published as well, this will happen sooner.
For example, in 2012 I submitted a conference report to the British Journal of Obstetrics and Gynaecology (BJOG) because I thought people should know about the exciting, international changes that were beginning to happen around the way breech births were managed. It was rejected within 24 hours (ouch!). But soon, I started being asked to review articles in this area – probably due to very few other people listing ‘breech presentation’ as their area of interest. BJOG has still never accepted one of my academic articles, but by 2016, I was awarded a certificate as one of their top 50 reviewers! In 2018, I was rated a top 1% reviewer in Clinical Medicine by Publons peer review tracker, part of Web of Science. The insight I have gained into the publication process through peer review has been invaluable.
The other way you may get asked to peer review is because someone who is declining to peer review has nominated you as an alternative. Usually, senior academics will nominate more junior academics. This is what I have been doing for clinical midwives who hold at least a Masters at Imperial, provided I know their areas of interest. Again, if you accept the invitation, your details will be in the system, and you will likely receive future invitations.
You can also write to the editor of a journal you are interested in, with your CV, and offer to do peer review.
Benefits of doing peer review
Once they finish a further degree, clinicians often start to feel detached from the academic research world. Doing peer review is one way to stay engaged and be inspired by others’ work. It helps you develop critical appraisal skills. You observe how successful articles are structured, and why, until it becomes second-nature when you begin to plan your own work. You gain exposure to other methods and methodologies being used to answer research questions in your field. And you begin to see gaps in knowledge or need for further research, which may help you define a project you would like to pursue yourself.
Midwife in training Jacana Bresson
If your professional aims include applying for fellowship or research funding, peer review activity is regarded favourably on your CV. You can automatically upload your peer review confirmation e-mail to the Publons website, just by forwarding it. And you can then simply list your public peer review profile on your CV – here’s my Web of Science profile, including peer review.
Personally, I also enjoy the feeling that I am influencing what gets published and becomes part of our evidence base. For example, I have reviewed innumerable articles which either directly concern midwifery practice or have the potentially to significantly impact it, yet the research team does not include a midwife. I have consistently given the feedback that, in the future, it should; and that this should be acknowledged as a limitation in the discussion. By remaining present in the sphere of peer review, midwives and NMAHPPs can make a genuine difference.
Support with this process
For NMAHPPs working at Imperial, I can help you become involved in peer review for the journals you read. If you would find it helpful, I can support you to complete the review, so that you feel confident returning your critical appraisal. The involvement of another person needs to be declared to the editor, as the peer review process is otherwise confidential, but this is acceptable when less experienced reviewers are receiving support.
We are in the process of developing a research proposal for a feasibility study to investigate the implementation of bedside resuscitation for breech babies who require breathing assistance at birth.
Research indicates that providing this immediate care next to mothers/birthing people reduces parental distress and is found to be more favourable by clinicians due to improving communication with parents while they provide care.
The purpose of this group session is to gain insight and feedback regarding our research aims and design from stakeholders to ensure the research is the next piece of the puzzle in improving breech care, designed appropriately, and acceptable to women/birthing people.
We have scheduled this meeting for 90mins to ensure everyone has enough time to discuss the proposal and ask any questions and we will also provide an optional short survey for anyone to provide any additional feedback if they were not able to during the meeting.
The meeting will be held on Sunday 30th October 10am – 11.30am via Microsoft Teams. You can attend the meeting for the full 90mins or attend like a drop in session.
We look forward to meeting with you and hearing your thoughts.
Plain English summary of the research (limit 400 words):
OptiBreech Care is a specialist care pathway for women whose baby is positioned bottom-down (breech) at the end of pregnancy. Our team previously studied how hospitals provide team care when a woman requests a vaginal breech birth to make sure it was possible. In this model, women found it easier to plan their choice of a vaginal breech birth or a pre-labour caesarean birth. Fewer women had emergency caesarean births, and outcomes for babies were at least as good as standard care. OptiBreech teams found one aspect difficult: leaving the umbilical cord attached if the baby needs help to start breathing. Team members told us this is challenging to achieve because they do not have appropriate equipment and 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.
We aim to learn how to get optimal cord management right for every birth, how much it will cost and how it may improve outcomes for babies if we do this. We will supply one site with bedside trolleys and team training; another site will use trolleys they already have, with additional support; all thirteen remaining sites will continue to try to implement the recommendations with what they already have. We will observe the process for 12 months initially, during which we would expect 205 planned breech births to occur. We will conduct interviews with staff, parents and birth supporters following births where babies have needed support, to understand how this is working, or not.
By studying the process within small teams, who care for a population at higher risk of needing assistance to begin breathing at birth, we will be able to study and share insights that can improve the process for all teams, across the UK population of term births. We will share our results in scientific papers and a toolkit. Our research team includes a service user who has planned an OptiBreech birth, who will help us to involve other service users in shaping the research and to communicate the results of the research to a wide audience.
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.
OptiBreech 