Breech specialist midwives and clinics in the OptiBreech Trial feasibility study: An implementation process evaluation

Abstract

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Authors’ reply

“…Multiple research papers have demonstrated that some women wish to plan a VBB rather than an elective caesarean birth (CB), and despite current guidance, most are not able to access that care option. 1,2 Our goal is to enable women to make informed decisions by providing them with reasonable options, rather than 'standard care'. We agree with you: this is inadequate and unsafe.…”

The OptiBreech Care Pathway: evaluating the feasibility and acceptability of team care for women seeking to plan a vaginal breech birth (OptiBreech 1) – a mixed methods implementation feasibility study

“…Qualitative data provided insight into observed differences in recruitment at centres with clinics and/or specialist midwives. (43,48) In interviews and informal contacts, women reported numerous incidences of imbalanced counselling in favour of caesarean birth as the only reasonable option from obstetricians, except for those involved in the study. They reported some instances of imbalanced counselling in favour of VBB as a low-risk option from midwives, except for those involved in the study.…”

“…Women also reported increased con dence to plan a VBB when they had a reasonably good chance of an experienced attendant, which they felt the OptiBreech care pathway provided them. (43,48) Staff shortages during the COVID-19 pandemic in uenced recruitment gures. For example, Sites 100A and 100B were not able to receive self-referrals throughout their participation on this study, despite multiple requests from women who wanted to transfer their care to an OptiBreech site to participate in the research.…”

“…Where this criterion was met it was due to attendants (midwives or obstetricians) who were already fully pro cient working exibly (on-call) to attend the births and support other staff to acquire experience. (43) Although the study was not powered to detect statistically signi cant differences, in all delity categories, greater delity to the protocol was observed with trained and/or pro cient attendants at the birth (Table 8:…”

“…The estimate above has been prepared to support current and future sites seeking to train staff working in a dedicated clinic with a breech specialist midwife. (43) One site is currently being funded to evaluate the accuracy of this estimate. Observational data about the time taken for speci c tasks, such as counselling or facilitating a transfer of care, is needed.…”