Physiological breech birth training: An evaluation of clinical practice changes after a one‐day training program

Mattiolo, Stella; Spillane, Emma; Walker, Shawn

doi:10.1111/birt.12562

Cited by 15 publications

(20 citation statements)

References 23 publications

(26 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…When professionals had enhanced training and/or pro ciency, this gure rose to 80% and 81.5% and above. The nding that upright positioning was used increasingly following OptiBreech training and pro ciency accords with previous physiological breech birth training evaluation data, in which this gure was also 80% following training (44). Where professionals receive adequate training, both women and professionals appear to nd upright birth positioning in vaginal breech births acceptable, and some prefer it.…”

supporting

confidence: 81%

See 1 more Smart Citation

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

Walker

Spillane

Stringer

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

Background OptiBreech Care is a care pathway for breech presentation at term, including where chosen, physiological breech birth attended by professionals with advanced training and/or proficiency. We aimed to assess the feasibility of implementing OptiBreech team care to test it in trial-within-a-cohort study. Methods Our design was a mixed methods trial feasibility assessment across England and Wales, January 2021 – June 2022. Our objectives were to determine whether Trusts could provide attendants with advanced training (implementation feasibility), who deliver protocol-consistent care (fidelity), in a way acceptable to women and staff (acceptability), within existing resources (costs), while maintaining low neonatal admission rates (safety) and adequate recruitment rates (trial feasibility). Participants were women > 37 weeks pregnant with a breech-presenting fetus, requesting support for a vaginal breech birth following standard counselling, and the staff involved in the study. No randomisation occurred in this first stage of feasibility work. Results Thirteen National Health Service sites recruited. A total of 82 women planned births on the study, and 21 staff were interviewed. Sites with a breech specialist midwife and/or dedicated clinic recruited 1 woman/month, while sites without recruited an average of 2 women every 3 months. Referrals into the study came from midwives (46%), obstetricians (34%) and women themselves (20%). Vaginal births were attended by staff with OptiBreech training at 87.5% (35/40) and by staff who met stricter proficiency criteria at 67.5% (27/40). Fidelity criteria were met more consistently by staff who met proficiency criteria. There were four neonatal admissions (4.9%, 4/82), including one serious adverse outcome (1.2%, 1/82); these outcomes compare well with previous breech research. Women found the model of care highly acceptable compared to standard care, and staff providing care generally found the OptiBreech model acceptable. However, staffing shortages throughout the pandemic and persistent negative views of vaginal breech birth outside the teams created challenges. Conclusions A large prospective observational cohort of OptiBreech Care, which could potentially support nested or cluster randomisation, appears feasible in sites willing to establish a dedicated clinic and develop further proficient members of staff strategically, with back-up plans for supporting rapidly progressing births. Randomisation procedures remain to be feasibility-tested. Funded by the NIHR (300582).

show abstract

supporting

confidence: 81%

“…The training programme had previously been fully evaluated within NHS Trusts. (44) However, during the COVID-19 pandemic, it became di cult to release staff for in-person training. The entire training package was moved on-line and supplemented with hands-on skills training delivered by leads whenever possible.…”

Section: Interventionmentioning

confidence: 99%

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

Walker

Spillane

Stringer

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…A recently published evaluation gathered prospective outcome data following training based on the Algorithm 25 . The evaluation included 90 vaginal breech births occurring in 6 NHS hospitals, with 21/90 births attended by someone who had completed the training.…”

Section: Discussionmentioning

confidence: 99%

Optimal time intervals for vaginal breech births: a case-control study

2022

Self Cite

View full text Add to dashboard Cite

Background: Breech births are associated with a high rate of hypoxic injury, in part due to cord occlusion during emergence. Maximum time intervals and guidelines oriented toward earlier intervention have been proposed in a Physiological Breech Birth Algorithm. We wished to further test and refine the Algorithm for use in a clinical trial. Methods: We conducted a retrospective case-control study in a London teaching hospital, including 15 cases and 30 controls, during the period of April 2012 to April 2020. Our sample size was powered to test the hypothesis that exceeding recommended time limits is associated with neonatal admission or death. Data collected from intrapartum care records was analysed using SPSS v26 statistical software. Variables were intervals between the stages of labour and various stages of emergence (presenting part, buttocks, pelvis, arms, head). The chi-square test and odds ratios were used to determine association between exposure to the variables of interest and composite outcome. Multiple logistic regression was used to test the predictive value of delays defined as non-adherence the Algorithm. Results: Logistic regression modelling using the Algorithm time frames had an 86.8% accuracy, a sensitivity of 66.7% and a specificity of 92.3% for predicting the primary outcome. Delays between umbilicus and head >3 minutes (OR: 9.508 [95% CI: 1.390-65.046] p=0.022) and from buttocks on the perineum to head >7 minutes (OR: 6.682 [95% CI: 0.940-41.990] p=0.058) showed the most effect. Lengths of time until the first intervention were consistently longer among the cases. Delay in intervention was more common among cases than head or arm entrapment. Conclusion: Emergence taking longer than the limits recommended in the Physiological Breech Birth algorithm may be predictive of adverse outcomes. Some of this delay is potentially avoidable. Improved recognition of the boundaries of normality in vaginal breech births may help improve outcomes.

show abstract

“…A recently published evaluation gathered prospective outcome data following training based on the Algorithm 24 . The evaluation included 90 vaginal breech births occurring in 6 NHS hospitals, with 21/90 births attended by someone who had completed the training.…”

Section: Discussionmentioning

confidence: 99%

Optimal time intervals for vaginal breech births: a case-control study

2022

Self Cite

View full text Add to dashboard Cite

Background: Breech births are associated with a high rate of hypoxic injury, in part due to cord occlusion during emergence. Maximum time intervals and guidelines oriented toward earlier intervention have been proposed in a Physiological Breech Birth Algorithm. We wished to further test and refine the Algorithm for use in a clinical trial. Methods: We conducted a retrospective case-control study conducted in a London teaching hospital, including 15 cases and 30 controls, during the period of April 2012 to April 2020. Our sample size was powered to test the hypothesis that exceeding recommended time limits is associated with neonatal admission or death. Data collected from intrapartum care records was analysed using SPSS v26 statistical software. Variables were intervals between the stages of labour and various stages of emergence (presenting part, buttocks, pelvis, arms, head). The chi-square test and odds ratios were used to determine association between exposure to the variables of interest and composite outcome. Multiple logistic regression was used to test the predictive value of delays defined as non-adherence the Algorithm. Results: Logistic regression modelling using the Algorithm time frames had an 86.8% accuracy, a sensitivity of 66.7% and a specificity of 92.3% for predicting the primary outcome. Delays between umbilicus and head >3 minutes (OR: 9.508 [95% CI: 1.390-65.046] p=0.022) and from buttocks on the perineum to head >7 minutes (OR: 6.682 [95% CI: 0.940-41.990] p=0.058) showed the most effect. Lengths of time until the first intervention were consistently longer among the cases. Delay in intervention was more common among cases than head or arm entrapment. Conclusion: Emergence taking longer than the limits recommended in the Physiological Breech Birth algorithm is predictive of adverse outcomes. Some of this delay is potentially avoidable. Improved recognition of the boundaries of normality in vaginal breech births may help improve outcomes.

show abstract

Physiological breech birth training: An evaluation of clinical practice changes after a one‐day training program

Cited by 15 publications

References 23 publications

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

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

Optimal time intervals for vaginal breech births: a case-control study

Optimal time intervals for vaginal breech births: a case-control study

Contact Info

Product

Resources

About