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

Dasgupta, T ORCID: 0000-0002-7874-9519, Hunter, S, Reid, S, Sandall, J ORCID: 0000-0003-2000-743X, Shennan, A ORCID: 0000-0001-5273-3132, Davies, SM ORCID: 0000-0001-5662-7038 and Walker, S ORCID: 0000-0003-3658-8988 (2022) Breech specialist midwives and clinics in the OptiBreech Trial feasibility study: An implementation process evaluation. Birth. ISSN 0730-7659

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Abstract

Background: Attendance of skilled and experienced professionals at breech births has been associated with a reduction in adverse perinatal outcomes. We aimed to determine whether United Kingdom National Health Service (NHS) sites could reliably provide attendants with OptiBreech training and/or advanced proficiency (intervention feasibility) and consistent care (fidelity) that meets women's needs (acceptability), with low neonatal admission rates (safety) and recruitment adequate to support a clinical trial (trial feasibility).
Methods: Mixed methods implementation evaluation was used. Settings were 13 services in England and Wales. Participants were 82 women requesting support for a vaginal breech birth (VBB) at term. Outcomes were descriptively analyzed. Twenty-one women were interviewed, and transcripts were analyzed using the Theoretical Framework of Acceptability. Iterative analysis informed subsequent interviews and the ongoing process of implementation across sites.
Results: Although we initially suggested multidisciplinary teams, actively recruiting Trusts yielded services where VBB care was provided through a dedicated clinic, organized and delivered primarily by a lead midwife who functioned as a specialist. This model achieved 87.5% fidelity with the intervention's goal of ensuring the attendance of OptiBreech-trained professionals. Neonatal outcomes remained stable, with an admission rate of 5.5%. Women reported care from specialist midwives as highly acceptable, but the model is vulnerable without a strategic effort to develop additional proficient team members.
Conclusions: Dedicated clinics coordinated by specialist midwives appear to be an acceptable and feasible implementation strategy to test the safety and effectiveness of proficient team care for VBB in a clinical trial. Back-up arrangements should be maintained while additional members of the team develop proficiency.

Item Type:	Article
Uncontrolled Keywords:	breech clinics; breech presentation; breech teams; feasibility; implementation; specialist midwives; vaginal breech delivery; Obstetrics & Reproductive Medicine; 11 Medical and Health Sciences
Subjects:	R Medicine > RG Gynecology and obstetrics
Divisions:	Psychology (from Sep 2019)
Publisher:	Wiley
Date of acceptance:	6 October 2022
Date of first compliant Open Access:	16 November 2022
Date Deposited:	16 Nov 2022 11:52
Last Modified:	05 Jul 2025 12:30
DOI or ID number:	10.1111/birt.12685
URI:	https://researchonline.ljmu.ac.uk/id/eprint/18116

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