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Breech specialist midwives and clinics in the OptiBreech Trial feasibility study: An implementation process
Tisha Dasgupta1, Sarah Hunter1,2, Sharna Reid1,3
1Department of Women & Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK.
Birth (Berkeley, Calif.)
|October 26, 2022
Summary
Skilled care for breech births improves outcomes. Dedicated specialist midwife clinics in the UK show feasibility and acceptability for training professionals and providing consistent, safe care for vaginal breech births.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Healthcare Implementation Science
Background:
- Skilled attendance at breech births is linked to reduced adverse perinatal outcomes.
- The study investigates the feasibility, fidelity, acceptability, and safety of implementing specialized care models for vaginal breech births (VBB) within the UK National Health Service (NHS).
- Key trial feasibility metrics, including recruitment, were also assessed.
Purpose of the Study:
- To evaluate the implementation feasibility of providing OptiBreech-trained professionals for vaginal breech births (VBB).
- To assess the fidelity, acceptability, safety (neonatal admission rates), and trial feasibility of a VBB care model.
- To determine if NHS sites can reliably offer consistent and high-quality care for women desiring a VBB.
Main Methods:
- A mixed-methods implementation evaluation was conducted across 13 services in England and Wales.
- Eighty-two women requesting VBB support were recruited, with outcomes descriptively analyzed.
- Qualitative data from 21 interviewed women, analyzed using the Theoretical Framework of Acceptability, informed iterative implementation adjustments.
Main Results:
- Dedicated VBB clinics, led by specialist midwives, achieved 87.5% fidelity to the intervention's training goals.
- Neonatal outcomes were stable, with a 5.5% admission rate.
- Women found care from specialist midwives highly acceptable, though the model requires strategic development of additional proficient team members.
Conclusions:
- Dedicated clinics coordinated by specialist midwives represent a feasible and acceptable strategy for implementing VBB care in clinical trials.
- This model shows potential for testing the safety and effectiveness of proficient team care for VBB.
- Maintaining back-up arrangements is crucial while developing team member proficiency.
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