Access to skilled breech birth care
- It was very convenient because I think Naimh was based at the
hospital that I was already getting my care from. So yeah, it was a
case of, Oh, we have a breech consultant, let me just refer you to
her. And it wasn’t like I had to sort of do loads of research in
finding a doctor or a consultant that would do this. She was already
there, so, which was lucky for me. (W101-B-VBB)
- I have the appointment with the doctor the same day that [the
breech specialist midwife] was in the hospital and they referred me
immediately. (W110-A-FBB)
- I was referred [to the breech specialist midwife] straight
after my ECV. (W100-B-VBB)
- My home birth midwife that explained that a vaginal breech birth
is only risky when you have practitioners that aren’t experienced in
breech delivery, and that’s where the sort of the riskiness comes in.
But if you have somebody who is experienced in breech delivery, then
they are much less likely to be a difficult birth. And she let us know
that the consultant midwife at [OptiBreech site] was a breech
birth specialist and that if we decided to go down a vaginal breech,
she would caseload us so that she would become our midwife for the
birth no matter what. (W102, B, EMCS)
- And obviously you don’t want to have that journey in labour. But
I was like, I prefer to have that because I think she really
understands what is happening and what I want to do. And she’s not
scared. This is for me really important. Because I felt everyone in
[booking hospital] was a little bit scared of the breeched baby.
Because they didn’t have the specialist that you need for delivering a
breech. Which is fair enough, but I wanted to have that type of person
that was chill and relaxed and knew what was going on. Because it’s
really going to have an impact on your birth experience …
Because for me it was so – well I’m not religious but I’m very
spiritual. So I knew that giving birth was like an opportunity to get
closer to God and to my body, it was quite special. So she allowed me
to give birth or allowed me to try to give birth in the conditions I
wanted with my husband. So yeah, that was wonderful. (W104-B-EMCS)
- And I think I wouldn’t have felt confident enough to do it
because of the added risk. I think having a team of people who really
felt like experts meant that I felt safe and confident to try for
that. I don’t think I would have done, as much. I would have wanted to
still go for it, but I might have been less likely to. (W106, C,
EMCS)
- So [the breech specialist midwife] kind of was open to me
having the birth wherever I wanted. I met with her, I met with an
obstetrician at [OptiBreech Hospital], I made a booking
appointment there. [The breech specialist midwife] spoke through
all of my questions that I had, she also shared with me lots of their
research studies, and then I was able to make my decision. So within
this time, I also basically went through all of the Royal College of
Gynaecology, all of their studies. So I actually read up on that
myself. So I understood all of the stats and data around it. And
essentially, my research led me to conclude that the experience of the
midwife or the obstetrician is the only factor really in determining
my safety, considering I’m a low risk mum as well. And that’s why I
went with [this midwife], because I was like, if that’s the only
factor really that’s going to make a difference, then I’ll go with the
midwife or the obstetrician that I think’s got the most experience to
help deliver the baby where I want to, which is at home. (W108-B-VBB)
- So later that day, I had the ECV, which was fine. I’m glad I
tried it. But her – I think she was just breech for so long, her bum
was, like, deeply sort of engaged into my pelvis. So there was just,
like, no budging her. She was quite happy throughout the process, like
she didn’t really notice it, but yeah, there was just no moving her.
And that was fine because I had already made my decision what I wanted
to do. And at this point, I knew like, because I met [the team at
the OptiBreech hospital], like I knew that they were really good
for, like, breech and stuff. So I felt like I was in good hands. And I
felt comfortable with pursuing a vaginal breech birth as well, because
I think that’s an important aspect, having like a skilled
practitioner. (W109-A-VBB)
- I mean, they completely made that a possible option because,
yeah, it really felt like we were taking a bit of a risk by choosing
to have a home breech birth with the team that didn’t have the
experience. So finding [the breech specialist midwife] really
found like a kind of defining moment of someone that we could trust
and someone who was going to listen to us and support us. I mean, I
guess maybe because Ebony’s also the consultant midwife, but felt very
confident, very, very empowering. So really, it was there, that game
changer at that point. And so we were relieved to find Ebony. …
I think having like an experienced team of midwives on call was really
important to me. So Ebony was available most of the time and sort of
did really strive to make herself available. (W112-C-VBB)
- When they told me that he was breech, I started looking at the
NHS website to see what it meant to me and that this option was over
there, although I didn’t know exactly how it would work, if I could
have it at all hospitals, because it was clear that the problem is I’d
need to have a team that was prepared for that, and I thought that
maybe it’s not a reality everywhere. But then, … the midwife at
birthing choices made me aware that I could try to have one, and that
put me under control. (W114-A-EMCS)
- Well, actually, she gave me the confidence that I could because
I knew that I was going to do the vaginal breech birth, but meeting
with her gave me the the confidence that I want, that I have a someone
that knows how to do it. But she is an expert in in that kind of
birth. (W110, A, FBB)
- So [non-OptiBreech site] at that time weren’t even aware of
an obstetrician within their group that specialised a little bit more
in breech. So it was really just kind of single-handedly with my
husband making a lot of effort to find out what I could do.
(W108-B-VBB)
- We only agreed to the ECV, it was – we agreed to it before we
met Ebony. So it was like, when it was very much like there wasn’t
really any option apart from having the ECV or having a C-section. And
we were sort of led to believe it was going to be the consultant doing
the ECV. And he mentioned that hospital they have about a 40% success
rate. On the day the consultant was not available. It was just sort of
– and we’d been waiting for hours just on the lay ward. It wasn’t
an ECV clinic and it was just sort of the reg [registrar] who was
on that day, and she sort of didn’t seem like she done an ECV before.
She was talking about kind of success rate in Malta it being 60% but
it just seemed like she was quoting like, you know, general stats, not
her stats. And the ECV was really brutal. Really painful. It wasn’t
– at no point did it seem like the baby was actually gonna move.
But she was so determined that she could get him to move because I met
the like criteria for being a successfully ECV. He wasn’t engaged.
There wasn’t the right amount of fluid and stuff. And she did four
attempts. I think it was like 11 minutes in total. It was over what
they were supposed to do and I couldn’t really – because I was laid
flat, I couldn’t really see what she was doing. I just knew it was
painful and because she was so adamant that she was getting the baby
to move and it could get to work, I guess I kept saying, Yeah, OK,
carry on. (W112-C-VBB)
- It seemed like some other midwives we met in the unit – like we
went into triage at one point and just a general midwife mentioned,
“Oh, so have you booked a C-section because your baby’s breech?” and
we were like, “No, no, we’re part of the project.” So obviously it
hadn’t really filtered through the other staff kind of knew that was
happening. And then, yeah, the screening midwife was very anti having
a breech birth. (W112-C-VBB)
- It was in the, you know, the paper that she gave me, the
pamphlet. But she didn’t tell me anything. She just told me that it
was very risky. Gave me the information. Insisting the C section
instead of that the vaginal breech that it was an option. And they
have a team – she never told me about that the hospital have a
special team for that. (W110-A-FBB)
- For me the worst was cutting the cord too soon… So I
understand that for her it was an emergency. So she did what she
thought was better. I understand. But for me, I know that I couldn’t
change her mind right in that very moment. You know what I mean?
That’s something that she had to know before and she reacted in
another way, bad. Anyway, for me, it was difficult to accept that
that. Now I’m in a better place. I know that she did what she thought
was better. (W110-A-FBB)
- I just think maybe it would be good if the, I guess, the other
doctors or consultants at the hospital were more aware of the breech
clinic and that it is actually a safe option that is being offered by
experienced people and that, you know, that it is a service of the
hospital. (W103-A-VBB)
- It was a bit inconvenient because, as I said, I have another
child, he’s at school already. So I had to kind of accommodate his
being at school with me going to hospital, especially because it’s not
because the causes hospital to where I live. Also, I had to be driven
over there a bit because it is a bit further away, but also because of
the pandemic. I didn’t want to get to public transport while pregnant,
so my husband had to kind of stop working to drive me over there.
(W114-A-EMCS)
- The only thing I didn’t get from being out of the catchment area
was the continuity, I think, as I didn’t see the same midwife. Maybe
two weeks I think I saw the same person. But apart from that all my
appointments, I saw someone completely different. So I guess if I had
been to like my local hospital, I would have seen the same midwife or,
you know, a couple of people. Whereas this felt bit more like, not
personalised. Like I basically just saw whoever was there and no one
really knew me. Someone different each time. (W111-C-VBB)
- Just have more places to be available because, you know, I had
to go across [the city] to get it. And I cannot imagine how it
would be for people who live outside [the city]. Like I don’t
think there is an option for people outside [the city] to do that.
Like [a different big city] or something, maybe there is.
(W104-B-EMCS)