Introduction
‘Physiological breech birth’ is an approach to facilitating vaginal
breech birth (VBB) centred on the optimisation and restoration of normal
physiological processes to achieve a safe outcome. This includes upright
maternal birth positions, such as kneeling, which promote active
maternal movement and efficiency during expulsion. Interventions are
performed in response to specific clinical indications, based on
evidence of what is considered ‘normal’ breech birth physiology. These
are summarised in the Physiological Breech Birth Algorithm. The use of
upright positions for VBBs has been associated with a significantly
reduced need for manoeuvres, neonatal and maternal birth injuries,
lengths of second stage and intrapartum caesarean sections (CS) when
compared with routine supine positioning in observational studies.
However, neither upright maternal positioning nor the physiological
breech birth approach have been tested in a randomised clinical trial.
Before a trial can be conducted, the ability to reliably deliver the
intervention needs to be established. This depends on the capacity to
ensure, to a reasonable standard, attendance at breech births by
professionals who have, at a minimum, completed an enhanced training
package in these methods, and ideally, who have achieved proficiency, as
defined by previous research. The OptiBreech 1 study was designed to
evaluate whether teams are able to implement a service in which they
reasonably ensure proficient professionals attend VBBs (intervention
feasibility) and provide consistent care (fidelity), in a way that is
acceptable to woman and staff (acceptability), while maintaining low
neonatal admission rates (safety), and whether women are willing to
participate in such a study (trial feasibility). We wanted to understand
why or why not by speaking with care recipients and providers. A
detailed implementation process evaluation alongside a feasibility study
will increase the chances of a successful substantive trial and
potentially quicken the public health impact of the intervention if it
is effective. The purpose of a process evaluation to inform trials of
complex interventions is to understand the effects of implementing a new
intervention and the mechanisms of these effects in new contexts.
OptiBreech 1 is a qualitative and observational study, following women
who request to plan a VBB at term under current Trust guidelines. This
report focuses on analysis of data concerning the models of
service delivery , to refine the programme theory for the trial.