Qualitative data and analysis
Qualitative data included semi-structured interviews, lasting 36 minutes
average (range 15-51). Care recipient- and provider-specific interview
guides were drafted, based on the Theoretical Framework of Acceptability
(TFA). Interviews were conducted via Microsoft Teams by a non-clinical
member of the research team experienced in qualitative research (TD) and
transcribed. A maximum variation purposeful sampling strategy was used
to explore the acceptability of the intervention for different
stakeholders across settings. Participants included 15 women across 4
sites (A,B,C,D). Their experience included 7 VBBs, 1 forceps breech
birth (FBB), 6 CS in labour (EMCS), 1 CS prior to labour (ELCS). Three
cases involved difficulties with communication or births where the
attendants did not meet the full proficiency criteria. Two women chose
to give birth at home or in a midwife led unit. One woman was the first
recruit at a slowly recruiting site. We additionally interviewed 6
breech lead midwives, who were also PIs, across 6 sites (A,B,C,E,F,G).
Anonymised transcripts were initially coded with reference to the TFA
component constructs, using NVivo 12 qualitative data analysis software.
Recurrent themes and patterns were compared across interviews. Lay
members of the team were provided with a sample of anonymised
transcripts and supported to provide narrative feedback on the themes
they identified with and comment on those identified by other members of
the research team. Matrix and cross tabulation features within NVivo
were used to compare results across demographic categories and to
observe how recurrent themes interacted with the TFA component
constructs. Analytic memo-writing, reflective meetings among the
research team and open meetings with stakeholders to discuss emerging
results were used to refine these results.
When the centrality of the breech lead midwife’s role in each setting
became apparent, we also performed a thorough content analysis to
identify the roles the midwives described themselves doing. We refined
our topic guide to include exploration of the role of the breech lead
midwife, as understood by our participants.