Limitations
Our finding that a model in which a specialist clinic and team are led
by a breech specialist midwife is the only one that appears feasible to
test in a trial at this time does not mean other models are ineffective.
Our findings are heavily influenced by context, including the continuing
impacts of the COVID-19 pandemic on staffing levels within the NHS, and
low overall breech experience levels in these settings after decades of
erosion. We therefore consider this our transparent record of what is
working in these contexts at this time, to explain the way we have
defined our intervention. Other models have been reported in other
contexts.
We have focused on interviews with women in this analysis. Further work
is needed to describe the roles of breech specialist midwives and
evaluate acceptability of the role among the wider MDT team.
The Chief Investigator (SW) in this study fulfils multiple roles,
including service leadership and delivery in one of the sites. This may
introduce bias. To balance this, a non-clinical member of the team
conducted and independently analysed all interviews (TD). The findings
were subject to member checking with participants and lay research team
member feedback (SH, SR).