Conclusion
Implementation of physiological breech birth-proficient care within these settings so far has been achieved through the enablement of a breech specialist midwife, who leads on service and skill development. A model of care in which breech services are delivered in dedicated clinics and flexible intrapartum care teams by specialist midwives, working in collaboration with obstetric colleagues, is the only model of service delivery that appears feasible to test in a trial at this time. Testing OptiBreech Care in a substantive trial will require additional sites to achieve a similarly adequate level of implementation and recruitment in a relatively short period of time. Therefore, we have refined our intervention in the OptiBreech Care pilot trial to reflect this, to maximise the chances of an efficient and successful trial.