Interpretation
Although the operationalisation of a breech specialist midwife in these settings led to increased numbers of vaginal breech births, this does not appear to be a result of ‘normality-centred care’ or encouraging vaginal birth ‘at all costs.’ Our findings suggest that where women are given clear and balanced information about risks and benefits, more women feel able to express their preference to plan a vaginal breech birth. This is consistent with previous research and the ethical principles of informed choice about medical interventions.
While the care model delivered by breech specialist midwives in these services is highly acceptable and successfully achieving fidelity targets, more time will be required for the service to embed and for all members of the MDT to be exposed to the fundamental principles of the intervention. Meanwhile, the burdens of time and responsibility on these midwives is significant, and the service may be vulnerable when they are not available. The model depends on the ability of the specialists to protect their time and work flexibly to cover the service, which will require funding to be sustainable and may explain its lack of prevalence throughout other settings. On-going implementation evaluation work should focus on determining how to manage women’s expectations with a new service, the best way to develop additional team members to the level of proficiency, how long it takes for the entire MDT to be exposed to the training, and what level of funding would be required if it were to become standard practice. Safety should be evaluated in a clinical trial.