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.