Access to skilled breech birth care
  1. It was very convenient because I think Naimh was based at the hospital that I was already getting my care from. So yeah, it was a case of, Oh, we have a breech consultant, let me just refer you to her. And it wasn’t like I had to sort of do loads of research in finding a doctor or a consultant that would do this. She was already there, so, which was lucky for me. (W101-B-VBB)
  2. I have the appointment with the doctor the same day that [the breech specialist midwife] was in the hospital and they referred me immediately. (W110-A-FBB)
  3. I was referred [to the breech specialist midwife] straight after my ECV. (W100-B-VBB)
  4. My home birth midwife that explained that a vaginal breech birth is only risky when you have practitioners that aren’t experienced in breech delivery, and that’s where the sort of the riskiness comes in. But if you have somebody who is experienced in breech delivery, then they are much less likely to be a difficult birth. And she let us know that the consultant midwife at [OptiBreech site] was a breech birth specialist and that if we decided to go down a vaginal breech, she would caseload us so that she would become our midwife for the birth no matter what. (W102, B, EMCS)
  5. And obviously you don’t want to have that journey in labour. But I was like, I prefer to have that because I think she really understands what is happening and what I want to do. And she’s not scared. This is for me really important. Because I felt everyone in [booking hospital] was a little bit scared of the breeched baby. Because they didn’t have the specialist that you need for delivering a breech. Which is fair enough, but I wanted to have that type of person that was chill and relaxed and knew what was going on. Because it’s really going to have an impact on your birth experience … Because for me it was so – well I’m not religious but I’m very spiritual. So I knew that giving birth was like an opportunity to get closer to God and to my body, it was quite special. So she allowed me to give birth or allowed me to try to give birth in the conditions I wanted with my husband. So yeah, that was wonderful. (W104-B-EMCS)
  6. And I think I wouldn’t have felt confident enough to do it because of the added risk. I think having a team of people who really felt like experts meant that I felt safe and confident to try for that. I don’t think I would have done, as much. I would have wanted to still go for it, but I might have been less likely to. (W106, C, EMCS)
  7. So [the breech specialist midwife] kind of was open to me having the birth wherever I wanted. I met with her, I met with an obstetrician at [OptiBreech Hospital], I made a booking appointment there. [The breech specialist midwife] spoke through all of my questions that I had, she also shared with me lots of their research studies, and then I was able to make my decision. So within this time, I also basically went through all of the Royal College of Gynaecology, all of their studies. So I actually read up on that myself. So I understood all of the stats and data around it. And essentially, my research led me to conclude that the experience of the midwife or the obstetrician is the only factor really in determining my safety, considering I’m a low risk mum as well. And that’s why I went with [this midwife], because I was like, if that’s the only factor really that’s going to make a difference, then I’ll go with the midwife or the obstetrician that I think’s got the most experience to help deliver the baby where I want to, which is at home. (W108-B-VBB)
  8. So later that day, I had the ECV, which was fine. I’m glad I tried it. But her – I think she was just breech for so long, her bum was, like, deeply sort of engaged into my pelvis. So there was just, like, no budging her. She was quite happy throughout the process, like she didn’t really notice it, but yeah, there was just no moving her. And that was fine because I had already made my decision what I wanted to do. And at this point, I knew like, because I met [the team at the OptiBreech hospital], like I knew that they were really good for, like, breech and stuff. So I felt like I was in good hands. And I felt comfortable with pursuing a vaginal breech birth as well, because I think that’s an important aspect, having like a skilled practitioner. (W109-A-VBB)
  9. I mean, they completely made that a possible option because, yeah, it really felt like we were taking a bit of a risk by choosing to have a home breech birth with the team that didn’t have the experience. So finding [the breech specialist midwife] really found like a kind of defining moment of someone that we could trust and someone who was going to listen to us and support us. I mean, I guess maybe because Ebony’s also the consultant midwife, but felt very confident, very, very empowering. So really, it was there, that game changer at that point. And so we were relieved to find Ebony. … I think having like an experienced team of midwives on call was really important to me. So Ebony was available most of the time and sort of did really strive to make herself available. (W112-C-VBB)
  10. When they told me that he was breech, I started looking at the NHS website to see what it meant to me and that this option was over there, although I didn’t know exactly how it would work, if I could have it at all hospitals, because it was clear that the problem is I’d need to have a team that was prepared for that, and I thought that maybe it’s not a reality everywhere. But then, … the midwife at birthing choices made me aware that I could try to have one, and that put me under control. (W114-A-EMCS)
  11. Well, actually, she gave me the confidence that I could because I knew that I was going to do the vaginal breech birth, but meeting with her gave me the the confidence that I want, that I have a someone that knows how to do it. But she is an expert in in that kind of birth. (W110, A, FBB)
  12. So [non-OptiBreech site] at that time weren’t even aware of an obstetrician within their group that specialised a little bit more in breech. So it was really just kind of single-handedly with my husband making a lot of effort to find out what I could do. (W108-B-VBB)
  13. We only agreed to the ECV, it was – we agreed to it before we met Ebony. So it was like, when it was very much like there wasn’t really any option apart from having the ECV or having a C-section. And we were sort of led to believe it was going to be the consultant doing the ECV. And he mentioned that hospital they have about a 40% success rate. On the day the consultant was not available. It was just sort of – and we’d been waiting for hours just on the lay ward. It wasn’t an ECV clinic and it was just sort of the reg [registrar] who was on that day, and she sort of didn’t seem like she done an ECV before. She was talking about kind of success rate in Malta it being 60% but it just seemed like she was quoting like, you know, general stats, not her stats. And the ECV was really brutal. Really painful. It wasn’t – at no point did it seem like the baby was actually gonna move. But she was so determined that she could get him to move because I met the like criteria for being a successfully ECV. He wasn’t engaged. There wasn’t the right amount of fluid and stuff. And she did four attempts. I think it was like 11 minutes in total. It was over what they were supposed to do and I couldn’t really – because I was laid flat, I couldn’t really see what she was doing. I just knew it was painful and because she was so adamant that she was getting the baby to move and it could get to work, I guess I kept saying, Yeah, OK, carry on. (W112-C-VBB)
  14. It seemed like some other midwives we met in the unit – like we went into triage at one point and just a general midwife mentioned, “Oh, so have you booked a C-section because your baby’s breech?” and we were like, “No, no, we’re part of the project.” So obviously it hadn’t really filtered through the other staff kind of knew that was happening. And then, yeah, the screening midwife was very anti having a breech birth. (W112-C-VBB)
  15. It was in the, you know, the paper that she gave me, the pamphlet. But she didn’t tell me anything. She just told me that it was very risky. Gave me the information. Insisting the C section instead of that the vaginal breech that it was an option. And they have a team – she never told me about that the hospital have a special team for that. (W110-A-FBB)
  16. For me the worst was cutting the cord too soon… So I understand that for her it was an emergency. So she did what she thought was better. I understand. But for me, I know that I couldn’t change her mind right in that very moment. You know what I mean? That’s something that she had to know before and she reacted in another way, bad. Anyway, for me, it was difficult to accept that that. Now I’m in a better place. I know that she did what she thought was better. (W110-A-FBB)
  17. I just think maybe it would be good if the, I guess, the other doctors or consultants at the hospital were more aware of the breech clinic and that it is actually a safe option that is being offered by experienced people and that, you know, that it is a service of the hospital. (W103-A-VBB)
  18. It was a bit inconvenient because, as I said, I have another child, he’s at school already. So I had to kind of accommodate his being at school with me going to hospital, especially because it’s not because the causes hospital to where I live. Also, I had to be driven over there a bit because it is a bit further away, but also because of the pandemic. I didn’t want to get to public transport while pregnant, so my husband had to kind of stop working to drive me over there. (W114-A-EMCS)
  19. The only thing I didn’t get from being out of the catchment area was the continuity, I think, as I didn’t see the same midwife. Maybe two weeks I think I saw the same person. But apart from that all my appointments, I saw someone completely different. So I guess if I had been to like my local hospital, I would have seen the same midwife or, you know, a couple of people. Whereas this felt bit more like, not personalised. Like I basically just saw whoever was there and no one really knew me. Someone different each time. (W111-C-VBB)
  20. Just have more places to be available because, you know, I had to go across [the city] to get it. And I cannot imagine how it would be for people who live outside [the city]. Like I don’t think there is an option for people outside [the city] to do that. Like [a different big city] or something, maybe there is. (W104-B-EMCS)