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).