Qualitative data and analysis
Qualitative data included semi-structured interviews, lasting 36 minutes average (range 15-51). Care recipient- and provider-specific interview guides were drafted, based on the Theoretical Framework of Acceptability (TFA). Interviews were conducted via Microsoft Teams by a non-clinical member of the research team experienced in qualitative research (TD) and transcribed. A maximum variation purposeful sampling strategy was used to explore the acceptability of the intervention for different stakeholders across settings. Participants included 15 women across 4 sites (A,B,C,D). Their experience included 7 VBBs, 1 forceps breech birth (FBB), 6 CS in labour (EMCS), 1 CS prior to labour (ELCS). Three cases involved difficulties with communication or births where the attendants did not meet the full proficiency criteria. Two women chose to give birth at home or in a midwife led unit. One woman was the first recruit at a slowly recruiting site. We additionally interviewed 6 breech lead midwives, who were also PIs, across 6 sites (A,B,C,E,F,G).
Anonymised transcripts were initially coded with reference to the TFA component constructs, using NVivo 12 qualitative data analysis software. Recurrent themes and patterns were compared across interviews. Lay members of the team were provided with a sample of anonymised transcripts and supported to provide narrative feedback on the themes they identified with and comment on those identified by other members of the research team. Matrix and cross tabulation features within NVivo were used to compare results across demographic categories and to observe how recurrent themes interacted with the TFA component constructs. Analytic memo-writing, reflective meetings among the research team and open meetings with stakeholders to discuss emerging results were used to refine these results.
When the centrality of the breech lead midwife’s role in each setting became apparent, we also performed a thorough content analysis to identify the roles the midwives described themselves doing. We refined our topic guide to include exploration of the role of the breech lead midwife, as understood by our participants.