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Walker S, Spillane E, Stringer K, Meadowcroft A, Dasgupta T, Davies SM, Sandall J, Shennan A. The feasibility of team care for women seeking to plan a vaginal breech birth (OptiBreech 1): an observational implementation feasibility study in preparation for a pilot trial. Pilot Feasibility Stud 2023; 9:80. [PMID: 37173798 PMCID: PMC10175899 DOI: 10.1186/s40814-023-01299-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 04/10/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND OptiBreech Care is a care pathway for breech presentation at term, including where chosen, physiological breech birth attended by professionals with advanced training and/or proficiency. We aimed to assess the feasibility of implementing OptiBreech team care prior to proceeding with a planned pilot randomised controlled trial. METHODS Our design was an observational implementation feasibility assessment across England and Wales, January 2021-June 2022. Our objectives were to determine whether Trusts could provide attendants with advanced training (implementation feasibility), who deliver protocol-consistent care (fidelity), within existing resources (costs), while maintaining low neonatal admission rates (safety) and adequate recruitment rates (trial feasibility). Participants included women > 37 weeks pregnant with a breech-presenting foetus, requesting support for a vaginal breech birth following standard counselling, and staff involved in the study. No randomisation occurred in this first stage of feasibility work. RESULTS Thirteen National Health Service sites were recruited. A total of 82 women planned births in the study. Sites with a breech specialist midwife recruited at double the rate of sites without (0.90/month, 95% CI 0.64-1.16 vs 0.40, 95% CI 0.12-0.68). Referrals into the study came from midwives (46%), obstetricians (34%) and women themselves (20%). Vaginal births were attended by staff with OptiBreech training at 87.5% (35/40, 95% CI 0.732-0.958) and by staff who met additional proficiency criteria at 67.5% (27/40, 95% CI 0.509-0.814). Fidelity criteria were more consistently met by staff who also met proficiency criteria. There were four neonatal admissions (4.9%, 4/82), including one serious adverse outcome (1.2%, 1/82). CONCLUSIONS A prospective observational cohort of OptiBreech collaborative care, which could potentially support nested or cluster randomisation, appears feasible in sites willing to establish a dedicated clinic and strategically develop further proficient members of staff, with back-up plans for supporting rapidly progressing births. Randomisation procedures remain to be feasibility tested. It is funded by the NIHR (NIHR300582).
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Affiliation(s)
- Shawn Walker
- Department of Women & Children's Health, Faculty of Life Sciences & Medicine, School of Life Course and Population Sciences, King's College London, London, SE1 7EH, UK.
- Women's and Children's Services, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Rd, London, SW10 9NH, UK.
| | - Emma Spillane
- Kingston Hospital NHS Foundation Trust, Galsworthy Road, Surrey, Kingston upon Thames, KT2 7QB, UK
| | - Kate Stringer
- Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Canada Avenue, Redhill, RH1 5RH, UK
| | - Amy Meadowcroft
- Northern Care Alliance NHS Foundation Trust, Royal Oldham Hospital, Rochdale Road, Oldham, Greater Manchester, OL1 2JH, UK
| | - Tisha Dasgupta
- Department of Women & Children's Health, Faculty of Life Sciences & Medicine, School of Life Course and Population Sciences, King's College London, London, SE1 7EH, UK
| | - Siân M Davies
- Department of Women & Children's Health, Faculty of Life Sciences & Medicine, School of Life Course and Population Sciences, King's College London, London, SE1 7EH, UK
| | - Jane Sandall
- Department of Women & Children's Health, Faculty of Life Sciences & Medicine, School of Life Course and Population Sciences, King's College London, London, SE1 7EH, UK
| | - Andrew Shennan
- Department of Women & Children's Health, Faculty of Life Sciences & Medicine, School of Life Course and Population Sciences, King's College London, London, SE1 7EH, UK
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Morgan ER, Hu AE, Brezak AMV, Rowley SS, Littman AJ, Hawes SE. Predictors of a successful external cephalic version: A population-based study of Washington state births. Women Birth 2018; 32:e421-e426. [PMID: 30150151 DOI: 10.1016/j.wombi.2018.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/21/2018] [Accepted: 08/01/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Breech presentation affects approximately 3% of women with singleton pregnancies. External cephalic version is a manual procedure that reorients a foetus to cephalic position in preparation for birth, reducing indications for caesarean birth. However, unsuccessful attempts are associated with some adverse health outcomes. Versions are successful in 17-86% of attempts. Temporal trends in version success and association between maternal height or prenatal care and version success are unknown. Few population-based studies and no recent investigations in the United States have evaluated predictive factors for version success. OBJECTIVES This study aimed to estimate the proportion of successful version procedures in the United States and to evaluate factors associated with version success. METHODS We used birth certificate and hospital administrative data. The study included all women who had a singleton birth in Washington State between 2003-2014 following a version procedure (total n=4981). Prevalence ratios and 95% confidence intervals were calculated using Poisson regression. FINDINGS 57.2% of version attempts were successful. Primiparity (Prevalence Ratio:1.43; 95% Confidence Interval:1.29-1.60) and multiparity (Prevalence Ratio:1.68; 95% Confidence Interval:1.50-1.88) were associated with procedure success. Oligohydramnios was associated with lower version success (Prevalence Ratio:0.75; 95% Confidence Interval:0.57-1.00). Maternal height, pre-pregnancy weight, polyhydramnios, frequency of prenatal care, smoking, infant sex, and year of birth were not significantly associated with version outcome. CONCLUSION We found that most version procedures are successful. This reinforces that procedures may be able to reduce the frequency of caesarean birth. These contemporary results can help women and clinicians make decisions with realistic estimates of success.
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Affiliation(s)
- Erin R Morgan
- Department of Epidemiology, University of Washington, Seattle, WA, United States.
| | - Audrey E Hu
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Audrey M V Brezak
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Seth S Rowley
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Alyson J Littman
- Department of Epidemiology, University of Washington, Seattle, WA, United States; Epidemiologic Research and Information Center, VA Puget Sound Healthcare System and Center of Innovation for Patient-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, WA, United States
| | - Stephen E Hawes
- Department of Epidemiology, University of Washington, Seattle, WA, United States
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Morris S, Geraghty S, Sundin D. Moxibustion: An alternative option for breech presentation. ACTA ACUST UNITED AC 2018. [DOI: 10.12968/bjom.2018.26.7.440] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sara Morris
- PhD candidate, Edith Cowan University, Perth, Australia
| | - Sadie Geraghty
- Senior lecturer Midwifery, Edith Cowan University, Perth, Australia
| | - Deborah Sundin
- Clinical Director, School of Nursing and Midwifery Edith Cowan University, Perth, Australia
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Watts NP, Petrovska K, Bisits A, Catling C, Homer CSE. This baby is not for turning: Women's experiences of attempted external cephalic version. BMC Pregnancy Childbirth 2016; 16:248. [PMID: 27561416 PMCID: PMC5000477 DOI: 10.1186/s12884-016-1038-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 08/11/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Existing studies regarding women's experiences surrounding an External Cephalic Version (ECV) report on women who have a persistent breech post ECV and give birth by caesarean section, or on women who had successful ECVs and plan for a vaginal birth. There is a paucity of understanding about the experience of women who attempt an ECV then plan a vaginal breech birth when their baby remains breech. The aim of this study was to examine women's experience of an ECV which resulted in a persistent breech presentation. METHODS A qualitative descriptive exploratory design was undertaken. In-depth semi-structured interviews were conducted and analysed thematically. RESULTS Twenty two (n = 22) women who attempted an ECV and subsequently planned a vaginal breech birth participated. Twelve women had a vaginal breech birth (55 %) and 10 (45 %) gave birth by caesarean section. In relation to the ECV, there were five main themes identified: 'seeking an alternative', 'needing information', 'recounting the ECV experience', 'reacting to the unsuccessful ECV' and, 'reflecting on the value of an ECV'. CONCLUSIONS ECV should form part of a range of options provided to women, rather than a default procedure for management of the term breech. For motivated women who fit the safe criteria for vaginal breech birth, not being subjected to a painful experience (ECV) may be optimal. Women should be supported to access services that support vaginal breech birth if this is their choice, and continuity of care should be standard practice.
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Affiliation(s)
- N P Watts
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - K Petrovska
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - A Bisits
- Royal Hospital for Women, Sydney, Australia
| | - C Catling
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - C S E Homer
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.
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