Breech specialist midwives and clinics in the OptiBreech Trial feasibility study: An implementation process evaluation.

Dasgupta, T; Hunter, S; Reid, S; Sandall, J; Shennan, A; Davies, SM; Walker, S

Breech specialist midwives and clinics in the OptiBreech Trial feasibility study: An implementation process evaluation.

Dasgupta, T Hunter, S Reid, S Sandall, J

Shennan, A Davies, SM Walker, S

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Publisher:: WILEY
Publication Type:: Journal Article
Citation:: Birth, 2022
Issue Date:: 2022-10-26

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Field	Value	Language
dc.contributor.author	Dasgupta, T
dc.contributor.author	Hunter, S
dc.contributor.author	Reid, S
dc.contributor.author	Sandall, J https://orcid.org/0000-0003-2000-743X
dc.contributor.author	Shennan, A
dc.contributor.author	Davies, SM
dc.contributor.author	Walker, S
dc.date.accessioned	2022-12-01T04:50:38Z
dc.date.available	2022-10-06
dc.date.available	2022-12-01T04:50:38Z
dc.date.issued	2022-10-26
dc.identifier.citation	Birth, 2022
dc.identifier.issn	0730-7659
dc.identifier.issn	1523-536X
dc.identifier.uri	http://hdl.handle.net/10453/164006
dc.description.abstract	BACKGROUND: Attendance of skilled and experienced professionals at breech births has been associated with a reduction in adverse perinatal outcomes. We aimed to determine whether United Kingdom National Health Service (NHS) sites could reliably provide attendants with OptiBreech training and/or advanced proficiency (intervention feasibility) and consistent care (fidelity) that meets women's needs (acceptability), with low neonatal admission rates (safety) and recruitment adequate to support a clinical trial (trial feasibility). METHODS: Mixed methods implementation evaluation was used. Settings were 13 services in England and Wales. Participants were 82 women requesting support for a vaginal breech birth (VBB) at term. Outcomes were descriptively analyzed. Twenty-one women were interviewed, and transcripts were analyzed using the Theoretical Framework of Acceptability. Iterative analysis informed subsequent interviews and the ongoing process of implementation across sites. RESULTS: Although we initially suggested multidisciplinary teams, actively recruiting Trusts yielded services where VBB care was provided through a dedicated clinic, organized and delivered primarily by a lead midwife who functioned as a specialist. This model achieved 87.5% fidelity with the intervention's goal of ensuring the attendance of OptiBreech-trained professionals. Neonatal outcomes remained stable, with an admission rate of 5.5%. Women reported care from specialist midwives as highly acceptable, but the model is vulnerable without a strategic effort to develop additional proficient team members. CONCLUSIONS: Dedicated clinics coordinated by specialist midwives appear to be an acceptable and feasible implementation strategy to test the safety and effectiveness of proficient team care for VBB in a clinical trial. Back-up arrangements should be maintained while additional members of the team develop proficiency.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	WILEY
dc.relation.ispartof	Birth
dc.relation.isbasedon	10.1111/birt.12685
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	11 Medical and Health Sciences
dc.subject.classification	Obstetrics & Reproductive Medicine
dc.title	Breech specialist midwives and clinics in the OptiBreech Trial feasibility study: An implementation process evaluation.
dc.type	Journal Article
utslib.location.activity	United States
utslib.for	11 Medical and Health Sciences
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Midwifery
utslib.copyright.status	open_access	*
dc.date.updated	2022-12-01T04:50:37Z
pubs.publication-status	Published online

Abstract:

BACKGROUND: Attendance of skilled and experienced professionals at breech births has been associated with a reduction in adverse perinatal outcomes. We aimed to determine whether United Kingdom National Health Service (NHS) sites could reliably provide attendants with OptiBreech training and/or advanced proficiency (intervention feasibility) and consistent care (fidelity) that meets women's needs (acceptability), with low neonatal admission rates (safety) and recruitment adequate to support a clinical trial (trial feasibility). METHODS: Mixed methods implementation evaluation was used. Settings were 13 services in England and Wales. Participants were 82 women requesting support for a vaginal breech birth (VBB) at term. Outcomes were descriptively analyzed. Twenty-one women were interviewed, and transcripts were analyzed using the Theoretical Framework of Acceptability. Iterative analysis informed subsequent interviews and the ongoing process of implementation across sites. RESULTS: Although we initially suggested multidisciplinary teams, actively recruiting Trusts yielded services where VBB care was provided through a dedicated clinic, organized and delivered primarily by a lead midwife who functioned as a specialist. This model achieved 87.5% fidelity with the intervention's goal of ensuring the attendance of OptiBreech-trained professionals. Neonatal outcomes remained stable, with an admission rate of 5.5%. Women reported care from specialist midwives as highly acceptable, but the model is vulnerable without a strategic effort to develop additional proficient team members. CONCLUSIONS: Dedicated clinics coordinated by specialist midwives appear to be an acceptable and feasible implementation strategy to test the safety and effectiveness of proficient team care for VBB in a clinical trial. Back-up arrangements should be maintained while additional members of the team develop proficiency.

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http://hdl.handle.net/10453/164006