Sara Elizabeth Morris
School of Nursing and Midwifery
Aim: To establish consensus regarding care of women with a breech presenting fetus through the exploration of participants’ knowledge, experiences and opinions regarding breech presentation and care.
Design: Three round Delphi e-survey
Participants: A panel of fifteen midwives, four obstetricians and one academic with an interest in breech care and birth.
Methods: The initial survey comprised of open-ended questions. Answers were coded and integrated to form statements presented to participants over 3 sections in the second round due to the abundance of information collected from first round responses. Consensus was deemed reached if 70% or more of participants responses ranged from strongly to somewhat agree or strongly disagree to somewhat disagree. Three statements plus suggested changes to two algorithms and four sections ranking the importance of certain skills for clinicians caring for women with breech presentations were presented to the panel in the third round.
Data analysis is currently taking place and will be ready in time for the conference. Consensus was met on a total of 302 statements. Where possible further statement amalgamation was conducted. There were 94 statements on which consensus was not reached. This demonstrates that even among those supportive of breech birth there are differing opinions.
The main findings include the development of a definition for a footling breech presentation, a clinical care pathway for women experiencing a breech presenting fetus close to or at term and a clinical skills framework for the development, maintenance and recording of breech birth skills.
A standard definition for a footling breech presentation has the potential to reduce the incident of unnecessary and even unwanted clinical intervention. The care pathway and clinical skills framework could be used by services to streamline breech care and aid in addressing the current clinical skills deficit in relation to vaginal breech birth. This would improve the accessibility to skilled, confident clinicians for women who desire a vaginal breech birth and subsequently the safety of VBB.
Published as: Morris, S. (2021). Into the breech: A multi-national e-Delphi study exploring breech presentation and birth care. Abstract submitted for Australian College of Midwives Virtual Conference 14th October 2021