PPI: Influence on design

In addition to face-to-face activities, when developing this proposal I circulated an invitation to participate in PPI via my professional blog (breechbirth.org.uk) and social media. Twenty-one women and three people who work with pregnant women (midwife, doula, osteopath) expressed an interest. Some of these women attended the face-to-face meeting at St Thomas’ Hospital in April 2019, organised by the South London Maternity Voices Partnership. I met with two women individually in East Anglia, and seven women responded to a survey (via SurveyMonkey) asking about their views on the plain English summary of my proposal. This post reports the responses of these seven women to this summary and how this has influenced the form of the final proposal.

All comments are reported and all women were asked for permission to share these responses anonymously.

All seven women (100%) indicated that, “I or my partner have had a breech baby within the last 5 years,” within the UK. Comments included:

I had an undiagnosed breech vaginal delivery in 2015, in spite of having had numerous palpations/sweeps in the weeks leading up to the birth.

I experienced my own undiagnosed breech birth (vaginal delivery) in December 2015. Happy to provide in depth detail of my birth story; it is also published in my own work on this.

My breech baby was undiagnosed as breech, so I have no experience of what it feels like to contemplate the choice between natural breech birth or cesaerean. I am however part of various breech networks on social media and take part in many discussions about this. I had my breech baby at home, and unassisted, with no complications.

“I gave birth at home to my frank breech baby. I wasn’t supported by most of the health professionals I met and when it came to the birth it didn’t feel safe to go to our hospital where they were very short staffed and my labour progressed too quickly for me to get there! I trusted my body knew what to do and our baby was born safely with my just my husband watching! Paramedics arrived and our doula as our baby was born. The midwifes weren’t available for another 4 hours! It was a huge shame as they missed the opportunity to experience my calm, pain free, extremely well researched breech birth.” 

Impact on proposal: ‘Undiagnosed breech birth’ means the breech presentation is diagnosed for the first time when the woman is in active labour, rather than during her antenatal care. Occurrences of undiagnosed breech births seem a significant component of ‘breech experience’ among women in the UK. My original proposal focused solely on management of breech presentations that are diagnosed antenatally, but I realised this is not enough. Also, the last randomised controlled trial of term breech births (Hannah et al 2000) included breech presentations diagnosed for the first time in labour. Although recruitment during labour is particularly challenging, PPI feedback indicates meeting this challenge is important.

These results were similar to those received in the face-to-face and staff PPI activities.

I think women will want to take part to ensure that breech pregnancies and births are better dealt with. Natural births of breech babies should be supported more, so this study will help.

I feel women would participate especially if they have had choice taken away from them. Enabling informed choice and joint decision making is crucial for all woman no matter what presentation.

Yes but only if they are reassured prior to birth that they will not be forced into a certain birthing choice because they signed up for the trial. I think constant reminders would be helpful to them that they still have choice throughout otherwise this could be a potential barrier to recruitment.

I felt very pressured during my pregnancy by doctors, and really struggled to make choices. (Whether to homebirth or not). I feel that any woman in this situation or who has had previous experience of hospital would be very glad to take part in something that could change the way women are treated and spoken to in hospitals. I personally would be willing to take part in any research that improved the way pregnant women are treated.

If the question is meaning the breech births that have already happened then it is likely the women will want to take part to help other women. If it is for women about to give birth to breech babies then it depends on how confident, trusting and educated her team of midwives and consultants are of breech vaginal delivery.

Influence on research design: At least some women find decision-making around mode of childbirth with a breech baby difficult, and that at least some women have felt pressured and have experienced a lack of respectful care. Ensuring this research does not result in harm of this type is important to me. This influenced the design in the direction of a pragmatic RCT. In the original proposal, I had planned to conduct an efficacy study, which requires strict adherence to group allocation. However, through engagement with women I came to feel this would not be ethical, nor would it provide the type of ‘real world’ decision-making information women wanted. Recruitment would also have been more difficult.

It will give women a better understanding of their options and what they consist of. It will help women come to the right decision that best suits them.

Empowering women to trust in their body’s natural ability will always be a positive thing

Yes, any additional information to what is already known will always serve to be helpful to women and allow them to make more informed choices.

I think there is very little information available on breech birth, and the stuff that is isn’t “readily” available unless you go looking for it and do your own research. I think newer studies and studies with more data are definitely needed and would provide women with up to date research and the information they need to make informed decisions. 

Any extra research would definitely be helpful, the way the world is now it seems most people like statistics and there’s so much health and safety surrounding breech births in many hospitals/countries. Women are then too nervous by the lack of skill so they opt for a c-section.

This is fantastic! I gave birth to my breech baby in November 2017! It was the most incredible experience of my life where I truly tuned into my body. I did huge amounts of research during pregnancy and continue to do so now. Birth is incredible but breech birth is fascinating and it’s become my passion. I would love to be involved with this as much as possible!

Influence: I have created a mailing list to keep all respondents informed of the progress of this research and aware of any opportunities to contribute further, with clear information about how to remove themselves from the list and have any personal data deleted.

Below are some additional comments from women who did not participate in the survey, but expressed interest in PPI participation in general. Although I have anonymised responses, aside from one link the person wanted to share, they came from all over the UK. Women seeking support for a current pregnancy were referred to an independent breech midwife not involved with this research, with their permission.

I just came across this. I’m don’t work in the medical profession but my baby was a breech baby. I requested a vaginal delivery which was very negatively received by my hospital. I very much wanted to attempt it, which I did (in the understanding that if it became too dangerous I would agree to a c-section) However I have found out from a report that the second stage of my delivery was very poorly managed and sadly my baby died just after he was born. I was very much made to feel Like it was my fault for the birth choice I made. I truly wish there had been more open discussion about how my hospital felt about it and why they were so reluctant to support me. Breech birth should be talked about and openly discussed more. Great that it’s finally happening.

I experienced primi breech vaginal birth under Dr X in X Hospital, X city in 2014. I had a doula and I’ve trained to be a doula since. Breech birth in hospital can and should happen, and happen safely. I’m interested in being involved if I can be of use.

During my last pregnancy we found out baby was footling breech at about 36 weeks during a growth scan. Previous to this all midwives and doctors has told me he was head down. I had an ecv and went on to have a successful vaginal birth at 41 +3

I had a breech baby by (reluctant) c-section 3 years ago. There was a general lack of experience in vaginal breech birth in my area.

My daughter (born November 2016) was undiagnosed breech. My waters broke and instead of waiting for the normal 24hrs, the obstetrician recommended an induction as the midwife had picked up a small drop in her heart rate. It was the obstetrician’s opinion that the drop was probably due to position but still no one noticed she was breech. The diagnosis came when I was 5cm dilated and a midwife felt the my daughter’s bum during a VE. I wasn’t given much of an option then and whisked into an emergency c-section.

I’m pregnant again and though still early (28 weeks) baby is currently breech too. I’m trying to explore all my options and to be prepared for different scenarios this time round, but am finding that a lot of the research I come across is inconclusive. If there’s anything I can do to help, I’d be very happy to contribute.

Im currently pregnant with extended breech baby. my second pregnancy. no risks.

I would like to consider the natural birth. Doctors recommend CS but I don’t feel I got all the information to make informed decision.

I heard confusing message like we have no experience which is concerning and no statistics but more list of things which can go wrong.

I would like to find out pros and cons so I can make informed choice.

I would appreciate if you can get in touch with me.

I am 38.5 weeks pregnant.

I’ve stumbled on your website by chance. I had a breech baby in October 2016 at X Hospital. We didn’t discover breech until 41 weeks and at that point I was immediately coerced into agreeing to a c-section which was performed less than 12 hours later. I found the experience highly traumatic and ended up with anxious episodes (flashbacks/obsessive thoughts/nightmares etc etc) which required counselling. 

I would love to be able to help with your research in the hope that future women do not have to experience what I did. 

I’d like to register my interest. I had a breech pregnancy in 2014 which resulted in a Caesarean section. 

I’d love to help in anyway possible. I’m currently a final year Midwifery Student with a passion for VBB and the topic is also my dissertation topic. 

Definitely interested in helping in any way with the research!

I used this site and many others in order to make a decision about my recent birth. My baby was extended breech for most of the pregnancy and after reading as much as I possibly could about why a possible vaginal delivery was possible I declined the elective section and waited for natural labour to happen.

Supported by my NHS midwives, I went into labour and made the plan to labour naturally in hospital for a set amount of time and opt for no intervention and an emergency c if things didn’t progress. After an amazing 22 hour labour, a few hours fully dilated with faint declining contractions and no desire to push and no descending baby, I opted for (a calm and requested by myself) “emergency” c and was so happy to have been given the opportunity to give natural birth a good go, and know when to call it a day and not force it.

My full story is here:

http://breechbabiesclub.org/rebecca-and-jax-breech-birth-letting-go-and-taking-control/

I wanted to share my story but am really happy to be involved in any research. I was only able to make a decision about my birth as I asked CONSTANT questions and read every single possible thing I could about breech birth. More information definitely needed so women can also make this decision for themselves and like me, EVEN thought I had an emergency c, come out the other end ELATED with their experience as they know they made all the right decisions based on information and not scare stories or sweeping statements.

Thanks for listening 🙂

I am currently 40 weeks pregnant with a breech baby hoping for a natural delivery and I would like to be involved in this project.

I had a very happy breech birth experience in February this year at X Hospital in Wales, X. I was due to have a c-section but went into labour early and then opted for vaginal birth, with encouragement from team of medical staff. Incredible midwives guided me through whole process. I feel so pleased and privileged to have such a positive birth story.

I had an undiagnosed breech vaginal birth 15th March 2015. My daughter had no complications and neither did I. She was born at 40+1. I would be happy to take part in any studies that I may be able to help with.

I saw on the X Facebook page that you are conducting studies on Breech babies.

Unfortunately I’m not available on 29th April but would be happy to help in any other way I can.

My daughter now 13months was a breech baby and I desperately wanted a vaginal birth so had to ECVs to try and turn her. They were both unsuccessful. I refused a planned c-section hoping to deliver vaginally but after 18hours of labour which didn’t progress very well I eventually had a c-section out of fear of endangering her life.

I wish there had been more support to enable a vaginal delivery. I felt that most staff didn’t feel confident enough to support and allow a breech vaginal delivery.

Author: midwifeshawn

Midwife with a special interest in complex normality, especially breech.

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