An initial objective of this research is to develop a core outcome set for effectiveness trials of vaginal breech birth (COMET). Establishing a core outcome set enables the results of trials to be combined and compared in meta-analysis and gives us a way to judge the effectiveness of interventions across settings.
If it does not prove feasible to conduct a randomised trial, a different design may work better. For example, a large prospective observational study, using the same core outcome criteria. While many sites within the UK are implementing physiological breech birth, many successful early adopters are outside of the UK. Collaborating with them will enable each of us to demonstrate local results, and to identify the incidence of rarer outcomes such as perinatal morbidity and mortality (death or serious illness around the time of birth).
Therefore I am proceeding with both potential projects in mind, so that the work has a flexible back-up plan for providing the answers that women and health care professionals want about physiological breech birth. I have applied for a smaller grant, which would fund the outcomes consensus project and creation of an on-line database, to which collaborators anywhere in the world could contribute once local approvals are obtained. If both applications are successful, the international prospective observational study would provide evidence of the generalisability of any results we see within the UK study.
International collaborators who have agreed to lead data collection in their countries are:
- Germany — Dr Anke Reitter, Chief Obstetrician, Krankenhaus Sachsenhausen, Frankfurt
- Australia — Dr Andrew Bisits, Director of Obstetrics, Royal Hospital for Women, Sydney
- Denmark — Dr Kamilla Gerhard-Nielsen, Obstetrician, Syghus Sønderjylland, Aabenraa
- Netherlands — Dr Floortje Vlemmix, Amsterdam Universitair Medische Centra; and Dr Leonie van Rheenan-Flach, OLVG West, Amsterdam
- Sweden — Dr Julia Savchenko, Obstetrician, Södersjukhuset, Stockholm
- Canada — Jane Wines, Midwifery Lecturer, University of British Columbia
- Ethiopia — Kidist Eshetu Berhahu, Hawassa College of Health Science, Ethiopia; and Shimeles Tsegaya Tessema, Dilla University
- Hungary — Dr Zoltan Kovacs, Obstetrician, Robert Hospital, Budapest
- Brazil — Professor Melania Amorim, Senior Researcher & Obstetrician, Instituto Paraibano de Pesquisa Professor Joaquim Amorim Neto (IPESQ) and Dr Priscila Ribeiro Huguet, San Paolo
- Belgium — Dr Caroline Daelemans and Dr Sara Derisbourg, Erasme Hospital, Brussels
- India — Dr Evita Fernandez and Indie Kaur, Fernandez Hospital Foundation, Hyderabad