Eligibility: Women >36 pregnant with a confirmed breech presentation, including breech presentations diagnosed for the first time in labour, no absolute contraindications for a vaginal birth
Feasibility sample: 100 women, minimum of 10 per site, 4 Trusts in South London Clinical Research Network (Guy’s and St Thomas’, King’s, Lewisham & Greenwich, Kingston)
Stratifiedby nulliparous / multiparous. Randomised to standard care or PBB care.
- Competence to deliver standard care is expected from consultant obstetric team on duty or as delegated. Specialist care is not available outside of participation in the trial.
- Counselling provided by a member of the obstetric team on duty, or a midwife as delegated.
- Recommend ECV if diagnosed before labour.
- Offer planned CS or planned vaginal breech birth.
- Supervision of all vaginal breech births by consultant obstetrician on duty.
physiological breech birth care
- Designated specialists: Breech Lead Obstetrician, Breech Specialist Midwife
- All care is provided by a specialist or another practitioner ‘skilled and experienced’ in physiological breech birth, as assessed by the specialists. These leaders are responsible for ensuring 24/7 availability of ‘skilled and experienced’ staff (the ‘breech team’) and flexible working is enabled. At a minimum, this would include ability for staff called to a breech birth outside of normal working hours to claim these hours back, but the exact arrangements will be staff-led and determined by local circumstances.
- Counselling provided by one of the specialists or a member of the ‘breech team.’
- Explanation of the support mechanisms put in place to make vaginal breech birth as safe as possible – but that we do not know if it works.
- Offer ECV or CS if this is unacceptable.
- Attendance in labour and supervision of all vaginal breech births by a member of the ‘breech team.’