I am incredibly grateful for the time my senior obstetric and midwifery colleagues have taken to read and engage with the plans for the #termbreech2020 Physiological Breech Trial. If feasible, this will be the first trial of term breech birth in over 20 years. Multi-disciplinary involvement in the trial design is essential to its success. This will be the first in a series of blogs addressing some potential barriers identified. The purpose is to 1) involve others in the discussion and reflection; 2) invite further feedback; and 3) share the learning with colleagues who are planning to implement a Breech Team, within the feasibility study or independently.
‘Breech Team’ is a succinct term for a Breech Clinical Teaching Team.
A Breech Clinical Teaching Team is a multi-disciplinary group of clinicians within a maternity care team who are proficient in facilitating physiological breech births, leading on breech training within the institution and attending vaginal breech births regularly in their clinical teaching role.
What does this look like?
In the #termbreech2020 feasibility study, we will start by providing Physiological Breech Birth training to five consultant obstetricians and five senior midwives.* These 10 initial Breech Team members will organise themselves to cover the service. The team has autonomy over determining how this will work, but support from the institution is essential. The role needs to be recognised so that, at a minimum, team members can be released from other duties temporarily when required to attend a breech birth, or given time back if they have attended a birth outside their normally scheduled hours.
The core team should include clinicans who 1) spend a lot of time on the Labour Ward; 2) enjoy teaching; and 3) have skill and experience attending vaginal breech births.
When attending a breech birth, the role of a Breech Team member is to 1) support the attending clinicians to develop their own physiological breech birth skill set; 2) to maintain safety while this occurs; and 3) to continue their own learning. Following each breech birth attended, the Breech Team member shares the learning from that birth by providing a brief reflective account and simulation if appropriate, or supporting the attending clinican to do so, for other members of the maternity care team who did not attend the birth.
The Breech Team also collaborates and leads on breech guidelines and education within the institution. This promotes a consistent approach and dissemination throughout the wider maternity care team.
What a Breech Team is not: A small group of clinicians who are the only people allowed to attend breech births. The role is an additional safety and training mechanism.
Do you have a breech team in operation within your unit? Is it formally set up or informally arranged on a per-woman basis? I would love to hear your thoughts and experiences.
Upcoming Breech Team blogs:
- What is the evidence for Breech Teams?
- What are the proficiency criteria?
- Wouldn’t it make more sense to train everyone?
- Isn’t this what Consultant Obstetricians do?
- Is it equitable?
- What if we can’t guarantee 24/7 cover?
- When a Breech Team member supports a breech birth, who is legally responsible?
- Isn’t counselling the biggest issue? Why can’t we just improve counselling to make sure every woman is able to make an informed choice?
- How much will it cost?
* All breech training is provided free of charge for the institutions that are participating in #termbreech2020. The feasibility study includes a budget for the release of time for the initial 10 Breech Team members. Breech Team members will then lead on education within the insitution, but training materials (videos, presentations, etc.) and support will be provided. Institutions can request further free training at any time.
What is Physiological Breech Birth? Read more here: Walker S, Scamell M, Parker P (2016) Principles of physiological breech birth practice: A Delphi Study. Midwifery. 43:1-6. (Author version archived at City Research Online)