You are invited to an open discussion about the Draft of the new NICE Antenatal Care Guideline. Breech Birth Network would like to collect the views of families who have experienced a breech presentation at term and care providers on the draft guidance.
The NICE Antenatal Care Guideline covers the detection of breech presentation (how midwives and obstetricians pick up that your baby is breech) and how a known breech presentation at term should be managed by your care providers.
The recommendations are based on outcomes that are considered ‘critical’ and ‘important.’ A discussion of how the committee has prioritised outcomes and decided upon a recommendation is included in the Evidence Reviews.
This is a first meeting. A second will be held in March to review the results of this meeting and any written responses Breech Birth Network has received, before the deadline at the end of March. At the meeting we will:
Help you understand what the guideline and evidence reviews are saying.
Ask you how you feel about the recommendations.
Ask you if you would like to provide any feedback to the committee, which we will include in a collective response.
If you are unable to attend this meeting, you are also welcome to:
engage in this discussion by posting a comment on this blog page;
contact us using the e-mail form below to provide non-public feedback;
Note: We have observed that some of the women we work with have experienced distress or sometimes trauma in their breech pregnancies. If your experience makes it uncomfortable to participate in a group event, and you would like to have a 1:1 meeting with someone from the Breech Birth Network, please contact us using the e-mail form below.
Shawn Walker is inviting you to a scheduled Zoom meeting.
Topic: Consultation on draft NICE Antenatal Guideline Time: Feb 13, 2021 02:00 PM London
From Tisha Dasgupta, OptiBreech Research Assistant, re-blog from The OptiBreech Project: We would like to invite women, birthing people and their families who have experienced a breech pregnancy at term to attend an online focus group discussion on Thursday 10th December 10.30-11.30am to be conducted via Microsoft Teams. Anyone with an interest and experience of breech pregnancy can participate.
The purpose of this meeting will be to get your perspective on the following issues:
A core outcome set is a minimum set of outcomes that should be collected in every study about a topic, in this case vaginal breech birth at term. Making these consistent means that we can better compare and combine studies, and ensure research meets the needs of those who use it.
To develop a core outcomes set, we have conducted a systematic review of the available literature relevant to this project (brief summary below). However, we need your input to determine if these outcomes are important to the people who will use the results of research to make decisions, and how important each is. Does this meet all your informational needs or are there outcomes that have not been identified, which you think is important to record?
Do you think it is important to include salutogenically focused outcomes that emphasize positive well-being of the mother and newborn such as maternal satisfaction, relationship with baby etc.? If so, which factors would you like to see and how important do you think these are?
The next stage will be to ask both professionals and service users to rate the importance of the outcomes to be included in the core outcome set. But before we do this, we want to insure all of the outcomes important to you are included.
You are welcome to share your feedback directly during the focus group meeting or by emailing Tisha Dasgupta (firstname.lastname@example.org), the OptiBreech Research Assistant, at any point. If you are unable to make it and would like to contribute, or have further feedback after the session, please also contact Tisha.
While we do not require written consent for your participation in the meeting, it is important to let you know that the session will be recorded. We intend to take the feedback you provide into consideration while designing the next stage of this project: a multinational Delphi study. No identifiable information will be used such as direct quotes or anecdotes, and we will only report summary data.
Thank you very much for your consideration. Please could you send your RSVP to email@example.com by Monday, 7th December to confirm your attendance at the session? She will be in touch thereafter to provide you access to the online meeting.
We’d also love to hear your views on the information presented on the OptiBreech website!
Overall summary of the Systematic Review
A systematic review of all relevant literature was conducted to identify outcomes, definitions and measurements previously reported in effectiveness studies of breech births at term. 108 studies were identified comprising of systematic reviews, randomised controlled trials and comparative observational studies, with full-text available in English. Below are the most common outcome measures, with a percentage of how many studies reported them. These are the top 10 most frequently reported measures in each category grouped by neonatal, maternal, features of labour, and long-term maternal outcomes respectively.
% studies reported
APGAR score at 5 minutes
Perinatal or neonatal mortality
Admission to neonatal intensive care unit (NICU)
Neonatal birth trauma/morbidity
Brachial plexus injury / peripheral nerve injury
Low umbilical artery pH
Hematoma (cephalic or subdural)
Post-partum haemorrhage (PPH)
PPH requiring blood transfusion
Other serious maternal morbidity/other complications
Providing evidence-based information to parents throughout the pregnancy, birth and post-partum journey is an essential part of the role of all healthcare professionals working in maternity services. However, evidence suggests in some areas of maternity, such as the highly politicised area of vaginal breech birth, the information provided to parents is biased towards that of what the system supports or the individual healthcare professional providing the counselling prefers. A compelling ethical and legal requirement exists to provide the evidence to parents which they have a right to receive, as discussed by Kotaska et al (2007).
An international qualitative survey by Petrovska et al (2017) surveyed women who had a breech presentation and were seeking support for their choice of mode of birth. Petrovska et al (2017) examines how mothers found inadequate system and clinical support for vaginal breech birth which impeded their access to unbiased information on their options for mode of birth and the care they received. In a paper written by Powell et al (2015) they also found that parents were often given unbalanced information. This lack of balanced information was a motivating factor in developing an information leaflet for parents identified with a breech presentation at or near the end of their pregnancy. The development of an information leaflet is supported by many papers such as that by Guittier et al (2011) and Sloman et al (2016) who also found parents were often provided with biased information. We hope the development and provision of useful, unbiased information material will assist with decision making and enable parents to make an informed choice of their options with a breech presentation.
Since setting up a breech service within the Trust I work I have seen the difference in counselling techniques and the information provided to parents. As part of my clinical role I meet parents for birth options discussions, often parents seeking support to use a Birth Centre for labour and birth despite having either medical or obstetric complexities which means the recommendation would be to labour and birth on the obstetric unit. Many of these discussions are with mothers who have had a previous caesarean section often for breech presentation in their first pregnancy. In nearly all of these cases the parents say they were never given the option to have a vaginal breech birth and yet the NMC Code states:
2.3 encourage and empower people to share in decisions about their treatment and care
2.4 respect the level to which people receiving care want to be involved in decisions about their own health, wellbeing and care
2.5 respect, support and document a person’s right to accept or refuse care and treatment
6 Always practise in line with the best available evidence
To achieve this, you must:
6.1 make sure that any information or advice given is evidence-based including information relating to using any health and care products aor services
Clinicians should counsel women in an unbiased way that ensures a proper understanding ofthe absolute as well as relative risks of their different options. [New 2017]
It is alarming that despite this guidance, and in light of more recent evidence which has emerged on the suitability of vaginal breech birth for selective pregnancies, that parents are still not being given all their options and more importantly the impact it is having on their future pregnancies.
The information leaflet has been developed in response to the acknowledged lack of balanced information available to parents. To ensure the information is evidence-based it includes data from the RCOG (2017) guidelines as well as other research sources such as that from Louwen et al (2016) and the NICE Caesarean Section Guideline (2013). The information leaflet was circulated to healthcare professionals of all grades (midwives, SHO’s, Registrars and Consultants) as well as parents who had experienced a breech presentation previously. They were asked to comment via a SurveyMonkey on the information which was provided in the leaflet to ensure it was easy to understand, informative, evidence-based and unbiased. The leaflet is provided below in both PDF leaflet form as well as an MS Word format, so healthcare professionals are able to download and edit for use in their own healthcare organisation.
Providing this readily available resource for parents and healthcare professionals is invaluable for ensuring the correct information is easily accessible and shared to not only support parents in making an informed choice about their options, but also for assisting with the counselling healthcare professionals provide to those in their care. If you have any questions or comments about the information leaflet, please do not hesitate to contact us on the contact form provided below.
We are seeking your thoughts on two new pieces of research currently in the development stage. If you have experienced a breech pregnancy within the last 5 years in the UK, either yourself or your partner, or you work with pregnant women in a non-medical capacity (e.g. doula, antenatal teacher, breastfeeding supporter, etc.), we would love to hear from you.
Emma Spillane would like your feedback on an Information Leaflet for people pregnant with breech-presenting babies. The leaflet will be used in research to determine an approximate level of demand for vaginal breech birth, with balanced counselling and adequate support.
Talking through elevate and rotate
Shawn Walker is preparing an application for a large grant to fund a pilot randomised controlled trial. No term breech trials have been published since 2000 (Hannah et al). The team around this project would like to gather a Breech Advisory Group composed of people who have experienced a breech pregnancy within the last 5 years in the UK, either yourself or your partner, and non-medical birth workers, such as doulas and antenatal teachers. At this stage, we would like your feedback on the suggested design of the trial, to ensure that the information resulting from the research will be useful to those considering breech options. For those of you who would like to remain with the project if funding is obtained, we will send regular updates with opportunities to provide feedback at stages like final project design, advertising the trial and analysing the results.
If you are interested in participating in our research in this way, please complete the form below and one of us will be in touch.