Breeching the System: An exploration of women’s experiences and breech care recommendations

Aim: This presentation reports the findings of a mixed methods study exploring women’s experiences of breech birth in Western Australia (WA) and professional recommendations for breech care. Methods: This pragmatic study consisted of a clinical guideline review, semi-structured interviews with women who had experienced a breech birth in WA and a multi-national e-Delphi study involving professionals with knowledge and/or experience of caring for women with a breech presenting fetus. These methods were deemed the optimal way of incorporating current clinical practice guidelines, with multi-disciplinary recommendations and consumer feedback. Findings: The clinical guideline review revealed similarities in antenatal care structure and indications for a caesarean section. However inconsistencies existed in recommendations for birth mode counselling, intrapartum management and the basis for each recommendation. Women reported experiencing varying levels of disciplinary power throughout their experiences. Five distinct stages of the breech experience were identified: Reacting, Information, Bargaining, Decision-making and Acceptance. Midwives were identified as navigators and negotiators of a medicalised, patriarchal health system. The e-Delphi study resulted in the development a consensus based care pathway from diagnosis to birth, as well as a framework for developing, maintaining and recording of breech birth skills and proposes a definition for a footling breech. Midwifery-led continuity of care with supportive obstetric input was recommended as the ideal model of care. Implications: The data from this study will inform the development of a breech specific Integrated Care Pathway (ICP). A more woman-centred approach is recommended for breech presentation. Practice improvement recommendations include balanced information provision and access to skilled and supportive clinicians through the implementation of a specialised breech service or team. A breech specific ICP has the potential to streamline care, promote un-biased counselling and improve communication between women and clinicians. It may aid the implementation of a dedicated breech service for women in WA