Standards for maternity care professionals attending planned upright breech births: A Delphi study

Objective: to establish a consensus of opinion on standards of competence for professionals attending upright breech births. Design: a three-round Delphi e-survey. Setting: multinational. Participants: a panel of 13 obstetricians, 13 midwives and two user representatives. Clinicians had attended > 20 upright breech births, or > 10 upright among > 40 total breech births. Mean level of experience = 135 breech births, median = 100 breech births. Methods: an initial survey contained open-ended questions. Answers were coded and amalgamated to form 164 statements in the second round and 9 further statements in the third round. Panellists were asked to evaluate their agreement with each statement using a 5-point Likert scale. The pre-determined level of consensus was 70% of respondents indicating agreement or strong agreement with the statement. Findings: the panel returned a consensus-level agreement on 63 statements under the theme, 'Standards of Competence.' Panellists supported teaching breech as a 'normal' skill rather than an emergency, including optimal mechanisms and breech-specific progress measures, upright variations of classical manoeuvres, the initiation of resuscitation with the umbilical cord intact, birth videos as learning tools, and the development of breech teams to support the wider team in all maternity care settings. Conclusions: although every health professional should maintain basic competence to assist unanticipated breech births, establishing enhanced training and standards for those who support planned breech births may help protect users and providers of maternity services, while introducing greater choice and flexibility for women seeking the option of vaginal breech birth. (C) 2016 Elsevier Ltd. All rights reserved.