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Changing the tide: influencing factors for midwives on vaginal breech birth skill acquisition

02 August 2021
Volume 29 · Issue 8



Breech presentation at term occurs in 3%–5% of pregnancies. Many midwives are not skilled in vaginal breech births which affects the safety of vaginal breech birth. This research study begins to explore the influencing factors for skill attainment and potential areas for change to enhance education and competence.


This was a small exploratory qualitative study that used a focus group with four participants for data collection.


The influence of internal and external factors in midwives' competence are represented by a ‘continuum of change’ and by moving from a place of fear to one of educational enlightenment. This encompasses three themes: ‘not a good place’, ‘changing the tide’ and ‘new normal’.


Education of student midwives and registered midwives is key in creating a safe space for vaginal breech births. Introducing normal physiology early in curriculums can impact the initial framing of vaginal breech birth. The uptake of specialised physiological breech birth training by registered midwives and other birth practitioners is upskilling all practitioners.

Breech presentation at term gestation has been estimated to occur in 3%-5% (1:25) of pregnancies (Hannah et al, 2000; Walker et al, 2018a) with very few of these resulting in a vaginal birth. Following the recommendations of the ‘Term Breech Trial’ (TBT) by Hannah et al (2000), most developed countries almost immediately changed policies to advising women to choose a planned caesarean section for breech presentation based on the results regarding safety, morbidity and mortality. Much debate has ensued since the publication by Hannah et al (2000) regarding the methodology of the study and follow-up outcomes (Lawson, 2012; Sloman et al, 2016; Walker et al, 2018a). The speed of change suggests this was the permission practitioners were waiting for to move away from vaginal breech births with the implementation of planned caesarean sections leading to a quick reduction in the number of skilled clinicians familiar with vaginal breech births (VBBs) on a global scale.

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