title: Standards for midwife practitioners of external cephalic version: A Delphi study.
abstract: BACKGROUND
  expansion of advanced and specialist midwifery practitioner roles across professional boundaries requires an evidence-based framework to evaluate achievement and maintenance of competency. In order to develop the role of Breech Specialist Midwife to include the autonomous performance of external cephalic version within one hospital, guidance was required on standards of training and skill development, particularly in the use of ultrasound.
  
  
  METHODS
  a three-round Delphi survey was used to determine consensus among an expert panel, including highly experienced obstetric and midwife practitioners, as well as sonographers. The first round used mostly open-ended questions to gather data, from which statements were formed and returned to the panel for evaluation in subsequent rounds.
  
  
  RESULTS
  standards for achieving and maintaining competence to perform ECV, and in the use of basic third trimester ultrasound as part of this practice, should be the same for midwives and doctors. The maintenance of proficiency requires regular practice.
  
  
  CONCLUSIONS
  midwives can appropriately expand their sphere of practice to include ECV and basic third trimester ultrasound, according to internal guidelines, following the completion of a competency-based training programme roughly equivalent to those used to guide obstetric training. Ideally, ECV services should be offered in organised clinics where individual practitioners in either profession are able to perform approximately 30 or more ECVs per year in order to maintain an appropriate level of skill.
authors: James Paget University Hospitals NHS Foundation Trust, Lowestoft Road, Gorleston, Gt Yarmouth, Norfolk NR31 6LA, UK. Electronic address: Shawn.Walker@nhs.net.
authors: Shawn
authors: S
authors: Walker
authors: James Paget University Hospitals NHS Foundation Trust, Lowestoft Road, Gorleston, Gt Yarmouth, Norfolk NR31 6LA, UK. Electronic address: Prasanth.Perilakalathil@jpaget.nhs.uk.
authors: Prasanth
authors: P
authors: Perilakalathil
authors: School of Nursing Sciences, Edith Cavell Building, University of East Anglia, Norwich NR4 7TJ, UK. Electronic address: J.F.Moore@uea.ac.uk.
authors: Jenny
authors: J
authors: Moore
authors: James Paget University Hospitals NHS Foundation Trust, Lowestoft Road, Gorleston, Gt Yarmouth, Norfolk NR31 6LA, UK. Electronic address: Claire.Gibbs2@jpaget.nhs.uk.
authors: Claire L
authors: CL
authors: Gibbs
authors: James Paget University Hospitals NHS Foundation Trust, Lowestoft Road, Gorleston, Gt Yarmouth, Norfolk NR31 6LA, UK. Electronic address: Karen.Reavell@jpaget.nhs.uk.
authors: Karen
authors: K
authors: Reavell
authors: School of Nursing Sciences, Edith Cavell Building, University of East Anglia, Norwich NR4 7TJ, UK. Electronic address: K.Crozier@uea.ac.uk.
authors: Kenda
authors: K
authors: Crozier
mesh_terms: D001946:Breech Presentation / Q000628:therapy*; D002983:Clinical Competence / Q000592:standards*; D032921:Consensus; D003697:Delphi Technique; D005260:Female; D006801:Humans; D008880:Midwifery / Q000193:education* / Q000379:methods; D024802:Nurse's Role; D011247:Pregnancy; D011795:Surveys and Questionnaires; D006113:United Kingdom
keywords: Breech; Cephalic version; Midwives; Training; Ultrasound