title: Standards for maternity care professionals attending planned upright breech births: A Delphi study.
abstract: OBJECTIVE
  to establish a consensus of opinion on standards of competence for professionals attending upright breech births.
  
  
  METHODS
  a three-round Delphi e-survey.
  
  
  METHODS
  multinational.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
authors.affiliation: City University London, Centre for Maternal and Child Health Research, Northampton Square, London EC1V 0HB, UK; Imperial College Healthcare NHS Trust, St. Mary׳s Hospital, Praed Street, London W2 1NY, UK. Electronic address: Shawn.Walker@city.ac.uk.
authors.forename: Shawn
authors.initials: S
authors.lastname: Walker
authors.affiliation: City University London, Centre for Maternal and Child Health Research, Northampton Square, London EC1V 0HB, UK. Electronic address: Mandie.Scamell.1@city.ac.uk.
authors.forename: Mandie
authors.initials: M
authors.lastname: Scamell
authors.affiliation: City University London, Learning Enhancement and Development, Northampton Square, London EC1V 0HB, UK. Electronic address: P.M.Parker@city.ac.uk.
authors.forename: Pam
authors.initials: P
authors.lastname: Parker
mesh_terms: D000328:Adult; D001946:Breech Presentation; D003697:Delphi Technique; D005260:Female; D006801:Humans; D020407:Internet; D008131:London; D008880:Midwifery; D009774:Obstetrics; D056888:Patient Positioning; D017410:Practice Guidelines as Topic; D057184:Practice Patterns, Nurses' / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011247:Pregnancy; D013222:State Medicine; D011795:Surveys and Questionnaires
keywords: Breech presentation; Clinical competence; Delphi; Midwifery; Obstetrics; Training