Principles of physiological breech birth practice: A Delphi study

- Upright positioning is a tool, and not a rule, of physiological breech birth.
- In physiological birth, locus of greatest efficacy perceived within mother-infant unit.
- Clinical ability to enable rather than control birth process is linked to experience.
- Calm, supportive relationships in birth environment considered a key safety factor.
- Restrictive policies and negative attitudes may undermine safety of breech birth.

Objectiveto establish a multi-professional consensus on shared principles underlying the practice of physiological breech birth.Designthree-round Delphi e-survey.Settingmulti-national.Participantsa panel of thirteen obstetricians and thirteen midwives, experienced in facilitating physiological breech births in varied settings, and involving varied maternal birthing positions, and two service user representatives.Methodsan initial survey contained open-ended questions. Answers were coded and amalgamated into 60 statements in Round 1 and a further 6 statements in Round 2. Participants considered statements in the following categories: first principles (14), maternal positioning (12), birth environment (18), fetal positions (14), safe progress (8). The panel indicated the extent of their agreement using a 5-point Likert scale. The pre-determined level of consensus was 70% of respondents indicating 4 or 5 on the Likert scale (agreement or strong agreement).Findingsthe panel indicated consensus on 37 of 66 proposed statements concerning 'Principles of Practice.' Negative data (29/66 statements) are also reported, highlighting areas of divergent opinions. The findings suggest a paradigm shift away from risk management strategies based on prediction and control, and towards facilitation strategies based on relationship and response. Upright positions are a tool and not a rule of physiological breech birth.Conclusionthe parameters of 'normal for breech' require further exploration to support professionals working within a paradigm of complex normality. The principles articulated in this research can be used to design further research exploring the influence of physiological breech practices on neonatal and maternal outcomes, including women's experiences of maternity care.