City, University of London, Centre for Maternal and Child Health Research, Northampton Square, London EC1 V0HB, UK; King's College London, Florence Nightingale Faculty of Nursing and Midwifery, London SE1 8WA, UK.
City, University of London, Centre for Maternal and Child Health Research, Northampton Square, London EC1 V0HB, UK.
Women Birth. 2018 Jun;31(3):e170-e177. doi: 10.1016/j.wombi.2017.09.008. Epub 2017 Sep 29.
Research suggests that the skill and experience of the attendant significantly affect the outcomes of vaginal breech births, yet practitioner experience levels are minimal within many contemporary maternity care systems.
Due to minimal experience and cultural resistance, few practitioners offer vaginal breech birth, and many practice guidelines and training programmes recommend delivery techniques requiring supine maternal position. Fewer practitioners have skills to support physiological breech birth, involving active maternal movement and choice of birthing position, including upright postures such as kneeling, standing, squatting, or on a birth stool. How professionals learn complex skills contrary to those taught in their local practice settings is unclear.
How do professionals develop competence and expertise in physiological breech birth?
Nine midwives and five obstetricians with experience facilitating upright physiological breech births participated in semi-structured interviews. Data were analysed iteratively using constructivist grounded theory methods to develop an empirical theory of physiological breech skill acquisition.
Among the participants in this research, the deliberate acquisition of competence in physiological breech birth included stages of affinity with physiological birth, critical awareness, intention, identity and responsibility. Expert practitioners operating across local and national boundaries guided less experienced practitioners.
The results depict a specialist learning model which could be formalised in sympathetic training programmes, and evaluated. It may also be relevant to developing competence in other specialist/expert roles and innovative practices.
Deliberate development of local communities of practice may support professionals to acquire elusive breech skills in a sustainable way.
研究表明，助产妇的技能和经验显著影响阴道臀位分娩的结果，但在许多当代产科护理系统中，执业经验水平很低。
由于经验不足和文化抵制，很少有从业者提供阴道臀位分娩，许多实践指南和培训计划推荐采用仰卧产妇体位的分娩技术。很少有从业者具备支持生理性臀位分娩的技能，包括积极的产妇运动和分娩姿势的选择，包括直立姿势，如跪着、站着、蹲着或坐在分娩凳上。专业人员如何在与其当地实践环境中教授的技能相反的情况下学习复杂技能尚不清楚。
专业人员如何在生理性臀位分娩方面发展能力和专长？
9 名有经验的助产士和 5 名产科医生参与了半结构化访谈。使用建构主义扎根理论方法对数据进行迭代分析，以发展生理性臀位技能获取的经验理论。
在这项研究的参与者中，在生理分娩方面获得能力的刻意获取包括与生理分娩的亲和力、批判性意识、意图、身份和责任等阶段。在本地和国家边界运作的专家从业者指导经验较少的从业者。
研究结果描绘了一种专门的学习模式，可以在同情的培训计划中正式化，并进行评估。它也可能与在其他专业/专家角色和创新实践中发展能力有关。
有针对性地发展实践社区可能以可持续的方式支持专业人员获得难以捉摸的臀位技能。
