Women's and Children's Health, Epsom and St Helier University Hospitals, Epsom, UK.
Kingston Hospital NHS Foundation Trust, Kingston, UK.
Birth. 2021 Dec;48(4):558-565. doi: 10.1111/birt.12562. Epub 2021 Jun 23.
The "physiological breech birth" one-day training program is based on evidence about the physiology of breech births and how clinicians learn breech skills. Previous evaluations have demonstrated positive effects on confidence and knowledge, but the training's effect on clinical practice and outcomes is unknown.
A mixed-methods evaluation was conducted in eight National Health Service hospitals in England and Northern Ireland. Changes in confidence and knowledge were assessed using pretraining and post-training surveys. Mode of birth and maternal birth positions were evaluated using audit data covering one year before the training and one year after, for all singleton vaginal breech births at term.
A total of 263 participants completed the surveys. Confidence in managing breech births in both upright and supine positions significantly increased, as did participant knowledge. Audited data for 1402 women were collected. Overall vaginal birth rates remained similar in both periods. Among singleton vaginal breech births >37 weeks, the use of upright birthing positions increased significantly (P = .002). The study was not powered to detect differences in other outcomes, but pilot data were collected to inform the design of future studies.
Increase in use of upright birthing positions suggests that physiological breech birth training is likely to lead to clinical practice changes, which may help support maternal choice in line with current guidance. However, provision of a one-day training program did not change overall vaginal breech birth rates. Adequately powered research is needed to determine effects of clinical practice changes on clinical outcomes.
“生理性臀位分娩”一日培训课程基于臀位分娩的生理学知识和临床医生学习臀位技能的方式。此前的评估表明，该培训对信心和知识有积极影响，但培训对临床实践和结果的影响尚不清楚。
在英格兰和北爱尔兰的 8 家国民保健制度医院进行了一项混合方法评估。使用培训前后的调查评估信心和知识的变化。使用审核数据评估分娩方式和产妇分娩姿势，审核数据涵盖培训前一年和培训后一年所有足月单胎阴道臀位分娩。
共有 263 名参与者完成了调查。在直立和仰卧位管理臀位分娩的信心显著提高，参与者的知识也有所增加。共收集了 1402 名女性的审核数据。两个时期的阴道分娩率总体相似。在>37 周的单胎阴道臀位分娩中，直立分娩姿势的使用显著增加（P=0.002）。该研究没有足够的能力来检测其他结果的差异，但收集了试点数据，为未来研究的设计提供了信息。
直立分娩姿势的使用增加表明，生理性臀位分娩培训可能会导致临床实践的改变，这有助于根据当前指南支持产妇的选择。然而，提供为期一天的培训课程并没有改变总体阴道臀位分娩率。需要进行足够有力的研究，以确定临床实践变化对临床结果的影响。
