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Expertise in physiological breech birth: A mixed-methods study

Research output: Contribution to journalArticle

Shawn Walker, Pam Parker, Mandie Scamell

Original languageEnglish
Pages (from-to)202-209
Number of pages8
JournalBIRTH
Volume45
Issue number2
Early online date5 Dec 2017
DOIs
Accepted/In press21 Oct 2017
E-pub ahead of print5 Dec 2017
Published1 Jun 2018

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Abstract

Background
The safety of vaginal breech birth depends on the expertise of birth attendants, yet the meaning of “expertise” remains unclear and subjectively defined. The objective of this study was to define expertise and the roles experts may play in expanding access to this service.

Methods
We performed an integrative analysis of two strands of data concerning expertise in physiological breech birth, including the following: survey data from a Delphi study involving 26 very experienced clinicians (mean experience = 135 breech births) and 2 service user representatives, and interviews from a grounded theory study of 14 clinicians more moderately experienced with physiological methods (5-30 upright breech births). Data were pooled and analyzed using constant comparative methods.

Results
Expertise is defined by its ongoing function, the generation of comparatively good outcomes, and confidence and competence among colleagues. Although clinical experience is important, expertise is developed and expressed in social clinical roles, which expand as experience grows: clinician, mentor, specialist, and expert. To develop expertise within a service, clinicians who have an interest in breech birth should be supported to perform these roles within specialist teams.

Conclusions
Specialist breech teams may facilitate the development of expertise within maternity care settings. Evaluation of expertise based on enablement of women and colleagues, as well as outcomes, will potentially avoid the pitfalls of alienation produced by some forms of specialist authority.

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