Group 1: The meaning of 'expertise' in physiological breech birth: Findings from a mixed methods study

Background: The 2017 Royal College of Obstetricians and Gynaecologists’ guideline on Management of Breech Presentation makes frequent reference to the need for skilled practitioners as a key safety factor for vaginal breech... [ view full abstract ]

Background: The 2017 Royal College of Obstetricians and Gynaecologists’ guideline on Management of Breech Presentation makes frequent reference to the need for skilled practitioners as a key safety factor for vaginal breech births. But the meaning of ‘skilled’ is undefined.

Method: This study triangulates unpublished findings from two studies for which the main results have already been published. These include a Delphi technique study involving a panel of 13 midwives and 13 obstetricians experienced with physiological breech birth (>20 births), and a grounded theory study of in-depth interviews with 9 midwives and 5 obstetricians who were gaining experience with upright breech birth (5-30 upright breech births). Consensus statements from the Delphi study were used to guide analysis of the interviews, using the constant comparative technique associated with grounded theory, in order to explore the function of experts in the deliberate development of competence.

Results: The comparative analysis of data from these two studies suggest that experts are experienced professionals who have successfully resolved a number of complications and reflected on these experiences in a way that enables them to teach others how to recognise and promote normality, as well as anticipate, avoid and resolve complications. They play an important role in other professionals' deliberate acquisition of competence.

Discussion: Identification of how ‘experts’ function in a maternity care team may enable training programmes to more effectively develop specialists with expertise in areas of complex normality. The results have implications for the development of expertise in other areas, such as vaginal birth after caesarean section and physiological twin birth.