What are women's experiences of seeking to plan a vaginal breech birth? A systematic review and qualitative meta-synthesis.

Background: Guidelines for breech management at term emphasise choice and informed decision-making. Despite this, the choice of vaginal breech birth (VBB), is not always available or accessible. We aimed to describe the experiences of women seeking a VBB as reported in primary research and to offer strategies for improving this experience that are grounded in evidence. Methods: We conducted a systematic review and qualitative meta-synthesis of the results, using grounded theory analysis methods (PROSPERO registration CRD42021262380), with literature published between January 2000 and February 2022. Seven databases were searched. Our review included literature about women with breech presentation, who sought a planned or unplanned VBB. Studies considering only experiences of alternative management (e.g. caesarean, external cephalic version), and those investigating healthcare workers' experiences were excluded. Covidence systematic review software was used for screening and quality assessment. Qualitative data were extracted using NVivo software (20.5.0). Data were analysed through an iterative process based on constant comparison methods, with an iterative and reflexive code generation process. Codes were then arranged into 'categories of experience', which gave rise to over-arching themes. Results: Our review included 19 studies. We present one overarching theory: 'Women who wish to plan a vaginal breech birth seek connected autonomy'. Our schematic, depicting this theory, includes seven main categories of experience: paternalistic healthcare; emotional turmoil; judgement and self-doubt; mother vs society: refusing to conform; isolated but united by breech; welcomed direction; and supported self-determination and self-efficacy. Conclusions: Women seeking to plan a VBB feel vulnerable and wish to connect with capable and confident healthcare providers. To meet their needs, services should be designed so that they can connect with clinicians who are willing and able to support their autonomy. Services should also seek to limit their exposure to disrespectful and judgemental interactions with healthcare providers.

Members of our public involvement and engagement group and some participants in the OptiBreech research reported difficulty in attempts to access supportive care when trying to plan a vaginal breech birth. This conflicts with national guidance, which emphasises choice and informed decision-making. We wanted to understand more about the experience of seeking to plan a vaginal breech birth, so we searched for research on this topic. We made a careful plan before we started and registered this plan. We searched seven online databases for literature published between January 2000 and February 2022. We focused on studies about women pregnant with breech babies, who sought to plan a vaginal breech birth or whose baby was discovered to be breech in labour. We used Covidence systematic review software to organise and assess the quality of the research we collected. We gathered main themes and illustrative quotes from all of the papers and compared these. We met frequently to discuss our observations and to agree on how we would summarise information we gathered. We agreed that, overall, women who wanted to plan a vaginal breech birth felt vulnerable. They wanted to connect to confident, capable healthcare providers who could help them achieve a vaginal birth as safely as possible: 'connected autonomy.' But their actual experiences ranged widely, including: paternalistic healthcare; emotional turmoil; judgement and self-doubt; mother vs society: refusing to conform; isolated but united by breech; welcomed direction; and supported self-determination and self-efficacy. We concluded that, to meet the needs of women who wish to plan a vaginal breech birth, services should be designed so that they can connect with clinicians who are willing and able to support their autonomy. Services should also limit their exposure to disrespectful and judgemental interactions with healthcare providers.

Effect of time of diagnosis to surgery on outcome, including long-term neurodevelopmental outcome, in necrotizing enterocolitis.

A systematic review of the PubMed and EMBASE databases was carried out to determine if time from diagnosis to surgery affects outcomes in necrotising enterocolitis. The study was registered on the PROSPERO website. Studies reporting both time to surgery and at least one clinical outcome measure in infants undergoing surgery for NEC were included. The initial search returned 1121 articles. After removing duplicates, title, and abstract screening, 49 remained for full-text review. Of these, only two reported both timing of surgery for NEC and at least one clinical outcome. The total number of neonates included was 202. Outcomes reported were death and/or parenteral nutrition use 28 days post surgery in one study and white matter brain injury in the other. No statistically significant association was found between any of the outcomes reported and timing of surgery. There were, however, significant differences associated with non-modifiable risk factors, such as age and gestation, at presentation. However, very few studies report this as a variable. Given the continuing poor outcomes and heterogeneous nature of NEC and its treatments, further large-scale prospective studies are required to examine the impact of timing of surgery, alongside other, potentially modifiable factors on outcome in NEC.

Using active Leptospermum honey in the debridement process: 6 challenging cases from the inner city.

The use of honey-based dressings has been documented for thousands of years. Recent studies suggest their effectiveness may be, in part, related to their ability to facilitate autolytic debridement. Six patients who presented with multiple comorbidities and risk factors for delayed healing whose wounds required debridement were managed with active Leptospermum honey (ALH) to evaluate the safety and effectiveness of this treatment modality. The 6 patients ranged in age from 39 to 81 years. The ALH was covered with a foam dressing; both dressings were changed approximately every 3 days. After 9 to 20 days of use, wounds were completely, or almost completely, debrided, and a 75% concomitant average increase in the amount of granulation tissue in the wound bed was observed. No adverse events were noted. The use of ALH in this case series was effective, and no surgical debridement was needed. Research to compare the efficacy of ALH to other debridement methods is warranted.