OptiBreech collaborative care versus standard care for women with a breech-presenting fetus at term: A pilot parallel group randomised trial to evaluate the feasibility of a randomised trial nested within a cohort

by Shawn Walker, Emma Spillane, Kate Stringer, Lauren Trepte, Siân M. Davies, Jacana Bresson, Jane Sandall, Andrew Shennan, the OptiBreech Collaborative

OptiBreech collaborative care is a multi-disciplinary care pathway for breech presentation at term, with continuity from a breech specialist midwife, including where chosen, for vaginal breech birth (VBB). Pilot randomised trial using unblinded 1:1 parallel group allocation to OptiBreech versus standard care, within a cohort. Participants were women with a breech-presenting fetus > 33 weeks, at four sites in England, January–June 2022. A two-stage consent process was used. Participants consented to undergo random selection to be offered a ‘new care process’, with a choice to accept it, or not. Primary objectives were to identify recruitment, acceptance, and attrition rates. Randomisation procedures and potential primary outcomes for a substantive study were also feasibility-tested. 68 women were randomised between January–June 2022. The consent process was acceptable to participants, but randomisation was unacceptable to women who specifically sought OptiBreech care. Two women withdrew due to concerns about sharing personal information. More women planned a VBB when randomised to OptiBreech Care (23.5% vs 0, p = .002, 95% CI = 9.3%,37.8%). Women randomised to OptiBreech care had: lower rates of cephalic presentation at birth (38.2% vs 54.5%), higher rates of vaginal birth (32.4% vs 24.2%), lower rates of in-labour caesarean birth (20.6% vs 36.4%), lower rates of neonatal intensive care (5.9% vs 9.1%), and lower rates of severe neonatal morbidity (2.9% vs 9.1%). Randomisation was stopped on the advice of the steering committee before the planned sample of 104, as lack of access to VBB within standard care prohibited comparison of outcomes. Demand for VBB is sufficient for a cohort study, but comparison of outcomes by 1:1 randomisation is not feasible. OptiBreech care would be best evaluated using stepped wedge cluster randomisation. Funded by the United Kingdom National Institute for Health and Care Research (NIHR300582). Clinical trial registration: ISRCTN 14521381.

Women’s socioeconomic status and attitudes toward intimate partner violence in Eswatini: A multilevel analysis

by Garikayi B. Chemhaka, Stanzia Moyo, Maswati S. Simelane, Clifford Odimegwu

Introduction

Attitudes supportive of spousal violence retards developmental efforts worldwide, and in particular in patriarchal African settings. It is important to curb this behavior by designing preventative evidence-based policies. This study examines the acceptance of intimate partner violence among women residing in Eswatini and determines whether attitudes supportive of intimate partner violence are associated with women’s low socioeconomic status both at the individual- and community-level.

Methods

Cross-sectional secondary data from two Eswatini Multiple Indicator Cluster Surveys (MICS) conducted in 2010 and 2014 with representative samples of 4,686 and 4,761 women, respectively were analyzed using descriptive statistics and multilevel (random effect) logistic regressions.

Results

Overall, the prevalence of acceptance of intimate partner violence declined significantly between 2010 and 2014 in Eswatini (29.0% vs. 19.8%, p Conclusions

Secondary or higher education for individual women and a high proportion of women in the community with low socioeconomic disadvantage are important socioeconomic predictors of reducing women’s supportive attitudes toward intimate partner violence. Therefore, further gains in non-supportive attitudes toward acceptance of intimate partner violence could be achieved through efforts and intervention in the education of individual women and improving women’s socioeconomic status in the community.