Attitudes of maternity care providers toward regional centralisation of vaginal breech birth: a qualitative study

Danielle Luiting-Wagenaar; Merle Van Dijk; Wessel Ganzevoort; Etelka Moll; Fedde Scheele; Joost Velzel

doi:10.1136/bmjopen-2025-110114

Attitudes of maternity care providers toward regional centralisation of vaginal breech birth: a qualitative study

Danielle Luiting-Wagenaar
, Merle Van Dijk^*
, Wessel Ganzevoort
, Etelka Moll
, Fedde Scheele
, Joost Velzel

^*Corresponding author for this work

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

Objectives To explore maternity care providers’ attitudes toward regional centralisation of vaginal breech birth (VBB) care and gather their recommendations for maintaining clinical proficiency.

Design Exploratory qualitative study using semi-structured interviews and thematic analysis.

Participants 10 hospital-based maternity care professionals (nine obstetricians and one clinical midwife), purposively sampled to represent experience and institutional diversity.

Setting 10 hospital maternity units in a metropolitan region of the Netherlands. Key themes describing provider attitudes towards two proposed models of centralised care (mobile breech team, designated referral centre) and alternative strategies.

Results Three core themes emerged: (1) proficiency—providers valued regular exposure, formal training and peer support, expressing concern that centralisation would reduce overall workforce readiness; (2) organisation—concerns included unequal access, staffing burden, legal risks and inefficiencies in mobile teams and (3) alternatives—participants preferred a regional breech network with shared training, joint video review and expert on-call support.

Conclusions Maternity care providers opposed full centralisation of VBB, favouring a networked model that distributes expertise and preserves local access. These insights highlight the importance of involving frontline providers in service redesign.

Original language	English
Article number	e110114
Pages (from-to)	1-7
Number of pages	7
Journal	BMJ Open
Volume	16
Issue number	1
Early online date	13 Jan 2026
DOIs	https://doi.org/10.1136/bmjopen-2025-110114
Publication status	Published - Jan 2026

Bibliographical note

Publisher Copyright:
© Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.

Keywords

Clinical Decision-Making
OBSTETRICS
Organisation of health services
Patient-Centered Care
QUALITATIVE RESEARCH

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10.1136/bmjopen-2025-110114

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Cite this

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title = "Attitudes of maternity care providers toward regional centralisation of vaginal breech birth: a qualitative study",

abstract = "Objectives To explore maternity care providers{\textquoteright} attitudes toward regional centralisation of vaginal breech birth (VBB) care and gather their recommendations for maintaining clinical proficiency.Design Exploratory qualitative study using semi-structured interviews and thematic analysis.Participants 10 hospital-based maternity care professionals (nine obstetricians and one clinical midwife), purposively sampled to represent experience and institutional diversity.Setting 10 hospital maternity units in a metropolitan region of the Netherlands. Key themes describing provider attitudes towards two proposed models of centralised care (mobile breech team, designated referral centre) and alternative strategies.Results Three core themes emerged: (1) proficiency—providers valued regular exposure, formal training and peer support, expressing concern that centralisation would reduce overall workforce readiness; (2) organisation—concerns included unequal access, staffing burden, legal risks and inefficiencies in mobile teams and (3) alternatives—participants preferred a regional breech network with shared training, joint video review and expert on-call support.Conclusions Maternity care providers opposed full centralisation of VBB, favouring a networked model that distributes expertise and preserves local access. These insights highlight the importance of involving frontline providers in service redesign.",

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AU - Scheele, Fedde

AU - Velzel, Joost

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N2 - Objectives To explore maternity care providers’ attitudes toward regional centralisation of vaginal breech birth (VBB) care and gather their recommendations for maintaining clinical proficiency.Design Exploratory qualitative study using semi-structured interviews and thematic analysis.Participants 10 hospital-based maternity care professionals (nine obstetricians and one clinical midwife), purposively sampled to represent experience and institutional diversity.Setting 10 hospital maternity units in a metropolitan region of the Netherlands. Key themes describing provider attitudes towards two proposed models of centralised care (mobile breech team, designated referral centre) and alternative strategies.Results Three core themes emerged: (1) proficiency—providers valued regular exposure, formal training and peer support, expressing concern that centralisation would reduce overall workforce readiness; (2) organisation—concerns included unequal access, staffing burden, legal risks and inefficiencies in mobile teams and (3) alternatives—participants preferred a regional breech network with shared training, joint video review and expert on-call support.Conclusions Maternity care providers opposed full centralisation of VBB, favouring a networked model that distributes expertise and preserves local access. These insights highlight the importance of involving frontline providers in service redesign.

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Attitudes of maternity care providers toward regional centralisation of vaginal breech birth: a qualitative study

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