Inequalities in maternal and infant mortality and morbidity are a challenge for public health policy and service delivery in the UK. Antenatal care can prevent adverse outcomes for mothers and babies and has an important role in giving every child the best start in life. The REACH Pregnancy Programme aims to provide high quality evidence on how to improve antenatal care for socially disadvantaged and ethnically diverse women. This programme is led by the University of East London and funded by a National Institute for Health Research Programme Grant for Applied Research. The REACH Pregnancy Programme, which is funded until 2019, involves three separate research strands:
- Enhancing women’s access to antenatal care (RCT of a community-based co-designed intervention)
- Enhancing women’s experience and outcomes of antenatal care (feasibility study, pilot trial and full RCT of Pregnancy Circles, a group approach to antenatal care)
- Improving use involvement in maternity services (work with Maternity Services Liaison Committees)
Contact: Christine McCourt
Preterm birth is one of the most important causes of infant mortality and morbidity. This UK-wide research program includes a series of research studies to improve the care provided for the baby and parents during preterm birth. Work done by researchers from this centre includes looking at parents’ experiences of having a very preterm baby, and evaluated a new mobile resuscitation trolley that means the baby can be stabilised next to the mother, without the umbilical cord being cut. This program is led by the University of Nottingham and funded by a National Institute for Health Research Programme Grant for Applied Research.
Contact: Susan Ayers
The BuMP programme, funded by the National Institute for Health Research, is investigating whether giving pregnant women the means to monitor their own blood pressure and urine safely from home can result in an earlier diagnosis of raised blood pressure and pre-eclampsia. Many women have expressed an interest in monitoring their own blood pressure in between antenatal visits there was very little research to guide this. Such measures could result in faster access to treatment and reduce the risk of complications for both the mother and the baby, but we are also looking at the impact on pregnant women and on the maternity services.
This Programme involves academics from the University of Oxford, King’s College London, Queen Mary University of London and the University of Birmingham as well as City, University of London.
Contact: Christine McCourt
Writing about difficult or stressful experiences is associated with small but potentially long-term improvements in health. The HABiT project is a randomised controlled trial involving 548 women that evaluates whether writing about stressful events during the transition to motherhood has an impact on women’s postnatal mental and physical health. This project is funded by the National Institute for Health Research’s Research for Patient Benefit programme.
Contact: Susan Ayers
Wellbeing in pregnancy. Psychological difficulties in pregnancy and after birth are common but many women do not recognise their symptoms or are reluctant to talk about how they are feeling in order to access treatment. The Wellbeing Plan was created by the Boots Family Trust Alliance to raise awareness of perinatal mental health and facilitate conversations about emotional wellbeing between women and health professionals. The Wellbeing in pregnancy project is a pilot randomised controlled trial to evaluate the effectiveness, acceptability and feasibility of the Wellbeing Plan funded by the Boots Family Trust Alliance.
Contact: Susan Ayers
Factors influencing the use of freestanding and alongside midwifery units in England
At present in England, pregnant women have three choices about where to have their baby: in traditional labour wards in a maternity hospital, in midwifery units (MUs) or at home. Only 11% of women in England have their baby in a MU. This is despite very good evidence that for women with uncomplicated pregnancies, having a baby in a MU results in better outcomes than having a baby on a traditional labour ward and is cheaper. For example, the risk of caesarean section is reduced by two thirds and mothers’ satisfaction with care is significantly improved. The project will use both quantitative and qualitative methods to explore factors influencing the utilisation of MUs in England. This study is being led by the University of Nottingham and is funded by the National Institute for Health Research’s Health Services and Delivery Research programme.
Contact: Christine McCourt
How can NICE recommendations on place of birth for women with uncomplicated pregnancies be implemented in practice?
Evidence suggests that midwifery-led birth settings, such as midwifery units in hospital or community as well as home birth can reduce intervention such as instrumental and cesarean births while offering safe care for the mother and her baby. Midwifery-led birth settings are also less expensive than obstetric units (OU). Despite recommendations by NICE (2014) to commissioners and providers to ensure that all birth settings (Home, Alongside and Freestanding Midwifery Units, Obstetric Unit) are available, in London to date there are only three FMUs and the majority of women give birth in hospital. Many NHS services still offer OU as the mainstream option and midwifery-led birth settings as an alternative.
This subject therefore provides an ideal case to study and address the challenge of implementation of research knowledge into NHS settings. Studies of knowledge implementation have highlighted that strategies for change should focus on context, culture and systems in the NHS as well as practices and should use more active and inter-disciplinary approaches to sharing and learning.
This is a Participatory Action Research (PAR) project which aims to implement and evaluate the impact of a Midwifery-led Birth Settings Pathway (The Pathway) aimed at translating NICE recommendations on place of birth for women with uncomplicated pregnancies into an actionable plan for increasing the number of births outside OUs.
Contact: Lucia Rocca Ihenacho
Direct-entry midwives moving into Health Visiting
Since 2004, direct-entry midwives (without a nursing qualification) have been able to apply to train as Health Visitors (HVs) but must maintain their midwifery registration through relevant practice. HVs and midwives work with the same client group, though with a different focus. There is much literature on multidisciplinary working between HVs and midwives, but almost nothing on the migration of one work group to the other, which has implications for workforce development and planning in both professions. This study is exploring why direct entry midwives move into health visiting, how they subsequently sustain their midwifery registration, and how they view their professional identity.
