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Theme 5: Redesigned maternity support services for multi-ethnic disadvantaged groups

Our approach

The team developed strong links with commissioners in the former Heart of Birmingham PCT and Birmingham and Solihull NHS Cluster, and a range of clinicians at Birmingham Women’s NHS Foundation Trust, Heart of England NHS Foundation Trust, and Sandwell and West Birmingham Hospitals NHS Trust.

The main project was the ELSIPS trial, but as a result of the increasingly strong relationships with the local maternity trust providers, there were an additional range of projects. This involved the development of unique complementary relationships, which meant that service changed at every level: from evaluating services in existence, to developing and evaluating new services and translating evidence into practice. This was undertaken using the most robust evaluation methodology possible for the particular issue and the clinical timelines.

The issues concerned were identified using an iterative process between academics and clinicians and managers, which matured as time passed. The success of these relationships has been substantially influenced by the responsiveness of the researchers to service needs and the flexibility with which the academics were able to work. Inter-sector working has ensured a variety of relationships have developed not only with clinicians working in the local maternity units and in the community, but also with the newly inaugurated Clinical Commissioning Group.

Our projects

ELSIPS (Evaluation of Lay Support In Pregnant women with Social risk) trial

The main project within Theme 5 was the ELSIPS trial (Evaluation of Lay Support In Pregnant women with Social risk). This trial evaluated a new service (initially proposed by the commissioners, and developed and refined with the CLAHRC team) of Pregnancy Outreach Workers (POWs) to support women with social risk.

Step wedge evaluation of training for midwives to increase membrane sweeping to reduce induction of labour
Birmingham Women’s Hospital NHS Trust (BWH) identified through a small local audit that community midwives were not offering women membrane sweeping at term to reduce induction of labour as National Institute for Health and Clinical Excellence (NICE) guidelines advocate. Workshops were held with midwives to look at barriers, and a training package developed for community midwifery teams at BWH and Heart of England NHS Foundation Trust. The effect of the training was evaluated using a step wedge design study.

Maternal Request for Caesarean Section

Following publication of the Caesarean Section (CS) Guidelines in 2011, which allow maternal request for CS, there wasa desire to explore more fully the experiences and opinions of those involved. The study used semi-structured interviews to explore the views of women who had recently had a CS for maternal request (with and without clinical indications) at Birmingham Women’s Hospital (BWH) along with the views of the Community Midwifery Manager, a sample of community midwives, Consultant Midwives and Consultant Obstetricians.

Evaluation of new system for Maternity Triage

Triage is well established within main A&E departments across the UK, where the Manchester Triage System is used to prioritise the urgency with which patients require medical attention. Triage of pregnant women has been identified as being less reliable, and this area was highlighted as requiring development of specific guidelines and education packages.

Development of the four category system for symptom-based algorithms for the identification and immediate care of women admitted to triage was led by the team

Birthplace study

Birthplace was a large prospective cohort study that looked at the relative safety of the different places of birth within England. The findings showed evidence on increased adverse perinatal outcome for babies born to nulliparous women planning birth at home, and no evidence of increased adverse perinatal outcome for babies born in midwife-led settings compared to an Obstetric Unit. There was no evidence of adverse perinatal outcome for multiparous women planning birth in any of the settings outside an Obstetric Unit. There was evidence of reduced rates of intervention for all women planning birth in all settings outside the Obstetric Unit.

This evidence has enormous potential to influence service provision nationwide and has received national recognition.

Evaluation of Postnatal Care

This involved a programme of work undertaken to improve postnatal care within the Birmingham Women’s Hospital (BWH). A questionnaire was developed to look at the Newborn and Infant Physical Examination (NIPE) Programme, is a national screening programme in which newborn babies receive a health check within the first 72 hours of birth.

Outpatient Induction of Labour

A group was formed, including midwives and obstetricians, to develop criteria and a care pathway to enable low risk women to go home once they have had Propess inserted (to ripen the cervix, prior to labour). This service change was subsequently evaluated.

Publications
Author(s) Title Journal Publication date
Kenyon, S; Sears, J; Reay, H The development of a standard training toolkit for research studies that recruit pregnant women in labour Trials
2013, 14:362 doi:10.1186/1745-6215-14-362
30 October 2013
Hall, HR; Jolly, K Women’s use of complementary and alternative medicines during pregnancy: a cross-sectional study Midwifery
doi: 10.1016/j.midw.2013.06.001
15 July 2013
Paliwal, P; Ali, S; Bradshaw, S; Hughes, A; Jolly, K Management of type iii female genital mutilation in Birmingham, UK: a retrospective audit Midwifery
2013 Jun 5
doi: 10.1016/j.midw.2013.04.008.
5 June 2013
Prost, A; Colbourn, T; Seward, N; Azad, K; Coomarasamy, A; Copas, A; Houweling, T; Fottrell, E; Kuddus, A; Lewycka, S; MacArthur, C; Manandhar, C; Morrison,J; Mwansambo, C; Nair, N; Nambiar, B; Osrin, D; Pagel, C; Phiri, T; Pulkki-Brannstrom, A; Rosato, M; Skordis-Worrall, J; Saville, N; More, NS; Shrestha, B; Tripathy, B; Wilson, A; Costello, A Women’s groups practising participatory learning and action to improve maternal and newborn health in resource-limited settings: systematic review and meta-analysis Lancet
2013;381(9879):1736-46.
doi: 10.1016/S0140-6736(13)60685-6.
18 May 2013
Daley AJ, Jolly K, Sharp DJ, Turner KM, Blamey RV, Coleman S, McGuinness M, Roalfe AK, Jones I & Macarthur C The effectiveness of exercise as a treatment for postnatal depression: study protocol BMC Pregnancy Childbirth
2012; 12(1):45
doi:10.1186/1471-2393-12-45
9 June 2012
Theme lead

Professor Christine MacArthur

Partners
  • Former Heart of Birmingham Primary Care Trust
  • Former South Birmingham Primary Care Trust
  • Former Birmingham East and North Primary Care Trust
  • University of Birmingham