The importance of clinical trials in maternity care: why we need to stop throwing the baby out with the bathwater
Summary of talk
All women who give birth in the UK are entitled to postnatal care from NHS clinicians, including midwives, health visitors and GPs. This has been a routine part of universal NHS maternity services for over 50 years but despite places of birth moving from home to hospital, the changing health profile of pregnant women, increase in medical interventions and short in-patient stay, care following birth remains the ‘poor relation’ of maternity care. Reasons for this are unclear, especially as concerns about poor maternal health outcomes are increasing. Successive UK confidential enquiries into maternal deaths show women are more likely to die following birth than during pregnancy, and evidence of life-course health impacts of pregnancy complications such as diabetes, hypertensive disorders and severe mental health problems is accruing. The UK also has one of the lowest breastfeeding rates in Europe.
In my lecture, I will reflect on the important role clinical trials have played in improving the outcomes of pregnancy and birth, but will consider that unless we turn our attention to postnatal care, we will miss opportunities to promote longer term physical and mental maternal and infant health.
After obtaining a degree in history, I completed my nurse and midwifery training in Birmingham. Following the birth of my twin daughters, I accepted a secondment to the Department of Public Health and Epidemiology, University of Birmingham, to work on a study to explore the extent and severity of maternal morbidity following birth, data from which informed my master’s degree.
I then completed my PhD at Birmingham using data from a large cluster randomised controlled trial of a new model of midwifery-led, community-based postnatal care. I was also part of a team which completed a multi-centre trial to compare outcomes of traditional epidural block in labour with outcomes of ‘mobile’ epidurals which enabled women to walk during labour. We found that women who had mobile epidurals were more likely to have a normal birth, and our findings changed clinical practice. I enjoyed research so much that my ‘secondment’ lasted for ten years!
After Birmingham, I spent two years at The Royal College of Nursing Institute in Oxford where I worked on systematic reviews and guidelines for clinical practice, and led responses to national and international policy reviews. In 2003, I was appointed Professor of Midwifery at the University of West London where I continued to develop and lead postnatal research, including a multi-centre cluster trial to improve the clinical assessment and management of perineal trauma sustained during birth.
I was appointed as Professor of Evidence Based Midwifery at King’s College London (KCL) in 2008, where I led a programme of primary and secondary studies on topics including breastfeeding among women who had more complex pregnancies, support for postnatal weight management and maternal recovery following hypertensive disorders of pregnancy. I collaborated with KCL colleagues on several high-profile studies on perinatal mental health, use of NHS maternity care among women trafficked in the UK, and demand-side financing to improve maternity care in low-income countries. I also collaborated on important clinical trials, including BUMPES, a multi-centre trial of maternal upright compared with supine positions during second stage of labour (British Medical Journal research paper of 2018) and ‘Big Baby’, a trial led by Warwick Clinical Trials Unit (WCTU).
In 2019 I was appointed as Professor of Clinical Trials in Maternal Health in Warwick at WCTU where I lead the maternity research theme and continue to develop new trials and studies relevant to improving postnatal care and maternal health. In this role, I work closely with clinical colleagues based at University Hospitals Coventry and Warwickshire.
Alongside my research, I have supervised many PhD and MSc students, contributed to clinical teaching and led teaching modules. I am an honorary professor at KCL and Birmingham, a member of several UK research funding committees and NHS policy advisory groups, and editor in chief of the journal ‘Midwifery’. I was recently appointed as Deputy Pro Dean for Research for Warwick Medical School.
Date: Tuesday 20 October 2020,
12.00pm - 1.00pm
Location: Microsoft Teams