FutureSuture

Warwick Applied Health - Projects

FutureSuture

A study to improve new midwives’ confidence and skills in perineal care.

Project background

What problem will FutureSuture address?

Each year around 450,000 UK women have a vaginal birth with midwife support, and of these around 80% have tears or a cut (an episiotomy) to the area between their anus and vagina (the perineum) during birth.

All midwives should be able to:

i) Cut an episiotomy

ii) Assess the type of perineal tear a woman has suffered.

iii) Stitch perineal tears (stitching of more severe anal sphincter tears requires specialist training).

Studies show some midwives do not feel confident in suturing and 76% felt their training was insufficient. This means that some women do not have care from maternity staff who are skilled and confident to assess and manage perineal tears. Sometimes women have ‘missed’ injuries as maternity staff mis-identify them at the birth or experience life-long pain and discomfort from perineal tears or episiotomies which were not correctly stitched.

80% midwives and student midwives wanted more training in pelvic health (Webb et al., 2021)

Reference

Webb SS, Skene ER, Manresa M, Percy EK, Freeman RM, Tincello DG. Evaluation of midwifery pelvic floor education and Training across the UK and Spain. Eur J Obstet Gynecol Reprod Biol. 2021 Jan;256:140-144. doi: 10.1016/j.ejogrb.2020.10.065. Epub 2020 Nov 5. PMID: 33227686.

What's the aim of FutureSuture?

To support newly-registered midwives develop, consolidate and implement skills to assess and manage a woman’s perineum immediately after birth.

• We will develop an online training tool for newly-registered midwives to help them to develop skills and confidence in practice.

• This will help midwives to correctly identify and stitch tears and how to cut an episiotomy.

What outputs will FutureSuture deliver?

• We will produce a co-designed and pilot tested e-learning pathway resource to improve midwifery skills and competencies in perineal care, hosted by the RCM and accessible to all RCM members.

• Newly-registered midwives across the UK will be able to access the pathway, to develop confidence in their skills with the support of their preceptor to immediately benefit birthing women.

• Published papers, reports, events and other forms of knowledge-sharing will be tailored for women, clinicians, education providers and regulatory bodies.

• The work will be shared with the Nursing and Midwifery Council with a view to potentially recommending a national standard for midwifery training in perineal care.

• We will consider potential for future studies to evaluate implementation and impact.

What will the FutureSuture study do?

Planned timing of the work package sections

Work Package 1 (WP1) - Rapid Evidence Review

Identify interventions to enhance and sustain clinical skills and competencies in wound assessment and management

Work Package 2 (WP2) - Qualitative Interviews

Interviews with women who had perineal tears or episiotomy to explore priorities for midwifery training in perineal care. Interviews with newly registered midwives, preceptors, university lecturers, student midwives, and consultant midwives to explore perceptions, expectations and experiences of teaching on perineal care.

Work Package 3 (WP3) - Co-Design of E-Learning Pathway and Implementation Toolkit

Includes workshops with wide variety of patients, midwives, preceptors and lecturers to develop the e-learning tool

Work Package 4 (WP4) - Feasibility Testing and Pilot Testing of Intervention

Interviews and pilot testing of e-learning package to refine and test, including an interrupted time-series analysis (Study Within A Project) to compare trends at 3 months pre and post implementation.

Work Package 5 (WP5) - Economic Modelling

Develop economic models to highlight potential NHS costs/savings. Assess feasibility of collecting resource usage including cost of training, episiotomy, suturing methods, staff time and other healthcare resources, costs and outcomes data for the e-learning pathway.

Meet Our Team

Joint Co-Leads

Beck Taylor

Public Health Clinical Academic University of Warwick

Beatrice Bennett

Governance Midwife at University Hospitals Birmingham

Fiona Cross-Sudworth

Research Fellow and Midwife

Debra Bick, OBE

Emeritus Professor of Clinical Trials in Maternal Health and Chair of Trustees at MASIC who developed and secured funding and continues to provide input into the work

Academics at Warwick Medical School and University of Birmingham

Hema Mistry

Health Economist

Jo Parsons

Women's Health Academic, Qualitative Expertise

George Bouliotis

Statistician

MASIC Foundation Public Involvement Leads

Anna Clements

Jen Hall

E-Learning Expert(s)

Matt Smith