National guidance and policy supports choice of birth setting for healthy women with straightforward pregnancies and the number of midwifery units is increasing. Most women, however, still give birth in consultant-led hospital obstetric units and there is uncertainty about how best to configure services. As part of the Birthplace Choices project Jennifer Hollowell and others have reviewed quantitative evidence on women's preferences for place of birth in order to better understand what attributes 'low risk' women prefer or prioritise when choosing their intended birth setting. The review, published in BMC Pregnancy and Childbirth, found that much of the evidence came from poor quality studies carried out before 2000. Some service attributes, including local services, being looked after by a known midwife and being involved in decision-making, were almost universally valued by women. For other attributes, including the availability and involvement of medical staff, the availability of pain relief and a clinical or more 'homely' environment, women's views and preferences varied. Read the full paper.
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Director of the NPEU Clinical Trials Unit, Ed Juszczak, has co-authored a paper in Archives of Disease in Childhood - Education and Practice outlining how clinical trials units work with clinicians in paediatric and neonatal care to develop clinical trials.
Building on the successful National Maternity Surveys in England, NPEU Social Scientist Maggie Redshaw has collaborated with colleagues from the School of Nursing and Midwifery at Queen's University in Belfast on a Survey of Women's Experiences of Care in Northern Ireland. The survey report, the first of its kind in Northern Ireland, details the experiences of 2,722 women who gave birth between October 2014 and December 2016. Comparisons with the English National Maternity Surveys show that the experiences of women in Northern Ireland and in England are broadly similar, but that overall women in Northern Ireland were less likely to feel involved in decision making about their care and were more satisfied with their care after the birth of their baby. Read the report.
A letter published in the Lancet by NPEU researchers Maria Quigley and Claire Carson shows that around 1 in 10 UK women are still breastfeeding when their baby is 12 months old. This estimate is based on a UK study of 14,848 women who gave birth in 2000-2001 and then answered questions about infant feeding when their baby was 9 months old and again at 5 years. Corroborated with data from the last three UK Infant Feeding Surveys, their estimate of 1 in 10 contrasts with a recent report which suggested that only 1 in 200 UK women are still breastfeeding at 12 months.
NPEU Clinical Trials Unit staff will be getting out and about at Oxford University Hospitals on Friday 20th May, to mark International Clinical Trials Day, celebrated in commemoration of the day that James Lind started his famous trial on treatments for scurvy in sailors. Together with staff from the five other UKCRC registered CTUs in Oxford, and in collaboration with NIHR Clinical Research Network Thames Valley and South Midlands, we will be presenting our work on over 80 clinical trials answering important clinical questions in a wide range of specialties. If you'd like to know more about our trials investigating care for pregnant women and babies come and find us at one of the research stands at the John Radcliffe Hospital or pick up a flyer at the Churchill Hospital, the Nuffield Orthopaedic Centre or the Horton Hospital in Banbury.
Join us at the Nuffield Orthopaedic Centre in the evening to hear Professor Sallie Lamb, Co-Director of the Oxford Clinical Trials Unit, talk about Clinical Trials: One of the most important medical inventions in the last 100 years.
Two pieces of NIHR-funded NPEU research, the Birthplace in England Research Programme and the UKOSS study of H1N1 influenza in pregnancy, feature as case studies in the NIHR 10th anniversary report which identifies and celebrates 100 examples of impact arising from NIHR funded research.
Birthplace is commended for changing “through policy recommendations, the advice given to pregnancy women and practice” and for continuing “to produce findings that will likely translate into quantifiable safer and cost-effective births in England”.
The UKOSS study of pregnant women hospitalised with H1N1 infection in 2009 influenced policy and guidance updates during the pandemic, changed policy recommendations on seasonal immunisation for pregnant women and as a result led to a doubling of the number of pregnant women immunised against influenza in England between 2009 and 2015.
Perinatal Mortality Surveillance Report – UK Perinatal Deaths for Births from January to December 2014
The report shows a slight fall in the rates of stillbirth and neonatal death in the UK compared with 2013, continuing the downward trend in rates seen since 2003. However, this overall trend masks variations in rates across the UK. These variations remain despite the fact that a novel method of analysis introduced by MBRRACE-UK takes into account aspects of case-mix to allow ‘fairer’ comparisons of mortality rates between services provided for high risk and low risk pregnancies. The new analytical method, which divides the figures for Trusts and Health Boards into five groups based on the services they deliver, also takes into account the random variation in rates which can occur because of small numbers of births in some areas.
Led by the MBRRACE-UK collaborators based in the Department of Health Sciences at the University of Leicester, the report also explores the effect of gestational age on perinatal mortality rates in more detail. This shows that around two thirds of stillbirths and neonatal deaths were born preterm, indicating that initiatives to reduce stillbirth and neonatal deaths must include a focus on reducing preterm birth as well as ensuring high quality care for all women whose pregnancies reach full term. Read the full report.
Between 2007 and 2010 the CORONIS trial recruited almost 16,000 women in Argentina, Chile, Ghana, India, Kenya, Pakistan and Sudan to compare different caesarean section techniques. Over 13,000 participants were followed up during 2011-14 to investigate longer term outcomes including pelvic pain, pain during sexual intercourse, hysterectomy and outcomes of subsequent pregnancies.
The results of the CORONIS follow-up study, published in the Lancet, indicate no evidence of a difference in the risk of any outcomes for the five intervention pairs. Overall, severe adverse outcomes were uncommon in these settings, limiting the power of the study to detect differences.
Since the study provides no evidence to favour one technique over another, other considerations, such as time and cost savings of the different approaches, can be used to determine clinical practice. Read the paper and associated commentary.
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