Women with learning disability have equal rights to maternity care that meets their needs, but many have poor pregnancy and birth outcomes compared to other women in the UK.
NPEU researchers Reem Malouf, Jenny McLeish, Ron Gray and Maggie Redshaw, with Sara Ryan of Oxford University’s Department of Primary Care, carried out an in-depth qualitative study to explore the maternity experiences of nine mothers with learning disability.
The mothers were very conscious of feeling different from other mothers. Most were pleased with their maternity care and liked their midwives, but some had been denied opportunities to make informed choices, or encountered disrespectful staff attitudes. Their experiences of communicating with professionals were also mixed: some described midwives taking time to explain things that the mothers found confusing, while others had encountered midwives who gave the impression that they were too busy to communicate effectively. The mothers were aware that to succeed as parents they needed to have good support from family or professionals, and several who had been well supported were flourishing. Others described the stress of having their parenting ability formally assessed immediately after birth, and their distress and guilt when they were not allowed to care for their babies.
In the UK, around 40% of new mothers report that their pregnancy was unplanned. A higher proportion of unplanned pregnancies occur among women in their 20s and 30s than among teenagers, and more often among women who are in a stable, cohabiting or married partnerships. There is limited research exploring the impact of unplanned motherhood on the subsequent wellbeing of partnered women, but new research from NPEU has recently been published in BMC Pregnancy and Childbirth.
The research, which was conducted by Katherine Barton, an MSc Global Health student at the University of Oxford, and NPEU researchers Claire Carson, Maria Quigley and Maggie Redshaw, analysed over 12,000 partnered women whose children are enrolled in the UK Millennium Cohort Study. They found that unplanned motherhood was associated with increased risk of psychological distress at 9 months postpartum, particularly among women who felt unhappy or ambivalent about their pregnancy at the start. They concluded that, while the quality of the partner relationship is an important factor in maternal wellbeing, neither relationship quality nor wider social support explained the observed association. Read the published research in full.
The SIFT protocol was published in the journal BMC Pediatrics on 28 January 2017.
The protocol explains the background, rationale, methods and design of the trial. SIFT compares two different speeds of milk feed increase, one 'faster' and one 'slower', both within rates currently used in United Kingdom neonatal units. The study aims to find out if either speed of milk feed increase gives better outcomes for the infants. Investigators will measure a variety of outcomes, such as survival without disability, infection, bowel problems, growth and long-term physical and mental development, as well as the impact on families and the National Health Service, including costs. It is led by Dr Jon Dorling in Nottingham and co-ordinated by the NPEU.
The aim of this review was to investigate the existing evidence regarding specialist preterm clinics for women who are at risk of preterm birth. Reem Malouf and Maggie Redshaw found eleven studies which looked at the effect of the clinic with regards to preterm birth and other important outcomes.
The evidence from the five randomised controlled trials showed that there was no significant difference between care at a specialist clinic and standard care for most of the neonatal outcomes. However, these studies were conducted before 1990 and the intervention was limited to increasing the number of antenatal visits in addition to educating the women about signs and symptoms of preterm labour. In contrast, the five most recent cohort studies in which new tests are used such as the foetal Fibronectin screening test (fFN), showed some positive neonatal outcomes.
In this review we only found one qualitative study where women expressed their anxiety about being labelled as high-risk of preterm birth and being reassured about interventions and treatments received in the clinic. In this study, women reported that their partners were struggling to cope emotionally. Further clarification is necessary on the optimal referral and standardized management plan in the clinic.
“Saving Lives, Improving Mothers’ Care - Surveillance of maternal deaths in the UK 2012-14 and lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009-14”
Led by the MBRRACE-UK team at the National Perinatal Epidemiology Unit at the University of Oxford this report details the findings of maternal mortality surveillance 2012 to 2014 in the UK and the lessons learned from the confidential enquiries into maternal deaths from cardiovascular causes, blood pressure disorders of pregnancy, early pregnancy causes together with messages for critical care.
There have been many changes in maternity care policy and practice over the last 20 years and women’s experience and satisfaction with care have become more important over this period. This study used secondary analysis of data collected in four postal surveys of maternity care experiences in 1995, 2006, 2010 and 2014 to see how women's experiences have changed. Jane Henderson and Maggie Redshaw found that, in the antenatal period, an increasing proportion of women had early first contact with a healthcare professional, screening for Down’s syndrome, both dating and anomaly scans, and the total number of ultrasound scans increased over the period. Rates of intervention during labour and birth have increased and women were less likely to be cared for by a known midwife. In the postnatal period, length of hospital stay declined over time but the proportion of women who considered their length of stay too short remained constant. The number of postnatal home visits also declined and there was a substantial increase in the proportion of women who would have liked more visits. Overall satisfaction with care remained high especially for care during pregnancy, labour and birth.
The protocol for the Poppi Trial (Procedural Pain in Premature Infants) has been published on the Wellcome Open Research platform. The protocol documents the background, rationale, methods and design of the trial. The Poppi trial, which aims to establish whether oral morphine provides effective analgesia for procedural pain in infants, is led by Dr Eleri Adams and Dr Rebeccah Slater in collaboration with the NPEU and the Paediatric and Infant Pain & Anaesthesia (PiPA) group. You can read the protocol now for more details about the trial. Our congratulations go out to the entire Poppi Trial team.
A study exploring the association between father involvement in children’s early upbringing and behavioural outcomes in the pre-adolescent years has been published in the BMJ Open. The study by Charles Opondo, Maggie Redshaw, Emily Savage-McGlynn and Maria Quigley identified over 6,000 children in the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort who were reported to be living with both parents during infancy. The researchers found evidence that greater paternal involvement in the children’s early months was associated with fewer signs of behavioural problems in the children’s pre-teen years. Specifically, fathers’ emotional response and confidence in their new role were most strongly associated with lower odds of behavioural problems when their children reached 9 and 11 years of age.