Maternal and Child Health Evidence

Members of the Mother and Child Epidemiology team undertook research with a range of study designs on a variety of topic areas, including childbirth related health problems, postnatal care, maternity care in deprived populations, postnatal depression, urinary and faecal incontinence, breastfeeding support, smoking in pregnancy and maternity care in the developing world. 


Randomised controlled trials evaluating interventions, such as low dose epidural techniques, redesigned postnatal care, breastfeeding peer support and traditional birth attendants in Pakistan have been completed, as well as large-scale observational studies with record linkage and cohort studies.

We aimed to:

  • facilitate the incorporation of research based evidence (and where evidence is lacking, examples of good practice) into commissioning, delivery and monitoring of maternity services in the West Midlands.
  • undertake high quality research generated by the team identifying the gaps in the evidence; and from consultations with health commissioners and providers, to assist in the evaluation of service delivery.

The Team

Professor Christine MacArthur is a leading expert on childbirth-related health and postnatal care research and contributed to the postbirth NSF.

Dr Sara Kenyon is a maternity researcher with experience of quantitative and qualitative research.

Elaine Kidney, Research Disseminator

Relevant Publications

In press

Wilson A,  Gallos I, Planar N, Lissauer D, Khan K, Zamora J, MacArthur C, Coomarasamy A, (in press).  Effectiveness of strategies incorporating training and support of traditional birth attendants on perinatal and maternal mortality: A meta-analysis, BMJ.


Jolly K, Ingram L,  Freemantle N, Khan K , Chambers J, Hamburger R, Brown J, Dennis C-L,

MacArthur C. (2011).  Effect of a peer support service on breastfeeding continuation in the UK: a randomised controlled trial, Midwifery, doi:10.1016/j.midw.2011.08.005.

Hassan H, Jokhio A, Winter H, MacArthur C. Safe delivery practices in Sindh, Pakistan: a community-based investigation of mothers and health workers. Midwifery doi:10.1016/j.midw.2011.06012.

Webb S, Plana M, Zamora J, Ahmad A, Earley B, MacArthur C, Khan K. Abdominal palpation to determine fetal position at labor onset: a test accuracy study. Acta Obstetrica Gynecologica Scandinavica.Jun 23. doi: 10.1111/j.1600-0412.2011.01226.x.

Wilson A, Lissauer D, Thangaratinam S, Khan K, MacArthur C, Coomarasamy A. A comparison of clinical officers with medical doctors on caesarean section outcomes in the developing world: a meta-analysis of controlled studies. BMJ 342:d2600.

MacArthur C, Glazener C, Lancashire RJ, Herbison P, Wilson D. [accepted].  Exclusive caesarean section delivery and subsequent urinary and faecal incontinence: a twelve year longitudinal study.  BJOG 118:no.doi:10.1111/j1471-0528.2011.02964.x.

Daley A, Stokes-Lampard H, MacArthur C. Exercise for vasomotor menopausal symptoms. Cochrane Database of Systematic Reviews 2011, Issue 5. Art No:

Neilson S, Kai J, MacArthur C, Greenfield S. Caring for children dying from cancer at home: a qualitative study of the experience of primary care practitioners. Family Practice.

Brown SJ, Gartland D, Donath S, MacArthur C.  Effects of prolonged second stage, method of birth, timing of caesarean section and other obstetric risk factors on postnatal urinary incontinence: an Australian nulliparous cohort study.  BJOG.

Wilson M, Moore P, Shennan A,  Lancashire R MacArthur C. Long term effects of epidural analgesia in labour: a randomised controlled trial of low does mobile compared with high dose techniques, Birth. Issues in Perinatal Care.

Daley A, Stokes-Lampard H, Wilson S, Rees M, Roalfe A, MacArthur C. What women want? Exercise preferences of menopausal women. Maturitas 68:174-178.


Ingram L, MacArthur C, Khan KS, Deeks J, Jolly CB. Does antenatal peer support increase breastfeeding initiation?  A systematic review.  CMAJ 182:1739-1746. DOI:10.1503/cmaj.091729.

Kelly J, Kohls E, Poovan P, Schiffer R, Redito T, Winter H, MacArthur C. The role of a Maternity Waiting Area (MWA) in reducing maternal mortality and stillbirths in high-risk women in rural Ethiopia. BJOG doi:10.111/j.1471-0528.2010.02669.x  Published online 29 July 2010.

Wilson M, MacArthur C, Cooper G, Moore P, Bick D, Shennan A. (2010). Epidural analgesia and breastfeeding: a randomised controlled trial of epidural techniques with and without fentanyl and a non epidural comparison group. Anaesthesia  65(2):145-153 Epub 2009 Nov 12.

Daley A, Stokes-Lampard H, MacArthur C. Postnatal Care: Exercise and Quality of Life in Menopause.  In Preedy VR, Watson RR (Eds). Handbook of Disease Burdens and Quality of Life Measures, Springer, New York. ISBN:978-0-387-78664-3 (Print) 078-0-387-78665-0 (Online). doi:10.1007/978-0-387-78665-0.

Holme A, Lancashire R, MacArthur C. The effects of breastfeed on cognitive and neurological development of children at 9 years. Child Care, Health and Development 2010 Feb 23 [Epub ahead of print].

Cooper GM, MacArthur C, Wilson M, Moore P, Shennan A. Satisfaction, control and pain relief: short and long term assessments in a randomised controlled trial of low-dose and traditional epidurals and a non-epidural comparison group. International Journal of Obstetric Anaesthesia 19:31-37 doi:10.10.16/j/ijoa.2009.05.004..

Brown SJ, Donath S, MacArthur C, McDonald EA, Krastev AH. Urinary incontinence in nulliparous women before and during pregnancy: prevalence, incidence and associated risk factors. International Urogynecology Journal 21:193-202 doi:10.1007/s00192-009-1011-x.


Daley A, Stokes-Lampard H, MacArthur C. Exercise to reduce vasomotor and other menopausal symptoms: A systematic review, Maturitas 63:176-180.

Freemantle N, Wood J, Griffin C, Gill P, Calvert MJ, Shankar A, Chambers J, MacArthur C. What factors predict differences in infant and perinatal mortality in Primary Care Trusts in England?  A prognostic model. BMJ 339:b2892. doi: 10.1136/bmj.b2892.

Wilson M, MacArthur C (2009) Epidural analgesia and breastfeeding initiation: results from a randomised controlled trial of traditional versus mobile techniques.  Annual meeting of the Obstetric Anaesthetists’ Association, May 2009, International Journal of Obstetric Anesthesia 18:S7.

MacArthur C, Jolly K, Ingram L, et al. Antenatal peer support workers and breastfeeding initiation: a cluster randomised controlled trial.  BMJ 338:b131. doi:10.1136/bmj.b131.

Kidney E, Winter HR, Khan KS, Gulmezoglu AM, Meads CA, Deeks JJ, MacArthur C. Systematic review of effect of community-level interventions to reduce maternal mortality.  BMC Pregnancy Childbirth 9:2. doi:10.1186/1471-2393-9-2.

Daley A, Jolly K, MacArthur C. The effectiveness of exercise in the management of post-natal depression: systematic view and meta-analysis.  Fam Pract. Advanced access doi:10.1093/fampra/cmn101.

Wilson M, MacArthur C, Cooper GM, Shennan A.  Ambulation in labour and delivery mode: a randomised controlled trial of high-dose versus mobile epidural analgesia.  Anaesthesia 64(3):266-272.

Wilson M, MacArthur C, Shennan A.  Urinary catheterisation in labour with high-does versus mobile epidural analgesia: a randomised controlled trial.  Br J Anaesthesia 102(1):97-103.


Dhillon N, MacArthur C.  Antenatal depression and male gender preference in Asian women in the UK.  Midwifery doi:10.1016/j.midw.2008.09.001.

Hutzal CE, Boyle EM, Kenyon SL, et al. Use of antibiotics for the treatment of preterm parturition and prevention of neonatal morbidity: a meta analysis.  Am J Obstet Gynaecol. 199(6):620 e1-8.

Kenyon S, Pike K, Jones DR, et al.  Childhood outcomes following the prescription of antibiotics to pregnant women with preterm rupture of the membranes: 7 years follow-up of the ORACLE I trial.  Lancet 372:1310-1318.

Kenyon S, Pike K, Jones DR, et al. Childhood outcomes following the prescription of antibiotics to pregnant women with spontaneous preterm labour: 7 years follow-up of the ORACLE II trial.  Lancet 372:1319-1327.

Bick DE, MacArthur C, Knowles H, Winter H. Postnatal Care: Evidence and Guidelines for Management.  2nd Ed. Churchill Livingstone, London.

Dean N, Wilson D, Herbison P, Glazener C, Aung T, MacArthur C.   Sexual function, delivery mode history, pelvic floor muscle exercises and incontinence: A cross-sectional study six years postpartum.
Aust NZJ Obstet Gynaecol 48:302-311.

Gregory A, Penrose K, Morrison C, Dennis C-L, MacArthur C.   Psychometric properties of the Breastfeeding Self-Efficacy Scale Short Form in an Ethnically Diverse United Kingdom Sample.
Public Health Nurs 25:278-284.

Daley A, Winter H, Grimmett C, McGuinness M, McManus R, MacArthur C. Feasibiity of an exercise intervention in depressed postnatal women.  Br J Gen Pract 58:178-183.

Anonymous. Health and Care After Childbirth. Informed Choice Leaflet (1) Professionals and (2) for Women. MIDIRS and NHS Centre for Reviews and Dissemination. (Authored by Winter H and MacArthur C).


Kenyon S, Ullman R, Mori R, Whittle M. Intrapartum Care.  Care of healthy women and their babies during childbirth. Summary of NICE Guidance.  BMJ 335: 667-668.

Daley A, Stokes-Lampard H, Mutrie N, MacArthur C.  Exercise for the management of vasomotor menopausal symptoms.  Cochrane Database of Systematic Reviews Oct 17;(4):CD006108.

Daley A, Stokes-Lampard H, MacArthur C. Feeling "hot, hot, hot": is there a role for exercise in the management of vasomotor and other menopausal symptoms?  J Fam Plan Reprod Health Care 33(3):143-145.

Sirpal A, MacArthur C. (2007). Antenatal Depression and Male Gender Preference in India, Marce Society, Sept 2006, Archives of Women’s Mental Health 10:XIX.

Duhig K, MacArthur C, May A, Shennan AH. (2007). The hypotensive and fetal heart rate response to low dose epidurals: analysis of an RCT data set.  Annual meeting of the Obstetric Anaesthetists’ Association, Sept 2007, International Journal of Obstetric Anesthesia 16:S7.

MacArthur C.  Traditional birth attendant training for improving health behaviours and pregnancy outcomes: RHL commentary (last revised 27 September 2007) The WHO Reproductive Health Library, Geneva, World Health Organisation.

Kelly J, Winter H. Reflections on the knowledge base for obstetric fistula.  Int J Gynecol Obstet 99:Suppl 1:S21-S24.

Kidney E, MacArthur C, Winter H, Rudge G. Maternity services in the West Midlands, Ch 12 in West Midlands Key Health Data 2006/7.

MacArthur C, Winter H, Bick D. Effectiveness of postpartum support [letter].  Birth 34(2):188-189.

Daley A, MacArthur C, Stokes-Lampard H, et al. Exercise participation, body mass index, and health-related quality of life in women of menopausal age.  Br J Gen Pract 57;535:130-135.

Holme A, Breen M, MacArthur C. Obstetric fistulae: a study of patients managed at the Monze Mission Hospital, Zambia.  BJOG 114(8):1010-1017.

Daley A, MacArthur C, Winter H. The role of exercise as a treatment for postnatal depression: a review of the literature.  J Midwifery Women's Health 52(1):56-62.

Jokhio A, Winter H, Cheng KK, Khan K, MacArthur C. Strategies for reducing maternal mortality [comment]. Comment on: Lancet 2006 Oct 7;368(9543):1284-1299.  Lancet 368(9553):2122.

MacArthur C, Winter H, Bick D.  Effectiveness of postpartum support.  Birth 34(2):188-189.

MacArthur C, Winter H, Kidney E.  Maternal public health., March:12.


Akkad A, Jackson C, Kenyon S, et al. Patients  perception of written consent: questionnaire study.  BMJ 333(7567):528.

Dixon-Woods M, Williams SJ, Jackson C, et al.  Why do women consent to surgery, even when they do not want to?  An interactionist and Bourdieusian analysis.  Soc Sci Med 62(11):2742-2753.

Kenyon S, Dixon-Woods M, Jackson CJ, et al.  Participating in a trial in a critical situation: a qualitative study in pregnancy.  Qual Saf Health Care 15:98-101.

Dixon-Woods M, Jackson C, Windridge K, Kenyon S.  Receiving a summary of the results of a trial in pregnancy: Qualitative study of participants' views.  BMJ 332:206-210.

Kelly J, Winter HR.  Better training in instrumental delivery may reduce caesarean section rates.   Rapid Response to Spencer C, Murphy D, Bewley S. Caesarean delivery in the second stage of labour [Editorial] BMJ 333(7569):613-614.

Brown SJ, Lumley JM, McDonald EA, Krastev AH, and collaboration with the Maternal Health Study Collaborative group.  Maternal health study: a prospective cohort study of nulliparous women recruited in early pregnancy.  BMC Pregnancy Childbirth 6:12.

MacArthur C, Glazener CMA, Wilson PD, et al. Persistent urinary incontinence and delivery mode history: a six-year longitudinal study. BJOG 113:218-224.

Glazener CMA, Herbison GP, MacArthur C, et al. New postnatal urinary incontinence: obstetric and other risk factors in primiparae. BJOG 113:208-217.

Daley A, MacArthur C, McManus R, et al.  Factors associated with the use of complementary medicine and non-pharmacological interventions in symptomatic menopausal women.  Climacteric 9:336-346.

Jokhio A, Winter H, Cheng KK, Khan K, MacArthur C. Strategies for reducing perinatal mortality [letter].  Lancet 368(9553):2112.


Jokhio AH, Winter HR, Cheng KK. Effectiveness of training and integrating Traditional Birth Attendants (TBAs) with existing health services on perinatal and maternal mortality: A cluster randomized controlled trial in rural Pakistan.  NEJM 352:2091-2099.

Brocklehurst P, Kenyon S. Group B Streptococcus in pregnancy.  Recent Advances in Obstetrics and Gynaecology 23, Section 1; Chapter 6:65-77.

Kenyon S, Pike K, Jones D, et al. The effect of a financial incentive on return of a postal health and development questionnaire: a randomised trial.  BMC Health Serv Res 5:55.

Gilbert RE, Pike K, Kenyon SL, et al.  The effect of pre-partum antibiotics on the type of neonatal bacteraemia: insights from the MRC ORACLE trials.  BJOG 12(6):830-832.

MacArthur C, Glazener CM, Wilson PD, et al. Faecal incontinence and mode of first and subsequent delivery: a six year longitudinal study. BJOG 112:1075-1082.

Collins SI, Mazloomzadeh S, Winter H, et al. Proximity of first intercourse to menarche and the risk of human papillomavirus infection: a longitudinal study.  Int J Cancer 114:498-500.

MacArthur C, Winter H, Bick D, et al. Re-designing community postnatal care trial: how care was delivered.  Br J Midwifery 13:319-24.

Glazener CMA, Herbison GP, MacArthur C, et al. Randomised controlled trial of conservative management of postnatal urinary and faecal incontinence: six year follow up.  BMJ 330:337-339.

MacArthur C. Longer-term morbidity following childbirth. Ch 44 In Henderson & MacDonald: Mayes' Midwifery, 13th Edition Elsevier, Science Ltd, Edinburgh.


Habiba M, Jackson C, Akkad A, Kenyon S, Dixon-Woods M.  Women's accounts of consenting to surgery: is consent a quality problem?  Qual Saf Health Care 13:422-427.

Kenyon S, Dixon-Woods M.  What do they know?: a content analysis of women's perceptions of trial information.  BJOG 111:1341-1345.

Kenyon S, Boulvain M, Neilson J.  Antibiotics for preterm rupture of the membranes: a systemic review.  Obstet Gynaecol 104(5) 1051-1057.

Akkad A, Jackson C, Kenyon S, et al.  Informed consent for elective and emergency surgery: a questionnaire study.  BJOG 111:1133-1138.

Kenyon S, Brocklehurst P, Blackburn A, Taylor D.  Antenatal screening and intrapartum management of group B streptococcus in the UK.  BJOG 111:226-230.


Kenyon S, Boulvain M, Neilson J.  Antibiotics for preterm rupture of membranes.  In Cochrane Collaboration:  Cochrane Database Syst Rev. 2003 (2): CD001058. Review.

MacArthur C, Winter H, Bick D, et al. Redesigning postnatal care: a randomised controlled trial of protocol-based midwifery-led care focussed on individual women's physical and psychological health needs.  Health Technol Assess 7(37).


Kenyon S, Taylor DJ.  The effect on clinical practice of the publication of a major clinical trial in a high impact journal: The ORACLE Trial experience.  BJOG 109:1341-1343.

Kenyon S, Taylor DJ, Tarnow-Mordi W.  ORACLE: antibiotics for preterm prelabour rupture of the membranes: short-term and long-term outcomes.  Acta Paediatr (Oslo, Norway) Supplement, 437:12-15.

Kenyon S, Neilson J, Boulvain M.  Antibiotics for preterm premature rupture of membranes.  In Cochrane Collaboration: Cochrane Library, Issue 1, Oxford: Update Software, 2002.

MacArthur C, Winter H, Bick D, et al. Effects of redesigned community postnatal care on women's health 4 months after birth: a cluster randomised controlled trial.  Lancet 359:378-385.

Wilson M, Cooper G, MacArthur C, Shennan A, et al. A randomized controlled trial comparing traditional with two 'mobile' epidural techniques: anesthetic and analgesic efficacy.  Anesthesiology 97:1567-1575.

MacArthur C, Winter H, Bick D.  Individualized postpartum care by midwives in improved mental health.  Evidence-based Obstet Gynecol 4:175-176.

Bick DE, MacArthur C, Knowles H, Winter H. Postnatal Care: Evidence and Guidelines for Management. Churchill Livingstone, London.


Kenyon S, Taylor DJ, Tarnow-Mordi W for the ORACLE Collaborative Group. Broad spectrum antibiotics for preterm prelabour rupture of the fetal membranes: the ORACLE I randomised trial.  Lancet 357:979-988.

Kenyon S, Taylor DJ, Tarnow-Mordi W for the ORACLE Collaborative Group. Broad spectrum antibiotics for spontaneous preterm labour (intact membranes): the ORACLE II randomised trial.  Lancet 357:989-994.

MacArthur C, Shennan A, May A, et al. Effect of low-dose mobile versus traditional epidural techniques on mode of delivery: a randomised controlled trial.  Lancet 358:19-23.

MacArthur C, Shennan A, et al. Instrumental delivery and epidural anaesthesia (letter).  Lancet 358:1726.

Glazener C, Herbison G, Wilson P, MacArthur C, et al. Conservative management of persistent postnatal urinary and faecal incontinence: randomised controlled trial.  BMJ 323:593-596.

MacArthur C, Glazener C, Wilson P, et al. Obstetric practice and faecal incontinence three months after delivery.  BJOG 108:678-683.

MacArthur C, Knox E, Lancashire R. Effects at age nine of maternal smoking in pregnancy: experimental and observational findings.  BJOG 108:67-73.

Winter H, MacArthur C, Bick D, et al. Postnatal care and its role in maternal health and well-being.  MIDIRS 11(1 Suppl 1):S3-S7.

Disseminator's Reports

Newsletter July 2010
Responses to our questionnaire
Improving breastfeeding rates
Antenatal education
CMACE/RCOG obesity guideline
Infant mortality
Factors influencing implementation of evidence-based guidelines

Newsletter May 2009
Results of an RCT of antenatal peer support to promote breastfeeding initiation in HoBPCT
Breastfeeding interventions
Why randomised controlled trials provide the best evidence of what really works
Nurse Family Partnership

Newsletter January 2009
Research funding to evaluate service redesign to improve maternity services for disadvantaged women
Improving postnatal maternity care for women and their families
Summary of the Maternity NSF and Maternity Matters

Newsletter December 2007
Interventions to reduce low birthweight and perinatal mortality
Improving antenatal care for disadvantaged women
Interventions to reduce caesarean section rates

Newsletter September 2006
Improving maternity services across the region: what PCTs saw as the main challenges

Interventions to improve breastfeeding: evidence reviews and links to publications

Critique of the Nurse Family Partnership trials

Evidence for programmes to improve outcomes for infants age 0 to 2

Report for Sandwell PCT on impact of breastfeeding on health and impact of Baby Friendly Hospital on duration of breastfeeding

Smoking cessation programmes in pregnancy: evidence reviews and links to publications