Maternal and Child Health

babyfeet_150719_iahr-2The research group undertakes studies on research questions that impact upon public health services and on clinical practice in maternal, infant and child health using high quality designs to provide best evidence. Collaborative working with maternity service and children’s health service providers is an emphasis in studies.

Aims of the research

The programme of work of our research group aims to improve the health and care of women and infants during and after pregnancy and birth and of children and young people. It includes cohort studies to establish risk factors, randomised controlled trials to test potentially effective interventions, systematic reviews and qualitative research. These studies are within a variety of topic areas, including childbirth related health problems, antenatal and postnatal care, maternity care in deprived populations, use of lay workers, postnatal depression, urinary and faecal incontinence, perineal trauma, swaddling, vitamin D supplementation, weaning food, breastfeeding, maternity care, health in the low and middle income countries (LMIC), care of children with life-limiting conditions and support of their families.

We aim to:

  • Undertake high quality research generated by the team through identifying gaps in the evidence.
  • Assist in the evaluation of service delivery through consultations with health commissioners and providers – in this capacity we are involved in NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) West Midlands 2014-2019, WHO and Ministries of Health in LMIC.
  • Facilitate the incorporation of research based evidence (and where evidence is lacking, examples of good practice) into commissioning, delivery and monitoring of maternity, and child services.

Current projects

Children and Maternity theme of the CLAHRC

  • Place of Birth (training for community midwives)
  • Birmingham Symptom specific Obstetric Triage System (BSOTS)
  • Homebirth study(completed)
  • The health effects of early postnatal discharge from hospital for healthy women and term infants, focusing on the pathway for the management of neonatal jaundice in the community
  • Assessment of the implementation of advance care plans for children
  • Parenting in the context of children with life-changing admissions to hospital: development of an intervention

High Or Low Dose Syntocinon® for delay in labour (HOLDS)

Professor Sara Kenyon is Chief Investigator for the HOLDS trial which is a multicentre (around 30 UK obstetric units) randomised, double blind controlled trial which will recruit 1500 nulliparous women at term, with confirmed delay in labour (using NICE definitions) and ruptured membranes. The trial is funded by the HTA NIHR and will compare the standard dose regimen of synocinon (2mU/min increasing every 30 minutes to a maximum of 32mU/min) with a high dose regimen (4mU/min increasing every 30 minutes to a maximum of 64mU/min). The primary outcome is Caesarean section and secondary outcomes include key safety, maternal and neonatal outcomes. The trial is currently suspended due to issues regarding the production and storage of the study drug.  A request for extension has been submitted to the HTA and the outcome will be known in the autumn of 2019.

Professor Kenyon is also the Chief Investigator on a recently funded study iHOLDS.  This is a comparison of the same dose regimens of syntocinon (2mU/min increasing every 30 minutes to a maximum of 32mU/min) with a high dose regimen (4mU/min increasing every 30 minutes to a maximum of 64mU/min) for nulliparous women for whom it is described as part of the induction of labour process.  The trial will recruit 2400 women from the same 30 maternity units over 36 months, beginning in autumn 2019.

MBBRACE-UK

The Maternal, Newborn and Infant Clinical Outcome Review Programme (previously the Confidential Enquiries in Maternal, Newborn and Infant death)

This is a collaboration apppointed by the Healthcare Quality Improvement Partnership (HQIP) in 2012 to continue the national programme of work investigating maternal deaths, stillbirths and infant deaths, including the Confidential Enquiry into Maternal Deaths (CEMD).  Professor Sara Kenyon is involved in both the maternal confidential enquiry and co-chairs the perinatal confidential enquiries.

Perinatal Mortality Review Tool

This was funded by HQIP in 2017 on behalf of DH (England), NHS Wales and Scottish Government to develop and establish a national standardised Perinatal Mortality Review Tool (PMRT).  The PMRT is used by all UK Trusts and has been designed with user and parent involvement to support high quality standardised perinatal reviews on the principle of 'review once, review well'.

Weaning food hygiene in Gambian villages

Weaning food is a potential source of infection for the vulnerable young child. There is a great deal of research into the content of weaning food, but little into interventions that can improve its hygienic preparation in low resource settings. We are conducting formative research and a cluster randomised controlled trial in 30 villages of rural Gambia to test community level interventions to reduce contamination of weaning food and water drank by young children. This is a collaborative piece of work with London School of Hygiene and Tropical Medicine (LSHTM) using critical control point methodology and motivational theories of behaviour change.

Mongolian maternal, child and adolescent health

The first ever RCT in Mongolia was conducted by our members in 2002-6, investigating the effects of health swaddling in Mongolia in infants. Extended data on 1300 families, mothers and infants enable on-going research. We intend to follow-up these children, now adolescents for risk factors and health outcome measures.  Further studies, such as first ever studies of PND in Mongolia and other maternal and child health research continue in Mongolia. More recent studies investigate the state of inequalities in service provisions for maternal-child health services and child and adolescent health services.

Breastfeeding

A low intensity NHS delivered peer support worker service to increase breastfeeding initiation and continuation in Heart of Birmingham PCT was evaluated in a cluster RCT (HoBBIT).  The findings showed no benefit of the service in increasing initiation (BMJ) or continuation to 6 months postpartum.  Two systematic reviews by the team (BMJ and CMAJ) further examine evidence on breastfeeding peer support.  Building on this work we are developing new interventions to increase breastfeeding in the UK and low and middle income countries. 

Childbirth-related urinary and faecal incontinence

This work, over the last 20+ years, is based around a cohort study (Prolong) of 7879 women who gave birth in 1993/4. The study (with colleagues in Aberdeen and New Zealand) has followed women at 6 and 12 years to investigate persistence and risk factors of incontinence and prolapse.  It is currently the largest long-term postpartum recruited cohort study on the topic. Examples of recent findings (BJOG) are that Caesarean section, relative to vaginal birth is not associated with a reduction in stress incontinence unless all a woman’s deliveries are by Caesarean.  And even exclusive Caesarean delivery is not associated with less faecal incontinence: whilst just one forceps delivery will increase the risk. A linked RCT (PINT) of pelvic floor muscle exercise for women with symptoms at 3 months postpartum showed improvement at 1 year but not at 6 years (both BMJ).  A current linked RCT (PREVPROL) is on exercise to prevent prolapse, funded in UK centres by RCOG charity Wellbeing, about to report.  Follow-up at 22 years is planned.

Other work in this area includes collaborations on a pregnancy recruited cohort study followed to 4 years with colleagues at University of Melbourne; and a population based study of pelvic floor disorders in Pakistan. The latter has also investigated obstetric fistula. A 5 year NIHR funded programme of work (APPEAL) is investigating antenatal prophylactic pelvic floor exercise in the prevention of postnatal incontinence including qualitative developmental work, systematic reviews leading to a pilot RCT.

FGM Sister Study

 

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The Female Genital Mutilation (FGM) Sister Study is a qualitative study exploring the views of FGM survivors, male partners and healthcare professionals on the timing of deinfibulation surgery. 

 

Principle Investigator: Laura Jones

Meet the team

Principal investigators: 
Professor Christine MacArthur
Professor Sara Kenyon
Dr Carole Cummins
Dr Semira Manaseki-Holland

Lecturers/ research fellows: 
Sally Bradshaw
Dr Karen Shaw
Dr Beck Taylor
Dr Farina Kokab
Ellie Jones

Students: 
Buba Manjang
Tolulope Olufunlayo

Administrator: 
Anne Walker

Key collaborators from other research groups in IAHR
Dr Danai Bem
Jonathan Bishop
Professor Karla Hemming
Gavin Rudge