Maternal and Child Health

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

Overview

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

The group undertakes studies on research questions that impact upon public health services and on clinical practice in maternal and child health, emphasising high quality designs.

Our research group

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, public health and behaviour change initiatives in a children’s hospital and the introduction of electronic prescribing.

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) Birmingham and the Black Country 2009-2013 and 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

  • Birmingham Symptom specific Obstetric Triage System (BSOTS)
  • Homebirth study
  • The health effect s of early postnatal discharge from hospital for healthy women and term infants
  • Assessment of the implementation of advance care plans for children
  • A project to evaluate the early implementation and impact of Magnolia House on sharing life-altering information and bereavement care within a paediatric acute hospital
  • Evaluation of the implementation of e-prescribing at the Birmingham Children’s Hospital
  • Parenting in the context of children with life-changing admissions to hospital: development of an intervention
  • A point of care test for exposure to tobacco smoke:  feasibility of use in behaviour change interventions in a children’s hospital

 

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


Dr 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 (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 will begin recruiting women early in 2017 and recruitment will be completed by August 2017, with the trial closing in May 2018.

A multicentre randomised controlled trial of an intelligent system to support decision making in the management of labour using the cardiotocogram (INFANT)

Accordion content

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

Accordion content

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.

Vitamin D status and supplementation in mothers and young children in Afghanistan

In 2009-12, we conducted the largest RCT of vitamin D supplementation to date with respiratory outcomes and the first ever substantial community RCT in Afghanistan. Data from this and other studies of vitamin D in Afghanistan continue being analysed and developed. We are currently collaborating with Queen Mary London Medical School recently with a large patient-data meta-analysis to investigate the collective effect of all vitamin D trials on respiratory infections.

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) has just commenced to investigate antenatal prophylactic pelvic floor exercise in the prevention of postnatal incontinence including qualitative developmental work, systematic reviews leading to an RCT.

Epidural analgesia

An earlier two centre RCT (COMET) found low dose mobile epidural techniques resulted in fewer instrumental deliveries than traditional higher dose epidurals and the results (Lancet) credited as showing that the latter technique is no longer justified in routine practice.  However there are still more instrumental births with mobile epidurals than without. A current NIHR funded trial (BUMPES - lead Brocklehurst) of over 3000 women with epidurals has investigated effects of maternal position in 2nd stage labour on mode of delivery. A currently recruiting RCT (RESPITE- lead Wilson) is comparing use of remifentanil versus pethidine. 

FGM Sister Study

 

Study Lead/PI:  Dr Laura Jones

Research Fellows: Emma Danks, Dr Lailah Alidu

Study Coordinator: Dr Joanne Clarke

UoB Co-Applicants: Professor Julie Taylor, Professor Kate Jolly

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.

The FGM Sister Study aims to explore and understand (1) the timing preferences for deinfibulation surgery amongst FGM survivors, male partners and healthcare professionals; and (2) how to improve NHS FGM services for type 3 FGM survivors and their families. The study aims will be address in two work packages.

In Work Package 1, we seek to recruit up to 50 women who are FGM survivors, up to 10 male partners and up to 50 healthcare professionals to take part in an interview or discussion group to explore their views on timing preferences for deinfibulation and NHS FGM services.

In Work Package 2, we will hold community engagement and stakeholder events to synthesise the findings of the study and inform best practice and policy recommendations around the timing of deinfibulation and FGM care provision, and identify future actions.

This research is funded by the National Institute of Health Research (NIHR). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health or the Department of Health.

Twitter link: @FGMSisterStudy

Study email: fgmsisterstudy@contacts.bham.ac.uk

Study phone number: 0121 414 3024

Link to National FGM Centre: www.nationalfgmcentre.org.uk

Participant Leaflets:

FGM Sister Study_PIL HCP_6pp DL_screen

FGM Sister Study_PIL Male Partners_6pp DL_screen

FGM Sister Study_PIL Women Survivors_6pp DL_screen


Staff

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

Lecturers/ research fellows:
Sally Bradshaw, Albert Farre, Karen Shaw, Beck Taylor

Research Associates and assistants: 
Rachel Adams

Students: 
Ellie Jones, Buba Manjang, Tolulope Olufunlayo

Administrator:
Anne Walker

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