The presentation includes some of the findings from out recently completed THET-funded study on a maternal mental health intervention in southern Nepal as well as some reflections on working and researching in the country. The slides for tomorrow’s presentation can be found at LinkedIn, click here!
Tagged / maternity
Last week I attended and presented e-poster at the RCOG (Royal College of Obstetrics & Gynaecology) World Congress 2018 in Singapore. The main congress programme run 22 to 24 March. RCOG president Professor Lesley Regan told in her opening speech that this Congress had more than 2,800 delegates and 150 speakers from 82 countries. Prof Regan also said that the Congress focused on the need for all to work in the field of obstetrics and gynaecology and to act as advocates for women’s health. Furthermore, she stressed that it is necessary to look beyond clinical aspects and provide safe, high-quality care to speak for the needs of the women, many of whom have no choice of their own.
The e-poster I presented ‘Study of rural maternity and childbirth care in a southern district of Nepal’ is part of my PhD study on maternity care in Nepal.
My poster was displayed on the morning of 22nd March (8:08– 8:16 AM) under the topic ‘early pregnancy and acute gynaecology’. Over the three days programme schedule, I also attended several plenary sessions, oral presentations and viewed many e-posters. Although there were many topics specific to clinical aspects of obstetrics and gynaecology, I was mostly interested in presentations related to contraception and fertility control, abortion, gender equality, reproductive and sexual health of marginalised communities, female genital mutilation, breastfeeding and so on. Overall, it was a great experience to learn about research in women’s health and maternity care and an opportunity to do networking with researchers with similar interests.
Finally, I would like to thank Santander Awards to provide me fund to cover my expenses to attend this congress and my supervisors for motivating me to apply for this conference.
Our BU briefing papers are designed to make our research outputs accessible and easily digestible so that our research findings can quickly be applied – whether to society, culture, public policy, services, the environment or to improve quality of life. They have been created to highlight research findings and their potential impact within their field.
This paper focuses on the perspectives of Afghan healthcare providers on their roles, experiences, values and motivations, and the impact this has on the quality of care for perinatal women and their newborn babies. To understand their perspectives , the researchers undertook a six-week observation – including interviews and focus groups – to analyse the culture of a maternity hospital in Kabul, Afghanistan.
This research study offers multiple insights into Afghan healthcare provider behaviour and reveals complex interrelated issues that affect care in this setting. It is one of few international studies that explore care from the perspective of healthcare providers in their cultural and social environment. It reveals that understanding the context of healthcare is crucial to understanding behaviour and the underlying problems to quality of care.
For more information about the research, contact Professor Edwin van Teijlingen at firstname.lastname@example.org or Immy Holloway at email@example.com.
To find out how your research output could be turned into a BU Briefing, contact firstname.lastname@example.org.
Yesterday the Scottish Government has published its national maternity review ‘The Best Start – A Five Year Forward Plan for Maternity and Neonatal Care in Scotland’. The report has been widely welcomed and gained, among others, the full support from the Royal College of Midwives (RCM). Mary Ross-Davie, RCM Director for Scotland noted: “This is a defining moment for maternity services in Scotland and will be a seismic shift for our maternity services. The plan has the potential to revolutionise maternity care, to deliver safer and better services for women, babies and their families, and to improve the health of our population.”
The Best Start recognises that maternity and neonatal services matter to the health and wellbeing of Scotland’s people. The report’s underpinning is more of a social model of childbirth as it observes that “The health, development, social, and economic consequences of childbirth and the early weeks of life are profound, and the impact, both positive and negative, is felt by individual families and communities as well as across the whole of society.”
Having lived for 25 years in Scotland I am happy to have made a small contribution to this import report.
Prof. Edwin van Teijlingen
Centre for Midwifery, Maternal & Perinatal Health
Yesterday saw the publication of the paper ‘Antenatal care trial interventions: a systematic scoping review and taxonomy development of care models’, which is the first paper this year for the Centre for Midwifery, Maternal & Perinatal Health (CMMPH) . The paper is based on a cross-UK collaboration led by Dr. Andrew Symon from the University of Dundee which is published in the Open Access journal BMC Pregnancy & Childbirth. This is the second paper from this collaboration, the first one ‘Midwifery-led antenatal care models: Mapping a systematic review to an evidence-based quality framework to identify key components & characteristics of care ‘ was published last year .
The latest BMC Pregnancy & Childbirth paper is a first step in establishing a taxonomy of antenatal care models. The article concludes that interventions can be defined and described in many ways. The intended antenatal care population group proved the simplest and most clinically relevant way of distinguishing trials which might otherwise be categorised together. Since our review excluded non-trial interventions, the taxonomy does not represent antenatal care provision worldwide. It offers a stable and reproducible approach to describing the purpose and content of models of antenatal care which have been tested in a trial. perhaps key is that the paper highlights a lack of reported detail of trial interventions and usual care processes.
Our paper provides a baseline for future work to examine and test the salient characteristics of the most effective models, and could also help decision-makers and service planners in planning implementation.
Moreover we look forward to conducting more research as part of this exciting collaboration in midwifery and maternity care.
Prof. Edwin van Teijlingen & Prof. Vanora Hundley
- Symon, A., Pringle, J., Downe, S., Hundley, V., Lee, E., Lynn, F., McFadden, A., McNeill, J., Renfrew, M., Ross-Davie, M., van Teijlingen, E., Whitford, H., Alderdice, F. (2017) Antenatal care trial interventions: a systematic scoping review and taxonomy development of care models BMC Pregnancy & Childbirth 17:8 http://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-016-1186-3
- Symon, A., Pringle, J., Cheyne, H., Downe, S., Hundley, V., Lee, E., Lynn, F., McFadden, A., McNeill, J., Renfrew, M., Ross-Davie, M., van Teijlingen, E., Whitford, H, Alderdice, F. (2016) Midwifery-led antenatal care models: Mapping a systematic review to an evidence-based quality framework to identify key components & characteristics of care, BMC Pregnancy & Childbirth 16: 168 http://www.biomedcentral.com/1471-2393/16/168
On previous occasions we have written on the BU Research Blog about our THET-funded project, for example earlier this year on the first training sessions in Nepal. Bournemouth University is leading on a project in collaboration with Tribhuvan University (the largest and oldest university in Nepal) and Liverpool John Moores University (LJMU). The project receives funding from DFID, and is managed through THET and supported locally in Nepal by a non-governmental organisation called Green Tara Nepal. We have been working with this charity for nearly ten years.
This time we would like to highlight a regular research blog written by Ish Fawcett who went out to Nepal last month as one of the UK volunteers. She has written some lovely blogs on her time in Nepal, about the training sessions as well as her general experiences of and observations on Nepal. Her blogs can be accessed here!
We would like to take this opportunity to repeat our call for volunteers. If you are a health or education professional with an interest in mental health and/or maternity care and you are interested in volunteering later this year for a week to ten days in Nepal please contact Edwin van Teijlingen (email@example.com ).
Prof. Edwin van Teijlingen
Today saw the publication “Is it realistic?” the portrayal of pregnancy and childbirth in the media, a paper which is truly interdisciplinary, both in terms of its authorship as well as its topics. The lead-author, Dr. Ann Luce is based in the Faculty of Media & Communication, whilst her BU co-authors Dr. Catherine Angell, Prof. Vanora Hundley, Prof. Edwin van Teijlingen and Dr. Marylin Cash are all associated with the Faculty of Health & Social Sciences. Prof. Helen Cheyne, the only non-BU co-author, is based at the University of Stirling.
The paper is a scoping review to assess the influence media have on pregnant women. Much of the academic literature discusses the influence of (reality) television, which often portrays birth as risky, dramatic and painful. Although many claim that the portrayal of childbirth has a negative effect on society, there is little research evidence to support this claim. It has been suggested that women seek out such programmes to help understand what could happen during the birth because there is a cultural void through the increasing anticipation of negative outcomes. However the impact that has on normal birth has not been explored. Our paper highlighted three key themes: (a) the medicalisation of childbirth; (b) women using media to learn about childbirth; and (c) birth as a missing everyday life event. The key conclusions are the media appear to influence how women engage with childbirth. The dramatic television portrayal of birth may perpetuate the medicalisation of childbirth, and last, but not least, portrayals of normal birth are often missing in the popular media. Hence midwives need to engage with television producers to improve the representation of midwifery and maternity in the media.
BMC Pregnancy and Childbirth is an Open Access journal so our paper is freely available to researchers, journalists, childbirth activists as well as pregnant women anywhere in the world. This paper builds on a growing number of academic papers published by staff in the Centre for Midwifery, Maternal & Perinatal Health (CMMPH) on the role the media play in health and midwifery, both in the UK [2-3] and in Nepal [4-6].
Prof. Edwin van Teijlingen
- Luce, A., Cash, M., Hundley, V., Cheyne, H., van Teijlingen, E., Angell, C., (2016) “Is it realistic?” the portrayal of pregnancy and childbirth in the media BMC Pregnancy & Childbirth 16: 40
- Hundley, V., Duff, E., Dewberry, J., Luce, A., van Teijlingen, E. (2014) Fear in childbirth: are the media responsible? MIDIRS Midwifery Digest 24(4): 444-447.
- Hundley, V., Luce, A., van Teijlingen, E. (2015) Do midwives need to be more media savvy? MIDIRS Midwifery Digest 25(1):5-10.
- Devkota, S., Simkhada, P., van Teijlingen, E., Rai, L.D. (2012) Media use for Health Promotion: Communicating Childhood Immunisation Messages to Parents. Journal of Health Promotion 4(1): 1-9.
- Devkota, S., Simkhada, P., van Teijlingen, E., Rai, L.D. (2013) Childhood Immunisation in Nepal: Parents’ knowledge, attitudes and behaviour & implications for Health Policy. Health Science Journal 7(4):370-383.
- Devkota, S., Maharjan, H.M., van Teijlingen, E. (2015) Media and Health. In: Wasti, S.P., Simkhada, P.P. & van Teijlingen, E. (Eds.) The Dynamics of Health in Nepal, Kathmandu, Nepal: Social Science Baha & Himal Books: 169-184.
BU Ph.D. student and Consultant Midwife Kathryn Gutteridge and Hannah Dahlen Associate Professor of Midwifery at the University of Western Sydney contributed a chapter to the book ‘The Roar behind the Silence: Why kindness, compassion and respect matter in maternity care’. Kathryn Gutteridge and Hannah Dahlen wrote under the title ‘Stop the fear and embrace birth’. BU’s Dr. Jenny Hall also wrote a chapter called ‘Spirituality, compassion and maternity care’.
The volume edited by Sheena Byrom and Soo Downe was published this week by Pinter & Martin (London). I received my copy of the book yesterday, but didn’t have a chance to look at it until today. The Roar Behind the Silence is both a practical and inspirational book, which likely to be of interest to people working in maternity care (midwives, doctors, managers), local and regional maternity-care policy-makers as well as politicians and funders and, of course, to many pregnant women and maternity-care pressure groups. The book highlights examples of good practice, and offers practical tools for making change happen, advice on how to use evidence and real-life stories.
Prof. Edwin van Teijlingen
The paper ‘Risk, theory, social and medical models’ published in 2010 co-authored with Dr. Helen Bryers made it into the top ten most downloaded articles in the past 90 days from the journal Midwifery. See http://www.journals.elsevier.com/midwifery/most-downloaded-articles/
It is also in the top 12 most quoted papers published in Midwifery. This interesting as all 11 papers that have been cited more often are older, i.e. have been in print longer and therefore had more time to be cited.
The Abstract of the paper reads:
Background: there is an on-going debate about perceptions of risk and risk management in maternity care. Objectives: to provide a critical analysis of the risk concept, its development in modern society in general and UK maternity services in particular. Through the associated theory, we explore the origins of the current preoccupation with risk Using Pickstone’s historical phases of modern health care, the paper explores the way maternity services changed from a social to a medical model over the twentieth century and suggests that the risk agenda was part of this process. Key conclusions: current UK maternity services policy which promotes normality contends that effective risk management screens women suitable for birth in community maternity units (CMUs) or home birth: however, although current policy advocates a return to this more social model, policy implementation is slow in practice. Implications for practice: the slow implementation of current maternity policy in is linked to perceptions of risk. We content that intellectual and social capital remains within the medical model. © 2010 Elsevier Ltd.
The full reference this paper is MacKenzie Bryers, H. & van Teijlingen, E. (2010) Risk, theory, social and medical models: A critical analysis of the concept of risk in maternity care. Midwifery 26(5): 488-496.
Prof. Edwin van Teijlingen
Centre for Midwifery, Maternal & Perinatal Health
We would like to invite you to an afternoon seminar by one of our Visiting Faculty, Professor Mike Wee, presenting some exciting new research findings to come out of a recently completed Research for Patient Benefit funded study comparing two methods of pain relief during labour (abstract and biography below). This paper was just voted best paper of the conference at the Obstetric Anaesthetists Association Annual Conference in Liverpool and was featured recently in the Bournemouth Echo http://www.bournemouthecho.co.uk/news/9770928.Pain_relief_in_labour__study_at_Poole_hospital_makes_important_discovery/
The seminar is scheduled for Thursday 19th July 2-3pm in BG10 Bournemouth House (after the HSC end of term lunch and next door for your convenience).
We hope you can make it and look forward to seeing you then.
Administrator: +44 (0)1202 961939 / firstname.lastname@example.org
Title: The IDvIP Trial: A two-centre double blind randomised controlled trial comparing i.m. diamorphine and i.m. pethidine for labour analgesia
Research team and affiliations: MYK Wee, JP Tuckey,* P Thomas,† S Burnard,* D Jackson.
Poole Hospital NHS Foundation Trust, Poole, UK, *Royal United Hospital, Bath, UK, †Bournemouth University Clinical Research Unit, Bournemouth, UK.
Background: Intramuscular pethidine, the commonest parenteral opioid analgesic used in obstetrics and more recently diamorphine usage has increased in the UK. The maternal, fetal and neonatal side effects are well known for pethidine but there are no sufficiently powered large RCTs comparing pethidine with diamorphine. The aim of this trial is to address this.
Methods: After ethical approval, informed consent was obtained from 484 women randomised to receive either 7.5mg diamorphine i.m. or 150mg pethidine i.m. for labour analgesia. The sample size calculation derived from a small RCT giving 90% power (at the 5% significance level) is based upon the maternal primary outcome measure of pain relief at 60mins and the neonatal primary outcome measures of Apgar Score of <7 at 1min and neonatal resuscitation. Secondary outcome measures include verbal pain intensity at 60mins and over 3hrs post-analgesia, pain relief over first 3hrs, maternal oxygen saturation, sedation, nausea and vomiting and maternal satisfaction with analgesia. Fetal and neonatal secondary outcomes include CTG trace, meconium staining, UApH, UVpH, time of delivery to first breath, Apgar Score at 5mins, naloxone use, neonatal oxygen saturations, sedation and feeding behaviour for the first 2hrs after delivery.
Results: Reported using CONSORT guidelines. At 60mins post-administration and over a 3hr period, diamorphine is better at reducing pain scores than pethidine (p<0.001). There were no statistical differences between the two groups regarding Apgar Scores of <7 at 1min and the need for neonatal resuscitation. The time between first dose administered and delivery is on average 82mins longer with the diamorphine group compared to pethidine (p<0.001). The vast majority of women experienced moderate to severe pain at all times. Women receiving diamorphine were more satisfied with their analgesia. There were no statistically significant differences in maternal sedation, nausea and vomiting or oxygen saturations over the 3hr period. There were no statistically significant differences in the fetal and neonatal outcomes including feeding behaviour between the two groups within 2hrs of birth but neonates in the pethidine group were more likely to be moderately or severely sedated at delivery.
Discussion: Intramuscular 7.5mg diamorphine gives significantly better analgesia than 150mg pethidine but prolongs delivery by approx. 82mins. Women given diamorphine are more likely to be satisfied with their analgesia. The mechanism for the prolongation of delivery time in the diamorphine group should be investigated further.
Acknowledgement: This research was funded by the NIHR Research for Patient Benefit Programme (PB-PG-0407-13170).
1. Tuckey JP, Prout RE, Wee MYK. Prescribing intramuscular opioids for labour analgesia in consultant-led maternity units: a survey of UK practice. International Journal of Obstetric Anesthesia 2008, 17(1):3-8.
2. Fairlie FM, Marshall L, Walker JJ et al. Intramuscular opioids for maternal pain relief for labour: a randomised controlled trial comparing pethidine with diamorphine. British Journal of Obstetrics and Gynaecology 1999; 106(11): 1181 -1187.
Biography of speaker:
Michael Wee is a consultant anaesthetist from Poole Hospital and Royal Bournemouth Hospitals. He has a special interest in obstetric anaesthesia and is the lead obstetric anaesthetist at Poole Hospital. He is chair of the Research and Innovations Group at Poole Hospital and is a Board member of the Western Comprehensive Local Research Network. He was awarded a visiting professorship at Bournemouth University in 2009. He is a referee for several medical journals. His research interests include patient information, safety in anaesthesia, maternal analgesia and simulation in epidural anaesthesia. He is a co-supervisor of a PhD student at BU and chief investigator of the MObs study investigating early warning scores in obstetrics.