Tagged / maternity

Dr. Rachel Arnold’s first paper as BU staff

Congratulations to Dr. Rachel Arnold in the Centre for Midwifery, Maternal & Perinatal Health who had her first paper accepted since she started working at BU two months ago. Her paper ‘Villains or victims? An ethnography of Afghan maternity staff and the challenge of high quality respectful care’ is co-authored with her former PhD supervisors Professor Kath Ryan (BU Visiting Faculy), Professor Emerita Immy Holloway and CMMPH’s Professor Edwin van Teijlingen [1].  The paper is Open Access funded by Bournemouth University’s Open Access Fund which will help promote the visibility of the paper before REF 2021.

I was tempted to head this blog ‘Dr. Arnold only two months at BU and first paper published’, but I decide this would perhaps send the wrong message to other new BU staff.  Rachel completed her PhD in CMMPH and this is paper is the third publication from her thesis.  The other academic publications by Dr. Arnold on Afghanistan have been in BJOG and Social Science & Medicine [2-3].

 

References:

  1. Arnold, R., van Teijlingen, E., Ryan, K., Holloway, I. (2019) Villains or victims? An ethnography of Afghan maternity staff and the challenge of high quality respectful care ,     BMC Pregnancy and Childbirth (accepted).
  2. Arnold R., van Teijlingen E, Ryan K., Holloway I. (2015) Understanding Afghan health care providers: Qualitative study of culture of care in Kabul maternity hospital, BJOG 122: 260-267.
  3. Arnold, R., van Teijlingen, E., Ryan, K., Holloway, I. (2018) Parallel worlds: an ethnography of care in an Afghan maternity hospital, Social Science & Medicine 126:33-40.

New collaborative paper BU-NHS colleagues

The month saw the publication of the latest collaborative paper between FHSS academics, BU Visiting Faculty and NHS clinicians.  Our paper ‘Design errors in vital sign charts used in consultant-led maternity units in the United Kingdom’ [1] is available for a free download from Elsevier until August 28, 2019. Till then no sign up, registration or fees are required, click here.

The authors, as part of the Modified Obstetric Warning Score (MObs) Research Group, lead by BU Visiting Faculty Richard Isaac, argue that obstetric observation charts in the UK contain poor design features. These charts have common errors such as an inappropriate use of colour, poor alignment and axes labelling.  Consequently, these design errors render charts difficult to use and could compromise patient safety. The article calls for an evidence-based, standardised obstetric observation chart, which should integrate ‘human factors’ and user experience.

This research team, earlier published ‘Vital signs and other observations used to detect deterioration in pregnant women: Analysis of vital sign charts in consultant-led maternity units’. [2]

References:

  1. Isaacs, R., Smith, G., Gale-Andrews, L., Wee, M., van Teijlingen, E., Bick, D.E., Hundley, V. on behalf of the Modified Obstetric Warning Score (MObs) Research Group. (2019) Design errors in vital sign charts used in consultant-led maternity units in the United Kingdom, International Journal of Obstetric Anesthesia 39:60-67.
  2. Smith, G., Isaacs, R., Gale-Andrews, L., Wee, M., van Teijlingen, E., Bick, D., Hundley, V. (2017) Vital signs and other observations used to detect deterioration in pregnant women: Analysis of vital sign charts in consultant-led maternity units. International Journal of Obstetric Anesthesia 30: 44-51.

 

Congratulations to PhD student Alice Ladur

FHSS PhD student Alice Ladur has been awarded a small but very competitive grant by FfWG, the Funds for Women Graduates.  FfWG is the trading name of the BFWG Charitable Foundation and the BFWG (British Federation of Women Graduates), which is affiliated to the International Federation of University Women.

Alice is based in the Centre for Midwifery, Maternal & Perinatal Health (CMMPH).  Her PhD research in Uganda is supervised by Prof. Vanora Hundley and Prof. Edwin van Teijlingen. Her thesis research has already resulted in an academic paper published in the international journal BMC Pregnancy & Childbirth, which Open Access.

Key role of volunteers in the health system

This week saw the publication of ‘Perceived barriers to accessing Female Community Health Volunteers’ (FCHV) services among ethnic minority women in Nepal: A qualitative study’ [1].  This article in the Open Access journal PLoS ONE highlights the key role volunteers play in delivering health services to minorities/the poorest people, especially in low-income countries like Nepal.

This paper studies community health workers in Nepal, who are known as Female Community Health Volunteers (FCHVs). To address this issue, we conducted a qualitative study to explore perceived barriers to accessing maternal and child healthcare services among ethnic minority groups in two different parts of Nepal with varying degrees of access to local healthcare centres. Semi-structured interviews were conducted with twenty FCHVs, 26 women service users and 11 paid local health workers. In addition, 15 FCHVs participated in four focus group discussions.

A thematic analysis of the data identified five major themes underlying barriers to accessing available maternal and child healthcare services by ethnic minority groups. These themes include: a) lack of knowledge among service users; b) lack of trust in volunteers; c) traditional beliefs and healthcare practices; d) low decision-making power of women; and e) perceived indignities experienced when using health centres.  The paper concluded that community health programmes should focus on increasing awareness of healthcare services among ethnic minority groups, and the programmes should involve family members (husband and mothers-in-law) and traditional health practitioners. Both the FCHVs and local healthcare providers should be trained to communicate effectively in order to deliver respectful care among ethnic minorities if we want to achieve universal healthcare coverage for maternal and child health in low- and -middle income countries.

The paper is based on the PhD research conducted by Dr. Sarita Panday in ScHARR at the University of Sheffield.  Dr. Panday is currently affiliated with the Walter H. Shorenstein Asia-Pacific Research Centre (APARC) at Stanford University in the USA.  Her co-authors are Prof. Paul Bissell at the University of Huddersfield, FHSS’s Visiting Prof. Padam Simkhada at the Liverpool John Moores University and BU Prof. Edwin van Teijlingen.  This is the second paper from Dr. Panday’s excellent thesis, the first paper was also published in an Open Access journal BMC Health Services Research [2].

 

References:

  1. Panday S, Bissell P, van Teijlingen E, Simkhada P (2019) Perceived barriers to accessing Female Community Health Volunteers’ (FCHV) services among ethnic minority women in Nepal: A qualitative study. PLoS ONE 14(6): e0217070.
  2. Panday S, Bissell P, van Teijlingen E, Simkhada P (2017) The contribution of female community health volunteers (FCHVs) to maternity care in Nepal: a qualitative study. BMC Health Services Research 17(1):623.

Paper in top 30 most cited Journal Advanced Nursing articles

BU’s Dr. Bibha Simkhada’s paper ‘Factors affecting the utilisation of antenatal care in developing countries: a systematic review of the literature’ [1] is currently the 27th most cited paper in the Journal of Advanced Nursing.  This is great achievement considering that the journal has published nearly ten thousand articles since its inception (to be precise 9,847).  The Journal of Advanced Nursing (published by Wiley) is one of the prestigious journals in the nursing field.  This extremely well-cited paper was part of Bibha’s Ph.D. study at the University of Aberdeen.  Dr. Bibha Simkhada is Lecturer in Adult Nursing in the  Department of Nursing and Clinical Sciences.  One of her co-authors also works at BU, Prof. Edwin van Teijlingen and a second co-author, Prof. Padam Simkhada from Liverpool John Moores University is Visiting Professor in the Faculty of Health & Social Sciences.  The third co-author Dr. Maureen Porter retired a few years ago.

 

 

Reference:

  1. Simkhada, B., van Teijlingen E., Porter, M., Simkhada, P. (2008) Factors affecting the utilisation of antenatal care in developing countries: a systematic review of the literature, Journal of Advanced Nursing 61(3): 244-260.

MIDIRS reproduced Afghanistan paper

Dr. Rachel Arnold’s paper ‘Parallel worlds: an ethnography of care in an Afghan maternity hospital’ [1] originally published in Social Science & Medicine (Elsevier) has been reprinted in full in MIDIRS.  This is quite an accolade and should help this paper reach a wider audience.  Rachel graduated with a Ph.D. from the Faculty of Health & Social Sciences in 2016, illustrating that some of the best papers get into print (long) after completing one’s Ph.D. thesis.

 

 

Reference:

  1. Arnold, R., van Teijlingen, E., Ryan, K., Holloway, I. (2018) Parallel worlds: an ethnography of care in an Afghan maternity hospital, Social Science & Medicine 126:33-40.

Congratulations to Denyse King

Congratulations to Denyse King, who is currently attending the Future Technologies Conference, FTC 2018; Vancouver, BC; Canada (15-16 November).  Her conference paper ‘NoObesity apps – From approach to finished app’ has been published in Advances in Intelligent Systems and Computing [1].  Denyse is part of the Centre for Midwifery, Maternal & Perinatal Health (CMMHP) where she is a Lecturer (Academic) in Midwifery based at BU’s campus in Portsmouth ,

Obesity is still a growing public health problem in the UK and many healthcare workers find it challenging to have a discussion with service users about this sensitive topic. They also feel they are not competent to provide the relevant heath advice and are seeking easily accessible, evidence-based, mobile health learning (mHealth). mHealth applications (apps) such as the Professional NoObesity and Family NoObesity (due for release late 2018), have been designed to: support families with making sustainable positive behaviour changes to their health and well-being, ease pressure on practitioners’ overweight and obesity care related workloads, as well as to support the education of professionals, students and service users. This paper describes the process of designing the apps from the inception of the idea, through the stages of research, app builds and testing. The processes of collaborative working to design and develop the apps to meet the needs of both service users and health professionals will also be reflected upon. Childhood obesity is an complex problem and whilst it is recognised that the NoObesity apps cannot singlehandedly resolve this health crisis, it is proposed that they can support families to identify and reduce the barriers that prevent them from living healthier, happier lives. 

Reference:

King D., Rahman E., Potter A., van Teijlingen E. (2019) NoObesity Apps – From Approach to Finished App. In: Arai K., Bhatia R., Kapoor S. (eds) Proceedings of the Future Technologies Conference (FTC) 2018. FTC 2018. Advances in Intelligent Systems and Computing, vol 881. Springer, Cham, pp. 1145-1157.

Nepal paper by Lesley Milne (CMMPH)

Congratulations to Lesley Milne, senior lecturer in midwifery, on the acceptance of her latest paper on maternity care in Nepal.  This new paper ‘Gender inequalities and childbearing: A qualitative study of two maternity units in Nepal’ will appear soon in the Open Access publication: Journal of Asian Midwives [1].   This is the second publication from a qualitative research study undertaken in two birthing facilities in Kathmandu Valley to examine barriers to women accessing these services from the perspective of hospital staff [2].

The study received financial support from Wellbeing of Women and the RCM (Royal College of Midwives) as Lesley won their first International Fellowship Award.   The study was a collaboration led by Lesley in the Centre for Midwifery, Maternal & Perinatal Health (CMMPH) with two of FHSS’s Visiting Faculty, namely Prof. Padam Simkhada who is based at Liverpool John Moores University and Jillian Ireland, Professional Midwifery Advocate based at Poole NHS Hospitals Foundation Trust.

Well done!

Profs. Vanora Hundley & Edwin van Teijlingen

 

 

 

References

  1. Milne, L., Ireland, J., van Teijlingen, E., Hundley, V., Simkhada, P.P. (2018) Gender inequalities and childbearing: A qualitative study of two maternity units in Nepal, Journal of Asian Midwives (accepted).
  2. Milne, L., van Teijlingen, E., Hundley, V., Simkhada, P., Ireland, J. (2015) Staff perspectives of barriers to women accessing birthing services in Nepal: A qualitative study BMC Pregnancy & Childbirth 15:142 www.biomedcentral.com/1471-2393/15/142 .

E-poster presented by CMMPH student Preeti Mahato in Singapore

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 e-poster

 

 

 

 

 

 

 

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.

BU Briefing – Understanding Afghan healthcare providers

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.

Click here to read the briefing paper.


For more information about the research, contact Professor Edwin van Teijlingen at evteijlingen@bournemouth.ac.uk or Immy Holloway at ihollowa@bournemouth.ac.uk
To find out how your research output could be turned into a BU Briefing, contact research@bournemouth.ac.uk.

First 2017 publication by CMMPH academics

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)  [1].    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 [2].

symon-taxonomy-2017The 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

CMMPH

 

References:

  1. 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
  2. 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

New BU multidisciplinary media & health paper out today!

media childbirth

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[1]. 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 cover 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

CMMPH

 

References:

  1.  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
  2. 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.
  3. Hundley, V., Luce, A., van Teijlingen, E. (2015) Do midwives need to be more media savvy? MIDIRS Midwifery Digest 25(1):5-10.
  4. 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.
  5. 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.
  6. 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.

Two BU authored chapters in new book on childbirth

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

CMMPH

BU paper in top ten in the international journal Midwifery

Top 10 in MIDWIFERY

First page of the paper

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

 

 

BUCRU – Seminar presenting Breaking News!

 

BREAKING  NEWS…

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.

BUCRU

Website: http://microsites.bournemouth.ac.uk/bucru/

Administrator: +44 (0)1202 961939 / wardl@bournemouth.ac.uk

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.

Abstract:

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).

References

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.