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Analysis

Research set to reveal birthplace safety

23 October, 2008

Research set to reveal birthplace safety

Does place of birth affect outcome? The Birthplace in England cohort study goes national to find out. Does place of birth affect outcome? The Birthplace in England cohort study goes national to find out.

 

Midwives magazine: April/May 2008



For decades, debate has raged about whether there is a difference in outcomes between births planned at home, midwifery units or obstetric units. In spring last year, the Birthplace in England research programme began to develop a cohort study to address this question.

The original aim of the cohort study was to compare 17,000 births planned at home with 10,000 births planned in midwifery units and 30,000 planned in obstetric units to evaluate whether there was a difference in neonatal morbidity five days after birth.  To collect such a huge amount of data was recognised to present particular challenges, therefore before trying to run the study throughout England, a feasibility phase was carried out to test whether it would be possible to collect enough good quality information about births planned at home. 

The first step in the feasibility phase was when the Birthplace team from the National Perinatal Epidemiology Unit (NPEU) in Oxford approached the head of midwifery (HoM) to discuss midwives’ participation in their three diverse Trusts. Fortunately for Birthplace, HoM at Taunton and Somerset NHS Trust Sandra Reading, Liverpool Women’s Hospital Foundation NHS Trust’s HoM Lydia Moore, and Gill Walton, HoM at  Oxford Radcliffe NHS Trust generously committed themselves and their midwifery colleagues to the study.

Once their HoM gave the go-ahead for collaboration, a local coordinating midwife (LCM) was appointed for each Trust. These are Carol Puckett for the Taunton and Somerset Trust, Liverpool Women’s Hospital has Chelsea McDonough, and Laura Stewart-Maunder was appointed to the Oxford Radcliffe Trust.

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Supported by the NPEU, all three LCMs used their invaluable ‘local knowledge’ to set up data collection systems with their midwifery colleagues and solve on-the-ground problems. Data were collected between July and December 2007, during which midwives were asked to begin a Birthplace data form when they were called to a woman in labour who was more than 36 weeks’ gestation and was planning a home birth. Because only information already recorded in maternity notes was needed for Birthplace, no individual consent was necessary and therefore midwives in all three Trusts quickly integrated Birthplace into their care. Thanks to their efforts, data were returned for 94% of the 261 women eligible to be included and therefore feasibility study results convincingly showed it would be possible to collect sufficient high-quality data about birth planned at home in the national cohort study. Data collection for births planned at home is now continuing at the same level in all three pioneering sites.

The study clearly demonstrated how crucial LCMs are to the success of this research. Data collection for births planned at home and in free-standing midwifery units is being rolled out in England and LCMs are being appointed in every Trust in England. More than 50 have already been appointed and midwives in these first wave sites began data collection last month and this.

From this summer, births planned in midwifery units and obstetric units will be included in the study and midwives working in these locations will have the opportunity to become LCMs and to collect data for Birthplace. NPEU national coordinating research midwife for Birthplace Mary Stewart said: ‘We want every midwife in England to have the chance to be part of Birthplace and to help produce the best possible evidence to support choices and decisions about planning place
of birth.’


Further Information

For further information about the Birthplace in England Research Programme, please contact the NPEU’s national coordinating research midwife Mary Stewart at: mary.stewart@npeu.ox.ac.uk or visit the unit’s Birthplace in England Research programme website: www.npeu.ox.ac.uk/birthplace
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