To ask for your ideas about what research needs doing in midwifery?

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Sorry, posting for traffic!

I am a third year student midwife about to embark on a research project but I am struggling to decide on a topic.

As many of you are parents, is there anything in your experiences of maternity care that you think could have been done better or that you wondered why something was done or suggested? Anything you would have wanted more research on?

Any suggestions would be much appreciated.

Thanks in advance.

Maternity care for black women.

The use of forceps in this country , I believe they are no longer used in many countries ( and for good reason !)

Increasing use of Foleys Catheter for induction rather than hormonal methods.

I completely agree with this. Thank you.

So one thing that constantly came up to me is tongue tie. We were in hospital for a week and was told they checked 3 times and she had no tongue tie. Was discharged went to a lactation consultant who noticed it and it was also picked up by our health visitor at the new born visit and was referred back to the hospital to be seen by a nurse/midwife who was on my postnatal ward when discharged. I said hello and that I remembered her and explained I was bit confused that we were told by her colleagues that little one had no tongue tie and she said something along the lines of but that wasn't me.

It gave the impression that it is yet another area where staff who aren't fully trained and knowledgeable are tasked with something beyond their remit, rather than ensuring a TT champion is required to check before discharge.

Following on from that my baby group was online due to covid so there is an avid online support system for advice and support in the first instance over the NHS ... as soon as a mum was struggling with feeding/reflux etc it was always suggested by multiple members that they should get properly assessed for TT.

Considering the desire to increase BF rates and the emphasis placed on mothers mental health surely a competent TT process for all mums no matter feeding method should be in place.

Hi there I am a midwife working on a labour ward. I see so many women putting more than recommended amount of weight in pregnancy going for an emergency Caesarean section. There is plenty of research worldwide that excessive weight gain in pregnancy increases the risk. However in the UK we generally don't talk about BMI or pregnancy weight gain. I would really like to know whether talking to women about optimal weight gain early in pregnancy would be acceptable to them.

The effect of soft tissue conditions such as EDS on mothers during pregnancy, birth and the aftermath.

Thank you for this. In my trust, we are not qualified to diagnose TT but we are able to refer if we see an obvious one. It is definitely something to consider as I carry out NIPE checks and one of the checks is whether there is a TT visible.

This is definitely on my list, thank you.

I had a retained placenta with my 1st pregnancy, had to be removed in theatre w spinal anaesthetic (when I’d managed to give birth without epidural) plus large blood loss. It was traumatic and I believe it contributed to my PND plus struggling to breastfeed. So possibly some research into how having to undergo this type of procedure and/or blood loss affects women postnatally (both mentally and physically) would be good.

I'd like to see if antenatal care can be improved. Most pregnant women are working - many in professional jobs. The practice of making everyone rock up for the same clinic at the same time and then making the clients hang around for several hours before you see them is really inefficient and stressful. I had to get my classes covered for a whole afternoon each time and was never ever seen till after school had finished!

If GPs can offer timed appointments, why can't midwifery?

thank you. I agree it is a really taboo subject isn't it.

When I was pregnant 4 years ago I put on a lot of weight and I was told it was normal and I was never weighed or spoken to about it. I went from 9 stone pre pregnancy to over 14 after delivery!

In community I do try and push the subject of healthy weight with my women but other than a consultant or anaesthetic review later in pregnancy, nothing much more happens. this is also on the list.

Really like this, thank you.

2 broad things. Post natal care. Currently a very underfunded Cinderella service, I am a HCP and my experience professionally and personally has been very varied with regard to the access of post natal care/ support.

Secondly women from South Asia who have limited English. How can we improve maternity care for these women to reduce the significantly higher risk of complications/ still birth that they have.

Irritable uterus! My first pregnancy was affected by constant (every 3-5 mins all day, every day) mild Braxton-Hicks contractions from 20-ish weeks. They were dismissed, shrugged at and generally ignored right up until I gave birth at 33 weeks.

Or how about how to recognise labour. Seems a pretty basic one but in my first pregnancy I got to 10 cm dilated with strong urge to push before anyone acknowledged I was in labour, and with my second I was sent home from hospital an hour before baby was born, having been refused an examination, because "you can walk and talk through your contractions; you're days away yet."

(It was kinda satisfying that the same midwife was present for the very-much-not-days-away birth...)

I disagree. I am a midwife working on the labour ward. Forceps is a safe and versatile instrument in experienced hands. I did however raise the question of informed consent at a joint doctors and midwives meeting on our unit some years ago. If the doctors have time to properly consent for a Caesarean in a dire emergency, they have time to consent for an instrumental delivery. I am pleased report that our unit practice has changed and doctors do now take time to explain. This makes a huge difference in an otherwise scary situation. I wouldn't ban forceps, they are often a much better choice than a Caesarean at full dilatation when ventouse isn't possible

I developed intrahepatic cholestasis of pregnancy (ICP) during my second pregnancy and none of the midwifes I encountered seemed to know anything about it. I wonder why that was as the internet knows about it as does the NHS website. There also seems to be very little scientific research on the subject and no solution other than get the baby out as soon as possible.

Just interested what other options countries use rather than forceps? Both mine were forceps deliveries for different reasons. I was told ventouse wouldn't work due to babies head position, c section was an option but the 5-10 mins it would have taken to get me to theatre and under general anaesthetic could have been the difference between my baby being fine and them being dead or severely disabled due to hypoxia. The 2nd was done without any anaesthetic due to the urgency, was bloody painful but I chose a few minutes of pain over my child having a lifelong disability or worse

The impact of 'quiet night' policies on postnatal and children's wards on maternal wellbeing.

When I had ds, the sister and the team on the postnatal ward made it very clear that after 9pm all TVs were switched off, all visitors out, and it was a quiet ward. My sister's experience in a different hospital could not have been more different- groups of visitors, phones and screens going late into the night. Can't be ideal. (Tbf she was the one who went on to bf successfully, I didn't. But she never set foot in that hospital again).

In most areas it should be timed appointments but I think the problem is the minimum amount of time an appointment could potentially be completed in is allocated and so clinics inevitably over runs as it only takes a problem to be identified, a procedure to take a little bit longer to complete, a woman to ask a question or feel unwell, a referral that needs making etc which are all common and inevitable in every clinic and before you know it the clinic is running hours late. Staff are inevitably run off their feet and missing breaks etc to try not to keep women waiting any longer than necessary but given limited resources the priority is ensuring everyone gets good clinical care. Is difficult to know how to overcome this without more funding, if people happy to pay the taxes necessary for the equivalent of a private level of convenience but then if it’s a choice between paying that extra tax or having enough of your pay for swimming lessons for your child your likely to not want to pay more tax

The PN wards in my trust are not conducive to rest and relaxation so I hear you on this one. It would be interesting to see what the effects of time on a PN ward have on maternal mental health. Thank you.

Maybe a bit specific, but I wish there was better research out there for women like me with congenital uterine abnormalities (CUAs) and the best approach in terms of maternity care. It seems like different health boards have very different approaches in terms of offering cervical length scanning and foetal fibronectin testing (or not), offering regular growth scans in the third trimester and whether women with known CUAs should be under consultant care or not.

There is overall a very poor level of understanding about the risks facing women with this condition and the outcomes with different approaches to maternity care.

I think

• more research on how to better support mums with SPD to labour more comfortably and with fewer complications

How to encourage better uptake of early antenatal care. I work in paediatrics and there seems to be a correlation between children with complex developmental needs and mums not accessing early antenatal care, not knowing to take folic acid, having a child with a cousin or other relative, so definitely a need for more education

Sodding forceps use. My hospital has 9% forceps delivery- I wonder how many of those women have significant pelvic floor issues.

Midwives seem to have limited knowledge of effective pelvic floor exercises, and only make passing references to it antenatally ( my NCT friend literally didn't know what they are until 8 week PP GP appointment- we had the same midwife). It wasn't until I started going to physio that I learnt I hadn't been doing them properly the while pregnancy. I wonder how much suffering you could alleviate if physios ran training for trainee midwives.

@Bushmillsbabe
Having a quick scan of some studies it looks like they are more focused on preventing it getting to a stage where forceps is needed but otherwise it's ventouse/caesarean

I like this. We do not have anything much at uni to cover this, other than a lecture on different uterus shapes. I have only come across CUA's in the PN ward so a bit too late to learn. It would be beneficial for me to learn this as well as try and come up with some more clear pathways. Thank you.