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.

Increase in unnecessary inductions and the trauma they cause! Particularly leading to c-sections.

Impact of partners staying or not staying the night after delivery on post natal mental health (of the woman and the partner), perhaps controlling for delivery method. I had a C-section and my husband had to leave for the night before I could move my legs. I couldn't pick my baby up without help (or put them down again if holding them) that whole night (and tbh with C-section recovery, only with significant discomfort after). I feel this affecting bonding and definitely sleep (couldn't put baby down to sleep without help, which usually woke the baby). Was in hospital for a week so wonder if I'd have had a better experience if he (husband) stayed.

We used to have a physio visit all postnatal women on the ward and go through everything with them, give them a leaflet and contact details for if they ever had any problems. Physios really are the experts in this. Hopefully they will bring it back with the new focus on pelvic health

I second this, we had a very noticeable tounge tie that me and DH both noticed but were told at the hospital that nothing was really done about it these days! Finally got a referral two weeks later and the person that snipped tie was amazed I had been able to feed for so long like that

Care for disabled women without a doubt.

Just a few examples of what I had to deal with:

• A complete lack of understanding of my mobility issues with regards to getting up on beds etc. Comments like “oh you’ll be able to walk again when the baby comes, it won’t be for long!” …. No I won’t this is permanent!
• A complete and utter lack of understanding (and rudeness to boot) from the gestational diabetes midwife regarding my sensory issues around food and mobility restricting exercise (the dietitian was fabulous!)
• The NICE guidelines state you should have a multi-disciplinary team if you have a long term health condition. I never had that at all.
• Ignorant comments about the potential impact of vaginal birth on my hip condition from obstetricians which could have caused a less confident woman to attempt an unsafe vaginal delivery.
• Not a single person suggested any modes of support from social services or even for us to have an exemption from partners not being allowed to stay until a random midwife I happened to speak to heard about my issues and organised it for me (my husband stayed and we had a private room so as not to impact other women).

There’s definitely more but that’s what I can think of off the top of my head. Essentially, I was made to feel like their first ever disabled patient which can’t possibly be true but that was the level of their ignorance.

Also lack of exploration when it comes to pelvic girdle pain. Mine was so severe I couldn't walk. Ended up with crutches but still couldn't cope. I felt totally disabled and it started from 3 months pregnant and became progressively worse. Saw a different person at every appointment and when I was asked the general 'how are you?' Each time I tried to flag the extreme pain but the only support I got was a physio appointment. Which was a fat lot of use when I couldn't do the recommended exercises because of the pain. It got so bad towards the end they thought I had sepsis and I feel my care overall was absolutely dire. I'd love another baby but it was the toughest thing I've ever gone through and I genuinely don't even know what caused it!

Wow, advice on back care/lifting and handling. I bet lots and lots of new parents get injuries that way, especially with car seats and lifting in and out of cots (I didn't even know a drop sided cot was a thing till my mum mentioned it).

I actually thought when I was on maternity (after both DH and I injured our backs) that that would be the most cost effective thing the NHS could do, even if it was just a leaflet.

Agree, and also choose something that you will be able to apply to your practice on a regular basis as a midwife to make a positive difference for women and of course within the scope of the midwife

I am really sad to hear you had such a poor experience. Completely for my own learning as I haven't had the opportunity to care for many women with physical or mobility issues and I want to make sure when I do, I give them the best care. What would have made your care better?

A third of births were induced 2021-22!

Every single induced birth I have heard about ended in either a c-section or forceps.

In assessing 'risk', hospitals are forgetting about mothers IMO.

I've seen recently that the average length of pregnancy is actually 40+5 or some such number. I don't have the research to hand!
BUT if this is the case then inductions shouldn't be offered until then, not at 40 weeks

Inductions were my first thought. Some of the reasons we induce seem completely beyond reason. I have worked a lot in inductions and always question the reasoning with obstetricians and a lot of the answers are because it is guidelines? But why? I think this is a topic that will be covered by many in my cohort as we all feel the same way about it. It is quite a large scope for this project but I may narrow it down by taking a particular reason for induction, such as maternal age.

I’ve often wondered this too, it seems not many want to open this can of worms. It would be a brilliant and groundbreaking piece of research.

In my trust we offer induction for post dates between 40 + 7 and 40 + 10. I know some trusts offer earlier, especially at maternal request. I don't think women are given enough information on the induction process and what it could mean for the their labour and delivery.

I really do think it’s a case of someone taking the time to sit with you and talk it through. I basically got booted off my community midwife and over to the GD midwife who was awful so I lost that connection I’d had since my booking appointment. I think a specialist midwife for disabled mums would be amazing - in the same way we have those for teenaged mums, GD, mental health (perhaps more). Someone who is able to have a bit more specialist knowledge and the time to sit with you and work out how to best support within their scope. Someone who knows the avenues of support during pregnancy and after birth (our health visitors also have no clue who to seek support from!) rather than these women having to navigate it all on their own. As I say, another woman might have listened to the consultant about mode of delivery but I am older and have enough medical experience to know when to put my foot down. I actually dread to think what would have happened if I wasn’t so stubborn! If I’d had a midwife to fight my corner that would have been a weight off my shoulders. I also think that, to a certain degree, due to my medical conditions I was just sort of left to get on with it - I do think another mum in my situation would have been scooped up by the neonatal mental health team (as our new HV told me probably should have happened when we moved around baby’s first birthday). A specialist midwife could never be completely knowledgable about every disability or condition but they don’t have to be to get the right information to the right person.

Oh Yes, the first time I gave birth the ward was like a train station. I left in less than 24 hours. Second birth it was lovely and calm, midwifes had time to check in on everyone. (Different hospitals).

Thank you for this. I will at the very least take this on board for my own practice but equally will share this with my peers. You are right that a specialised midwife is needed here and could also incorporate those with SPD as mentioned up thread earlier and possibly higher BMI women with decreased mobility. Thank you.

Just because I had ivf I automatically had to have an induction if I didn't give birth before 40 weeks. Nothing else was taken into account, not my easy pregnancy, my health, baby's health, nothing. My induction birth was horrible and everything I didn't want to happen, happened due to this intervention.

It seemed there is very little research into ivf babies and delivery.

I think if you told women what induction might mean for their labour and delivery, you might find very few were willing to agree to it.

For all the emphasis on 'birth plans' and feeling safe and comfortable, every induced labour I know seemed spend days in hospital, forced to labour on a ward, to end up strapped to a bed, army of medical people around, immobile due to epidural / monitoring, concluding in episiotomy/forceps or emergency c-section after 24-48+ hours.

Also, with regards to what you can do in your own practice, it’s just taking that time to double check with patients who have declared those conditions. It was rather infuriating to have it in my notes but have to bring it up constantly to every new member of staff. I also think they saw “oh arthritis. Noted.” but never actually thought of the practical implications of that in examinations etc so to have been asked would have been amazing. As it happens, the staff in the NICU always mentioned my arthritis at handover as it had implications for me holding baby and my movement etc especially following a c-section. That was hugely appreciated as it meant I never had to think about it - they just knew I needed more support and it made the world of difference.

Also on my radar. All an obstetrician could tell me when I asked the question about IVF induction was because it is an assisted pregnancy! No scientific reason why...
Definitely needs looking into.

Yes but... (but, but) 'guidelines' ARE an answer to 'why'. Induction guidelines are based on research evidence. They're not pulled out of the air. The question is of course whether the evidence on resources and knowledge required to implement induction guidelines so that the benefit of fewer babies dying isn't accompanied by a huge increase in maternal morbidity are in place.

Thank you. Our handovers on labour suite are usually very in depth. Postnatal ward wise, it is dependent on the midwife caring for you as to how good of a handover the next midwives receive. There is no excuse though for poor documentation though!

I appreciate this, but surely an obstetrician should have known the physiological reasons why it is needed? Or at least admitted they didn't know? What if a woman about to be induced asked? Would you accept the answer that guidelines say so?

The focus should be on the individual patient not jut guidelines IMO.

We should be monitoring the individual circumstances and health of each patient, not just going 'it's a bit riskier so you automatically have to have an induction, even though the likelihood that will end in a very traumatic birth / emergency situation is high'.

These aren't women/babies with serious medical issues most of the time.

How many women could have had perfectly normal births and healthy babies, who actually had a traumatic labour and birth because of being forced to have an induction?