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.

Birth trauma - the rates are staggering. What are the risk factors, what interventions can help, etc.

Hyper stimulation from induction, especially at the early stages when adequate pain relief is not offered. Whether women are adequately informed about this possibility ahead of time.

Thank you. This is a very valid point.

That could also work. The problem is the NHS website isn't good either! I was "stopping a pretend wee" when I should have been "drawing spaghetti up my back passage" while doing diaphragmatic breathing. I made a lot of progress in a few months, I wonder whether I could have prevented my prolapse entirely if I had been doing it correctly the whole time.

The pelvic problem is compounded by the fact GPs are also poorly trained and will often misdiagnose.

Also, um, the fact that even after a traumatic delivery, forceps etc, literally no-one physically examines you after birth unless you ask??

So many women must walk (/waddle) away with problems that they feel are undeserving of attention. The fact the private Mummy MOT company exists tells you everything you need to know about the failure of NHS postnatal care.

How are you defining “safe” though @Kosenrufugirl? If you mean safe as in it won’t kill you then yes I agree, but surely increased risks of horrible and distressing complications is a safety issue?

OP - I would like to see follow up research on the evidence from Canada that actually C-sections are just as safe as vaginal delivery for first time mothers with no contra indications for surgery. The established view that is given to pregnant women is that vaginal birth is inherently better and safer, which I think is outdated and flawed.

I agree on post natal physio support. I still have SI joint problems 10+ years later. I had physio whilst pregnant on the NHS because my pelvis was unstable but absolutely nothing afterwards.

The other area is the follow up of damage / issues caused by episiotomy. How many women suffer ongoing problems and what support is offered?

The NICE guideline includes detailed discussion of the information and processes that should be in place around decisions to induct. Research on women's perspectives of discussions that the health professionals think complied with those parts of the guidelines would be interesting.

Lack of adequate post natal care/impact of this on mums long term health/mental health/bonding with baby. This seems to be a bit of a lottery and as PPs have mentioned, no one actually examines you unless you request it which is mind blowing.

Something around when babies are very large and yet the mum is allowed to go well over her due date.

DS was estimated to be 8lb 6oz at a
38 week scan but I was still allowed to carry him to 42 weeks and he was 10lb 4oz. I was in labour for 23 hours and pushing for 2.5 hours and had a ventouse delivery in the end.

How stats and guidelines impact the respect for maternal choice.

I've spoken to many women in my hospital trust area where they felt their maternal choices were railroaded or neglected due to stats.

For example:

elective C-section for first pregnancy, shouted down and told that they are putting baby at risk.

Inductions offered willy nilly, of our NCT group of 8, 3 were induced, 1 before due date due to "guidelines", 1 2 days after due date due to "guidelines", the other refused until 41 weeks but was badgered daily and at 41 weeks was told they would be refered to SS as putting baby "at risk" - completely healthy pregnancy. She agreed to induction as she didn't want to go on the list.

Planned C-section due to breech position on baby and placenta placement. Mother told to have ECV, do baby spinning and engage in all sorts of woo in the hope of avoiding a c-section. Baby was born via car crash C-section and had to be resuscitated 3 times.

Ignored quick labour due to it "been 1st baby and they take hours to come", baby was born within 1/2 hour of arrival at hospital in a corridor.

Forceps delivery due to labour not progressing. Mother induced, still didn't progress, after 22 hours of active labour forceps used, no option of C-section given. Mother has severe pelvic floor trauma and was incontinent for months.

My own was a car crash section, baby stuck. Midwife did not want to get the consultant for a section, wanted to try everything else. My husband said you do a c-section or there will be a lawsuit. Consultant took 1 look and said C-section was only option due to position of baby. I was the last of all NCT group, after hearing all their dire care my husband went in with I will threaten law suits and sue as that's the only way to get maternal choice.

Same with feeding. 4 tongue ties missed, 1 mother whose milk wasn't coming in was hooked up to a machine like a cow against her will when she wanted to bottle feed after 3 days of struggling. I was pressured to breast feed after a car crash section, no milk. Again until I threatened to sue for distress and ignoring consent I was not listened to and the lactation midwife tried to hook me up to the machine - the machine was in the room and she was going to do it regardless of consent until i said i would sue for not gaining consent. Queue matron coming in and apologising and begging me not to launch a lawsuit. 1 mother pressured to breast feed through severe mastitis where she was bleeding, leaking puss and had very bad nipple trauma, baby later found to have a very severe tongue tie that 4 NHS midwives missed.

Only 1 had a smooth labour and delivery and she went to a midwife led unit in a different trust.

Our NHS trust has targets to reduce c-sections and improve breast feeding rates.

Like the comments about tongue tie, midwives don't seem trained to look at stomach muscle separation and most women seem unaware of this too. I was hyper aware as my cousin had had it, flagged that I wanted to see a physio and it was like of personally insulted the midwife. She came and had a look and said it was fine (not even asking me to lie in the correct position to check) but said it was my choice to get referred. I actually had a 5 finger gap which is pretty bad! I did all the physio but it has never fully healed and I don't think it ever will. There's a golden period when your body knits back together much better especially if you do physio but I imagine most women miss this.

Yes I'd agree with the latter. Seems to be an assumption that all women labour slowly. Unsure why as many many women have quick labours and it often runs in families. Nothing at all on this in antenatal care/appts and how it might affect your experience and pain levels/ability to cope with the pain and therefore what your birth plan may be, plus any additional risks.

When I called the hospital to say my waters have broken, they were all "you'll have ages yet, take a bath blah blah blah". But my contractions were coming thick and fast very quickly and then we had to try to get to hospital in the centre of town through Saturday morning traffic. If I'd have left earlier it would have been less traumatic for all concerned! My mum had a quick labour with me and my aunt's first was fast and her second was only 45 minutes. My nan also had quick labours so it could have been predicted that mine might be the same. I don't understand why the assumption is that it'll take days!

SUA (single umbilical artery) or a 2-vessel cord and how often this leads to future issues for baby (underlying genetic disorders etc).

My SUA was diagnosed at 20-week scan. I had more follow-up scans but no-one seemed to know what they were checking for at the birth, post-birth check if baby or 6-week check.

At 10 weeks' old my baby had a sudden collapse as was left with life-changing complications.

It's not clear whether the SUA indicated genetic 'differences' (I think SUA would be considered a soft marker for genetic abnormalities) but in any case, because the SUA/pregnancy and the my dd's sudden illness are not connected in any notes or research study I don't think there's currently anyone tracking whether these two are linked, iyswim.

Ie. Research question could be 'Does SUA lead to higher incidences of onset of problems requiring referral to a paediatric consultant within baby's first year of life?'

Hi OP, I am a midwife and health visitor. I started this thread last night which has highlighted a very real gap in research if you're interested and brave enough to tackle it.

www.mumsnet.com/Talk/womens_rights/5008924-single-sex-support-groups-in-postnatal-period

Wishing you the best of luck with your research project. Is it a research proposal or full dissertation?

What about something focusing on the areas requiring improvement highlighted by the Ockenden report, and/or the Saving Babies Lives scheme? Trusts will be actively monitoring statistics, so data collection won't be an issue, and they (should) would welcome any insights.
Maybe outcomes affected by SATOD, mothers of BAME ethnicity, staffing levels, diabetes, trusts that operate Continuity of Carer vs not, perinatal mental health etc?

Yes it sounds like the information on the NHS site needs improving then as that’s where most professionals will signpost to or women will look. There is meant to be a new focus and investment in maternal pelvic health nationally starting and have noticed many new specialist physio posts coming up on nhs jobs to work in this area so looks like things should be improving very soon hopefully!! https://www.england.nhs.uk/mat-transformation/perinatal-pelvic-health-services/
Yes would be great if especially women who have had forceps etc were offered a routine appointment with a such a specialist physio. Even if women had an appointment specialist physiotherapist assistant then they are going to know so much more about pelvic floor health than GPs and midwives if that is their area of specialism and also reserve focussed time for that issue rather than be just one of hundreds of assessments/info the midwife is expected to cover in 10 seconds. Hopefully things will improve, maternal mental health was identified as a big issue a few years ago and there are now so many more specialist maternal mental health services available for midwives and GPs to refer to. Granted these services are still stretched but the women absolutely in need of help do tend to be getting the care they need now which not only provides these women with what they need but also doesn’t tie up midwives time in providing ineffective attempts at care which needed to be done by specialists. Hopefully will be the same for pelvic health 🤞

With a CS is the 2nd child and 2nd time mum that pay the price. There is an increased risk of stillbirth in future pregnancies. There is a vastly increased chance of placenta embedding itself in the uterus which could lead to catastrophic bleeding and hysterectomy. The list goes on. There reason the CS rates are high in Canada is because of the dire shortage of midwives over there. The CS are always high in obstetrician-led care, especially in the private sector. Call me cynical but if you can schedule work Monday to Friday 9-5 7 months in advance as an alternative to being woken up in the middle of the night any day of the week - then why not? Scandinavian countries and the Netherlands have a very strong midwifery tradition. They have half a CS rate to the UK and better baby outcomes too. They use forceps

Why midwives refuse to listen to women and what the women in their care are telling them.

The brutal way many midwives treat vulnerable women in their care who are dependent on substances/alcohol/smoking. The judgment, the stigma, to overt distaste, none of these actually improve outcomes for mums or babies. None.

And the absolute biggest: midwives need far better education on infant feeding. On the fact that there is no universal best way to feed a baby, as long as they are receiving sufficient calories from breast or formula milk. On the damage that the pressure to breastfeed at all costs causes new mums, both in the short and long term. On noticing and acting on cases of insufficient supply so babies don't starve unnecessarily. On providing proper evidence-based information to parents, instead of utter nonsense. There needs to be far more respect and person-centred care, on asking mums 'how do you hope to feed your baby?' and then supporting them to achieve their goal if possible and safe. Instead of assuming everyone should and can breastfeed and shaming those who don't.

It is shameful how few midwives have knowledge around the prevalence of insufficient supply, spotting it, and acting. The number who believe if you just keep trying to breastfeed, keep going, it will work. I couldn't believe the amount of nonsense we were given by midwives. We made a formal complaint at the other side after the terrible advice given led two new clueless parents into the neonatal unit with a baby almost brain-damaged from starvation.

Hi there I am a midwife interested in research too. I completed a research internship last year with my Trust. Hoping to do a PhD one day. I was told a small and well executed study is much better than a large and poor one, especiallyfora novice researcher. Have you had a look at the National Institute for Healthcare research website? Also, Google up NHS Midwifery Strategy for Research, led by Professor Sandall. You might also look at the latest guidelines to work out what priorities are. It's often easier to get the funding for research aligned with national priorities. NICE intrapartum guideline was updated last September. It mentioned women's weight for the first time. It's a massive issue in my experience of working on the labour ward

In France all post natal mums have specialist obstetric physio. It would be useful to look into the rates of pelvic floor problems postnatally, at 5 years, 10 years and so on in UK compared with France.
Listen to Elaine Miller talking about the cost to the NHS of allowing this situation to continue.

I had all my babies in the US and was shocked to learn that pregnant women in the UK are not routinely tested for GBS (group B strep) late in pregnancy.

The test is routinely done all over Europe as well as countries in South America and North America. It is cheap and effective, and antibiotic treatment if GBS is found is also cheap and effective.

GBS can cause sepsis, pneumonia, and meningitis in newborns, which can be hard to spot as they develop, can sometimes lead to death, and often lead to massively expensive and traumatic medical intervention for the baby. Long term effects of meningitis, sepsis, and pneumonia can profoundly affect the lives of babies and their families.

All the evidence from elsewhere points to solid grounds for routine, free testing.

So why not test?

My big one is Hyperemesis care!
Then consent and choice of mothers being ignored and pathways forced on them

My mum was in labour 5.5h total for four of us, and I asked again and again about how to manage precipitate labour, only to get the brush off. All her babies a bit early too.

My son shot out in 90m, a week early, before my much delayed 'high risk' birth planning appointment.

Several antenatal groups/instructions etc were a bit snotty about the "TV" birth of a woman on her back in stirrups screaming straight away. Which is pretty much how it went for me.

My midwife told me it was better to be off my hyperemesis meds!

Consent and choice is a tricky one. I think there actually needs to be a lot more emphasis on what could happen - choice is misleading IMO.

Pregnancy weight gain is difficult though. I gained a lot of weight despite not actually overeating at all. (Objectively).
I had hyperemesis on ondansetron and cyclizine through most of the pregnancy.
Trying to keep my weight gain under control whilst trying to get some nutrition would have been physically impossible.
I don't believe women are overeating. I think hormones and fluid shifts are the main culprits. Not sure what the answer is or what the advice could be as I'd have probably knocked the midwife out. I was trying to survive.