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

[UpUpUpU]

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.

There is a big UK trial on this topic going on in the UK at the moment

Pre emptying pre eclampsia. I was diagnosed at 35 weeks but I'm sure my BP was creeping up and baby's growth slowing down well before this. Ds must have completely stopped growing at 32 weeks. By the time I was raising eyebrows I was in a very dangerous condition. I think if my measurements had been plotted on a graph it could have been predicted as a serious possible risk.

But I also agree with one of the first posters. BAME outcomes. They shouldn't be worse.

My first was a brow presentation but it took many (many) internals then a scan to find out why my cervix didn't feel 'right' when I arranged at the hospital in labour. I believe it's rare but NO ONE knew what to do and I ended up with an emergency c section. So research into how births are affected and improved training for antenatal staff.

I would also be interested to see research on the effect of the reduction of funding in post natal care since the Tory's have been in power (midwives and health visitors post birth at home) and whether there has been a rise in post natal depression/baby blues.

The impact of NHS trusts and their Stonewall driven change in language to exclude the word "women" on women giving birth.

Because its a transient bacteria, it comes and goes. The chances of a baby becoming unwell are extremely low however the overuse of antibiotics in labour is helping the infection to become resistant to the usual treatment. There is also risks to the baby from antibiotic exposure. There is no research that proves whether routine testing is better for babies than risk based screening - but there certainly is evidence that it leads to overuse of antibiotics which definitely carries risk.

The WHO are moving towards vaccination - so prevention rather than cure. I have reservations about this too.

Sections increase risk in future pregnancies though - eg increased risk of placental issues. I know someone who recently had placenta accreta (associated with previous uterine surgery) which led to a massive PPH and hysterectomy.

They also limit how many children you can safely have.

But a TT isn't always visible. Some of the most restricted ones I've seen have been submucosal. Of my two children, only one had a clearly visible tie. If you're not being trained to assess, you should at least be aware of some of the other visual clues that there may be a restriction: a high palate, a slightly recessed lower jaw, a tongue that doesn't lift or looks bowl shaped when baby cries, along with the many different BF problems that can indicate TT.

How best to support the mental health needs of women with gestational diabetes. Huge research gap.

@mummeeee

So sorry to hear of your baby's outcome.

There is a body of fairly recent research on SUA, which your team should have been aware of. You and your baby may have fallen victim to bad communication among HCPs wrt the condition.

Oh god where to start! I’ve read half the thread and there’s some really good ideas here. I’ve recently submitted to the birth trauma enquiry chaired by Theo Clarke and Rosie Duffield, and I had a few key points in there that might be of interest. some of it is about lack of funding though so may just be really depressing to research. The best HCP I’ve ever seen was the women’s health physio I saw after my third degree tear high forceps delivery for a good two or three years. This was 13 years ago. She has now left the nhs.

The main issue I’d like to be properly researched is likelihood of women getting PTSD after birth. I had a lot of hospital experiences as a baby and child (surgery as a baby, incubator for 6 weeks, surgery and other hospital stays in early childhood - don’t want to give all details here) and so once I was in hospital in a high dependency unit (partly because of my medical history as a child, plus congenital abnormalities of uterus, cervix and vagina), being induced early with a drip etc etc as my baby hadn’t grown, it triggered all sorts of trauma from my childhood that I’d never really acknowledged. And it took me till my DS was over two to realise I had ptsd, and that it wasn’t just the traumatic birth on its own (which was hideous even for someone without any previous hospital inpatient experience) but it was all the previous experiences that made it worse. So what I want to know is, was it inevitable I’d get ptsd from the birth, because of my history, and what alternative care could the consultants and midwives have put in place to mitigate that? Can they identify who is at risk during pregnancy? Hope that makes sense.

You can be sure that when a test is done routinely in the US, a thorough cost-benefit analysis has been done.

Yes, the risks there include litigation costs. But that's not true for other countries where testing and treatment are routine. No matter where testing is done, part of the cost is the expense of subsequent medical care for babies and educational care for children who have adverse outcomes despite the expensive treatment they must undergo.

The risk of overuse of antibiotics is a global issue not related specifically to AB for GBS.

All strep comes and goes. This particular strain does huge damage. Why not try to limit that risk?

There is really no sound reason why the UK is such an outlier in this area.

Thanks. It was some years ago now, but since then I've had friends refer other friends to me, who've had SUA and I've felt at a bit of a loss as to what to tell them.

I've just done some more googling and there ARE some more recent studies, so thank you. They suggest there likely is a link between what happened to dd at 10 weeks and the SUA. There appear to be associations with intestinal atresia whilst in utero, which could well have the same origins as what happened to dd.

This was specifically a mesenteric ischaemia, but likely due to a narrowing/malformation of the superior mesenteric artery.

It's probably good for me to look at these studies every so often, both for interest for dd as she gets older and for my own healing from what was a traumatic event (and aftermath).

She is doing really well, but is dependent on parenteral nutrition due to the loss of all of her small intestine following the ischaemia.

• The case for tongue tie assessment and division capability as standard within 24h of delivery for all (E)BF babies.
• Uterine hyperstimulation in labour and more effective management strategies.
• How to promote recovery and rest in postnatal wards.
• Perineal wound assessment - are there any standards for this? Does this always take place?
• Hand expression education where babies are unable to latch at birth - so women can be more effectively supported to give colostrum and protect their supply rather than undermining it with formula.
• Maternity Assessment Units and their policies for triage/pain relief provision, ie why can a woman in active labour be trapped alone for long periods of time in an MAU with no pain relief and no midwife support?

Birth trauma.

Birth trauma and opening up the offering of a planned elc as a perfectly safe and positive way of giving birth for all women.

You don't need to have a medically called terrible physical birth for birth trauma you can have a so called medical perfect birth for it to be too much.

Every woman is more than a pair of birthing hips like an animal and they deserve to be listened too

Effect of epidural on rates of caesarian.

What about induction due to PROM?

My waters broke just before 36 weeks in my first pregnancy, so I was induced. My body was obviously not ready for labour and delivery, and my baby was not ready to be born (she was "sunny side up" for one thing), so it was a long drawn out, painful process, which ended in an episiotomy and forceps delivery. (The alternative, which they were trying to avoid, was an emergency C section).

Despite being a good weight my child struggled at first and was in the NICU. She is neurodiverse, and I do wonder if she had been full term if that would have been the case.

Maybe induction really was the only realistic option in my case, but would there have been alternatives? I think an interesting question might be at which stage of pregnancy does induction due to PROM lead to better outcomes than waiting for labour to start naturally.

I ended up with a forceps assisted birth due to baby getting stuck and reading this I’m now so worried for both his health and my pelvic floor. I suddenly feel like I failed both of us.

I had a forceps delivery with episiotomy over 20 years ago. My pelvic floor is just fine!

Thanks @Whatevs23 thats good to hear. I gave birth ten days ago and everything is either numb or tender at the moment. Did you do any exercises to recover?

Agree with a PP about tongue tie, but also more around support for breastfeeding mothers.

Would also like to know more about babies born with meconium aspiration, and the stats on how many end up in SCBU. Having meconium in your waters isn't classed as an emergency as a factor on its own, I believe.

Agree, knowing what I know I would not want the offer of routine testing personally. It would lead to so many women and babies being given IV antibiotics for whom there would have been no benefit and use up resources which would no doubt lead to other adverse knock on impacts, not to mention antibiotic resistance. I had a friend in a country which does do routine testing and rigid protocols who had missed the test and then ended up being subject to a lot of worry and kept in hospital for several days for her baby to have IV antibiotics when it turned out neither had GBS anyway. Neither had even had any signs of infection whereas in the UK the response is much more measured. The pros and cons of introducing testing have previously been evaluated. Investing those resources in a quick and effective response to babies that do either have significant risk factors or are showing indications of infection seems much more sensible

Pelvic girdle pain diagnosis in pregnancy and the effects it has after and causes

I wasn’t diagnosed until after my son was born, and I could barely move. I struggled from about 5 months in pain and waddling.

I have since read that intense exercise can cause it.

THIS!!! Woefully under researched and nearly killed my baby. Totally ruined my pregnancy and birth too I'll never get over it

Why women's pain in labour is funny and not something that needs to be controlled for better mental and physical outcomes.

Congratulations on the birth of your baby 👶 you haven't failed anyone! Your little one was stuck so needed assistance, this wasn't your fault. If he had been injured, it would have been apparent at birth - so please don't worry. Clearly your obstetrician weighed up the risk V benefit and felt the safest option was to assist with the birth, this is very common. It's normal to feel numb down below still at this stage, if you've any ongoing issues then referral to a women's health physio would be beneficial. But please don't worry, it is unlikely that you will have any ongoing issues.

This debate is due to forceps not being an option in some countries, but there's lots of reasons for this, don't let it worry you.