NIHR CLAHRC Community e-newsletter - Women’s health and maternity care

Published Date: 30 Apr 2018

NIHR CLAHRC Community e-newsletter - Women’s health and maternity care

Issue 70


CLAHRC East of England

My Baby’s Brain – an antenatal intervention for parents 

A large body of evidence strongly suggests that infant mental health in the period from conception to 2 years is influenced by the quality of the interaction between the baby and primary care giver.
The My Baby’s Brain study aimed to work closely with The Family Services Commissioning department at Hertfordshire County Council (HCC) to design and introduce an intervention that could be delivered through Children’s Centres, designed to increase parents’ awareness of the importance of early interaction with their baby during the antenatal period.
The overall findings showed that that mothers and practitioners found the DVD and discussion informative and useful in terms of thinking about the baby’s development. There was a small increase in Tool for Parenting Self-Efficacy (TOPSE) scores showing that the mothers also had a greater sense that they could succeed in their parenting role.
The Family Services Commissioning Department were pleased with the intervention and are using the materials county wide in their ante-natal provision.
Sally Kendall

CLAHRC East Midlands

Gestational diabetes education programme being developed by CLAHRC East Midlands

NIHR CLAHRC East Midlands researchers are looking to ensure women with a history of gestational diabetes can combat the increased risk of them developing Type 2 diabetes in the future.
An education programme is being developed by the CLAHRC for women with a history of gestational diabetes to combat the increase risk of them developing type 2 diabetes. Face-to-face and online education programmes are being developed and implemented in Leicestershire, which meet the social and cultural needs of women with a history of gestational diabetes.
NIHR CLAHRC East Midlands Director, Professor Kamlesh Kunti, said: “I was surprised with the interest in this study and the positive feedback we have had on the interactive mHealth tool the intervention group are using.”

More here

Bid to reduce smoking in pregnancy

A one-stop hub of resources is being created by CLAHRC East Midlands to help healthcare professionals support pregnant women in the region to give up smoking.
Methods to encourage expectant smokers to quit their habit are being identified and new ones will be developed where gaps exist.
The initiative is being launched because research shows one-to-one support delivered by trained anti-smoking advisors generates positive results.
Click here to read more about CLAHRC EM’s efforts to reduce smoking in pregnancy

CLAHRC East Midlands examines depressive symptoms and insulin resistance between men and women
The association between depressive symptoms and insulin resistance, inflammation and adiposity in men and women was investigated by study involving CLAHRC East Midlands researchers.
A cross-sectional analysis was carried out on a cohort of 639 participants from the ADDITION-Leicester dataset to assess differences in markers of diabetes risk, cardiovascular risk and inflammation in depressed and non-depressed individuals.

More here

NIHR CLAHRC East Midlands studies on polycystic ovary syndrome

Researchers at CLAHRC East Midlands are developing a series of projects that aim to tackle polycystic ovary syndrome



CLAHRC North Thames

CLAHRC North Thames research tackling gestational and postnatal diabetes 
The Barts Research Centre for Women’s Health (BARC) at Queen Mary University of London is supported by CLAHRC North Thames and has kicked off its first project - the EMmY study: preventing gestational diabetes with myo-inositol nutritional supplement.

The EMmY study (started recruitment in February 2018 and has so far randomised 60 out of a target of 200 women in East London and Manchester. We expect recruitment to be complete by mid-August. Data analysis, including NIHR CLAHRC North Thames-supported cost-effectiveness analysis, is set to begin in January 2019.
Work will soon start on another CLAHRC North Thames supported project - the OMAhA study. We aim to randomise 160 women with gestational diabetes and on metformin and/or insulin, within Barts Health Trust. Participants will be randomised to receive metformin or placebo daily, from delivery until 12 months post-delivery. As for EMmY, we will primarily be looking at recruitment and adherence rates. Qualitative analysis will explore attitudes and barriers to participation or adherence. NIHR CLAHRC North Thames are involved in the OMAhA study through support for analysis of cost-effectiveness. All these analyses will inform a future large-scale trial.
Read more about EMmY and OMAhA here.
Contact Trial Coordinator for info.

CLAHRCs West and North Thames on improving the response to domestic violence and abuse in sexual health clinics

A joint CLAHRC West and CLAHRC North Thames evaluation of a programme aiming to improve sexual health professionals’ response to women who have experienced domestic violence and abuse (DVA) has produced promising results.
The pilot investigated whether the intervention, already being implemented in general practice nationwide, could be successfully adapted for sexual health staff in clinics in Bristol and East London.

The study shows that it is feasible and acceptable to develop and implement the IRIS ADViSE training and referral package for sexual health clinics. At the policy and commissioning level, stronger recognition of the issues around DVA referrals, and more resources to support them, are needed. Commissioners and local NHS trusts need to engage and commit to financially support IRIS ADViSE to maximise its potential.

Read the research, a BITE-sized summary and listen to a podcast supporting the research


CLAHRC North West Coast

Perinatal Access to Resources and Support (PEARS) - Improving access to support for perinatal women through peer facilitation: a feasibility study with external pilot. 
The PEARS project was designed to examine access to health and community resources amongst socially deprived women and families. It aims to reduce gaps in health inequalities by testing whether combining elements of care, which have improved access to services and psychological health and wellbeing in other settings, can be implemented locally.
Read more about the PEARS project here.
Find the CLAHRCBITE for this project here.

Pioneering virtual reality tool being developed to train region’s midwives

CLAHRC NWC PhD student Stephanie Heys is using cutting edge technology to help reduce traumatic birth experiences for disadvantaged and vulnerable women across the North West Coast. 

Her study assesses the feasibility of developing and using a tailored educational programme to improve training for midwives. The training aims to reduce the incidence of birth trauma and post-traumatic stress disorder whilst tackling health inequalities for childbearing women with complex needs in Lancashire.

Stephanie said; “The aim of the VR programme will be to act as an innovative and immersive educational training tool, presenting a real world scenario for midwives".

Click here for more details.

Cancer screening uptake in South Asian women
A systematic review of social, cultural and individual influences on the beliefs, attitudes and behaviours of South Asian women regarding asymptomatic screening for female cancers, has been submitted for publication.
Full reasons for this are unclear, but poorer survival is partly attributable to South Asian women’s lower uptake of screening opportunities, which may be attributable to cultural factors within South Asian populations.

Dr Pooja Saini, of the University of Liverpool’s Department of Health Service Research, said; “This work will inform Interventions directed toward early detection of female cancers in South Asian women from hard to reach communities. Such interventions could improve cancer mortality and morbidity outcomes in these groups and help to reduce health inequalities.”



Reducing high blood pressure during pregnancy
Pre-eclampsia is a condition which affects pregnant women, and can put both mother and baby at risk. The warning signs of pre-eclampsia include high blood pressure and protein in urine. This high-blood pressure can continue even after birth.
If not treated pre-eclampsia can lead to seizures, kidney and blood clotting problems. For babies, it can lead to low birth weight and an increased risk of dying before birth. Treatment is usually in the form of blood pressure lowering drugs.
For those at risk of pre-eclampsia, their blood pressure is closely monitored and managed via more frequent antenatal clinics. However, despite more frequent monitoring, women's blood pressure can rise between these visits. This puts mother and baby at risk.

One possible solution to this problem is pregnant women self-monitoring their blood pressure at home. Self-monitoring at home may be able to detect rising blood pressure sooner, and women can then share this information with their care teams. This could lead to earlier diagnosis and treatment to prevent complications developing. CLAHRC Oxford is running two pieces of research looking to do this.
The first (now complete, pending outcomes), ‘Self-managing higher blood pressure after childbirth’ (SNAP-HT), aims to find out if home blood pressure monitoring, and self-adjustment of blood pressure medications (according to a bespoke plan), improve blood pressure control and patient satisfaction in women with new-onset raised blood pressure during pregnancy.
The second (ongoing), Self-monitoring of blood pressure for pregnant women with long-term high blood pressure (OPTIMUM-BP), is a feasibility study aiming to see if a similar approach of home monitoring of blood-pressure is acceptable to pregnant women with chronic (long-term) high-blood pressure (around 5% of pre-pregnancy women, putting them at a higher risk.
Read more about SNAP-HT here
Read more about OPTIMUM-BP here.


CLAHRC South London

Government plans for new models of maternity care informed by CLAHRC South London research

Research by CLAHRC South London’s maternity and women’s health theme has informed the Government’s plans, announced in March this year, to introduce continuity of midwife care by 2021. The announcement is informed by our research which shows women who used the model were 19% less likely to miscarry, and 24% less likely to give birth prematurely, as well have a better experience.

Professor Jane Sandall CBE and her colleagues are currently piloting a new continuity of care service with a team of midwives in Lewisham, south-east London, to develop a better way of supporting women who have a higher risk of preterm birth. Called the POPPIE trial, the team are working collaboratively with Lewisham CCG, the London Borough of Lewisham, and Lewisham & Greenwich NHS Trust.

Read the full story 

New animation enhances support for women with eating disorders during pregnancy

Researchers from CLAHRC South London’s maternity and women's health theme have translated research on eating disorders during pregnancy and motherhood into practical training resources, helping healthcare professionals provide the best care for pregnant women and mothers. The resources include an animation co-designed by the research team, women with lived experience, healthcare professionals and key organisations.

The animation raises awareness that eating disorders are serious mental illnesses that can impact on pregnancy and beyond, and highlights the importance of a trusting relationship between women and healthcare professionals.

For the full story, visit the web of the CLAHRC Partnership Programme

View the resources and animation at: 


Better postnatal care for all women and babies

Researchers from CLAHRC South London’s maternity and women's health are undertaking a project that aims to improve services for women after they have given birth – particularly those who have not had a straightforward pregnancy or birth, because they are more likely to develop health problems in future.

The research will focus on postnatal care for women who have developed hypertensive disorders in pregnancy and after birth, such as pre-eclampsia. The researchers will talk to women, midwives, hospital doctors and GPs to find out how they think postnatal support can be improved. The study aims to offer a better universal postnatal service by making sure that NICE guidance is implemented for all women across south London.

Read more about this project.

Visit the web of CLAHRC South London



Developing online Cognitive Behavioural Therapy and Behavioural Activation interventions for the treatment of postnatal depression 

One in ten mothers in the UK experience postnatal depression (PND), yet only 15-30% of women seek help for the condition. This project aimed to develop and test an online therapy in collaboration with Netmums, which women with PND could complete in their own time and in their own home. Results showed that women who received the online therapy improved more rapidly than women who received regular care, and continued to feel better 16 months after the treatment. Adapted versions of the programme are now being used in Torbay and Devon, and Netmums is also making the treatment available to its 1,000,000 members. The results have also been included in NICE’s Antenatal and Postnatal Depression Guidelines for doctors. Read more here.

Pelvic floor muscle training: Reducing the number and associated costs of surgical procedures for urinary incontinence
The NHS estimates that one in five women aged over 40 are affected by Urinary Incontinence (UI). The National Institute for Health and Clinical Excellence recommend three months of Pelvic Floor Muscle Training (PFMT) as the first line of treatment for stress incontinence, however there are currently insufficient levels of specialist staff trained to provide PFMT for all women with UI. The aim of this project was to evaluate if a package of PFMT delivered in primary care resulted in fewer referrals to secondary care for UI, thereby reducing the number and associated costs of surgical procedures for UI. For more information visit the project page.

Delivery of pelvic floor muscle exercise education for women during pregnancy: the APPEAL project

Pregnancy and childbirth are important risk factors for urinary incontinence (UI) in women. Guidelines for the management of UI recommend offering pelvic floor muscle training to women during their first pregnancy as a preventive strategy. APPEAL is an NIHR programme grant which aims to increase the number of women doing pelvic floor muscle exercises during pregnancy, and to ensure that they are doing them ‘properly’. This should reduce the number of women who suffer with symptoms of urinary incontinence after birth. Read more here.




A mixed-methods evaluation of the novel domestic abuse prevention partnership (‘DAPP’) in Hampshire, UK

According to evidence in the UK, USA and Australia, pregnancy remains a high-risk period for the initiation and escalation of intimate partner violence and the leading cause of maternal mortality. Domestic abuse has wider cost implications for the health and social care system, with direct medical and mental healthcare costs approximating £1,730 million per annum in the UK. Given that the majority of domestic abuse victims are women, the development and implementation of perpetrator programmes often take a gendered view; and apply cognitive behavioural, pro-feminist or psychodynamic treatments. The aims of our study was to evaluate the process and outcomes of the Domestic Abuse Prevention Partnership (DAPP), that engages perpetrators of domestic abuse in a group programme, centred around the ‘Duluth model’ of power and control. Developed by the Hampton Trust, and commissioned by Hampshire Police and Hampshire County Council, the DAPP is a novel multiagency intervention that aims to reduce harm to victims. The study findings will be published in June 2018. If you are interested in this study, please contact for further information.



Alcohol in pregnancy – next steps to implement findings
CLAHRC West published a major systematic review looking at the impact low levels of alcohol have during pregnancy. The findings were that there is little evidence to suggest small amounts are safe, and the researchers recommended abstention, in line with updated national guidelines. 
CLAHRC West is planning to work with organisations representing the alcoholic drinks industry, the Department of Health and Social Care and public health bodies to influence mandatory labelling of alcoholic drinks, including those with low alcohol. We will also provide evidence to maternity care reviews, especially around preventing early births and low birth weight related to alcohol consumption and guidance on low alcohol products. We will be working with the Royal Colleges for Midwives and Obstetricians to improve communication with pregnant women about alcohol. We will work with major search engines to ensure the new guidance on drinking in pregnancy appears on results, rather than the old advice.
See the alcohol in pregnancy research project.

Evaluating magnesium sulphate project to prevent cerebral palsy in premature babies
CLAHRC West’s is evaluating a major project to give magnesium sulphate mothers who are in labour, to prevent cerebral palsy in premature babies. The project, known as PReCePT, received Scaling Up funding from Health Foundation in October 2017. Working with the West of England AHSN, CLAHRC West carry out a full evaluation of the wider roll-out of PReCePT and it is hoped that this will inform future spread across all maternity units. If rolled out nationally, it is estimated that up to 1,400 low birthweight babies could benefit from this intervention each year.
Find out more about PReCePT.


CLAHRC West Midlands

Midwife Survey

In 2016 the National Maternity Review, ‘Better Births’, recommended that women in England have a named midwife, based in the community, who can provide continuity of care throughout pregnancy, birth and postnatal periods.  This will involve a significant change to midwives’ working patterns.  To explore midwives’ perspectives of changing the way they work to provide increased continuity, CLAHRC researchers worked with midwives and the Royal College of Midwives to undertake an online survey in October 2017. 798 midwives took part from across 27 organisations in the seven areas fast-tracking the Better Births Recommendations (NHS Maternity ‘Early Adopter’ sites).
Our findings indicate that there may be a gap between the number of midwives required to deliver plans, and the number willing or able to do so.  Those implementing the policy will need to engage midwives in the plans, and evaluate the impact of any changes on women, babies and midwives. 
Read the full story here.

For further information please contact Beck Taylor ( To view the report, see


First training session for national roll-out of a maternity triage system.

Unlike mainstream emergency medicine, there is currently no standardised triage system within maternity for women who attend for unscheduled appointments. Women are usually seen in the order in which they arrive, which can result in delays due to service capacity. This lack of clinical prioritisation can also cause safety issues as women who need urgent care may be seen after those with minor concerns.  The Birmingham symptom-specific obstetric triage system (BSOTS) was co-produced in 2013 by midwives and obstetricians from Birmingham Women’s and Children’s NHS Foundation Trust and researchers working on the CLAHRC maternity theme at the University of Birmingham.  The system is based on established triage systems in emergency medicine and uses a uniform assessment with clinical prioritisation of the common reasons that women present within maternity triage.

The system is currently used by 4 maternity units within the West Midlands and implementation is supported by the Royal College of Obstetricians and Gynaecologists and Royal College of Midwives.  On Friday 13th April 2018 we hosted the first of three planned training days to support national roll-out and clinicians from Heart of England, Worcester and Southampton attended.  We have also had interest from Maternity units in other parts of the UK and in Australia and New Zealand.

More here.


CLAHRC Yorkshire & Humber

Better Start Bradford

The NIHR CLAHRC YH Health children Healthy families theme provides support and shares academic expertise with Better Start Bradford project.
Better Start Bradford is a partnership programme working with families to help give children the best possible start in life in the Bowling & Barkerend, Bradford Moor and Little Horton areas of Bradford.  The project is developing and commissioning a broad range of projects that support, inform and engage families expecting babies or with children under four, and professionals and organisations working with them.  Over 20 projects to support families exist and you can read all about them here.
One of the unique aspects is that Born in Bradford are working with BSB to evaluate projects through a range of methods including a novel experimental birth cohort -  BiBBS (Born in Bradford’s Better Start) that will recruit 5000 expectant families and follow them as the child grows up using routinely collected data including which BSB projects they have attended 
More details here.


Intelligent guardianship

A part of the NIHR CLAHRC YH Translating knowledge into practice theme, the In-GOT project was designed to promote mother / partner and infant contact during their encounters with obstetric theatre. It was informed by an increasing understanding that separation can lead to emotional and physiological compromise in both the mother and her new infant.

An experienced senior midwife was appointed to the role of project lead and supported by consultant midwives and a multi-professional team / steering group. The project employed key concepts of implementation theory fostering engagement collaboration, and mutual goal sharing. Forum theatre was used as means of supporting these values, bringing staff together from a range of disciplines and experience to identify what and how changes could be made. Creative methods were used to share the insights such as this video.

The final report on the work is available here.