Title: Maternity Experiences and perinatal oUtcomes of Mothers facing Removal of their Infant due to Social Care proceedings - MUMS@RISC study
Funder: Department of Health and Social Care

Abstract: Research question:What is the impact of midwifery support and (models of) midwifery care on the experiences and outcomes of women who face separation from their baby at birth? Background In the last decade in the UK, the number of babies taken into State Care due to safeguarding concerns nearly doubled: from 1,700 in 2007/2008 (26/10,000 live births) to 3,080 in 2017/2018 (48/10,000 live births). Their mothers often face multiple adversities, with complex mental health needs before, during and after pregnancy. Conversely, the 2021 National Confidential Enquiry into Maternal Deaths in the UK highlighted a large of proportion of women who died by suicide (16%) or substance misuse (43%) had their baby taken into care. Evidence is lacking on the demographic characteristics of these women and how (models of) midwifery care can contribute to support them. This is important as the perinatal period offers a unique 'window of opportunity', with services more readily available to women than at any other time. Aims and objectives:To understand the impact of midwifery support and models of midwifery care on the experiences and outcomes of women who face separation from their baby due to care proceedings. Methods First, I will undertake a systematic review and meta-synthesis of existing literature. Subsequently, I will conduct a mixed methods study. Using qualitative methods, I will explore experiences of maternity care of both women who faced separation from their baby and midwives. Themes from the qualitative analysis will inform the quantitative component of the study. Using the Early-Life data cross Linkage in Research (eLIXIR) database, I will investigate women's characteristics, perinatal outcomes and engagement with maternity and healthcare services during the perinatal period. Qualitative and quantitative results will be merged and synthesised and cyclically reviewed by the PPIE Advisory Board. A stakeholder event will conclude the study to present findings and shape a policy brief and best practice guidance.Timelines for delivery The research and training elements will run in parallel and complement each other. In year one, systematic review training and research will be carried out; the qualitative and quantitative research will be conducted in year two and partially in year three, underpinned by relevant research methodology training. Year three will conclude with synthesis of results, a stakeholder meeting and conference presentations. Anticipated impact and dissemination This will be the first study to focus on maternity experiences and outcomes of a marginalised and under-researched group of women, whose complex needs are currently unmet. Study findings will inform a policy brief and best practice guidance, to be tested and evaluated in future research, with the ultimate aim of improving evidence-based maternity care and outcomes of this group of women and by extension of their babies. Dissemination of study findings will be through various channels: 1) A feedback session for study participants and the PPIE Advisory Board; 2) A stakeholder event, bringing together PPIE partners, clinical, academic and policy networks; 3) Academic publications and international conference presentations; 4) Social media to reach the wider public.

Lay abstract: Background In the last decade in the UK, there has been a worrying increase of babies separated from their mother's care shortly after birth due to safeguarding concerns. In 2017-2018, 3,080 babies were in State Care within a week after birth (48 per 10,000 live births), compared to 1,700 babies in 2007-2008 (26 per 10,000 live births). Their mothers often have difficult, complex lives and are very vulnerable - both during pregnancy and especially after their baby is removed. Evidence is lacking on who these women are and how midwifery care can contribute to support them during pregnancy and the postnatal period. This is important as this time offers a unique 'window of opportunity' for women where services are more readily available to them than at any other time. By studying who these women are, what care they receive, how it varies, and how it affects their experiences and outcomes, I aim to inform future practice to improve care for this group of marginalised mothers and their babies. Research question: What is the impact of midwifery support and (models of) midwifery care on the experiences and outcomes of women who face separation from their baby at birth due to safeguarding concerns? This mixed-methods study includes: 1. Review: Review previous research to understand what is already known about caring for women whose baby is taken into care shortly after birth2. Qualitative (Interview) Research Approximately 30 interviews will be conducted with women who faced separation from their baby, to understand their experiences of maternity care. Interviews will be written down and analysed to establish key themes. Four focus groups with midwives working in different maternity care settings will be carried out, to explore barriers and facilitators when supporting women facing separation from their baby. Focus groups will be written down and analysed to establish key themes.3. Quantitative research Analyse data from the early Life Cross Linkage in Research (eLIXIR) research database, which records maternity and mental health care outcomes for pregnant women across South London, including data on social care involvement. I will study characteristics of women who are at risk of separation from their baby, their perinatal outcomes and engagement with maternity and health care services.4. Policy brief Study findings will inform a policy brief and best practice guidance to improve maternity care for women who face separation from their baby, which can be implemented within the NHS and evaluated in future research.Patient and Public Involvement and Engagement (PPIE) I have strong links with three organisations that support women whose baby was taken into care (Birth Companions, MPower and Pause) who fully endorse the research. The Advisory Board of Pause, consisting of women with lived experience, was involved in preparing this proposal by checking relevance, defining research questions and fine-tuning sensitive use of language. They will remain involved throughout the project to help guide the research process. The engagement leads of the organisations will also play key roles in recruitment and support of participants. Dissemination The research findings will be disseminated in four ways: A feedback session for study participants and the Advisory Board to incorporate their feedback in the final results; A stakeholder event, inviting PPIE partners, clinical, academic and policy networks, to disseminate study results and shape policy recommendations; Academic publications and conference presentations; To reach the wider public, I will use social media to share findings and policy recommendations.A subsequent postdoctoral Fellowship will focus on assessing the effectiveness of maternity care innovations on the outcomes of this group of women and their babies.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH