Title: Evidence to improve the quality and safety of midwifery-led care
Funder: Department of Health and Social Care

Abstract: Aim Using national data on perinatal deaths and two studies involving primary data collection through a pioneering midwifery research and reporting system, this research programme aims to provide evidence and a research infrastructure to strengthen the development of safe, high quality midwifery-led care and improve outcomes for mothers and babies.Objectives To describe labour and delivery complications, mode of birth and causes of death in intrapartum stillbirths and early neonatal deaths occurring in births planned in midwifery units and at home, and compare with a sample of similar perinatal deaths occurring in births planned in obstetric units in the same NHS trusts/health boards To develop and establish a new national midwifery reporting and research system (UKMidS) To use UKMidS to estimate the current prevalence of obesity in women planning birth in alongside midwifery units (AMUs) and describe their maternal and clinical characteristics, management, labour complications and outcomes compared with women of normal weight To use UKMidS to determine the incidence of and risk factors for neonatal unit admission in births occurring in AMUs To use UKMidS to describe management of labour in the mothers of babies admitted to neonatal care following birth in an AMU, with particular reference to national clinical guidelines To develop a funding system and structure to ensure further development and sustainability of UKMidS to include other midwifery-led settings for birth Objective 1: Understanding and comparing cause(s) of perinatal death in births planned in different settings Methods Using national data on perinatal deaths submitted to MBRRACE-UK for 2013-14, I will use conditional logistic regression to compare labour complications, mode of birth and cause(s) of death in babies of women planning birth in midwifery-led settings with a frequency matched sample of deaths in planned obstetric unit births in the same NHS trusts/health boards. Outcomes and benefits Identification of possible risk factors, complications or causes of death for investigation in future studies. Objectives 2 & 6: A new national midwifery reporting and research system (UKMidS) Methods As an extension of the UK Obstetric Surveillance System (UKOSS) I will set up a national midwifery reporting and research system (UKMidS) for monthly prospective data collection in AMUs in England. Reporting midwives in each AMU will notify cases for each UKMidS study and complete study-specific data collection forms for cases and comparison women where required.Outcomes and benefits A research infrastructure to generate robust, promptly reported evidence on incidence, risk factors, clinical practice, management and outcome for uncommon conditions, events and outcomes, to support the development of midwifery research capacity and enable further high quality, clinical and policy-relevant research in this area. Objective 3: Obesity in women planning birth in AMUs Methods I will carry out a national cohort study, using data collected through UKMidS, to identify the current national prevalence of obesity in women planning birth in AMUs and use logistic regression to compare the progress and management of their labour and their outcomes with women of normal weight planning AMU birth. Outcomes and benefitsEvidence on safety of planned AMU birth for obese women to strengthen clinical guidelines and AMU admission criteria, improve outcomes and inform women's decision-making. Objectives 4 & 5: Neonatal admission following birth in an AMU Methods I will carry out a national case-control study on cases of neonatal admission following birth occurring in an AMU, identified using UKMidS, to calculate the national incidence of neonatal admission and use logistic regression to investigate potential risk factors for admission and adverse outcome, including progress and management of labour. Outcomes and benefits Evidence to inform clinical practice, strengthen evidence-based guidelines and ultimately improve outcomes.

Lay abstract: More women are planning to have their baby in midwifery-led units or at home. This research will use existing information and set up a national system to collect new information to find out more about births planned in these settings, focussing on births where babies die or need neonatal care, so that care can be improved and made safer. The research will also find out how many women with risk factors or complicated pregnancies plan birth in these settings, study how they are cared for and the outcomes for them and their babies, to help improve guidelines on care.

Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH