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Scotland Maternity & Midwifery Festival – Abstracts

SEMINAR 3: Women's psychological wellbeing following miscarriage from a salutogenic

perspective

Author: Dr Anne Marie Rennie, Recognition of Prior Learning, NHS Education for Scotland

Previous research into the psychological impact of miscarriage has taken a pathogenic approach,

with limited research examining the factors that relate to enhanced psychological wellbeing. As a

result, it is difficult to understand what predicts lower anxiety, depression and higher wellbeing. In

order to address such gaps my PhD study employed mixed methods, using a salutogenic perspective

to investigate the effects of miscarriage on women's psychological wellbeing over time.

This presentation will share my PhD findings of women’s experiences following miscarriage and

identifies factors related to enhanced psychological wellbeing.

SEMINAR 4: "I was thinking like this woman's actually going to die."

A study to explore obstetric emergencies

Author: Dr Lyz Howie, Midwife Lecturer, University of the West of Scotland

This conference presentation will inform the audience about the PhD study outlined below.

Aim: To explore psychological support mechanisms with student midwives following a simulated and

real-life obstetric emergency.

Rationale: Obstetric emergencies/critical incidents during childbirth are unpredictable and require

immediate management. These events can cause emotional trauma for midwifery students who will

encounter them during their clinical placements. It is crucial that students are prepared to deal with

them and feel supported after the event. An emergent explanatory sequential mixed-methods study

was conducted to explore psychological support mechanisms with student midwives from across

Scotland following a simulated and real-life obstetric emergency resulting in the Motivation And

Support for Traumatic Situations (MASTS) model.

Methods: Quantitative experimental phase; validated tools to assess anxiety, stress, mood, self-

efficacy and wellbeing; descriptive analysis. Qualitative phenomenological phase; unstructured

interviews; thematic analysis using Colaizzi’s framework. Sample: pre-registration student midwives

in Scotland.

Key messages: Student midwives experience emotional and physical reactions following exposure to

simulated and real-life obstetric emergencies. Feelings of fear and anxiety led to feelings of

helplessness, inadequacy, self-blame and avoidance tendencies. Students used both problem-based

and emotional-based coping strategies. Throughout this process, support mechanisms were

paramount to nurture and develop the student during traumatic situations. Reassurance from staff

fostered a safe environmental plus and a sense of belonging. Support mechanisms also enabled

experiential learning which informed future situations. The findings that also emerged were related

to stress and coping theory and synonymous with a motivational theory. These key developments

from the original research subsequently led to and informed the MASTS model.

Recommendations: Following a clinical obstetric emergency, students should be offered a support

mechanism, which is delivered by a trusted and empathetic person. Involvement with team

debriefing in the clinical area is beneficial. Further research should be undertaken to test the MASTS

model as well as physiological and psychological responses to obstetric emergencies.

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This presentation would be informative to student midwives, qualified staff and members of the

multidisciplinary team in preparation of supporting the future midwifery workforce through these

traumatic situations.

SEMINAR 5: Best Start workshops: 1 year on

Author: Sarah Turner, Practice Educator, NHS Education for Scotland

INTRODUCTION

NHS Education For Scotland (NES) prompted by the publication of the ‘Best Start: A Five-Year

Forward Plan for Maternity and Neonatal care in Scotland’ (Scottish Government 2017) employed

two midwives with caseload experience as practice educators to develop an interactive workshop

educating on aspects of continuity of carer and caseload management. These workshops were

focused on delivering the evidence around relational aspects of care to groups of midwives working

in all Scottish health boards. The workshop programme was varied and had lectures and interactive

sessions. They have been very well received with positive feedback and requests for further

education.

AIM

The aim of the workshop was to provide the research evidence around midwifery continuity of carer,

open discussions and an atmosphere conducive to assisting staff in working towards Best Start

within their own areas. NES offered the free 1-day workshop to the early adopter boards initially

prior to opening the offer to all the health boards across Scotland, open invitations were given to all

staff to attend.

METHODS

Midwives (group size 18 max), managers, consultants and project managers all attended for a full

day in their local area, feedback was requested on the day.

FINDINGS

From January to June 2019 there have been 15 completed sessions with 213 attendees. Challenges

delivering the workshop for many of the midwives included scepticism and reluctance to change

current working patterns. It was evident on some occasions that staff wanting to change practice

and develop continuity models were reluctant to voice their opinions freely in session times and

would discuss their feelings and thoughts in private with the educators. The educators were aware

of a shift in attitudes from the beginning of the day to the end where midwives appeared more open

to the idea of change and relational care -the consultants in Orkney even requested a Best Start day

for medics!

SEMINAR 7: Perinatal mental health befriending - support to empower

Author: Emma Cashmore-Gordon, Service Manager, Aberlour Child Care Trust

The session will provide an overview of Aberlours’ Perinatal Befriending Service Model and an

opportunity to hear from women with lived experience and volunteer befrienders who will share

their journey with Perinatal Befriending and beyond.

There will also be a learning opportunity for delegates to develop a greater understanding of

Perinatal Mental Health including signs and symptoms and strategies for support.

Aberlours’ Perinatal Mental Health Befriending Support Service delivered across East Lothian and

Forth Valley offers women experiencing mental health difficulties emotional and practical support

through pregnancy and during their baby’s first year.

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The service meets the needs of women, babies, partners, siblings and extended family members

through reducing social isolation, improving parent’s mental health and well -being whilst supporting

positive relationships between parents and their babies. The service adopts a person- centred

approach, matching women with highly trained Perinatal befrienders who meet regularly, working

flexibly around women’s’ desired outcomes from their engagement with the service, promoting self-

efficacy.

The aims, objectives and the model of service delivery will be outlined in our introduction.

The session will highlight a range of evidence-based outcomes using a range of of methodologies,

which have resulted from the positive, trusting relationships that have been built between families,

Befrienders and Perinatal Coordinators.

Perinatal befrienders have reported increased self-confidence and self-esteem as a result of their

roles, which has positively impacted on their own lives including parenting and family situations,

further education and career opportunities

A number of befrienders whose journey began as service recipients have, following recovery, gone

on to train as Perinatal befrienders.

Delegates will have the opportunity to hear from women with lived experience of the service and

from Perinatal befrienders.

Through working in parallel with the service, clinical stakeholders have noted positive changes in

mother’s confidence and well-being, with a reduction in the need for more intensive services. It was

felt that the service offers a valuable, effective primary early intervention, enabling women to be

supported and connected within their own communities.

There will be a learning opportunity for delegates to deepen their knowledge of Perinatal Mental

Health through a group learning exercise and a Question and Answer session to conclude.

SEMINAR 9: The Cardiff postpartum family planning initiative: evaluation of a midwife led

early postpartum family planning service

Author: Judith Cutter, Consultant Midwife, Cardiff & Vale University Health Board

The Royal College of Obstetrics and Gynaecology and Faculty of Sexual and Reproductive Health

recommend that contraception should be part of maternity care. Additionally, shortly spaced

pregnancies increase the chances of mortality and morbidity in the mother and child. The aim of

early postnatal contraception is to support women to make informed decisions relating to their

fertility including the avoidance of unintended pregnancies.

Aim:

To evaluate the progress and uptake of an early postnatal contraceptive service.

Methods Used:

To meet all objectives of the project a three pronged approach was used.

1) Training for midwives to prescribe and administer Progesterone only pill and progesterone only

injectable, through patient group directives,

2) Data collection describing the coverage and uptake of the service. Data was collected via the E3

maternity IT system.

3) Data analysis to describe the proportion of women offered early postnatal contraception.

Results and Discussion:

6 months of data was collected from 1st October 2018 to 1st April 2019 (N=2,516). 91.8% (n=2309)

had contraception methods discussed with them prior to discharge home from hospital, 14.5%

(N=297) received contraception in the immediate postpartum period, 4.4% (N=111) received Long

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acting reversible contraception. A total of 39.7% received their chosen method by final discharge

from maternity services.

An evaluation in 2016 found that 67% of women planned to use contraception after birth but none

were recorded as being discharged home with any.

Conclusion:

There has been an improvement in the number of contraceptive discussions now being recorded

from 67% requesting contraception in 2016 to 91.8% in 2019. A rise in acceptance is also noted from

3.7% to 14.2% uptake during the 6 month period following the intervention. However, there still

remains a number of women requesting and not receiving contraception prior to leaving hospital,

reason for this have been explored further.

SEMINAR 10: Preventing PTSD post childbirth through compassion: how the interactions

between women, midwives, and maternity services influence women’s childbirth

experiences and subsequent trauma

Author: Dr Jenny Patterson, Midwife and Research Fellow, Edinburgh Napier University

Background

Full PTSD post childbirth (PTSD-PC) develops in 4% of women1. Interpersonal factors are the

strongest predictors2 and negatively perceived interactions with midwives, measured as Quality of

care Provider Interaction or ‘QPI’ are significantly correlated3. This presentation combines novel

findings from two new studies.

Aim

Two independent, qualitative studies explored the lived experience of QPI from the perspective of

women and midwives.

Methods

One study explored QPI from the perspective of six women with PTSD-PC and six midwives. The

other explored 17 women’s experiences of perceiving compassionate interactions with midwives.

Both studies used semi-structured interviews which were audio recorded and transcribed verbatim,

and both used Interpretative Phenomenological Analysis (IPA)5. Both studies received ethical

approval.

Results

Both studies independently identified key convergent themes. The acknowledgement of Being

Human was central. This encompassed recognising one’s individuality and needs and being

supported. The concepts of ‘Being With’, ‘Being in Relationship’ were strongly desired and valued by

all informants. Lack of response to human needs, alongside dysfunctional, lost, or absent

relationships featured highly for women with PTSD-PC and midwives. Yet, compassionate

interactions helped women feel safer and more able to cope. Women and midwives desired positive

interactions but recognised some maternity care environments as barriers to high quality,

compassionate interactions. Deeper themes embedded across both studies regarding trust,

expectations, power, conflict, balance, and safety are also highlighted.

Conclusion

Negatively perceived QPI significantly correlates with the development of PTSD-PC. These studies

mirrored findings highlight that maternity services should acknowledge the human and relationship

requirements of women and midwives. Combined findings indicate that compassionate interactions

are powerful interventions that may reduce the risk of trauma and PTSD-PC. Further research is

essential to identify how midwives can develop interpersonal skills, thus optimising QPI and

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compassionate care. Also, how maternity services can support high quality woman/midwife

interactions.

References:

1: Yildiz, P. D., Ayers, S., & Phillips, L. (2017). The prevalence of posttraumatic stress disorder in

pregnancy and after birth: A systematic review and meta-analysis. Journal of Affective Disorders, 20

8, 634-645. doi: 10.1016/j.jad.2016.10.009

2: Harris, R. and Ayers, S. 2012. What makes labour and birth traumatic? A survey of intrapartum

‘hotspots’. Psychology & Health 27, 1166-1177 12p.

3: Sorenson, D. S., & Tschetter, L. (2010). Prevalence of negative birth perception, disaffirmation,

perinatal trauma symptoms, and depression among postpartum women. Perspectives in Psychiatric

Care, 46(1), 14-25. doi: 10.1111/j.1744-6163.2009.00234.x

4: Ayers, S., Wright, D. & Thornton, A. 2018. Development of a Measure of Postpartum PTSD: The

City Birth Trauma Scale. Frontiers In Psychiatry, 9.

5: Smith, J. A., Flowers, P. & Larkin, M. 2009. Interpretative Phenomenological Analysis Theory

Method and Research, London, Sage.

SEMINAR 11: Where’s dad? Introducing overnight stays on the postnatal ward for dads

Author: Donna Brough, Senior Midwife, NHS Tayside

Where’s dad? Working towards a father friendly maternity service

There is much emerging evidence telling us just how important the role of a dad is to the life chances

of any child. Unfortunately, as services, our practice often tends to overlook dads, focusing on

engaging and supporting mums, despite the fact that supportive father-child relationships are

equally important for boys and girls. (Scot Gov 2017) Fathers’ active involvement is linked with their

children’s higher educational achievement, attainment, improved social mobility; better behavior at

school including reduced risk of suspension or expulsion.

What better place to start than at the start of the parenthood journey however historically men

were excluded from many aspects of childbirth with even their presence at birth being relatively

modern. Women though tell us that they want partners to attend antenatal appointments, that

they rate a dad’s support more highly than that of midwives and that during labor they require less

pain killers when a partner is present. Most maternity services have provision for attendance

antenatal and in labour. In the postnatal period something changes, now that the baby is born, in

the first hours of life as a family Dads are sent home, refused access to postnatal wards and

separated from their new families.

NHS Tayside maternity service wants to raise the profile of the role of dads throughout the

maternity service and ensure that our service provides an excellent level of care to the whole family

around the baby. In partnership with the Fathers Network we have undertaken a number of

workshops attended by a wide range of staffing groups aiming to educate the teams around the

importance of Dads roles and how we can work towards a father friendly maternity service.

One of the first pieces of work undertaken was introducing the opportunity for partners to stay

overnight following birth allowing the first hours as new family to be spent together.

To date over 120 partners have stayed over on our busy maternity ward the journey to this

becoming routine practice has been long and at times challenging but the feedback and positivity

from the families in our care has been overwhelming

We would like to share our journey and learning.

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SEMINAR 12: Developing a homebirth team

Author: Lorna Ford, Homebirth and Caseload Community Midwife, Angus Team, Arbroath Maternity

Unit

Objectives

The Birthplace in England Study 2011 shows homebirth as a safe option. This led to the development

of a homebirth team with the aim of improving birth outcomes for women and babies. Also,

developing a way of working which is sustainable for staff. The successful model of care would be

used across the wider health board.

Results

Prior to the inception of the homebirth team there were 4 homebirths a year in the area. Following

the implementation of the team this increased yearly to 37 in 2018. Homebirth is offered to all

women. As a result of the team it was found that more women, who historically would not have

opted for a homebirth, did– with success.

The transfer rate for the target group is 4% for maternal complications. There were no adverse

outcomes for neonates. The results reflect that of the Birth Place in England Study.

Feedback received from women and their families was positive. The feedback from those

transferred was also surprisingly positive. This has increased the referrals due to word of mouth.

The staffing model has been adapted to make it attractive and workable for staff. On surveying the

staff they reported increased work satisfaction and a more positive work life balance.

Approach

Our main target group is parous women who are well in pregnancy with no previous birth

complications. However, everyone is offered homebirth as a valid option for place of birth at first

contact and throughout their antenatal care. When women are considering a home birth they will

have all their care with one of the three dedicated homebirth midwives. Our approach is woman

centred with a strong focus on continuity of carer. They will meet all the midwives prior to labour.

The principles of this have been adopted by the wider team in the implementation of Best Start.

Conclusion

The homebirth team is effective with both an increase in women and staff satisfaction. This

highlights that it is feasible for health boards to offer this model of care to women and their families.

Following the success of the team the health board has now implemented teams in other areas of

the trust. They have accomplished similar success. The health board has now achieved the highest

homebirth rate in the country.

More importantly the women are very positive about their experience which has lead to some

returning for subsequent births and an increase in requests for homebirths.

MINI MASTERCLASS: Prevention of haemolytic disease of the fetus and newborn: reducing

risk through evidence and education

Author: Susan Cottrell, Transfusion Education Nurse Specialist, NHS National Services Scotland -

Scottish National Blood Transfusion Service

Susan Cottrell, Transfusion Education Nurse Specialist, Scottish National Blood Transfusion Service,

Transfusion Team

Katherine Forrester, Transfusion Researcher, Scottish National Blood Transfusion Service,

Transfusion Team

Simon Carter-Graham, Clinical Incident Specialist, Serious Hazards of Transfusion

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Introduction

Haemolytic disease of the fetus and newborn (HDFN) is a potential complication of pregnancy in

women who have specific IgG red cell alloantibodies in their plasma, the most important being to D

(anti-D), C (anti-C) and Kell (anti-K). Increased risk of HDFN is more common in D negative women

carrying a D positive fetus.

Background

The Serious Hazards of Transfusion (SHOT) haemovigilance scheme collates national data on serious

adverse events (SAE) relating to the requesting and administration of anti-D Ig in D negative women

of child bearing age. This includes cases of immune anti-D.

Aim

To raise awareness of potential risks in D negative women and present evidence of errors in practice.

Results

In 2018, 14% (n=466/3326) of total errors reported to SHOT related to anti-D Ig errors which were all

preventable, an increase from the 13% (n=426/3230) of errors reported in 2017. In 2018, the

majority of errors occurred in the hospital setting in 84% of cases reported.

Recommendations

Prevention of errors and minimising risk to patients is critical to patient safety. SHOT promote key

messages and recommendations based on lessons learnt from incidents. Knowledge and

understanding of the potential transfusion associated risks are key to person-centered care during

the pregnancy journey, with SHOT additionally recommending the Learnbloodtransfusion: Anti- D

clinical module (https://nhs.learnprouk.com) as an evidence based education resource for all staff

involved in practice

Conclusion

Evidence continues to suggest D negative women carrying a D positive fetus is a potential risk factor

for HDFN. Improving patient safety through learning from incidents and education develops a

positive learning culture and creates a workforce appropriately trained in the management of D

negative women and associated transfusion related risks. The safe and timely administration of anti-

D is critical to prevention of errors in D negative women of child bearing age.

Mohawk midwifery and mothering (POSTER)

Author: Alison Perry, Lead Research Midwife/ Manager and NIHR Pre-doctorate Fellow, Imperial

College

My Mohawk Midwifery and Mothering poster will be based on my experience of visiting a First

Nations Reserve in Canada earlier this year. This experience formed part of my pre-doctorate NIHR

fellowship and was funded by a Florence Nightingale travel scholarship. I have since then had an

article written about the experience published in the September edition of the British Journal of

Midwifery. The poster I propose will capture the experience of both the international travel and the

BJM publication.

The purpose of the trip had been to learn from the midwives whether women are prepared in the

Mohawk culture in any particular way for becoming mothers. The Mohawk culture within the wider

Iroquois identity is matrilineal and presents contrast to the colonial context in Canada. Additionally,

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the history of colonialism and genocide in Canada presents a complex relationship with midwives

and mothers.

The poster will convey the key historical cultural points and highlight the reclamation of traditional

Mohawk midwifery in the current period in Canada. I will also have copies of the British Journal of

Midwifery article entitled, ‘The Place They Will be born’, (September, 2019, BJM) available. The

wider context of this article publication is the ongoing development of my PhD around the wellbeing

of women as mothers.

Psychological distress in midwives (POSTER)

Author: Gill Moncrieff, Student Midwife, Edinburgh Napier University

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References:

Cramer E and Hunter B (2018). Relationships between working conditions and emotional wellbeing

in midwives. Women and Birth. doi:10.1016/j.wombi.2018.11.010

Leinweber J, Creedy DK and Rowe H et al (2017a). Responses to birth trauma and prevalence of

posttraumatic stress among Australian midwives. Women and Birth, 30(1): 40-45.

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Leinweber J, Creedy DK and Rowe H et al (2017b). A socioecological model of posttraumatic stress

among Australian midwives. Midwifery, 45: 7-13.

Patterson J (2019). Traumatised midwives; traumatised women. AIMS journal, 30(4): Retrieved from

https://www.aims.org.uk/journal/item/traumatised-midwives-traumatised-women#Box%20B

Patterson J, Hollins Martin CJ and Karatzias T (2019). Disempowered midwives and traumatised

women: Exploring the parallel processes of care provider interaction that contribute to women

developing Post Traumatic Stress Disorder (PTSD) post childbirth. Midwifery, 76: 21-35.

Pezaro S, Clyne W and Turner A et al (2016). ‘Midwives Overboard!’ Inside their hearts are breaking,

their makeup may be flaking but their smile still stays on. Women and Birth, 29(3): e59-e66.

Rice H and Warland J (2013). Bearing witness: Midwives experiences of witnessing traumatic birth.

Midwifery, 29(9): 1056-1063.

Understanding dads within maternity services: keeping families together (POSTER)

Author: Alison Nicol, Midwife Educator, NHS Fife

Background

A survey undertaken by Fathers Network Scotland and Fathers Institute during 2018 showed though

their involvement is central to infant and maternal well-being and is desired by mothers, a large

number of fathers felt ignored before, during and after birth

The survey highlighted the following key issues:

Outdated visiting policies

Inadequate or non existing overnight facilities for dads to stay

48% saying that they had not been allowed sufficient time for the new family to spend

together after birth

Pioneer Change

Maternity services in NHS Fife are working with Fathers Network to promote dad-friendly best

practice through participation in the Understanding Dads programme. The programme provided

workshops funded by Scottish Government and Fife Council. Four workshops were held in 2018

attended by midwives, nursery nurses, healthcare support workers and health visitors.

The workshops allowed staff to consider the impact of:

• Attitude – How your attitudes and behaviours impact on others.

• Behaviours and language – valuing the role fathers play

• Policy – Encouraging and providing facilities for fathers/partners to stay overnight to provide

support for mothers and care for their baby.

• Systems – Questioning why we do what we do and asking if it can be done differently. Being

more aware of father inclusion

Feedback from Dads

“I felt really included in the care of my partner”

“I felt involved throughout and the staff were brilliant”

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Feedback from Staff

“Attending the workshop made me aware of my own practice and how excluded dads can feel”

“Discussion on how our environment impacts on Dads really gave me food for thought”

Going forward

Maternity services in NHS Fife continue to work with Fathers Network as a pilot site for the “How are

you Dad” programme which aims to increased the knowledge and understanding of the impact of

perinatal mental health on whole family and sign post to other services.

Going for gold – our journey to Baby Friendly Achieving Sustainability: Gold Award

(POSTER)

Author: Donna Robertson, Infant Feeding Advisor, NHS Fife

Background

In July 2019 NHS Fife was the first maternity unit in Scotland to receive the prestigious Baby Friendly

Achieving Sustainability Award.

Baby Friendly accreditation is based on evidence-based standards designed to:

• provide parents with the best possible care to build close and loving relationships with their

baby

• to feed their baby in ways which will support optimum health and development

The Journey

The service has been accredited as Baby Friendly since 2005. Following successful reaccreditation,

UNICEF assessors recommended applying for the Achieving Sustainability ‘Gold’ award. Led by the

Infant Feeding Advisor the teams focused on improvements across the following key themes

Developing a leadership team that promotes baby friendly standards

• Appointing a Baby Friendly Guardian at strategic level

• Delivering UNICEF baby friendly manager training

Fostering a positive culture

• Undertaking a staff survey

• Establishing a robust and evolving training programme

• Publishing a staff quarterly newsletter

• Providing positive feedback to teams

• Support for partners to stay overnight

Establishing monitoring processes

• Establishing regular audits and action plans

• Collaboration with e-health to develop systems which allows progress to be tracked over

time

Developing and progressing the service

• Establishing Achieving Sustainability Group to take ownership going forward and ensure that

baby friendly remains valued

• Working in partnership with the Health and Social Care Partnership Infant Feeding Advisor

Key successes

• Overall breastfeeding initiation rates have risen from 54.7% in 2015/16 to 64% in 2018/19

• 100% of mothers interviewed by the assessors reported that were able to have skin contact

for at least one hour and support to offer the first feed in skin contact (breast and formula

feeding)

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• Recognition that the service is not only implementing the Baby Friendly standards, but also

has the leadership, culture and systems to maintain this over the long term

Providing a safe and positive experience for women undergoing induction of labour

(POSTER)

Author: Anne Mackinnon, Quality Improvement Midwife, NHS Fife

Description

A review of the pathway for women undergoing induction of labour, alongside quantitative feedback

from women, highlighted areas for improvement such as protracted delays, multiple handoffs,

varying care experiences. Redesigning this pathway was identified as an area for improvement

within maternity services in NHS Fife (45)

Aims and Objectives

The project aimed to implement a reliable safe pathway of care and provide a positive experience

for women undergoing induction of labour. (22)

Methodology

A quality Improvement and co-production approach was adopted which focused on improvements

in the following areas:

• Establishing a dedicated midwife led multi-professional team and setting up dedicated

induction of labour suite

• Providing facilities for birth partners to stay throughout – this was what mattered most to

women

• Redesigning the current appointment system

• Adopting individualised care plans

• Using feedback from women and the team to drive continuous improvement

• Agreeing process and outcome measures to tract improvement

• Establishing communication channels through multidisciplinary meetings, newsletters and

social media (91)

Results and Outcomes

This improvement work is being delivered within the existing unit footprint and existing staffing

establishment. Early results for January – July 2019 show:

• Reduction in women experienced delays

• 60% required only a single intervention before establishing in labour

• Increased continuity of carer

• Reduced handovers

• Spontaneous Vaginal Delivery Rates of 64 - 73%

The most powerful signal of improvement has come from the consistent positive feedback from

women, families and from the commitment and energy of the team.

• 98% of women reported that they were very satisfied with the care they received

• 90% of women reported being fully informed throughout the process

Women reported that they felt involved, informed, safe, and cared for. Staff reported a real team

spirit and commitment to providing a safe and positive experience for women and families (137)

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Reframing birth knowledge through the lens of the microbiome (POSTER)

Author: Kate Cook, Senior Lecturer in Midwifery, Anglia Ruskin University

Summary of content and objectives - The objective of the poster is to present the findings of the

literature review undertaken as part of my PhD research which will aim to explore midwives and

obstetricians understanding of the microbiome and how this might impact on their practice. Within

this, birth professional’s perceptions of birth fluids in relation to the emerging evidence on the

microbiome will be explored.

The content will give an overview of the rationale and literature review findings.

Birth is an important event in many ways and emerging research is demonstrating that the way we

are born contributes to our health in previously unanticipated ways. The ‘human microbiome’ refers

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to the microorganisms present on and in every part of the body and they influence human health

(Guarner & Malagelada, 2003., Ferretti et al, 2018). They are passed from mother to infant at birth

mainly by vaginal and faecal matter and through breastfeeding and skin contact. Their transmission

can be interrupted by intervention and certain birth practices. Despite the emerging evidence, the

literature reveals limited knowledge and understanding of the microbiome in relation to childbirth.

Discussions within midwifery circles reveal efforts to protect the microbial environment as part of

respecting the physiological nature of birth but there is little in the established literature on the

topic. Obstetricians have some awareness but this is limited around anti-microbial stewardship and

the microbiome’s potential influence in pre-term birth. My research seeks to establish professional’s

understanding.

Theme - Putting research & evidence into practice

This poster is relevant to the conference theme of putting research into practice as the knowledge of

the microbiome in relation to childbirth is still emerging. As the multi-disciplinary team around the

mother and child, keeping updated with new knowledge is essential for a topic which appears to

have such an impact on the long term health of the infants in our care.

Ferretti, P., Pasolli, E., Tett, A., Huttenhower, C., Bork, P., and Segata, N., 2018. Mother to Infant

Microbial Transmission from Different Body Sites Shapes the Developing Infant Gut Microbiome. Cell

Host and Microbe, [e-journal] 24, pp.133-145.

Guarner, F., Malagelada, J, R., 2003. Gut Flora in Health and Disease. The Lancet, [e-journal] 361,

pp.512-19.

Keeping mums and babies together (POSTER)

Author: Amanda Kane, Senior Charge Midwife, NHS Tayside

Research and feedback from women in Scotland has shown that their greatest fear was being

separated from their babies. They expressed that if separation was unavoidable, they wanted it to

be minimised. In January 2017, The Best Start: A Five-year Forward Plan for Maternity and Neonatal

Care in Scotland recommended that where possible, babies with moderate additional care needs,

such as late preterm infants (LPI) be cared for in the postnatal ward alongside their Mums. These

babies would previously be cared for in the Special Baby Care setting and would be separated from

their mums. In NHS Tayside, we immediately took steps to implement this recommendation.

However, for those LPI who required a higher level of care such as nasogastric tube feeds, low birth

weight (1800g), significant neonatal abstinence syndrome requiring oral medication or additional

feeding support or rooming in before discharge but requiring additional needs such as nasogastric

feeding or home oxygen to name a few, admission to the Special Care Baby Unit (SCBU) was

unavoidable and they were separated from their mothers post birth. Until women were fit for

discharge, they could not be admitted to transitional care within NICU to be with their babies as

midwifery care was not provided in the unit.

Collaborative working between midwifery and neonatal staff enabled us to relocate transitional Care

to the postnatal ward where babies are cared for by the neonatal team and the women by the

midwifery team. This collaboration has not only reduced LPI admissions to the neonatal unit but has

ensured that we are avoiding unnecessary separation of mums and babies.

This QI project commenced in February 2018 and the move was made in October 2018. The positive

feedback from women and their families has been overwhelming and we continue to reduce

admissions to SCBU.