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Welcome to the Child & Maternal Health online newsfeed. Here you’ll find all the latest research, news stories, policy updates and guidelines. View our other newsfeeds for more subject-specific news.

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New impact report on maternity care

The Royal College of Medicines| New impact report on maternity care

NICE has published a new report that  explores how its evidence-based guidance contributes to improvements.
The reports are based on data from national audits, reports, survey and indicator frameworks that show the uptake of NICE guidance and quality statement measures (via Royal College of Midwives).

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Image source: nice.org.uk

You can download the full report from NICE 

NIHR research into labour for first-time mothers wins BMJ award

NIHR | May 2018 | NIHR-funded research wins The BMJ’s ‘UK Research Paper of the Year’

An NIHR funded piece of research BUMPES has won the BMJ’s  award for ‘UK Research Paper of the Year’. The research intended to explore the  aimed to investigate the most ideal position a first-time mother with a low dose epidural should adopt to increase the chance of a birth without interventions such as forceps or a Caesarean. The randomized controlled trial trial found that a lying-down position in the second stage of labour in first-time mothers with an epidural achieved more spontaneous vaginal births than an upright position (source NIHR).

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Full details about the project are available from the NIHR website 

Plain English Summary

The BUMPES study aimed to find out whether or not women having their first babies who have an epidural and give birth in an upright position (kneeling, sitting in a chair or upright in bed), rather than lying down (on their side), are more likely to have a vaginal birth and less likely to need forceps or ventouse.

Between October 2010 and January 2014, 3236 women took part in the study at 41 maternity units in England and Wales. Just over one-third (35.2%) of the women allocated to the ‘upright’ group had a spontaneous vaginal birth, compared with 41.1% in the ‘lying-down’ group. Outcomes for the health of the woman and baby (such as whether or not the baby needed special care or the woman had problems with incontinence) were no different between the two groups, either in the short term (just after the birth) or up to 1 year later.

The study offers clear evidence that women having their first baby and who have epidural pain relief in labour are more likely to have a straightforward vaginal birth if they adopt a lying-down position in the late stages of labour when their baby is ready to be born. There are no apparent disadvantages of lying down for either the woman or her baby in the short or long term.

The full report can be read at the NIHR Journals Library

Full reference: Bick D, Briley A, Brocklehurst P, Hardy P, Juszczak E, Lynch L, et al | A multicentre, randomised controlled trial of position during the late stages of labour in nulliparous women with an epidural: clinical effectiveness and an economic evaluation (BUMPES)|Health Technol Assess | 2017 | Vol. 21| (65)

Tooth decay in five-year-olds continues to decline

Figures reveal 23% of five year olds in England had decayed, missing or filled teeth in 2017, down from 30.9% in 2008.

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Levels of tooth decay in 5-year-old children are continuing on a steady decline, according to data recently published by Public Health England. However, clear inequalities in oral health remain, with children in deprived areas more likely to be affected. The risk of tooth decay is increased by consuming sugary foods and drinks and not brushing at least twice a day with fluoride toothpaste.

Public Health England has published two reports presenting information on the oral health of children at local authority level:

 

The Fifteen steps for Maternity Quality

NHS England|Fifteen steps for Maternity Quality from the perspective of people who use maternity services| May 2018

Fifteen steps for Maternity Quality from the perspective of people who use maternity service, is part of a suite of toolkits for The Fifteen Steps Challenge, which help to explore the experience of people who use maternity services and are a way of involving them in quality assurance processes.

Fifteen steps for Maternity
Image source: england.nhs.uk

This toolkit has been developed with Maternity Voice Partnerships (MVPs) in mind. MVPs are local teams of users/user reps, midwives, doctors and commissioners,
working together to review, co-design and co-produce local maternity services.
There are usually a number of MVPs per Local Maternity System (LMS). This toolkit is easy to use and aligns with NHS priorities for maternity care as outlined in the Better Births report published in 2016. This toolkit supports collaborative working between
all those involved in using, reviewing, designing and delivering maternity services, so that together improvements can be identified and implemented (Source: NHS England).

The report is available from NHS England 

 

NHS England pledges specialist mental health services for new mums in every part of the country

NHS England & NHS Improvement | The Perinatal Mental Health Care Pathways | May 2018

NHS England has confirmed that new and expectant mums will be able to access specialist perinatal mental health community services in every part of the country by April 2019. The second wave of community-perinatal is now being rolled out to areas of the country that are currently underserved; with full geographical coverage  anticipated.

This £23 million  funding forms part of a package of measures, altogether worth a total of £365m by 2021, to transform specialist perinatal services so that 30,000 additional women can access evidence based treatment that is closer to home and when they need it, through specialist community services and inpatient mother and baby units (NHS England).

The perinatal
Image source: england.nhs.uk

 

NHS England & NHS Improvement have published guidance to provide services with evidence on what works in perinatal mental health care, as well as case studies describing how areas are starting to make this a reality.

The full release can be read at NHS England 

The full guidance can be downloaded here

In the media:

BBC News Improved mental health care funding for new mums

The Guardian NHS to make perinatal mental health available across England

Leading Change, Adding Value: A framework for nursing, midwifery and care staff

NHS England | March 2018 | Leading Change, Adding Value: A framework for nursing, midwifery and care staff

NHS England has recently published this guidance for nursing, midwifery and care staff  to identify and address unwarranted variation in practice – recognising unequal standards of care and changing them. 

leading change
Image source: england.nhs.uk

 Leading Change, Adding Value (LCAV) is the national framework for nursing, midwifery and care staff within England. It builds  on the success of Compassion in Practice with the 6Cs remaining as the core values. Following extensive consultation and feedback from the professions, LCAV was developed to support nursing, midwifery and care staff to apply equal importance to ‘quantifying’ and ‘measuring’ the outcomes of our work as we do to demonstrating the quality and compassion that we are recognised for (NHS England).

Leading Change, Adding Value can be downloaded from NHS England 

New study finds online ads may encourage pregnant smokers to quit

NIHR | April 2018 | Online ads effective at helping pregnant women stop smoking 

An NIHR funded study has found that an online advertising campaign may be more effective in encouraging expectant mothers to quit smoking, than a clinic based intervention. The study was part of a collaboration between the University of Cambridge, University of East Anglia (UEA), and the University of Nottingham (via UEA).

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One of the researchers, Dr Felix Naughton, developed MiQuit, which is a text-messaging intervention specifically for pregnant smokers. As it is automated, the women could use it without health professional’s involvement. In tandem with this the research team also  advertised links to a website providing MiQuit information on Google and Facebook, which incurred a cost. Adverts were also placed on the National Childbirth Trust and NHS Choices websites free of charge.

The team found that the Facebook advert generated initiations throughout pregnancy, around 50 per cent of those who initiated MiQuit via Google were within their first five weeks’ gestation. Adverts attached to online search engines may therefore be a useful way to reach women when they are first pregnant and looking for support or information about smoking during pregnancy. Currently, the earliest cessation interventions tend to target pregnant smokers at their antenatal booking appointment, at around 8-12 weeks’ gestation.

Lead author of the study, Dr Joanne Emery, Research Associate at the University of Cambridge, said: “This study shows that online advertising appears to be a valuable means of promoting health interventions to hard-to-reach groups.

“We found that a significant minority of pregnant smokers were willing to initiate an automated text messaging intervention when offered this online. Given the high reach of the internet this could translate into substantial numbers of pregnant smokers supported to quit.” As a result of this study’s findings, a more definitive trial is now underway.

An article based on this study has been published in the Journal of Medical Internet Research

ABSTRACT

Background: Smoking in pregnancy is a major public health concern. Pregnant smokers are particularly difficult to reach, with low uptake of support options and few effective interventions. Text message–based self-help is a promising, low-cost intervention for this population, but its real-world uptake is largely unknown.

Objective: The objective of this study was to explore the uptake and cost-effectiveness of a tailored, theory-guided, text message intervention for pregnant smokers (“MiQuit”) when advertised on the internet.

Methods: Links to a website providing MiQuit initiation information (texting a short code) were advertised on a cost-per-click basis on 2 websites (Google Search and Facebook; £1000 budget each) and free of charge within smoking-in-pregnancy webpages on 2 noncommercial websites (National Childbirth Trust and NHS Choices). Daily budgets were capped to allow the Google and Facebook adverts to run for 1 and 3 months, respectively. We recorded the number of times adverts were shown and clicked on, the number of MiQuitinitiations, the characteristics of those initiating MiQuit, and whether support was discontinued prematurely. For the commercial adverts, we calculated the cost per initiation and, using quit rates obtained from an earlier clinical trial, estimated the cost per additional quitter.

Results: With equal capped budgets, there were 812 and 1889 advert clicks to the MiQuitwebsite from Google (search-based) and Facebook (banner) adverts, respectively. MiQuitwas initiated by 5.2% (42/812) of those clicking via Google (95% CI 3.9%-6.9%) and 2.22% (42/1889) of those clicking via Facebook (95% CI 1.65%-2.99%). Adverts on noncommercial webpages generated 53 clicks over 6 months, with 9 initiations (9/53, 17%; 95% CI 9%-30%). For the commercial websites combined, mean cost per initiation was £24.73; estimated cost per additional quitter, including text delivery costs, was £735.86 (95% CI £227.66-£5223.93). Those initiating MiQuit via Google were typically very early in pregnancy (median gestation 5 weeks, interquartile range 10 weeks); those initiating via Facebook were distributed more evenly across pregnancy (median gestation 16 weeks, interquartile range 14 weeks).

Conclusions: Commercial online adverts are a feasible, likely cost-effective method for engaging pregnant smokers in digital cessation support and may generate uptake at a faster rate than noncommercial websites. As a strategy for implementing MiQuit, online advertising has large reach potential and can offer support to a hard-to-reach population of smokers.
Full reference: Emery, J.L, Coleman, T., Sutton, S., Cooper, S., Leonardi-Bee, J., Jones, M., & Naughton F. | Uptake of Tailored Text Message Smoking Cessation Support in Pregnancy When Advertised on the Internet (MiQuit): Observational Study | J Med Internet Res |2018| Vol. 20 |4| e146| DOI: 10.2196/jmir.8525|PMID: 29674308
Related: University of East Anglia Online ads help pregnant smokers quit