RCM Research prioritisation project: AIMS suggestions

AIMS is proud to be supporting the RCM's Research Prioritisation project as a Project Partner and with one of our volunteers on the Steering Group www.rcm.org.uk/promoting/education-hub/research-and-funding/research-prioritisation-project

You can read more about this project, which aims to find the top 10 priorities for midwifery and maternity research based upon the perspectives voiced by midwives, student midwives, maternity support workers and women and pregnant people here Influencing the future of midwifery and maternity research

Please follow this link to the survey https://bit.ly/48kRbYH and have your say.

Here are the ideas for research priorities that AIMS volunteers have come up with. Do you agree? Do you have other suggestions?

• How much midwife time is needed to provide effective postnatal support? When and where should postnatal appointments take place to ensure that they are accessible, including to those who have had a caesarean birth?

• What training and support do midwives need in order to support genuinely informed decision-making and consent? In particular, what training and support do they need in order to support and give respectful personalised care to women and birthing people who decline aspects of routine care or the interventions that they are offered, especially in the case of those who have been labelled ‘high risk’?

• What is the most effective way for midwives to communicate information about risks and benefits in an objective, unbiased and non-judgemental way?

• How should midwives counsel people about the risks, benefits and potential consequences of induction, including how it would impact on their birth options and experience of labour?

• Many women are told that they should be induced at 39 weeks because they have ‘risk factors’ such as their age, ethnicity, BMI, IVF pregnancy, predicted large baby etc. but there is a lack of evidence for the benefit of induction on these grounds. How should midwives explain the lack or uncertainty of the evidence?

• What training and support do midwives need to ensure that they are using up-to-date and personalised evidence when discussing care options and have the confidence to explain when guidelines are not evidence-based?

• What impact does being labelled ‘high risk’ have on outcomes and emotional wellbeing?

• Women who want to continue their pregnancies beyond 42 weeks are frequently pressured into giving birth in hospital and having continuous fetal heart rate monitoring. There is a lack of evidence about the absolute risks of continuing pregnancy beyond 42 weeks or the benefits of fetal monitoring for this reason alone.

• There is often pressure for the placenta to be birthed within one hour. What are the risks and benefits of waiting longer?

• Guidelines for diagnosing Gestational Diabetes vary from place to place. At what level does raised blood sugar really become a problem and how great are the risks with different blood sugar levels at different gestational ages? What impact do lifestyle changes/diet control have on the risks? How do women feel about a diagnosis of GD? How does a diagnosis affect their experience of care and their outcomes?

• How far are local guidelines evidence-based versus responding to legal action or existing ‘standard practice?’

• Does the presence of a doula or other birth supporter improve birth outcomes, considering both the physical and emotional wellbeing of mother and baby? What about the impact of the presence or absence of a partner?

• There is much anecdotal evidence about things that support the physiological process of labour and promote progress, especially in the first stage, such as a calm atmosphere, dim lights, upright positions and relaxation techniques. What factors are most effective to support a physiological labour and birth?

• What initial training and continuing professional development do midwives need to enable them to support a physiological approach to pregnancy, birth and the postnatal period in all circumstances?

• What are the most effective ways of reducing the chances of a pre-term birth?

• A number of care bundles such as OASI and Saving babies Lives have been introduced but there seems to be a lack of evidence for which elements of these are actually of benefit and how great the benefit (if any) is. It would be very helpful to get evidence for which elements really contribute significantly to improving outcomes.

• What evidence and information on options do midwives need in order to counsel women about planning for a caesarean birth ‘their way’ e.g. management of cord-clamping, early skin-to-skin, microbiome seeding?

• What is the best model of Continuity of Carer from the point of view of meeting the needs of both midwives and mothers in a way that is sustainable? A comparison of the positives and negatives of different approaches that have been tried would be helpful in planning future implementation.