Baldwin, S, Malone, M, Sandall, J & Bick, D 2019, 'A qualitative exploratory study of UK first-time fathers' experiences, mental health and wellbeing needs during their transition to fatherhood.', BMJ open, vol. 9, no. 9.View/Download from: UTS OPUS or Publisher's site
OBJECTIVES:To develop an understanding of men's experiences of first-time fatherhood, their mental health and wellbeing needs. DESIGN:A qualitative study using semi-structured interviews. Data were analysed using framework analysis. SETTING:Two large National Health Service integrated care trusts covering four London (UK) local authority boroughs. PARTICIPANTS:First-time fathers with children under 12 months of age were included. Maximum variation sampling was used, with 21 fathers recruited. Ten of these men described their ethnic background as Indian, seven as White British, one as Spanish, one as Black African, one as Black Caribbean and one as Pakistani. Participants' ages ranged from 20 to over 60 years; completion of full-time education ranged from high school certificate to doctorate level; and annual income ranged from £15 000 to over £61 000. Non-English speaking fathers, those experiencing bereavement following neonatal death, stillbirth, pregnancy loss, sudden infant death, and fathers with existing severe mental illnesses were excluded. RESULTS:Nine major categories were identified: 'preparation for fatherhood', 'rollercoaster of feelings', 'new identity', 'challenges and impact', 'changed relationship: we're in a different place', 'coping and support', 'health professionals and services: experience, provision and support', 'barriers to accessing support', and 'men's perceived needs: what fathers want'. Resident (residing with their partner and baby) and non-resident fathers in this study highlighted broadly similar needs, as did fathers for whom English was their first language and those for whom it was not. A key finding of this study relates to men's own perceived needs and how they would like to be supported during the perinatal period, contributing to the current evidence. CONCLUSIONS:This study provides insight into first-time fathers' experiences during their transition to fatherhood, with important implications for healthcare policy makers, se...
Carter, J, Sandall, J, Shennan, AH & Tribe, RM 2019, 'Mobile phone apps for clinical decision support in pregnancy: a scoping review.', BMC medical informatics and decision making, vol. 19, no. 1.View/Download from: UTS OPUS or Publisher's site
BACKGROUND:The use of digital technology in healthcare has been found to be useful for data collection, provision of health information and communications. Despite increasing use of medical mobile phone applications (apps), by both clinicians and patients, there appears to be a paucity of peer-reviewed publications evaluating their use, particularly in pregnancy. This scoping review explored the use of mobile phone apps for clinical decision support in pregnancy. Specific objectives were to: 1. determine the current landscape of mobile phone app use for clinical decision support in pregnancy; 2. identify perceived benefits and potential hazards of use and 3. identify facilitators and barriers to implementation of these apps into clinical practice. METHODS:Papers eligible for inclusion were primary research or reports on the development and evaluation of apps for use by clinicians for decision support in pregnancy, published in peer-reviewed journals. Research databases included Medline, Embase, PsychoInfo, the Cochrane Database of Systematic Reviews and the online digital health journals JMIR mHealth and uHealth. Charting and thematic analysis was undertaken using NVivo qualitative data management software and the Framework approach. RESULTS:After screening for eligibility, 13 papers were identified, mainly reporting early stage development of the mobile app, and feasibility or acceptability studies designed to inform further development. Thematic analysis revealed four main themes across the included papers: 1. acceptability and satisfaction; 2. ease of use and portability; 3. multi-functionality and 4. the importance of user involvement in development and evaluation. CONCLUSIONS:This review highlights the benefits of mobile apps for clinical decision support in pregnancy and potential barriers to implementation, but reveals a lack of rigorous reporting of evaluation of their use and data security. This situation may change, however, following the issue of FDA a...
Chappell, LC, Green, M, Marlow, N, Sandall, J, Hunter, R, Robson, S, Bowler, U, Chiocchia, V, Hardy, P, Juszczak, E, Linsell, L, Placzek, A, Brocklehurst, P & Shennan, A 2019, 'Planned delivery or expectant management for late preterm pre-eclampsia: study protocol for a randomised controlled trial (PHOENIX trial).', Trials, vol. 20, no. 1.View/Download from: UTS OPUS or Publisher's site
BACKGROUND:Pre-eclampsia is a pregnancy disorder, characterised by hypertension and multisystem complications in the mother. The adverse outcomes of pre-eclampsia include severe hypertension, stroke, renal and hepatic injury, haemorrhage, fetal growth restriction and even death. The optimal time to instigate delivery to prevent morbidity when pre-eclampsia occurs between 34 and 37 weeks' gestation, without increasing problems related to infant immaturity or complications, remains unclear. METHODS/DESIGN:The PHOENIX trial is a non-masked, randomised controlled trial, comparing planned early delivery (with initiation of delivery within 48 h of randomisation) with usual care (expectant management) in women with pre-eclampsia between 34+ 0 and 36+ 6 weeks' gestation. The primary objectives of the trial are to determine if planned delivery reduces adverse maternal outcomes, without increasing the short-term harm to infants (composite of perinatal deaths or neonatal unit admissions up to infant hospital discharge) or impacting long-term infant neurodevelopmental status at 2 years corrected age (Parent Report of Cognitive Abilities-Revised). DISCUSSION:Current practice in the UK at the time of trial commencement for management of pre-eclampsia varies by gestation. Previous trials have shown that in women with pre-eclampsia after 37 weeks of gestion, delivery is initiated, as maternal complications are reduced without increasing fetal risks. Prior to 34 weeks of gestation, usual management aims to prolong pregnancy for fetal benefit, unless severe complications occur, necessitating preterm delivery. This trial aims to address the uncertainty for women where the balance of benefits and risks of delivery compared to expectant management are uncertain. Previous trials in this area have been undertaken, but have not provided a definitive answer, and the research question remains active. The results of this trial are expected to influence clinical practice internationally, th...
Easter, A, Howard, LM & Sandall, J 2019, 'Recognition and response to life-threatening situations among women with perinatal mental illness: a qualitative study.', BMJ open, vol. 9, no. 3.View/Download from: UTS OPUS or Publisher's site
OBJECTIVE:Mental illness has persistently been found to be a leading cause of death during pregnancy and the year after birth (the perinatal period). This study aims to explore barriers to detection, response and escalation of mental health-related life-threatening near miss events among women with perinatal mental illness. DESIGN:Qualitative study. PARTICIPANTS:Healthcare professionals (HCP) working in psychiatry, maternity and primary care (n=15) across community and hospital maternity and perinatal services within the UK. METHODS:In-depth semistructured interviews were conducted with a range of healthcare professionals working with women during the perinatal period. An iterative process of inductive and deductive thematic analysis, informed by systems theories of healthcare and the Three Delays model, was employed to analyse the data. RESULTS:Three overarching themes were identified: recognition of severity, communication of risk and service provision and access to treatment. Differing perspectives of mental illness severity influenced how life-threatening situations among women with perinatal mental illness were described, recognised and communicated between teams. Under-resourced mental health service provision, particularly within emergency and specialist perinatal mental health services, unclear thresholds for escalating care and poor infrastructure for sharing information all contributed to delays in a timely response to crisis situations. Reluctance to prescribe medication or admit women to psychiatric hospital, stigma and missed appointments created further delays. CONCLUSIONS:Response and escalation of care for life threatening near miss events among women with mental illness is strongly influenced by professional culture and understandings of mental illness embedded within different healthcare disciplines. Focusing on how differences in organisational and professional culture contribute to the recognition of severe mental illness and interdisciplinary...
Fernandez Turienzo, C, Bick, D, Bollard, M, Brigante, L, Briley, A, Coxon, K, Cross, P, Healey, A, Mehta, M, Melaugh, A, Moulla, J, Seed, PT, Shennan, AH, Singh, C, Tribe, RM & Sandall, J 2019, 'POPPIE: protocol for a randomised controlled pilot trial of continuity of midwifery care for women at increased risk of preterm birth.', Trials, vol. 20, no. 1.View/Download from: UTS OPUS or Publisher's site
BACKGROUND:High rates of preterm births remain a UK public health concern. Preterm birth is a major determinant of adverse infant and longer-term outcomes, including survival, quality of life, psychosocial effects on the family and health care costs. We aim to test whether a model of care combining continuity of midwife care with rapid referral to a specialist obstetric clinic throughout pregnancy, intrapartum and the postpartum period is feasible and improves experience and outcomes for women at increased risk of preterm birth. METHODS:This pilot, hybrid, type 2 randomised controlled implementation trial will recruit 350 pregnant women at increased risk of preterm birth to a midwifery continuity of care intervention or standard care. The intervention will be provided from recruitment (antenatal), labour, birth and the postnatal period, in hospital and community settings and in collaboration with specialist obstetric clinic care, when required. Standard care will be the current maternity care provision by NHS midwives and obstetricians at the study site. Participants will be followed up until 6-8 weeks postpartum. The composite primary outcome is the appropriate initiation of any specified interventions related to the prevention and/or management of preterm labour and birth. Secondary outcomes are related to: recruitment and attrition rates; implementation; acceptability to women, health care professionals and stakeholders; health in pregnancy and other complications; intrapartum outcomes; maternal and neonatal postnatal outcomes; psycho-social health; quality of care; women's experiences and health economic analysis. The trial has 80% power to detect a 15% increase in the rate of appropriate interventions (40 to 55%). The analysis will be by 'intention to treat' analysis. DISCUSSION:Little is known about the underlying reasons why and how models of midwifery continuity of care are associated with fewer preterm births, better maternal and infant outcomes and more...
Rayment, J, Rance, S, McCourt, C & Sandall Cbe Rm, J 2019, 'Barriers to women's access to alongside midwifery units in England.', Midwifery, vol. 77, pp. 78-85.View/Download from: UTS OPUS or Publisher's site
BACKGROUND:Alongside midwifery units (AMUs) are managed by midwives and proximate to obstetric units (OUs), offering a home-like birth environment for women with straightforward pregnancies. They support physiological birth, with fast access to medical care if needed. AMUs have good perinatal outcomes and lower rates of interventions than OUs. In England, uptake remains lower than potential use, despite recent changes in policy to support their use. This article reports on experiences of access from a broader study that investigated AMU organisation and care. METHODS:Organisational case studies in four National Health Service (NHS) Trusts in England, selected for variation geographically and in features of their midwifery units. Fieldwork (December 2011 to October 2012) included observations (>100 h); semi-structured interviews with staff, managers and stakeholders (n = 89) and with postnatal women and partners (n = 47), on which this paper reports. Data were analysed thematically using NVivo10 software. RESULTS:Women, partners and families felt welcome and valued in the AMU. They were drawn to the AMUs' environment, philosophy and approach to technology, including pain management. Access for some was hindered by inconsistent information about the existence, environment and safety of AMUs, and barriers to admission in early labour. CONCLUSIONS:Key barriers to AMUs arise through inequitable information and challenges with admission in early labour. Most women still give birth in obstetric units and despite increases in the numbers of women birthing on AMUs since 2010, addressing these barriers will be essential to future scale-up.
Rayment-Jones, H, Harris, J, Harden, A, Khan, Z & Sandall, J 2019, 'How do women with social risk factors experience United Kingdom maternity care? A realist synthesis.', Birth (Berkeley, Calif.), vol. 46, no. 3, pp. 461-474.View/Download from: UTS OPUS or Publisher's site
BACKGROUND:Echoing international trends, the most recent United Kingdom reports of infant and maternal mortality found that pregnancies to women with social risk factors are over 50% more likely to end in stillbirth or neonatal death and carry an increased risk of premature birth and maternal death. The aim of this realist synthesis was to uncover the mechanisms that affect women's experiences of maternity care. METHODS:Using realist methodology, 22 papers exploring how women with a wide range of social risk factors experience maternity care in the United Kingdom were included. The data extraction process identified contexts (C), mechanisms (M), and outcomes (0). RESULTS:Three themes, Resources, Relationships, and Candidacy, overarched eight CMO configurations. Access to services, appropriate education, interpreters, practical support, and continuity of care were particularly relevant for women who are unfamiliar with the United Kingdom system and those living chaotic lives. For women with experience of trauma, or those who lack a sense of control, a trusting relationship with a health care professional was key to regaining trust. Many women who have social care involvement during their pregnancy perceive health care services as a system of surveillance rather than support, impacting on their engagement. This, as well as experiences of paternalistic care and discrimination, could be mitigated through the ability to develop trusting relationships. CONCLUSIONS:The findings provide underlying theory and practical guidance on how to develop safe services that aim to reduce inequalities in women's experiences and birth outcomes.
Robbins, T, Shennan, A & Sandall, J 2019, 'Modified early obstetric warning scores: A promising tool but more evidence and standardization is required.', Acta obstetricia et gynecologica Scandinavica, vol. 98, no. 1, pp. 7-10.View/Download from: UTS OPUS or Publisher's site
Early warning systems involve the routine monitoring and recording of vital signs or clinical observations on specifically designed charts with linked escalation protocols. Meeting criteria for abnormal physiological parameters triggers a color-coded or weighted scoring system aimed to guide the frequency of monitoring, need for, and urgency of clinical review. Color-coded systems trigger a clinical response when one or more abnormal observation is recorded in the red zone or two or more mildly abnormal parameters in the amber zone. The principle of maternity-specific early warning systems to structure surveillance for hospitalized women is intuitive. The widespread use and policy support, including recommendations following confidential enquiries and from the National Health Service Litigation Authority, is not, however, currently backed up by a strong evidence base. Research is required to develop predictive models and validate evidence-based maternity-specific early warning systems in the general maternity population.
Sadler, E, Potterton, V, Anderson, R, Khadjesari, Z, Sheehan, K, Butt, F, Sevdalis, N & Sandall, J 2019, 'Service user, carer and provider perspectives on integrated care for older people with frailty, and factors perceived to facilitate and hinder implementation: A systematic review and narrative synthesis.', PloS one, vol. 14, no. 5.View/Download from: UTS OPUS or Publisher's site
INTRODUCTION:Older people with frailty (OPF) can experience reduced quality of care and adverse outcomes due to poorly coordinated and fragmented care, making this patient population a key target group for integrated care. This systematic review explores service user, carer and provider perspectives on integrated care for OPF, and factors perceived to facilitate and hinder implementation, to draw out implications for policy, practice and research. METHODS:Systematic review and narrative synthesis of qualitative studies identified from MEDLINE, CINAHL, PsycINFO and Social Sciences Citation Index, hand-searching of reference lists and citation tracking of included studies, and review of experts' online profiles. Quality of included studies was appraised with The Critical Appraisal Skills Programme tool for qualitative research. RESULTS:Eighteen studies were included in the synthesis. We identified four themes related to stakeholder perspectives on integrated care for OPF: different preferences for integrated care among service users, system and service organisation components, relational aspects of care and support, and stakeholder perceptions of outcomes. Service users and carers highlighted continuity of care with a professional they could trust, whereas providers emphasised improved coordination of care between providers in different care sectors as key strategies for integrated care. We identified three themes related to factors facilitating and hindering implementation: perceptions of the integrated care intervention and target population, service organisational factors and system level factors influencing implementation. Different stakeholder groups perceived the complexity of care needs of this patient population, difficulties with system navigation and access, and limited service user and carer involvement in care decisions as key factors hindering implementation. Providers mainly also highlighted other organisational and system factors perceived to facilit...
Smith, V, Kenny, LC, Sandall, J & Devane, D 2019, 'Physiological track-and-trigger/early warning systems for use in maternity care', Cochrane Database of Systematic Reviews, vol. 2019, no. 6.View/Download from: UTS OPUS or Publisher's site
© 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To evaluate the clinical and cost effectiveness of maternal physiological track-and-trigger systems/early warning systems on pregnancy, labour and birth, postpartum (up to 42 days) and neonatal outcomes.
Vieira, MC, Relph, S, Copas, A, Healey, A, Coxon, K, Alagna, A, Briley, A, Johnson, M, Lawlor, DA, Lees, C, Marlow, N, McCowan, L, Page, L, Peebles, D, Shennan, A, Thilaganathan, B, Khalil, A, Sandall, J, Pasupathy, D & DESiGN Collaborative Group 2019, 'The DESiGN trial (DEtection of Small for Gestational age Neonate), evaluating the effect of the Growth Assessment Protocol (GAP): study protocol for a randomised controlled trial.', Trials, vol. 20, no. 1.View/Download from: UTS OPUS or Publisher's site
BACKGROUND:Stillbirth rates in the United Kingdom (UK) are amongst the highest of all developed nations. The association between small-for-gestational-age (SGA) foetuses and stillbirth is well established, and observational studies suggest that improved antenatal detection of SGA babies may halve the stillbirth rate. The Growth Assessment Protocol (GAP) describes a complex intervention that includes risk assessment for SGA and screening using customised fundal-height growth charts. Increased detection of SGA from the use of GAP has been implicated in the reduction of stillbirth rates by 22%, in observational studies of UK regions where GAP uptake was high. This study will be the first randomised controlled trial examining the clinical efficacy, health economics and implementation of the GAP programme in the antenatal detection of SGA. METHODS/DESIGN:In this randomised controlled trial, clusters comprising a maternity unit (or National Health Service Trust) were randomised to either implementation of the GAP programme, or standard care. The primary outcome is the rate of antenatal ultrasound detection of SGA in infants found to be SGA at birth by both population and customised standards, as this is recognised as being the group with highest risk for perinatal morbidity and mortality. Secondary outcomes include antenatal detection of SGA by population centiles, antenatal detection of SGA by customised centiles, short-term maternal and neonatal outcomes, resource use and economic consequences, and a process evaluation of GAP implementation. Qualitative interviews will be performed to assess facilitators and barriers to implementation of GAP. DISCUSSION:This study will be the first to provide data and outcomes from a randomised controlled trial investigating the potential difference between the GAP programme compared to standard care for antenatal ultrasound detection of SGA infants. Accurate information on the performance and service provision requirements of the GA...
Vousden, N, Lawley, E, Nathan, HL, Seed, PT, Gidiri, MF, Goudar, S, Sandall, J, Chappell, LC, Shennan, AH & CRADLE Trial Collaborative Group 2019, 'Effect of a novel vital sign device on maternal mortality and morbidity in low-resource settings: a pragmatic, stepped-wedge, cluster-randomised controlled trial.', The Lancet. Global health, vol. 7, no. 3, pp. e347-e356.View/Download from: UTS OPUS or Publisher's site
BACKGROUND:In 2015, an estimated 303 000 women died in pregnancy and childbirth. Obstetric haemorrhage, sepsis, and hypertensive disorders of pregnancy account for more than 50% of maternal deaths worldwide. There are effective treatments for these pregnancy complications, but they require early detection by measurement of vital signs and timely administration to save lives. The primary aim of this trial was to determine whether implementation of the CRADLE Vital Sign Alert and an education package into community and facility maternity care in low-resource settings could reduce a composite of all-cause maternal mortality or major morbidity (eclampsia and hysterectomy). METHODS:We did a pragmatic, stepped-wedge, cluster-randomised controlled trial in ten clusters across Africa, India, and Haiti, introducing the device into routine maternity care. Each cluster contained at least one secondary or tertiary hospital and their main referral facilities. Clusters crossed over from existing routine care to the CRADLE intervention in one of nine steps at 2-monthly intervals, with CRADLE devices replacing existing equipment at the randomly allocated timepoint. A computer-generated randomly allocated sequence determined the order in which the clusters received the intervention. Because of the nature of the intervention, this trial was not masked. Data were gathered monthly, with 20 time periods of 1 month. The primary composite outcome was at least one of eclampsia, emergency hysterectomy, and maternal death. This study is registered with the ISRCTN registry, number ISRCTN41244132. FINDINGS:Between April 1, 2016, and Nov 30, 2017, among 536 223 deliveries, the primary outcome occurred in 4067 women, with 998 maternal deaths, 2692 eclampsia cases, and 681 hysterectomies. There was an 8% decrease in the primary outcome from 79·4 per 10 000 deliveries pre-intervention to 72·8 per 10 000 deliveries post-intervention (odds ratio [OR] 0·92, 95% CI 0·86-0·97; p=0·0056). After plann...
Vousden, N, Lawley, E, Seed, PT, Gidiri, MF, Charantimath, U, Makonyola, G, Brown, A, Yadeta, L, Best, R, Chinkoyo, S, Vwalika, B, Nakimuli, A, Ditai, J, Greene, G, Chappell, LC, Sandall, J, Shennan, AH & CRADLE Trial Collaborative Group 2019, 'Exploring the effect of implementation and context on a stepped-wedge randomised controlled trial of a vital sign triage device in routine maternity care in low-resource settings.', Implementation science : IS, vol. 14, no. 1.View/Download from: UTS OPUS or Publisher's site
BACKGROUND:Interventions aimed at reducing maternal mortality are increasingly complex. Understanding how complex interventions are delivered, to whom, and how they work is key in ensuring their rapid scale-up. We delivered a vital signs triage intervention into routine maternity care in eight low- and middle-income countries with the aim of reducing a composite outcome of morbidity and mortality. This was a pragmatic, hybrid effectiveness-implementation stepped-wedge randomised controlled trial. In this study, we present the results of the mixed-methods process evaluation. The aim was to describe implementation and local context and integrate results to determine whether differences in the effect of the intervention across sites could be explained. METHODS:The duration and content of implementation, uptake of the intervention and its impact on clinical management were recorded. These were integrated with interviews (n = 36) and focus groups (n = 19) at 3 months and 6-9 months after implementation. In order to determine the effect of implementation on effectiveness, measures were ranked and averaged across implementation domains to create a composite implementation strength score and then correlated with the primary outcome. RESULTS:Overall, 61.1% (n = 2747) of health care providers were trained in the intervention (range 16.5% to 89.2%) over a mean of 10.8 days. Uptake and acceptability of the intervention was good. All clusters demonstrated improved availability of vital signs equipment. There was an increase in the proportion of women having their blood pressure measured in pregnancy following the intervention (79.2% vs. 97.6%; OR 1.30 (1.29-1.31)) and no significant change in referral rates (3.7% vs. 4.4% OR 0.89; (0.39-2.05)). Availability of resources and acceptable, effective referral systems influenced health care provider interaction with the intervention. There was no correlation between process measures within or between domains, or between the composi...
Vousden, N, Lawley, E, Seed, PT, Gidiri, MF, Goudar, S, Sandall, J, Chappell, LC, Shennan, AH & CRADLE Trial Collaborative Group 2019, 'Incidence of eclampsia and related complications across 10 low- and middle-resource geographical regions: Secondary analysis of a cluster randomised controlled trial.', PLoS medicine, vol. 16, no. 3.View/Download from: UTS OPUS or Publisher's site
BACKGROUND:In 2015, approximately 42,000 women died as a result of hypertensive disorders of pregnancy worldwide; over 99% of these deaths occurred in low- and middle-income countries. The aim of this paper is to describe the incidence and characteristics of eclampsia and related complications from hypertensive disorders of pregnancy across 10 low- and middle-income geographical regions in 8 countries, in relation to magnesium sulfate availability. METHODS AND FINDINGS:This is a secondary analysis of a stepped-wedge cluster randomised controlled trial undertaken in sub-Saharan Africa, India, and Haiti. This trial implemented a novel vital sign device and training package in routine maternity care with the aim of reducing a composite outcome of maternal mortality and morbidity. Institutional-level consent was obtained, and all women presenting for maternity care were eligible for inclusion. Data on eclampsia, stroke, admission to intensive care with a hypertensive disorder of pregnancy, and maternal death from a hypertensive disorder of pregnancy were prospectively collected from routine data sources and active case finding, together with data on perinatal outcomes in women with these outcomes. In 536,233 deliveries between 1 April 2016 and 30 November 2017, there were 2,692 women with eclampsia (0.5%). In total 6.9% (n = 186; 3.47/10,000 deliveries) of women with eclampsia died, and a further 51 died from other complications of hypertensive disorders of pregnancy (0.95/10,000). After planned adjustments, the implementation of the CRADLE intervention was not associated with any significant change in the rates of eclampsia, stroke, or maternal death or intensive care admission with a hypertensive disorder of pregnancy. Nearly 1 in 5 (17.9%) women with eclampsia, stroke, or a hypertensive disorder of pregnancy causing intensive care admission or maternal death experienced a stillbirth or neonatal death. A third of eclampsia cases (33.2%; n = 894) occurred in women u...
Ziemann, A, Brown, L, Sadler, E, Ocloo, J, Boaz, A & Sandall, J 2019, 'Influence of external contextual factors on the implementation of health and social care interventions into practice within or across countries-a protocol for a 'best fit' framework synthesis.', Systematic reviews, vol. 8, no. 1, pp. 258-258.View/Download from: UTS OPUS or Publisher's site
BACKGROUND:The widespread implementation of interventions is often hindered by a decline and variability in effectiveness across implementation sites. It is anticipated that variations in the characteristics of the external context in different sites, such as the political and funding environment, socio-cultural context, physical environment or population demographics can influence implementation outcome. However, there is only a limited understanding about which and how external contextual factors influence implementation. We aim to develop a comprehensive framework conceptualising the influence of external contextual factors on implementation, particularly when spreading health and social care interventions within or across countries. METHODS:The review will use the 'best fit' framework synthesis approach. In the first stage of the review, we will examine existing frameworks, models, concepts and theories on external contextual factors and their influence on implementation from a variety of sectors and disciplines including health and social care, education, environmental studies and international development fields. The resulting a priori meta-framework will be tested and refined in the second review stage by analysing evidence from empirical studies focusing on the implementation of health and social care interventions within or across countries. Searches will be conducted in bibliographic databases such as MEDLINE, ERIC, HMIC and IBSS, grey literature sources and on relevant websites. We will also search reference lists, relevant journals, perform citation searches and ask experts in the field. There is no restriction to study type, setting, intervention type or implementation strategy to enable obtaining a broad and in-depth knowledge from various sources of evidence. DISCUSSION:The review will lead to a comprehensive framework for understanding the influence of external contextual factors on implementation, particularly when spreading health and social car...
Turienzo, CF, Roe, Y, Rayment-Jones, H, Kennedy, A, Forster, D, Homer, CSE, McLachlan, H & Sandall, J 2019, 'Implementation of midwifery continuity of care models for Indigenous women in Australia: Perspectives and reflections for the United Kingdom', MIDWIFERY, vol. 69, pp. 110-112.View/Download from: UTS OPUS or Publisher's site
Baldwin, S, Malone, M, Sandall, J & Bick, D 2018, 'Mental health and wellbeing during the transition to fatherhood: a systematic review of first time fathers' experiences.', JBI database of systematic reviews and implementation reports, vol. 16, no. 11, pp. 2118-2191.View/Download from: UTS OPUS or Publisher's site
OBJECTIVE:The aim of this systematic review was to identify and synthesize the best available evidence on first time fathers' experiences and needs in relation to their mental health and wellbeing during their transition to fatherhood. INTRODUCTION:Men's mental health and wellbeing during their transition to fatherhood is an important public health issue that is currently under-researched from a qualitative perspective and poorly understood. INCLUSION CRITERIA:Resident first time fathers (biological and non-biological) of healthy babies born with no identified terminal or long-term conditions were included. The phenomena of interest were their experiences and needs in relation to mental health and wellbeing during their transition to fatherhood, from commencement of pregnancy until one year after birth. Studies based on qualitative data, including, but not limited to, designs within phenomenology, grounded theory, ethnography and action research were included. METHODS:A three-step search strategy was used. The search strategy explored published and unpublished qualitative studies from 1960 to September 2017. All included studies were assessed by two independent reviewers and any disagreements were resolved by consensus or with a third reviewer. The recommended Joanna Briggs Institute (JBI) approach to critical appraisal, study selection, data extraction and data synthesis was used. RESULTS:Twenty-two studies met the eligibility criteria and were included in the review, which were then assessed to be of moderate to high quality (scores 5-10) based on the JBI Critical Appraisal Checklist for Qualitative Research. The studies were published between 1990 and 2017, and all used qualitative methodologies to accomplish the overall aim of investigating the experiences of expectant or new fathers. Nine studies were from the UK, three from Sweden, three from Australia, two from Canada, two from the USA, one from Japan, one from Taiwan and one from Singapore. The total numb...
Beake Rm Ma Research Associate, S, Chang Ba MPhil PhD Lecturer, Y-S, Cheyne Rm Rgn MSc PhD Professor Of Midwifery, H, Spiby MPhil Rn Rm Professor Of Midwifery, H, Sandall Rm MSc PhD Professor Of Social Science And Women's Health, J & Bick, D 2018, 'Experiences of early labour management from perspectives of women, labour companions and health professionals: A systematic review of qualitative evidence.', Midwifery, vol. 57, pp. 69-84.View/Download from: UTS OPUS or Publisher's site
to examine evidence of women's, labour companions' and health professionals' experiences of management of early labour to consider how this could be enhanced to better reflect women's needs.a systematic review of qualitative evidence.women in early labour with term, low risk singleton pregnancies, not booked for a planned caesarean birth or post-dates induction of labour, their labour companions, and health professionals responsible for early labour care (e.g. midwives, nurse-midwives, obstetricians, family doctors). Studies from high and middle income country settings were considered.21 publications were included from the UK, Ireland, Scandinavia, USA, Italy and New Zealand. Key findings included the impact of communication with health professionals (most usually midwives) on women's decision making; women wanting to be listened to by sympathetic midwives who could reassure that symptoms and signs of early labour were 'normal' and offer clear advice on what to do. Antenatal preparation which included realistic information on what to expect when labour commenced was important and appreciated by women and labour companions. Views of the optimal place for women to remain and allow early labour to progress differed and the perceived benefit of support and help offered by labour companions varied. Some were supportive and helped women to relax, while others were anxious and encouraged women to seek early admission to the planned place of birth. Web-based sources of information are increasingly used by women, with mixed views of the value of information accessed.women, labour companions and health professionals find early labour difficult to manage well, with women unsure of how decisions about admission to their planned place of birth are taken. It is unclear why women are effectively left to manage this aspect of their labour with minimal guidance or support. Tailoring management to meet individual needs, with provision of effective communication could reassure wome...
Carter, J, Tribe, RM, Sandall, J, Shennan, AH & UK Preterm Clinical Network 2018, 'The Preterm Clinical Network (PCN) Database: a web-based systematic method of collecting data on the care of women at risk of preterm birth.', BMC pregnancy and childbirth, vol. 18, no. 1, pp. 335-335.View/Download from: UTS OPUS or Publisher's site
BACKGROUND:Despite much research effort, there is a paucity of conclusive evidence in the field of preterm birth prediction and prevention. The methods of monitoring and prevention strategies offered to women at risk vary considerably around the UK and depend on local maternity care provision. It is becoming increasingly recognised that this experience and knowledge, if captured on a larger scale, could be a utilized as a valuable source of evidence for others. The UK Preterm Clinical Network (UKPCN) was established with the aim of improving care and outcomes for women at risk of preterm birth through the sharing of a wealth of experience and knowledge, as well as the building of clinical and research collaboration. The design and development of a bespoke internet-based database was fundamental to achieving this aim. METHOD:Following consultation with UKPCN members and agreement on a minimal dataset, the Preterm Clinical Network (PCN) Database was constructed to collect data from women at risk of preterm birth and their children. Information Governance and research ethics committee approval was given for the storage of historical as well as prospectively collected data. Collaborating centres have instant access to their own records, while use of pooled data is governed by the PCN Database Access Committee. Applications are welcomed from UKPCN members and other established research groups. The results of investigations using the data are expected to provide insights into the effectiveness of current surveillance practices and preterm birth interventions on a national and international scale, as well as the generation of ideas for innovation and research. To date, 31 sites are registered as Data Collection Centres, four of which are outside the UK. CONCLUSION:This paper outlines the aims of the PCN Database along with the development process undertaken from the initial idea to live launch.
Carter, J, Tribe, RM, Shennan, AH & Sandall, J 2018, 'Threatened preterm labour: Women's experiences of risk and care management: A qualitative study.', Midwifery, vol. 64, pp. 85-92.View/Download from: UTS OPUS or Publisher's site
BACKGROUND:Preterm birth is a major cause of neonatal death and severe morbidity, so pregnant women experiencing symptoms of threatened preterm labour may be very anxious. The risk assessment and management that follows recognition of threatened preterm labour has the potential to either increase or decrease this anxiety. The aim of this study was to explore women's experience of threatened preterm labour, risk assessment and management in order to identify potential improvements in practice. DESIGN:One-to-one semi-structured interviews with 19 women who experienced assessment for threatened preterm labour took place between March 2015 and January 2017. A purposive sample approach was employed to ensure participants from different risk and demographic backgrounds were recruited at an inner city UK NHS hospital. Interviews were recorded and transcribed. Data was managed with NVivo software and analysed using the Framework Approach. A public and patient involvement panel contributed to the design, analysis and interpretation of the findings. FINDINGS:Data saturation was achieved after 19 interviews. 11 women were low risk and 8 were high risk for preterm birth. All high risk women had experience of being supported by a specialist preterm team. Four main themes emerged: (i) coping with uncertainty; (ii) dealing with conflicts; (iii) aspects of care and (iv) interactions with professionals. Both low and high risk women experiencing TPTL struggle to cope with the uncertainty of this unpredictable state. The healthcare management they receive can both help and hinder their ability to cope with this extremely stressful experience. High risk women were less likely to receive conflicting advice. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE:Clinicians should acknowledge uncertainty, minimize conflicting information and advice, and promote continuity of care models for all women, including those attending high risk clinics and in the ward environment.
Easter, A, Howard, LM & Sandall, J 2018, 'Mental health near miss indicators in maternity care: a missed opportunity? A commentary', BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, vol. 125, no. 6, pp. 649-651.View/Download from: Publisher's site
Flynn, AC, Begum, S, White, SL, Dalrymple, K, Gill, C, Alwan, NA, Kiely, M, Latunde-Dada, G, Bell, R, Briley, AL, Nelson, SM, Oteng-Ntim, E, Sandall, J, Sanders, TA, Whitworth, M, Murray, DM, Kenny, LC, Poston, L & SCOPE and UBPEAT Consortiums 2018, 'Relationships between Maternal Obesity and Maternal and Neonatal Iron Status.', Nutrients, vol. 10, no. 8.View/Download from: UTS OPUS or Publisher's site
: Obesity in pregnancy may negatively influence maternal and infant iron status. The aim of this study was to examine the association of obesity with inflammatory and iron status in both mother and infant in two prospective studies in pregnancy: UPBEAT and SCOPE. Maternal blood samples from obese (n = 245, BMI ≥ 30 kg/m²) and normal weight (n = 245, BMI < 25 kg/m²) age matched pregnant women collected at approximately 15 weeks' gestation, and umbilical cord blood samples collected at delivery, were analysed for a range of inflammatory and iron status biomarkers. Concentrations of C- reactive protein and Interleukin-6 in obese women compared to normal weight women were indicative of an inflammatory response. Soluble transferrin receptor (sTfR) concentration [18.37 nmol/L (SD 5.65) vs 13.15 nmol/L (SD 2.33)] and the ratio of sTfR and serum ferritin [1.03 (SD 0.56) vs 0.69 (SD 0.23)] were significantly higher in obese women compared to normal weight women (P < 0.001). Women from ethnic minority groups (n = 64) had higher sTfR concentration compared with white women. There was no difference in maternal hepcidin between obese and normal weight women. Iron status determined by cord ferritin was not statistically different in neonates born to obese women compared with neonates born to normal weight women when adjusted for potential confounding variables. Obesity is negatively associated with markers of maternal iron status, with ethnic minority women having poorer iron statuses than white women.
Mackintosh, N, Sandall, J, Collison, C, Carter, W & Harris, J 2018, 'Employing the arts for knowledge production and translation: Visualizing new possibilities for women speaking up about safety concerns in maternity.', Health expectations : an international journal of public participation in health care and health policy, vol. 21, no. 3, pp. 647-658.View/Download from: UTS OPUS or Publisher's site
OBJECTIVES:This project used animated film to translate research findings into accessible health information aimed at enabling women to speak up and secure professional help for serious safety concerns during pregnancy and after birth. We tested as proof of concept our use of the arts both as product (knowledge production) and process (enabling involvement). BACKGROUND:Emergencies during pregnancy and birth, while unusual, can develop rapidly and unexpectedly, with catastrophic consequences. Women's tacit knowledge of changes in their condition is an important resource to aid early detection, but women can worry about the legitimacy of their concerns and struggle to get these taken seriously by staff. DESIGN:Arts-based knowledge translation. A user group of women who had experienced complications in the perinatal period (n = 34) helped us develop and pilot test the animation. Obstetricians and midwives (15), clinical leads (3) and user group representatives (8) helped with the design and testing. FINDINGS:The consultation process, script and storyboard enabled active interaction with the evidence, meaningful engagement with stakeholders and new understandings about securing help for perinatal complications. The method enabled us to address gender stereotypes and social norms about speaking up and embed a social script for women within the animation, to help structure their help seeking. While for some women, there was an emotional burden, the majority were glad to have been part of the animation's development and felt it had enabled their voices to be heard. CONCLUSION:This project has demonstrated the benefits of arts-science collaborations for meaningful co-production and effective translation of research evidence.
McCourt, C, Rance, S, Rayment, J & Sandall, J 2018, 'Organising safe and sustainable care in alongside midwifery units: Findings from an organisational ethnographic study.', Midwifery, vol. 65, pp. 26-34.View/Download from: UTS OPUS or Publisher's site
AIMS AND BACKGROUND:Alongside midwifery units (AMUs, also known as hospital or co-located birth centres) were identified as a novel hybrid organisational form in the Birthplace in England Research Programme. This follow-on study aimed to investigate how AMUs are organised, staffed and managed, the experiences of women, and maternity staff including those who work in AMUs and in adjacent obstetric units. This article focuses on study findings relating to the organisation and management of AMUs. METHODS:An organisational ethnography approach was used, incorporating case studies of four AMUs, selected for maximum variation on the basis of geographical context, length of establishment, size of unit, leadership and physical design. Interviews were conducted between December 2011 and October 2012 with service managers and key stakeholders (n = 35), with professionals working within and in relation to AMUs (n = 54) and with postnatal women and birth partners (n = 47). Observations were conducted of key decision-making points in the service (n = 20). FINDINGS:Managers saw four key areas as vital to developing and sustaining good quality midwifery unit care: finance and service management support, staffing, training, and appropriate guidelines. Development of AMUs was often opportunistic, with service leaders making use of service reconfigurations to achieve change, including development of MUs and new care pathways. Midwives working in AMUs valued the environment, approach and the opportunity to exercise greater clinical judgement but relations between groups of midwives in different units could be experienced as problematic. Key potential challenges for the quality, safety and sustainability of AMU care included: boundary work and management; professional issues; developing appropriate staffing models and relationships; midwives' skills and confidence; and information and access for women. Responses to such challenges included greater focus on interdisciplinary skills t...
Nathan, HL, Boene, H, Munguambe, K, Sevene, E, Akeju, D, Adetoro, OO, Charanthimath, U, Bellad, MB, de Greeff, A, Anthony, J, Hall, DR, Steyn, W, Vidler, M, von Dadelszen, P, Chappell, LC, Sandall, J, Shennan, AH & CLIP Working Group 2018, 'The CRADLE vital signs alert: qualitative evaluation of a novel device designed for use in pregnancy by healthcare workers in low-resource settings.', Reproductive health, vol. 15, no. 1, pp. 5-5.View/Download from: UTS OPUS or Publisher's site
Vital signs measurement can identify pregnant and postpartum women who require urgent treatment or referral. In low-resource settings, healthcare workers have limited access to accurate vital signs measuring devices suitable for their environment and training. The CRADLE Vital Signs Alert (VSA) is a novel device measuring blood pressure and pulse that is accurate in pregnancy and designed for low-resource settings. Its traffic light early warning system alerts healthcare workers to the need for escalation of care for women with hypertension, haemorrhage or sepsis. This study evaluated the usability and acceptability of the CRADLE VSA device.Evaluation was conducted in community and primary care settings in India, Mozambique and Nigeria and tertiary hospitals in South Africa. Purposeful sampling was used to convene 155 interviews and six focus groups with healthcare workers using the device (n = 205) and pregnant women and their family members (n = 41). Interviews and focus groups were conducted in the local language and audio-recorded, transcribed and translated into English for analysis. Thematic analysis was undertaken using an a priori thematic framework, as well as an inductive approach.Most healthcare workers perceived the CRADLE device to be easy to use and accurate. The traffic lights early warning system was unanimously reported positively, giving healthcare workers confidence with decision-making and a sense of professionalism. However, a minority in South Africa described manual inflation as tiring, particularly when measuring vital signs in obese and hypertensive women (n = 4) and a few South African healthcare workers distrusted the device's accuracy (n = 7). Unanimously, pregnant women liked the CRADLE device. The traffic light early warning system gave women and their families a better understanding of the importance of vital signs in pregnancy and during the postpartum period.The CRADLE device was well accepted by healthcare workers from a range of...
Nathan, HL, Duhig, K, Vousden, N, Lawley, E, Seed, PT, Sandall, J, Bellad, MB, Brown, AC, Chappell, LC, Goudar, SS, Gidiri, MF, Shennan, AH & CRADLE-3 Trial Collaboration Group 2018, 'Evaluation of a novel device for the management of high blood pressure and shock in pregnancy in low-resource settings: study protocol for a stepped-wedge cluster-randomised controlled trial (CRADLE-3 trial).', Trials, vol. 19, no. 1.View/Download from: UTS OPUS or Publisher's site
BACKGROUND:Obstetric haemorrhage, sepsis and pregnancy hypertension account for more than 50% of maternal deaths worldwide. Early detection and effective management of these conditions relies on vital signs. The Microlife® CRADLE Vital Sign Alert (VSA) is an easy-to-use, accurate device that measures blood pressure and pulse. It incorporates a traffic-light early warning system that alerts all levels of healthcare provider to the need for escalation of care in women with obstetric haemorrhage, sepsis or pregnancy hypertension, thereby aiding early recognition of haemodynamic instability and preventing maternal mortality and morbidity. The aim of the trial was to determine whether implementation of the CRADLE intervention (the Microlife® CRADLE VSA device and CRADLE training package) into routine maternity care in place of existing equipment will reduce a composite outcome of maternal mortality and morbidity in low- and middle-income country populations. METHODS:The CRADLE-3 trial was a stepped-wedge cluster-randomised controlled trial of the CRADLE intervention compared to routine maternity care. Each cluster crossed from routine maternity care to the intervention at 2-monthly intervals over the course of 20 months (April 2016 to November 2017). All women identified as pregnant or within 6 weeks postpartum, presenting for maternity care in cluster catchment areas were eligible to participate. Primary outcome data (composite of maternal death, eclampsia and emergency hysterectomy per 10,000 deliveries) were collected at 10 clusters (Gokak, Belgaum, India; Harare, Zimbabwe; Ndola, Zambia; Lusaka, Zambia; Free Town, Sierra Leone; Mbale, Uganda; Kampala, Uganda; Cap Haitien, Haiti; South West, Malawi; Addis Ababa, Ethiopia). This trial was informed by the Medical Research Council guidance for complex interventions. A process evaluation was undertaken to evaluate implementation in each site and a cost-effectiveness evaluation will be undertaken. DISCUSSION:All aspects...
Nathan, HL, Vousden, N, Lawley, E, de Greeff, A, Hezelgrave, NL, Sloan, N, Tanna, N, Goudar, SS, Gidiri, MF, Sandall, J, Chappell, LC & Shennan, AH 2018, 'Development and evaluation of a novel Vital Signs Alert device for use in pregnancy in low-resource settings.', BMJ innovations, vol. 4, no. 4, pp. 192-198.View/Download from: UTS OPUS or Publisher's site
Objectives:Haemorrhage, hypertension, sepsis and abortion complications (often from haemorrhage or sepsis) contribute to 60% of all maternal deaths. Each is associated with vital signs (blood pressure (BP) and pulse) abnormalities, and the majority of deaths are preventable through simple and timely intervention. This paper presents the development and evaluation of the CRADLE Vital Signs Alert (VSA), an accurate, low-cost and easy-to-use device measuring BP and pulse with an integrated traffic light early warning system. The VSA was designed to be used by all cadres of healthcare providers for pregnant women in low-resource settings with the aim to prevent avoidable maternal mortality and morbidity. Methods:The development and the mixed-methods clinical evaluation of the VSA are described. Results:Preliminary fieldwork identified that introduction of BP devices to rural clinics improved antenatal surveillance of BP in pregnant women. The aesthetics of the integrated traffic light system were developed through iterative qualitative evaluation. The traffic lights trigger according to evidence-based vital sign thresholds in hypertension and haemodynamic compromise from haemorrhage and sepsis. The VSA can be reliably used as an auscultatory device, as well as its primary semiautomated function, and is suitable as a self-monitor used by pregnant women. Conclusion:The VSA is an accurate device incorporating an evidence-based traffic light early warning system. It is designed to ensure suitability for healthcare providers with limited training and may improve care for women in pregnancy, childbirth and in the postnatal period.
November, L & Sandall, J 2018, ''Just because she's young, it doesn't mean she has to die': exploring the contributing factors to high maternal mortality in adolescents in Eastern Freetown; a qualitative study.', Reproductive health, vol. 15, no. 1.View/Download from: UTS OPUS or Publisher's site
In Sierra Leone, 34% of pregnancies and 40% of maternal deaths are in the adolescent population. Risks are known to be higher for younger adolescents, this being borne out by a household survey in Eastern Freetown in 2015. This current qualitative study, funded by Wellbeing of Women's international midwifery fellowship, was conducted to explore the causes of this high incidence of maternal death for younger teenagers, and to identify possible interventions to improve outcomes.This qualitative study used semi-structured interviews (n = 19) and focus groups (n = 6), with a wide range of professional and lay participants, recorded with consent. Recordings were transcribed by the first author and a Krio-speaking colleague where necessary, and Nvivo software was used to assist with theming of the data around the three main research questions.Themes from discussions on vulnerability to teenage pregnancy focused on transactional sex, especially for girls living outside of their birth family. They included sex for school fees, sex with teachers for grades, sex for food and clothes, and sex to lessen the impact of the time-consuming duties of water collection and petty trading. In addition, the criminal justice system and the availability and accessibility of contraception and abortion were included within this major theme. Within the major theme of vulnerability to death once pregnant, abandonment, delayed care seeking, and being cared for by a non-parental adult were identified. Several obstetric risks were discussed by midwives, but were explicitly related to the socio-economic factors already mentioned. A cross-cutting theme throughout the data was of gendered social norms for sexual behaviour, for both boys and girls, being reinforced by significant adults such as parents and teachers.Findings challenge the notion that adolescent girls have the necessary agency to make straightforward choices about their sexual behaviour and contraceptive use. For girls who do become...
Torres, JA, Leal, MDC, Domingues, RMSM, Esteves-Pereira, AP, Nakano, AR, Gomes, ML, Figueiró, AC, Nakamura-Pereira, M, de Oliveira, EFV, Ayres, BVDS, Sandall, J, Belizán, JM & Hartz, Z 2018, 'Evaluation of a quality improvement intervention for labour and birth care in Brazilian private hospitals: a protocol.', Reproductive health, vol. 15, no. 1.View/Download from: UTS OPUS or Publisher's site
BACKGROUND:In Brazilian private hospitals, caesarean section (CS) is almost universal (88%) and is integrated into the model of birth care. A quality improvement intervention, "Adequate Birth" (PPA), based on four driving components (governance, participation of women and families, reorganisation of care, and monitoring), has been implemented to help 23 hospitals reduce their CS rate. This is a protocol designed to evaluate the implementation of PPA and its effectiveness at reducing CS as a primary outcome of birth care. METHODS:Case study of PPA intervention conducted in 2017/2018. We integrated quantitative and qualitative methods into data collection and analysis. For the quantitative stage, we selected a convenient sample of twelve hospitals. In each of these hospitals, we included 400 women. This resulted in a total sample of 4800 women. We used this sample to detect a 2.5% reduction in CS rate. We interviewed managers and puerperal women, and extracted data from hospital records. In the qualitative stage, we evaluated a subsample of eight hospitals by means of systematic observation and semi-structured interviews with managers, health professionals and women. We used specific forms for each of the four PPA driving components. Forms for managers and professionals addressed the decision-making process, implemented strategies, participatory process in strategy design, and healthcare practice. Forms for women and neonatal care addressed socio-economic, demographic and health condition; prenatal and birth care; tour of the hospital before delivery; labour expectation vs. real experience; and satisfaction with care received. We will estimate the degree of implementation of PPA strategies related to two of the four driving components: "participation of women and families" and "reorganisation of care". We will then assess its effect on CS rate and secondary outcomes for each of the twelve selected hospitals, and for the total sample. To allow for clinical, socio-de...
Tribe, RM, Taylor, PD, Kelly, NM, Rees, D, Sandall, J & Kennedy, HP 2018, 'Parturition and the perinatal period: can mode of delivery impact on the future health of the neonate?', The Journal of physiology, vol. 596, no. 23, pp. 5709-5722.View/Download from: UTS OPUS or Publisher's site
Caesarean section and instrumental delivery rates are increasing in many parts of the world for a range of cultural and medical reasons, with limited consideration as to how 'mode of delivery' may impact on childhood and long-term health. However, babies born particularly by pre-labour caesarean section appear to have a subtly different physiology from those born by normal vaginal delivery, with both acute and chronic complications such as respiratory and cardio-metabolic morbidities being apparent. It has been hypothesized that inherent mechanisms within the process of labour and vaginal delivery, far from being a passive mechanical process by which the fetus and placenta are expelled from the birth canal, may trigger certain protective developmental processes permissive for normal immunological and physiological development of the fetus postnatally. Traditionally the primary candidate mechanism has been the hormonal surges or stress response associated with labour and vaginal delivery, but there is increasing awareness that transfer of the maternal microbiome to the infant during parturition. Transgenerational transmission of disease traits through epigenetics are also likely to be important. Interventions such as probiotics, neonatal gut seeding and different approaches to clinical care have potential to influence parturition physiology and improve outcomes for infants.
Vousden, N, Lawley, E, Nathan, HL, Seed, PT, Brown, A, Muchengwa, T, Charantimath, U, Bellad, M, Gidiri, MF, Goudar, S, Chappell, LC, Sandall, J, Shennan, AH & CRADLE Trial Collaborative Group 2018, 'Evaluation of a novel vital sign device to reduce maternal mortality and morbidity in low-resource settings: a mixed method feasibility study for the CRADLE-3 trial.', BMC pregnancy and childbirth, vol. 18, no. 1, pp. 115-115.View/Download from: UTS OPUS or Publisher's site
BACKGROUND:The CRADLE-3 trial is a stepped-wedge randomised controlled trial aiming to reduce maternal mortality and morbidity by implementing a novel vital sign device (CRADLE Vital Sign Alert) and training package into routine maternity care in 10 low-income sites. The MRC Guidance on complex interventions proposes that interventions and implementation strategies be shaped by early phase piloting and development work. We present the findings of a three-month mixed-methodology feasibility study for this trial, describe how this was informed by the MRC guidance and the study design was refined. METHODS:The fidelity, dose, feasibility and acceptability of implementation and training materials were assessed in three representative non-trial sites (Zimbabwe, Ethiopia, India) using multiple-choice questionnaires, evaluation of clinical management (action log), healthcare provider (HCP) semi-structured interviews and focus groups 4-10 weeks after implementation. Simultaneously, the 10 sites included in the main trial (eight countries) collected primary outcome data to inform the power calculation and randomisation allocation and assess the feasibility of data collection. RESULTS:The package was implemented with high fidelity (85% of HCP trained, n = 204). The questionnaires indicated a good understanding of device use with 75% of participants scoring > 75% (n = 97; 90% of those distributed). Action logs were inconsistently completed but indicated that the majority of HCP responded appropriately to abnormal results. From 18 HCP interviews and two focus groups it was widely reported that the intervention improved capacity to make clinical decisions, escalate care and make appropriate referrals. Nine of the ten main trial sites achieved ethical approval for pilot data collection. Intensive care was an inconsistent marker of morbidity and stroke an infrequent outcome and therefore they were removed from the main trial composite outcome. Tools and methods of data collectio...
Kennedy, HP, Cheyney, M, Dahlen, HG, Downe, S, Foureur, MJ, Homer, CSE, Jefford, E, McFadden, A, Michel-Schuldt, M, Sandall, J, Soltani, H, Speciale, AM, Sevens, J, Vedam, S & Renfrew, MJ 2018, 'Asking different questions: A call to action for research to improve the quality of care for every woman, every child', WOMEN AND BIRTH, vol. 31, no. 4, pp. 242-243.View/Download from: UTS OPUS or Publisher's site
Kennedy, HP, Cheyney, M, Dahlen, HG, Downe, S, Foureur, MJ, Homer, CSE, Jefford, E, McFadden, A, Michel-Schuldt, M, Sandall, J, Soltani, H, Speciale, AM, Stevens, J, Vedam, S & Renfrew, MJ 2018, 'Asking different questions: A call to action for research to improve the quality of care for every woman, every child', MIDWIFERY, vol. 65, pp. 16-+.View/Download from: Publisher's site
Kennedy, HP, Cheyney, M, Dahlen, HG, Downe, S, Foureur, MJ, Homer, CSE, Jefford, E, McFadden, A, Michel-Schuldt, M, Sandall, J, Soltani, H, Speciale, AM, Stevens, J, Vedam, S & Renfrew, MJ 2018, 'Asking different questions: A call to action for research to improve the quality of care for every woman, every child.', Birth (Berkeley, Calif.), vol. 45, no. 3, pp. 222-231.View/Download from: UTS OPUS or Publisher's site
Despite decades of considerable economic investment in improving the health of families and newborns world-wide, aspirations for maternal and newborn health have yet to be attained in many regions. The global turn toward recognizing the importance of positive experiences of pregnancy, intrapartum and postnatal care, and care in the first weeks of life, while continuing to work to minimize adverse outcomes, signals a critical change in the maternal and newborn health care conversation and research prioritization. This paper presents "different research questions" drawing on evidence presented in the 2014 Lancet Series on Midwifery and a research prioritization study conducted with the World Health Organization. The results indicated that future research investment in maternal and newborn health should be on "right care," which is quality care that is tailored to individuals, weighs benefits and harms, is person-centered, works across the whole continuum of care, advances equity, and is informed by evidence, including cost-effectiveness. Three inter-related research themes were identified: examination and implementation of models of care that enhance both well-being and safety; investigating and optimizing physiological, psychological, and social processes in pregnancy, childbirth, and the postnatal period; and development and validation of outcome measures that capture short and longer term well-being. New, transformative research approaches should account for the underlying social and political-economic mechanisms that enhance or constrain the well-being of women, newborns, families, and societies. Investment in research capacity and capability building across all settings is critical, but especially in those countries that bear the greatest burden of poor outcomes. We believe this call to action for investment in the three research priorities identified in this paper has the potential to achieve these benefits and to realize the ambitions of Sustainable Developm...
Kennedy, HP, Cheyney, M, Dahlen, HG, Downe, S, Foureur, MJ, Homer, CSE, Jefford, E, McFadden, A, Michel-Schuldt, M, Sandall, J, Soltani, H, Speciale, AM, Stevens, J, Vedam, S & Renfrew, MJ 2018, 'Asking Different Questions: A Call to Action for Research to Improve the Quality of Care for Every Woman, Every Child.', Journal of Midwifery and Women's Health, vol. 63, no. 5, pp. 516-517.View/Download from: UTS OPUS or Publisher's site
Sandall, J, Tribe, RM, Avery, L, Mola, G, Visser, GH, Homer, CS, Gibbons, D, Kelly, NM, Kennedy, HP, Kidanto, H, Taylor, P & Temmerman, M 2018, 'Short-term and long-term effects of caesarean section on the health of women and children.', Lancet (London, England), vol. 392, no. 10155, pp. 1349-1357.View/Download from: UTS OPUS or Publisher's site
A caesarean section (CS) can be a life-saving intervention when medically indicated, but this procedure can also lead to short-term and long-term health effects for women and children. Given the increasing use of CS, particularly without medical indication, an increased understanding of its health effects on women and children has become crucial, which we discuss in this Series paper. The prevalence of maternal mortality and maternal morbidity is higher after CS than after vaginal birth. CS is associated with an increased risk of uterine rupture, abnormal placentation, ectopic pregnancy, stillbirth, and preterm birth, and these risks increase in a dose-response manner. There is emerging evidence that babies born by CS have different hormonal, physical, bacterial, and medical exposures, and that these exposures can subtly alter neonatal physiology. Short-term risks of CS include altered immune development, an increased likelihood of allergy, atopy, and asthma, and reduced intestinal gut microbiome diversity. The persistence of these risks into later life is less well investigated, although an association between CS use and greater incidence of late childhood obesity and asthma are frequently reported. There are few studies that focus on the effects of CS on cognitive and educational outcomes. Understanding potential mechanisms that link CS with childhood outcomes, such as the role of the developing neonatal microbiome, has potential to inform novel strategies and research for optimising CS use and promote optimal physiological processes and development.
Carter, W, Bick, D, Mackintosh, N & Sandall, J 2017, 'A narrative synthesis of factors that affect women speaking up about early warning signs and symptoms of pre-eclampsia and responses of healthcare staff', BMC PREGNANCY AND CHILDBIRTH, vol. 17.View/Download from: Publisher's site
Keely, A, Cunningham-Burley, S, Elliott, L, Sandall, J & Whittaker, A 2017, '"If she wants to eat...and eat and eat... fine! It's gonna feed the baby": Pregnant women and partners' perceptions and experiences of pregnancy with a BMI > 40 kg/m(2)', MIDWIFERY, vol. 49, pp. 87-94.View/Download from: Publisher's site
Mackintosh, N, Rance, S, Carter, W & Sandall, J 2017, 'Working for patient safety: a qualitative study of women's help-seeking during acute perinatal events', BMC PREGNANCY AND CHILDBIRTH, vol. 17.View/Download from: Publisher's site
McAllister, S, Coxon, K, Murrells, T & Sandall, J 2017, 'Healthcare professionals' attitudes, knowledge and self-efficacy levels regarding the use of self-hypnosis in childbirth: A prospective questionnaire survey', MIDWIFERY, vol. 47, pp. 8-14.View/Download from: Publisher's site
Salgado, HDO, Souza, JP, Sandall, J & Diniz, CSG 2017, 'Patient safety in maternity care in Brazil: The maternity safety thermometer as a tool to improve the quality of care', Revista Brasileira de Ginecologia e Obstetricia, vol. 39, no. 5, pp. 199-201.View/Download from: Publisher's site
Turienzo, CF, Brasa, CC, Newsholme, W, Sandall, J, Chiodini, PL & Moore, DAJ 2017, 'Chagas disease among pregnant Latin American women in the United Kingdom: Time for action', BMJ Global Health, vol. 2, no. 4.View/Download from: Publisher's site
Vieira, MC, White, SL, Patel, N, Seed, PT, Briley, AL, Sandall, J, Welsh, P, Sattar, N, Nelson, SM, Lawlor, DA, Poston, L & Pasupathy, D 2017, 'Prediction of uncomplicated pregnancies in obese women: a prospective multicentre study', BMC MEDICINE, vol. 15.View/Download from: Publisher's site
Homer, CS, Leap, N, Edwards, N & Sandall, J 2017, 'Midwifery continuity of carer in an area of high socio-economic disadvantage in London: A retrospective analysis of Albany Midwifery Practice outcomes using routine data (1997-2009).', Midwifery, vol. 48, pp. 1-10.View/Download from: UTS OPUS or Publisher's site
OBJECTIVE: in 1997, The Albany Midwifery Practice was established within King's College Hospital NHS Trust in a South East London area of high social disadvantage. The Albany midwives provided continuity of care to around 216 women per year, including those with obstetric, medical or social risk factors. In 2009, the Albany Midwifery Practice was closed in response to concerns about safety, amidst much publicity and controversy. The aim of this evaluation was to examine trends and outcomes for all mothers and babies who received care from the practice from 1997-2009. DESIGN: a retrospective, descriptive analysis of data routinely collected over the 12.5 year period was undertaken including changes over time and outcomes by demographic features. SETTING AND PARTICIPANTS: all women booked with the Albany Midwifery Practice were included. FINDINGS: of the 2568 women included over the 12.5 year period, more than half (57%) were from Black, Asian and Minority Ethnic (BAME) communities; one third were single and 11.4% reported being single and unsupported. Almost all women (95.5%) were cared for in labour by either their primary or secondary midwife. There were high rates of spontaneous onset of labour (80.5%), spontaneous vaginal birth (79.8%), homebirth (43.5%), initiation of breastfeeding (91.5%) and breastfeeding at 28 days (74.3% exclusively and 14.8% mixed feeding). Of the 79% of women who had a physiological third stage, 5.9% had a postpartum haemorrhage. The overall rate of caesarean section was 16%. The preterm birth rate was low (5%). Ninety-five per cent of babies had an Apgar score of 8 or greater at 5minutes and 6% were admitted to a neonatal unit for more than two days. There were 15 perinatal deaths (perinatal mortality rate of 5.78 per 1000 births); two were associated with significant congenital abnormalities. There were no intrapartum intrauterine deaths. KEY CONCLUSIONS: this analysis has shown that the Albany Midwifery Practice demonstrated positive...
Allen, D, Braithwaite, J, Sandall, J & Waring, J 2016, 'Towards a sociology of healthcare safety and quality', SOCIOLOGY OF HEALTH & ILLNESS, vol. 38, no. 2, pp. 181-197.View/Download from: Publisher's site
Bassett, S, Bick, D & Sandall, J 2016, 'Exploring the provision of maternal high-dependency care in two specialist centres-the experience of women and their partners', BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, vol. 123, pp. 54-54.
Dunning, T, Harris, JM & Sandall, J 2016, 'Women and their birth partners' experiences following a primary postpartum haemorrhage: a qualitative study', BMC PREGNANCY AND CHILDBIRTH, vol. 16.View/Download from: Publisher's site
Furuta, M, Sandall, J, Cooper, D & Bick, D 2016, 'Predictors of birth-related post-traumatic stress symptoms: secondary analysis of a cohort study', ARCHIVES OF WOMENS MENTAL HEALTH, vol. 19, no. 6, pp. 987-999.View/Download from: Publisher's site
Furuta, M, Sandall, J, Cooper, D & Bick, D 2016, 'Severe maternal morbidity and breastfeeding outcomes in the early post-natal period: a prospective cohort study from one English maternity unit', MATERNAL AND CHILD NUTRITION, vol. 12, no. 4, pp. 808-825.View/Download from: Publisher's site
Mackintosh, N & Sandall, J 2016, 'The social practice of rescue: the safety implications of acute illness trajectories and patient categorisation in medical and maternity settings', SOCIOLOGY OF HEALTH & ILLNESS, vol. 38, no. 2, pp. 252-269.View/Download from: Publisher's site
Mackintosh, N, Rance, S, Carter, W & Sandall, J 2016, 'Early warning signs and help seeking: being a 'responsible patient' in emergency escalation of maternity care', BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, vol. 123, pp. 98-99.
Sandall, J, Murrells, T, Bick, D, Bewley, S, Dodwell, M & Coxon, K 2016, 'Impact of obstetric and midwife staffing and skill mix on maternal and infant birth outcomes in England', BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, vol. 123, pp. 11-11.
Sandall, J, Soltani, H, Gates, S, Shennan, A & Devane, D 2016, 'Midwife-led continuity models versus other models of care for childbearing women', COCHRANE DATABASE OF SYSTEMATIC REVIEWS, no. 4.View/Download from: Publisher's site
Sandall, J, Soltani, H, Gates, S, Shennan, A & Devane, D 2016, 'Midwife-led continuity models versus other models of care for childbearing women.', The Cochrane database of systematic reviews, vol. 4, p. CD004667.View/Download from: Publisher's site
BACKGROUND:Midwives are primary providers of care for childbearing women around the world. However, there is a lack of synthesised information to establish whether there are differences in morbidity and mortality, effectiveness and psychosocial outcomes between midwife-led continuity models and other models of care. OBJECTIVES:To compare midwife-led continuity models of care with other models of care for childbearing women and their infants. SEARCH METHODS:We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (25 January 2016) and reference lists of retrieved studies. SELECTION CRITERIA:All published and unpublished trials in which pregnant women are randomly allocated to midwife-led continuity models of care or other models of care during pregnancy and birth. DATA COLLECTION AND ANALYSIS:Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. The quality of the evidence was assessed using the GRADE approach. MAIN RESULTS:We included 15 trials involving 17,674 women. We assessed the quality of the trial evidence for all primary outcomes (i.e. regional analgesia (epidural/spinal), caesarean birth, instrumental vaginal birth (forceps/vacuum), spontaneous vaginal birth, intact perineum, preterm birth (less than 37 weeks) and all fetal loss before and after 24 weeks plus neonatal death using the GRADE methodology: all primary outcomes were graded as of high quality.For the primary outcomes, women who had midwife-led continuity models of care were less likely to experience regional analgesia (average risk ratio (RR) 0.85, 95% confidence interval (CI) 0.78 to 0.92; participants = 17,674; studies = 14; high quality), instrumental vaginal birth (average RR 0.90, 95% CI 0.83 to 0.97; participants = 17,501; studies = 13; high quality), preterm birth less than 37 weeks (average RR 0.76, 95% CI 0.64 to 0.91; participants = 13,238; studies = eight; high quality) and less all fetal loss ...
Turienzo, CF, Sandall, J & Peacock, JL 2016, 'Models of antenatal care to reduce and prevent preterm birth: a systematic review and meta-analysis', BMJ OPEN, vol. 6, no. 1.View/Download from: Publisher's site
Turienzo, FC, Sandall, J & Peacock, J 2016, 'Models of antenatal care to reduce and prevent preterm birth: a systematic review and meta-analysis', BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, vol. 123, pp. 116-116.
Vousden, N, Lawley, E, Nathan, H, Sandall, J, Muchengwa, T, Sengwe, I & Shennan, A 2016, 'The feasibility of implementing a novel vital sign device and training package across Masvingo District, Zimbabwe', BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, vol. 123, pp. 110-110.
Vousden, N, Lawley, E, Nathan, HL, Muchengwa, T, Brown, A, Charanthimath, U, Sandall, J & Shennan, AH 2016, 'Lessons learnt during the implementation of a novel vital sign device and training package across three low-resource settings: A mixed method feasibility study for the CRADLE trial', BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, vol. 123, pp. 31-32.
Waring, J, Allen, D, Braithwaite, J & Sandall, J 2016, 'Healthcare quality and safety: a review of policy, practice and research', SOCIOLOGY OF HEALTH & ILLNESS, vol. 38, no. 2, pp. 198-215.View/Download from: Publisher's site
White, SL, Lawlor, DA, Briley, AL, Godfrey, KM, Nelson, SM, Oteng-Ntim, E, Robson, SC, Sattar, N, Seed, PT, Vieira, MC, Welsh, P, Whitworth, M, Poston, L, Pasupathy, D, Shennan, A, Singh, C, Sandall, J, Sanders, T, Patel, N, Flynn, A, Badger, S, Barr, S, Holmes, B, Goff, L, Hunt, C, Filmer, J, Fetherstone, J, Scholtz, L, Tarft, H, Lucas, A, Tekletdadik, T, Ricketts, D, Gill, C, Ignatian, AS, Boylen, C, Adegoke, F, Lawley, E, Butler, J, Maitland, R, Khazaezadeh, N, Demilew, J, O'Connor, S, Evans, Y, O'Donnell, S, De La Llera, A, Gutzwiller, G, Hagg, L, Bell, R, Hayes, L, Kinnunen, T, McParlin, C, Miller, N, Kimber, A, Riches, J, Allen, C, Boag, C, Campbell, F, Fenn, A, Ritson, S, Rennie, A, Durkin, R, Gills, G, Carr, R, McSorley, T, Alba, H, Paterson, K, Johnston, J, Clements, S, Fernon, M, Bett, S, Rooney, L, Miller, S, Cherry, L, Patterson, N, Lee, S, Grimshaw, R, Hughes, C, Brown, J, Hinshaw, K, Campbell, G, Knight, J, Farrar, D, Jones, V, Butterfield, G, Syson, J, Eadle, J, Wood, D, Todd, M, Khalil, A, Brown, D, Fernandez, P, Cousins, E, Smith, M, Wardle, J, Croker, H, Broomfield, L, Robinson, S, Canadine, S, Greenwood, L & Nelson-Piercy, C 2016, 'Early antenatal prediction of gestational diabetes in obese women: Development of prediction tools for targeted intervention', PLoS ONE, vol. 11, no. 12.View/Download from: Publisher's site
© 2016 White et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. All obese women are categorised as being of equally high risk of gestational diabetes (GDM) whereas the majority do not develop the disorder. Lifestyle and pharmacological interventions in unselected obese pregnant women have been unsuccessful in preventing GDM. Our aim was to develop a prediction tool for early identification of obese women at high risk of GDM to facilitate targeted interventions in those most likely to benefit. Clinical and anthropometric data and non-fasting blood samples were obtained at 1518 weeks' gestation in 1303 obese pregnant women from UPBEAT, a randomised controlled trial of a behavioural intervention. Twenty one candidate biomarkers associated with insulin resistance, and a targeted nuclear magnetic resonance (NMR) metabolome were measured. Prediction models were constructed using stepwise logistic regression. Twenty six percent of women (n = 337) developed GDM (International Association of Diabetes and Pregnancy Study Groups criteria). A model based on clinical and anthropometric variables (age, previous GDM, family history of type 2 diabetes, systolic blood pressure, sum of skinfold thicknesses, waist:height and neck:thigh ratios) provided an area under the curve of 0.71 (95% CI 0.68-0.74). This increased to 0.77 (95%CI 0.73-0.80) with addition of candidate biomarkers (random glucose, haemoglobin A1c (HbA1c), fructosamine, adiponectin, sex hormone binding globulin, triglycerides), but was not improved by addition of NMR metabolites (0.77; 95%CI 0.74-0.81). Clinically translatable models for GDM prediction including readily measurable variables e.g. mid-arm circumference, age, systolic blood pressure, HbA1c and adiponectin are described. Using a ≥35% risk threshold, all models iden...
Temby, O, Rastogi, A, Sandall, J, Cooksey, R & Hickey, GM 2015, 'Interagency Trust and Communication in the Transboundary Governance of Pacific Salmon Fisheries', REVIEW OF POLICY RESEARCH, vol. 32, no. 1, pp. 79-99.View/Download from: Publisher's site
Briley, AL, Barr, S, Badger, S, Bell, R, Croker, H, Godfrey, KM, Holmes, B, Kinnunen, TI, Nelson, SM, Oteng-Ntim, E, Patel, N, Robson, SC, Sandall, J, Sanders, T, Sattar, N, Seed, PT, Wardle, J & Poston, L 2015, 'A complex intervention to improve pregnancy outcome in obese women; the UPBEAT randomised controlled trial (vol 14, 74, 2014)', BMC PREGNANCY AND CHILDBIRTH, vol. 15.View/Download from: Publisher's site
Coxon, K, Sandall, J & Fulop, NJ 2015, 'How Do Pregnancy and Birth Experiences Influence Planned Place of Birth in Future Pregnancies? Findings from a Longitudinal, Narrative Study', BIRTH-ISSUES IN PERINATAL CARE, vol. 42, no. 2, pp. 141-148.View/Download from: Publisher's site
Dunning, T, Harris, J & Sandall, J 2015, 'The four Ts of PPH experience: women and their birth partners' experiences of primary postpartum haemorrhage', BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, vol. 122, pp. 91-91.
Ehrich, K, Cowie, L & Sandall, J 2015, 'Expect the unexpected: patients' and families' expectations and experiences of new clinical procedures', HEALTH EXPECTATIONS, vol. 18, no. 5, pp. 918-928.View/Download from: Publisher's site
Goulding, L, Parke, H, Maharaj, R, Loveridge, R, McLoone, A, Hadfield, S, Helme, E, Hopkins, P & Sandall, J 2015, 'Improving critical care discharge summaries: a collaborative quality improvement project using PDSA.', BMJ quality improvement reports, vol. 4, no. 1.View/Download from: Publisher's site
Around 110,000 people spend time in critical care units in England and Wales each year. The transition of care from the intensive care unit to the general ward exposes patients to potential harms from changes in healthcare providers and environment. Nurses working on general wards report anxiety and uncertainty when receiving patients from critical care. An innovative form of enhanced capability critical care outreach called 'iMobile' is being provided at King's College Hospital (KCH). Part of the remit of iMobile is to review patients who have been transferred from critical care to general wards. The iMobile team wished to improve the quality of critical care discharge summaries. A collaborative evidence-based quality improvement project was therefore undertaken by the iMobile team at KCH in conjunction with researchers from King's Improvement Science (KIS). Plan, Do, Study, Act (PDSA) methodology was used. Three PDSA cycles were undertaken. Methods adopted comprised: a scoping literature review to identify relevant guidelines and research evidence to inform all aspects of the quality improvement project; a process mapping exercise; informal focus groups / interviews with staff; patient story-telling work with people who had experienced critical care and subsequent discharge to a general ward; and regular audits of the quality of both medical and nursing critical care discharge summaries. The following behaviour change interventions were adopted, taking into account evidence of effectiveness from published systematic reviews and considering the local context: regular audit and feedback of the quality of discharge summaries, feedback of patient experience, and championing and education delivered by local opinion leaders. The audit results were mixed across the trajectory of the project, demonstrating the difficulty of sustaining positive change. This was particularly important as critical care bed occupancy and through-put fluctuates which then impacts on work-lo...
Griffiths, J, Sandall, J & Bewley, S 2015, 'What's changed?', Midwives, vol. 18, pp. 62-65.
Hattan, J, Sandall, J & Frohlich, J 2015, 'No decision about me, without me: improving shared decision making when planning place of birth for women with 'high risk' pregnancies', BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, vol. 122, pp. 92-92.
Li, Y, Townend, J, Rowe, R, Brocklehurst, P, Knight, M, Linsell, L, Macfarlane, A, McCourt, C, Newburn, M, Marlow, N, Pasupathy, D, Redshaw, M, Sandall, J, Silverton, L & Hollowell, J 2015, 'Perinatal and maternal outcomes in planned home and obstetric unit births in women at 'higher risk' of complications: secondary analysis of the Birthplace national prospective cohort study', BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, vol. 122, no. 5, pp. 741-753.View/Download from: Publisher's site
Poston, L, Bell, R, Croker, H, Flynn, AC, Godfrey, KM, Goff, L, Hayes, L, Khazaezadeh, N, Nelson, SM, Oteng-Ntim, E, Pasupathy, D, Patel, N, Robson, SC, Sandall, J, Sanders, TAB, Sattar, N, Seed, PT, Wardle, J, Whitworth, MK & Briley, AL 2015, 'Effect of a behavioural intervention in obese pregnant women (the UPBEAT study): a multicentre, randomised controlled trial', LANCET DIABETES & ENDOCRINOLOGY, vol. 3, no. 10, pp. 767-777.View/Download from: Publisher's site
Rainey, H, Ehrich, K, Mackintosh, N & Sandall, J 2015, 'The role of patients and their relatives in 'speaking up' about their own safety - a qualitative study of acute illness', HEALTH EXPECTATIONS, vol. 18, no. 3, pp. 392-405.View/Download from: Publisher's site
Rayment, J, McCourt, C, Rance, S & Sandall, J 2015, 'What makes alongside midwiferyled units work? Lessons from a national research project', Practising Midwife, vol. 18, no. 6, pp. 31-33.
© 2015 Medical Education Solutions Ltd. All rights reserved. The findings of the Birthplace in England Research Programme showed that midwife-led units are providing the safest and most cost-effective care for low risk women in England. Since the publication of the updated National Institute for Health and Care Excellence (NICE) intrapartum guidelines, there is likely to be even more interest in the development of midwife-led units to promote birth outside obstetric units (OUs) for low-risk women. Professional bodies, policy makers and trusts have focused their energies on alongside midwife-led units (AMUs), which are seen to provide the 'best of both worlds' between home and an OU. Between 2012 and 2013, we carried out a study of the organisation of four AMUs in England and the experiences of midwives and women who worked and birthed there. Learning from their experiences, this article presents five key factors which help make AMUs work.
Rayment-Jones, H, Murrells, T & Sandall, J 2015, 'An investigation of the relationship between the caseload model of midwifery for socially disadvantaged women and childbirth outcomes using routine data - A retrospective, observational study', MIDWIFERY, vol. 31, no. 4, pp. 409-417.View/Download from: Publisher's site
Sandall, J, Soltani, H, Gates, S, Shennan, A & Devane, D 2015, 'Midwife-led continuity models versus other models of care for childbearing women', COCHRANE DATABASE OF SYSTEMATIC REVIEWS, no. 9.View/Download from: Publisher's site
Agha, M, Agha, RA & Sandell, J 2014, 'Interventions to Reduce and Prevent Obesity in Pre-Conceptual and Pregnant Women: A Systematic Review and Meta-Analysis', PLOS ONE, vol. 9, no. 5.View/Download from: Publisher's site
Bick, DE, Sandall, J, Furuta, M, Wee, MYK, Isaacs, R, Smith, GB & Beake, S 2014, 'A national cross sectional survey of heads of midwifery services of uptake, benefits and barriers to use of obstetric early warning systems (EWS) by midwives', MIDWIFERY, vol. 30, no. 11, pp. 1140-1146.View/Download from: Publisher's site
Briley, A, Seed, PT, Tydeman, G, Ballard, H, Waterstone, M, Sandall, J, Poston, L, Tribe, RM & Bewley, S 2014, 'Reporting errors, incidence and risk factors for postpartum haemorrhage and progression to severe PPH: a prospective observational study', BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, vol. 121, no. 7, pp. 876-888.View/Download from: Publisher's site
Briley, AL, Barr, S, Badger, S, Bell, R, Croker, H, Godfrey, KM, Holmes, B, Kinnunen, TI, Nelson, SM, Oteng-Ntim, E, Patel, N, Robson, SC, Sandall, J, Sanders, T, Sattar, N, Seed, PT, Wardle, J & Poston, L 2014, 'A complex intervention to improve pregnancy outcome in obese women; the UPBEAT randomised controlled trial', BMC PREGNANCY AND CHILDBIRTH, vol. 14.View/Download from: Publisher's site
Coxon, K, Sandall, J & Fulop, NJ 2014, 'To what extent are women free to choose where to give birth? How discourses of risk, blame and responsibility influence birth place decisions', HEALTH RISK & SOCIETY, vol. 16, no. 1, pp. 51-67.View/Download from: Publisher's site
Furuta, M, Sandall, J & Bick, D 2014, 'Women's perceptions and experiences of severe maternal morbidity - A synthesis of qualitative studies using a meta-ethnographic approach', MIDWIFERY, vol. 30, no. 2, pp. 158-169.View/Download from: Publisher's site
Furuta, M, Sandall, J, Cooper, D & Bick, D 2014, 'The relationship between severe maternal morbidity and psychological health symptoms at 6-8 weeks postpartum: a prospective cohort study in one English maternity unit', BMC PREGNANCY AND CHILDBIRTH, vol. 14.View/Download from: Publisher's site
Gourounti, K, Anagnostopoulos, F & Sandall, J 2014, 'Poor marital support associate with anxiety and worries during pregnancy in Greek pregnant women', MIDWIFERY, vol. 30, no. 6, pp. 628-635.View/Download from: Publisher's site
Grilo Diniz, CS, d'Orsi, E, Soares Madeira Domingues, RM, Torres, JA, Bastos Dias, MA, Schneck, CA, Lansky, S, Fanaia Teixeira, NZ, Rance, S & Sandall, J 2014, 'Implementation of the presence of companions during hospital admission for childbirth: data from the Birth in Brazil national survey', CADERNOS DE SAUDE PUBLICA, vol. 30.View/Download from: Publisher's site
Mackintosh, N, Humphrey, C & Sandall, J 2014, 'The habitus of 'rescue' and its significance for implementation of rapid response systems in acute health care', SOCIAL SCIENCE & MEDICINE, vol. 120, pp. 233-242.View/Download from: Publisher's site
Mackintosh, N, Watson, K, Rance, S & Sandall, J 2014, 'Value of a modified early obstetric warning system (MEOWS) in managing maternal complications in the peripartum period: an ethnographic study', BMJ QUALITY & SAFETY, vol. 23, no. 1, pp. 26-34.View/Download from: Publisher's site
Rowe, RE, Townend, J, Brocklehurst, P, Knight, M, Macfarlane, A, McCourt, C, Newburn, M, Redshaw, M, Sandall, J, Silverton, L & Hollowell, J 2014, 'Service configuration, unit characteristics and variation in intervention rates in a national sample of obstetric units in England: an exploratory analysis', BMJ OPEN, vol. 4, no. 5.View/Download from: Publisher's site
Sandall, J 2014, 'The 30th International Confederation of Midwives Triennial Congress: Improving Women's Health Globally', BIRTH-ISSUES IN PERINATAL CARE, vol. 41, no. 4, pp. 303-305.View/Download from: Publisher's site
Snow, R, Sandall, J & Humphrey, C 2014, 'Understanding the impact of patient education on the lives of people with diabetes, inside and outside the health system', DIABETIC MEDICINE, vol. 31, pp. 98-99.
Snow, R, Sandall, J & Humphrey, C 2014, 'Use of clinical targets in diabetes patient education: qualitative analysis of the expectations and impact of a structured self-management programme in Type 1 diabetes', DIABETIC MEDICINE, vol. 31, no. 6, pp. 733-738.View/Download from: Publisher's site
Torres, JA, Soares Madeira Domingues, RM, Sandall, J, Hartz, Z, Nogueira da Gama, SG, Theme Filha, MM, Correa Schilithz, AO & Leal, MDC 2014, 'Caesarean section and neonatal outcomes in private hospitals in Brazil: comparative study of two different perinatal models of care', CADERNOS DE SAUDE PUBLICA, vol. 30.View/Download from: Publisher's site
Homer, CS, Friberg, IK, Dias, MA, ten Hoope-Bender, P, Sandall, J, Speciale, AM & Bartlett, L 2014, 'The projected effect of scaling up midwifery', The Lancet, vol. 384, no. 9948, pp. 1164-1157.View/Download from: Publisher's site
This is paper 2 in the Lancet Series on Midwifery, published online June 2014.
Agha, M, Agha, RA & Sandall, J 2013, 'Interventions to reduce and prevent obesity in pre-conceptual and pregnant women: a systematic review and meta-analysis', BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, vol. 120, pp. 25-25.
Allen, D, Waring, J, Sandall, J & Braithwaite, J 2013, '22nd Sociology of Health & Illness Monograph Call for Abstracts The Sociology of Healthcare Safety and Quality', SOCIOLOGY OF HEALTH & ILLNESS, vol. 35, no. 8, pp. 1279-1280.View/Download from: Publisher's site
Brintworth, K & Sandall, J 2013, 'What makes a successful home birth service: An examination of the influential elements by review of one service', MIDWIFERY, vol. 29, no. 6, pp. 713-721.View/Download from: Publisher's site
Cowie, L, Sandall, J & Ehrich, K 2013, 'Reflections on the implementation of governance structures for early-stage clinical innovation', JOURNAL OF EVALUATION IN CLINICAL PRACTICE, vol. 19, no. 6, pp. 1019-1025.View/Download from: Publisher's site
Kennedy, HP, Grant, J, Walton, C & Sandall, J 2013, 'Elective caesarean delivery: A mixed method qualitative investigation', MIDWIFERY, vol. 29, no. 12, pp. E138-E144.View/Download from: Publisher's site
Poston, L, Briley, AL, Barr, S, Bell, R, Croker, H, Coxon, K, Essex, HN, Hunt, C, Hayes, L, Howard, LM, Khazaezadeh, N, Kinnunen, T, Nelson, SM, Oteng-Ntim, E, Robson, SC, Sattar, N, Seed, PT, Wardle, J, Sanders, TAB & Sandall, J 2013, 'Developing a complex intervention for diet and activity behaviour change in obese pregnant women (the UPBEAT trial); assessment of behavioural change and process evaluation in a pilot randomised controlled trial', BMC PREGNANCY AND CHILDBIRTH, vol. 13.View/Download from: Publisher's site
Rance, S, McCourt, C, Rayment, J, Mackintosh, N, Carter, W, Watson, K & Sandall, J 2013, 'Women's safety alerts in maternity care: is speaking up enough?', BMJ QUALITY & SAFETY, vol. 22, no. 4, pp. 348-355.View/Download from: Publisher's site
Rowe, RE, Townend, J, Brocklehurst, P, Knight, M, Macfarlane, A, McCourt, C, Newburn, M, Redshaw, M, Sandall, J, Silverton, L & Hollowell, J 2013, 'Duration and urgency of transfer in births planned at home and in freestanding midwifery units in England: secondary analysis of the Birthplace national prospective cohort study', BMC PREGNANCY AND CHILDBIRTH, vol. 13.View/Download from: Publisher's site
This article discusses the implications of new evidence from recently published research on maternity services across England. The Birthplace in England Research Programme was commissioned in 2007 to address key gaps in the evidence and inform those who plan, deliver, and use maternity services. These included the pattern of current services and availability of different models of care; the ways in which maternal and infant outcomes differ between settings; their comparative cost-effectiveness; and the organizational features of maternity care systems that might affect the quality and safety of care.
Sandall, J, Soltani, H, Gates, S, Shennan, A & Devane, D 2013, 'Midwife-led continuity models versus other models of care for childbearing women', COCHRANE DATABASE OF SYSTEMATIC REVIEWS, no. 8.View/Download from: Publisher's site
Snow, R, Humphrey, C & Sandall, J 2013, 'What happens when patients know more than their doctors? Experiences of health interactions after diabetes patient education: a qualitative patient-led study', BMJ OPEN, vol. 3, no. 11.View/Download from: Publisher's site
Yoshida, Y & Sandall, J 2013, 'Occupational burnout and work factors in community and hospital midwives: A survey analysis', MIDWIFERY, vol. 29, no. 8, pp. 921-926.View/Download from: Publisher's site
Freeth, D, Sandall, J, Allan, T, Warburton, F, Berridge, EJ, Mackintosh, N, Rogers, M & Abbott, S 2012, 'A methodological study to compare survey-based and observation-based evaluations of organisational and safety cultures and then compare both approaches with markers of the quality of care', HEALTH TECHNOLOGY ASSESSMENT, vol. 16, no. 25, pp. 3-+.View/Download from: Publisher's site
Furuta, M, Sandall, J & Bick, D 2012, 'A systematic review of the relationship between severe maternal morbidity and post-traumatic stress disorder', BMC PREGNANCY AND CHILDBIRTH, vol. 12.View/Download from: Publisher's site
Gourounti, K, Lykeridou, K, Taskou, C, Kafetsios, K & Sandall, J 2012, 'A survey of worries of pregnant women: Reliability and validity of the Greek version of the Cambridge Worry Scale', MIDWIFERY, vol. 28, no. 6, pp. 746-753.View/Download from: Publisher's site
Lindsay, P, Sandall, J & Humphrey, C 2012, 'The social dimensions of safety incident reporting in maternity care: The influence of working relationships and group processes', SOCIAL SCIENCE & MEDICINE, vol. 75, no. 10, pp. 1793-1799.View/Download from: Publisher's site
Mackintosh, N, Rainey, H & Sandall, J 2012, 'Republished original research: Understanding how rapid response systems may improve safety for the acutely ill patient: learning from the frontline', POSTGRADUATE MEDICAL JOURNAL, vol. 88, no. 1039, pp. 261-270.View/Download from: Publisher's site
Mackintosh, N, Rainey, H & Sandall, J 2012, 'Understanding how rapid response systems may improve safety for the acutely ill patient: learning from the frontline', BMJ QUALITY & SAFETY, vol. 21, no. 2, pp. 135-144.View/Download from: Publisher's site
McCourt, C, Rayment, J, Rance, S & Sandall, J 2012, 'Organisational strategies and midwives' readiness to provide care for out of hospital births: An analysis from the Birthplace organisational case studies', MIDWIFERY, vol. 28, no. 5, pp. 636-645.View/Download from: Publisher's site
Overgaard, C, Fenger-Gron, M & Sandall, J 2012, 'Freestanding midwifery units versus obstetric units: does the effect of place of birth differ with level of social disadvantage?', BMC PUBLIC HEALTH, vol. 12.View/Download from: Publisher's site
Overgaard, C, Fenger-Gron, M & Sandall, J 2012, 'The impact of birthplace on women's birth experiences and perceptions of care', SOCIAL SCIENCE & MEDICINE, vol. 74, no. 7, pp. 973-981.View/Download from: Publisher's site
Schroeder, E, Petrou, S, Patel, N, Hollowell, J, Puddicombe, D, Redshaw, M & Brocklehurst, P 2012, 'Cost effectiveness of alternative planned places of birth in woman at low risk of complications: evidence from the Birthplace in England national prospective cohort study', BMJ-BRITISH MEDICAL JOURNAL, vol. 344.View/Download from: Publisher's site
Barr, S, Poston, L, Briley, A, Oteng-Ntim, E, Holmes, B, Kinnunen, T, Croker, H, Bell, R, Wardle, J, Sandall, J, Sattar, N, Nelson, S & Sanders, TAB 2011, 'Habitual dietary intake of obese pregnant women in the UK', PROCEEDINGS OF THE NUTRITION SOCIETY, vol. 70, no. OCE1, pp. E14-E14.View/Download from: Publisher's site
Briley, AL, Holmes, B, Kinnunen, TI, Croker, H, Bell, R, Sanders, T, Wardle, J, Sandall, J, Robson, S, Sattar, N, Poston, L, Nelson, S & Barr, S 2011, 'Development of a Complex Intervention To Improve Outcome in Obese Pregnancies; the UPBEAT Protocol', REPRODUCTIVE SCIENCES, vol. 18, no. 3, pp. 143A-143A.
Brocklehurst, P, Hardy, P, Hollowell, J, Linsell, L, Macfarlane, A, McCourt, C, Marlow, N, Miller, A, Newburn, M, Petrou, S, Puddicombe, D, Redshaw, M, Rowe, R, Sandall, J, Silverton, L & Stewart, M 2011, 'Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study', BMJ-BRITISH MEDICAL JOURNAL, vol. 343.View/Download from: Publisher's site
Hundt, GL, Bryanston, C, Lowe, P, Cross, S, Sandall, J & Spencer, K 2011, 'Inside 'Inside View': reflections on stimulating debate and engagement through a multimedia live theatre production on the dilemmas and issues of pre-natal screening policy and practice', HEALTH EXPECTATIONS, vol. 14, no. 1, pp. 1-9.View/Download from: Publisher's site
Morgan, M, Barry, CA, Donovan, JL, Sandall, J, Wolfe, CDA & Boaz, A 2011, 'Implementing 'translational' biomedical research: Convergence and divergence among clinical and basic scientists', SOCIAL SCIENCE & MEDICINE, vol. 73, no. 7, pp. 945-952.View/Download from: Publisher's site
Overgaard, C, Moller, AM, Fenger-Gron, M, Knudsen, LB & Sandall, J 2011, 'Freestanding midwifery unit versus obstetric unit: a matched cohort study of outcomes in low-risk women', BMJ OPEN, vol. 1, no. 2.View/Download from: Publisher's site
Sandall, J, Bewley, S & Newburn, M 2011, '"Home birth triples the neonatal death rate": public communication of bad science?', AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, vol. 204, no. 4.View/Download from: Publisher's site
Gyte, G, Dodwell, M, Newburn, M, Sandall, J, Macfarlane, A & Bewley, S 2010, 'Safety of planned home births Findings of meta-analysis cannot be relied on', BRITISH MEDICAL JOURNAL, vol. 341.View/Download from: Publisher's site
Kemp, J & Sandall, J 2010, 'Normal birth, magical birth: the role of the 36-week birth talk in caseload midwifery practice', MIDWIFERY, vol. 26, no. 2, pp. 211-221.View/Download from: Publisher's site
Kennedy, HP, Grant, J, Walton, C, Shaw-Battista, J & Sandall, J 2010, 'Normalizing Birth in England: A Qualitative Study', JOURNAL OF MIDWIFERY & WOMENS HEALTH, vol. 55, no. 3, pp. 262-269.View/Download from: Publisher's site
Leap, N, Sandall, J, Buckland, SS & Huber, U 2010, 'Journey To Confidence: Women'S Experiences Of Pain In Labour And Relational Continuity Of Care', Journal of Midwifery and Women's Health, vol. 55, no. 3, pp. 234-242.View/Download from: UTS OPUS or Publisher's site
Introduction: An evaluation carried out at King's College Hospital Foundation National Health Service Trust in London identified that women who received continuity of carer from the Albany Midwifery Practice were significantly less likely to use pharmaco
Mackintosh, N & Sandall, J 2010, 'Overcoming gendered and professional hierarchies in order to facilitate escalation of care in emergency situations: The role of standardised communication protocols', SOCIAL SCIENCE & MEDICINE, vol. 71, no. 9, pp. 1683-1686.View/Download from: Publisher's site
Murray, SF, Buller, AM, Bewley, S & Sandall, J 2010, 'Metrics for monitoring local inequalities in access to maternity care: developing a basket of markers from routinely available data', QUALITY & SAFETY IN HEALTH CARE, vol. 19, no. 5.View/Download from: Publisher's site
Sandall, J, Devane, D, Soltani, H, Hatem, M & Gates, S 2010, 'Improving Quality and Safety in Maternity Care: The Contribution of Midwife-Led Care', JOURNAL OF MIDWIFERY & WOMENS HEALTH, vol. 55, no. 3, pp. 255-261.View/Download from: Publisher's site
Sheridan, M & Sandall, J 2010, 'Measuring the best outcome for the least intervention: can the Optimality Index-US be applied in the UK?', MIDWIFERY, vol. 26, no. 6, pp. E9-E15.View/Download from: Publisher's site
Kumar, D, Aggarwal, AK & Kumar, R 2009, 'The effect of interrupted 5-day training on Integrated Management of Neonatal and Childhood Illness on the knowledge and skills of primary health care workers', HEALTH POLICY AND PLANNING, vol. 24, no. 2, pp. 94-100.View/Download from: Publisher's site
Donkor, ES & Sandall, J 2009, 'Coping strategies of women seeking infertility treatment in southern Ghana.', African journal of reproductive health, vol. 13, no. 4, pp. 81-93.
Infertility is a health problem faced by an estimated 15% of women of childbearing age in Ghana. This study explores the coping strategies adopted by 615 women seeking infertility treatment in southern Ghana. Both closed and open-ended questions were used through a survey conducted using face-to-face interviews in three languages at three health sites--a hospital, a health centre and a private clinic. The findings suggest that the majority of the women preferred to keep issues of their fertility problems to themselves. The reason could be due to the associated stigma of infertility. Further, the majority of the women coped through drawing on their Christian faith. Others also coped through the support they received from their husbands, their occupation by way of achieving economic independence, and some avoided situations that reminded them of their infertility problem. The findings should have implications for health personnel as some strategies infertile women use may do more harm than good.
Finlay, S & Sandall, J 2009, '"Someone's rooting for you": Continuity, advocacy and street-level bureaucracy in UK maternal healthcare', SOCIAL SCIENCE & MEDICINE, vol. 69, no. 8, pp. 1228-1235.View/Download from: Publisher's site
Gottfredsdottir, H, Sandall, J & Bjoernsdottir, K 2009, ''This is just what you do when you are pregnant': a qualitative study of prospective parents in Iceland who accept nuchal translucency screening', MIDWIFERY, vol. 25, no. 6, pp. 711-720.View/Download from: Publisher's site
Gottfreosdottir, H, Bjornsdottir, K & Sandall, J 2009, 'How do prospective parents who decline prenatal screening account for their decision? A qualitative study', SOCIAL SCIENCE & MEDICINE, vol. 69, no. 2, pp. 274-277.View/Download from: Publisher's site
Gyte, G, Dodwell, M, Newburn, M, Sandall, J, Macfarlane, A & Bewley, S 2009, 'Estimating intrapartum-related perinatal mortality rates for booked home births: when the 'best' available data are not good enough', BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, vol. 116, no. 7, pp. 933-942.View/Download from: Publisher's site
Gyte, G, Dodwell, M, Newburn, M, Sandall, J, Macfarlane, A & Bewley, S 2009, 'No rising trend in home birth mortality', BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, vol. 116, no. 12, pp. 1687-1687.View/Download from: Publisher's site
Huber, US & Sandall, J 2009, 'A qualitative exploration of the creation of calm in a continuity of carer model of maternity care in London', MIDWIFERY, vol. 25, no. 6, pp. 613-621.View/Download from: Publisher's site
Leap, N, Sandall, J, Grant, J, Bastos, MH & Armstrong, P 2009, 'Using video in the development and field-testing of a learning package for maternity staff: Supporting women for normal childbirth', International Journal of Multiple Research Approaches, vol. 3, no. 3, pp. 302-320.View/Download from: UTS OPUS
This paper discusses methodological issues relating to the use of video technology to develop and field test educational resources. Research to develop and field test a learning package for National Health Service (UK) maternity staff used video to observe and describe exemplary practice and to elicit video clips for the purpose of stimulating interactive workshop activities and interprofessional learning. The project aimed to enhance the knowledge, skills and self-efficacy of maternity staff to support women to have a normal birth. Data from filmed observations of midwifery interactions, interviews and group discussions with a range of women, their partners, midwives and doctors, contributed to understandings of positive influences on women's experiences of childbirth. This data informed the development of learning outcomes for workshop activities and the selection of stimulus video clips. The rationale for using video in this way, the research process that was undertaken and some of the ethical and practical challenges encountered are discussed.
Sandall, J, Benoit, C, Wrede, S, Murray, SF, van Teijlingen, ER & Westfall, R 2009, 'Social Service Professional or Market Expert? Maternity Care Relations under Neoliberal Healthcare Reform', CURRENT SOCIOLOGY, vol. 57, no. 4, pp. 529-553.View/Download from: Publisher's site
Sandall, J, Hatem, M, Devane, D, Soltani, H & Gates, S 2009, 'Discussions of findings from a Cochrane review of midwife-led versus other models of care for childbearing women: continuity, normality and safety', MIDWIFERY, vol. 25, no. 1, pp. 8-13.View/Download from: Publisher's site
van Teijlingen, E, Wrede, S, Benoit, C, Sandall, J & DeVries, R 2009, 'Born in the USA: Exceptionalism in Maternity Care Organisation Among High-Income Countries', SOCIOLOGICAL RESEARCH ONLINE, vol. 14, no. 1.
Gourounti, K & Sandall, J 2008, 'Do pregnant women in Greece make informed choices about antenatal screening for Down's syndrome? A questionnaire survey', MIDWIFERY, vol. 24, no. 2, pp. 153-162.View/Download from: Publisher's site
Gourounti, K, Lykeridou, K, Daskalakis, G, Glentis, S, Sandall, J & Antsaklis, A 2008, 'Women's perception of information and experiences of nuchal translucency screening in Greece', FETAL DIAGNOSIS AND THERAPY, vol. 24, no. 2, pp. 86-91.View/Download from: Publisher's site
Gyte, G, Dodwell, M, Newburn, M, Sandall, J, Macfarlane, A & Bewley, S 2008, 'An estimation of intrapartum-related perinatal mortality rates for booked home births in England and Wales between 1994 and 2003', BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, vol. 115, no. 10, pp. 1321-U4.
Hatem, M, Sandall, J, Devane, D, Soltani, H & Gates, S 2008, 'Midwife-led versus other models of care for childbearing women', COCHRANE DATABASE OF SYSTEMATIC REVIEWS, no. 4.View/Download from: Publisher's site
McCandlish, R, Brocklehurst, P, Campbell, R, Logan, M, Macfarlane, A, McCourt, C, Miller, A, Murphy, D, Newburn, M, Petrou, S, Puddicombe, D, Redshaw, M, Rowe, R, Schroeder, E, Sandall, J, Silverton, L, Stewart, M & Marlow, N 2008, 'National evaluation safety and cost-effectiveness of planned place of birth', BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, vol. 115, no. 8, pp. 1063-U7.View/Download from: Publisher's site
Beebe, KR, Lee, KA, Carrieri-Kohlman, V & Humphreys, J 2007, 'The effects of childbirth self-efficacy and anxiety during pregnancy on prehospitalization Labor', JOGNN-JOURNAL OF OBSTETRIC GYNECOLOGIC AND NEONATAL NURSING, vol. 36, no. 5, pp. 410-418.View/Download from: Publisher's site
Donkor, ES & Sandall, J 2007, 'The impact of perceived stigma and mediating social factors on infertility-related stress among women seeking infertility treatment in Southern Ghana', SOCIAL SCIENCE & MEDICINE, vol. 65, no. 8, pp. 1683-1694.View/Download from: Publisher's site
Ehrich, K, Williams, C, Farsides, B, Sandall, J & Scott, R 2007, 'Choosing embryos: ethical complexity and relational autonomy in staff accounts of PGD', SOCIOLOGY OF HEALTH & ILLNESS, vol. 29, no. 7, pp. 1091-1106.View/Download from: Publisher's site
Gagnon, AJ & Sandall, J 2007, 'Individual or group antenatal education for childbirth or parenthood, or both (Withdrawn Paper. 2007, art. no. CD002869)', COCHRANE DATABASE OF SYSTEMATIC REVIEWS, no. 3.View/Download from: Publisher's site
Gourounti, K & Sandall, J 2007, 'Admission cardiotocography versus intermittent auscultation of fetal heart rate: Effects on neonatal Apgar score, on the rate of caesarean sections and on the rate of instrumental delivery - A systematic review', INTERNATIONAL JOURNAL OF NURSING STUDIES, vol. 44, no. 6, pp. 1029-1035.View/Download from: Publisher's site
Sandall, J, Jill, M & Mansfield, A 2007, 'Support workers in maternity services.', The journal of family health care, vol. 17, no. 6, pp. 191-192.
Reductions in doctors' hours and length of training and reconfigurations of obstetric and neonatal services in the UK have led to practitioners taking on new clinical roles. The need to free midwives' time for their extending clinical roles has led to greater use of support workers. These workers are increasingly assisting with clinical as well as clerical and administrative tasks but their training and responsibilities are variable. A recent scoping study of these workers in NHS Trusts in England, discussed here by its authors, reveals that managers welcome the support workers' contribution to maternity care, for example through breast-feeding support in the community, helping to provide continuity of care and one-to-one care in labour, attending at home births, assisting in obstetric theatres and running antenatal and postnatal groups. However, a national framework is needed to ensure governance, Research is also needed into the impact of support workers on outcomes for mothers and babies, the cost-effectiveness of the role, and the experience of mothers.
Ehrich, K, Williams, C, Scott, R, Sandall, J & Farsides, B 2006, 'Social welfare, genetic welfare? Boundary-work in the IVF/PGD clinic', SOCIAL SCIENCE & MEDICINE, vol. 63, no. 5, pp. 1213-1224.View/Download from: Publisher's site
Heyman, B, Hundt, G, Sandall, J, Spencer, K, Williams, C, Grellier, R & Pitson, L 2006, 'On being at higher risk: A qualitative study of prenatal screening for chromosomal anomalies', SOCIAL SCIENCE & MEDICINE, vol. 62, no. 10, pp. 2360-2372.View/Download from: Publisher's site
Sandall, J 2006, 'Investment in midwifery research.', RCM midwives : the official journal of the Royal College of Midwives, vol. 9, no. 11, p. 416.
Wrede, S, Benoit, C, Bourgeault, IL, van Teijlingen, ER, Sandall, J & De Vries, RG 2006, 'Decentred comparative research: Context sensitive analysis of maternal health care', SOCIAL SCIENCE & MEDICINE, vol. 63, no. 11, pp. 2986-2997.View/Download from: Publisher's site
Benoit, C, Wrede, S, Bourgeault, I, Sandall, J, De Vries, R & van Teijlingen, ER 2005, 'Understanding the social organisation of maternity care systems: midwifery as a touchstone', SOCIOLOGY OF HEALTH & ILLNESS, vol. 27, no. 6, pp. 722-737.View/Download from: Publisher's site
Green, RJ, Sandall, JC & Phelps, C 2005, 'Effect of experimenter attire and sex on participant productivity', SOCIAL BEHAVIOR AND PERSONALITY, vol. 33, no. 2, pp. 125-132.View/Download from: Publisher's site
Sandall, J 2005, 'A pleasing birth. Midwives and maternity care in the Netherlands', SOCIOLOGY OF HEALTH & ILLNESS, vol. 27, no. 7, pp. 1022-1023.
Williams, C, Sandall, J, Lewando-Hundt, G, Heyman, B, Spencer, K & Grellier, R 2005, 'Women as moral pioneers? Experiences of first trimester antenatal screening', SOCIAL SCIENCE & MEDICINE, vol. 61, no. 9, pp. 1983-1992.View/Download from: Publisher's site
Sandall, J 2004, 'Genetic politics: from eugenics to genome.', SOCIOLOGY OF HEALTH & ILLNESS, vol. 26, no. 3, pp. 379-380.
Humphrey, C, Ehrich, K, Kelly, B, Sandall, J, Redfern, S, Morgan, M & Guest, D 2003, 'Human resources policies and continuity of care', Journal of Health Organization and Management, vol. 17, no. 2, pp. 102-121.View/Download from: Publisher's site
Explores the implications for continuity of care of the wide range of policy initiatives currently affecting the management and use of human resources in the UK National Health Service. Draws on the findings of a short study undertaken in 2001 comprising a policy document analysis and a series of expert seminars discussing the impact of the policies in practice. A variety of potential long-term gains for continuity of care were identifiable in the current raft of policy initiatives and seminar participants agreed that, when these policies are fully implemented, continuity of care should be enhanced in several ways. However, the impact to date has been rather more equivocal because of the damaging effects of the process of policy implementation on continuity within the system and on staff attitudes and values. If continuity of care is accepted as an important element of quality in health care, more attention must be given to developing strategies which support system continuity. © 2003, MCB UP Limited
Madi, BC, Sandall, J, Bennett, R & MacLeod, C 1999, 'Effects of female relative support in labor: A randomized controlled trial', BIRTH-ISSUES IN PERINATAL CARE, vol. 26, no. 1, pp. 4-8.View/Download from: Publisher's site
Foureur, M & Sandall, J 2008, 'The challenges of evaluating midwifery continuity of care' in Homer, Brodie & Leap (eds), Midwifery Continuity of Care: A practical guide, Churchill Livingstone Elsevier, Sydney, Australa, pp. 165-180.View/Download from: UTS OPUS
In this chaprer) we describe some of the challenges associated with evaluating midwifery continuity of care. The notion of 'midwifery care as a complex intervention' is explored as this informs (he way it is evaluated. Midwifery models of care are complex as they consist of a package ofinrerventions. In evaluations we have often tried to reduce the cornplexity, which may actually leave out the things that arc most important. Murray Enkin, one of the original editors of Effective Care in Pregnancy and Childbirth (Chalmers et al. 1989), highlighted this underst·anding by saying "TI,e things that count cannot be counted'. This was a version of a famous quotation by Alben Einstein: 'Everything that can be counted does not necessarily count; and, everything that counts) cannot necessarily be counted'. 'lhis chapter deals with these issues and the importance of maintaining the complexity in evaluations by using a framework developed by the Medical Research Council of the United Kingdom as a way of thinking through and planning an evaluation. 'This chapter also includes a briefcritique of the evidence around midwifery continuity of care presented in Chapter 2.
Brigante, L & Sandall, J 2019, 'How is the implementation of a new continuity of care model for women at high risk of preterm birth (POPPIE) experienced by women? A qualitative thematic analysis', BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, WILEY, pp. 124-124.
Carter, J, Shennan, A, Sandall, J & Tribe, R 2019, 'Risk assessment in threatened preterm labour: results of the PETRA study', BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, WILEY, pp. 11-11.
Easter, A, Sandall, J & Howard, L 2019, 'Obstetric near miss events during childbirth among women with a history of mental illness: a data linkage study', BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, WILEY, pp. 10-10.
Rayment-Jones, H, Harris, J, Harden, A, Khan, Z & Sandall, J 2019, 'How do women with social risk factors experience UK maternity care? A realist synthesis', BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, WILEY, pp. 124-125.
Relph, S, Ong, M, Vieira, MC, Pasupathy, D & Sandall, J 2019, 'How do obese women perceive and make decisions regarding risks and choices presented during pregnancy? An evidence synthesis of qualitative literature', BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, WILEY, pp. 132-133.
Vousden, N, Lawley, E, Seed, PT, Gidiri, MF, Charantimath, U, Makonyola, G, Brown, A, Yadeta, L, Best, R, Chinkoyo, S, Vwalika, B, Nakimuli, A, Ditai, J, Greene, G, Chappell, LC, Sandall, J, Shennan, AH, Bukani, D, Toussaint, P, Vixama, A, Hill, C, Nakirijja, E, Birungi, D, Kalyowa, N, Namakuli, D, Byamugisha, J, Odeke, NM, Wandabwa, J, Momodou, F, Sesay, M, Sandi, P, Conteh, J, Kamara, J, Clarke, M, Miti, J, Chima, M, Kopeka, M, Vwalika, B, Jere, C, Musonda, T, Mambo, V, Guchale, Y, Surur, F, Mungarwadi, GM, Mastiholi, SS, Karadiguddi, CC, Hezelgrave, N, Duhig, KE, Kachinjika, M, Bellad, M & Makwakwa, J 2019, 'Exploring the effect of implementation and context on a stepped-wedge randomised controlled trial of a vital sign triage device in routine maternity care in low-resource settings', IMPLEMENTATION SCIENCE, BMC.View/Download from: UTS OPUS or Publisher's site
Whybrow, R, Webster, L, Sandall, J & Chappell, L 2019, 'Evaluating the uptake of evidence-based guidance and associated determinants to prevent severe hypertension in pregnant women with chronic hypertension: a mixed-method multi-centre study.', BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, WILEY, pp. 38-38.
Bye, A, Chang, Y-S, Taylor, C, Bramham, K, Chappell, L, Sandall, J & Bick, D 2018, 'Provision of postnatal care following a hypertensive disorder of pregnancy in South London: Does it reflect current NICE guidance?', BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, WILEY, pp. 75-76.
Carter, J, Shennan, AH, Sandall, J & Tribe, RM 2018, 'PETRA study: Antenatal corticosteroid use in women with symptoms of threatened preterm labour', BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, WILEY, pp. 7-8.
Carter, J, Tribe, RM, Sandall, J & Shennan, A 2018, 'Preterm clinical network database: An ongoing collaboration', BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, WILEY, pp. 47-47.
Sandall, J, Fernandez-Turienzo, C, Briley, A, Shennan, A, Bollard, M, Cross, P, Mehta, M, Seed, P, Bick, D, Singh, C, Tribe, R, Moulla, J & Healey, A 2018, 'Pilot study of midwifery Practice in Preterm birth including women's Experiences (POPPIE): Development and implemetation of a pilot randomised controlled trial of midwifery continuity of care and preterm birth clinic for women at higher risk of preterm birth in Lewisham', BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, WILEY, pp. 107-107.
Carter, J, Tribe, RM, Shennan, AH & Sandall, J 2017, 'Threatened preterm labour: Women's experiences of risk assessment and management', BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, WILEY, pp. 71-71.
Easter, A, Howard, L & Sandall, J 2017, 'QUALITY AND SAFETY IN PERINATAL MENTAL HEALTHCARE: DETECTION AND RESPONSE TO MATERNAL NEAR MISS EVENTS', INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE, OXFORD UNIV PRESS, pp. 58-58.
Mackintosh, N, Harris, J, Collison, C & Sandall, J 2017, 'THE VALUE OF ARTS BASED METHODS TO EMPOWER PREGNANT AND POSTNATAL WOMEN TO SHARE THEIR SAFETY CONCERNS ABOUT SERIOUS ILLNESS', INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE, OXFORD UNIV PRESS, pp. 12-12.
Vousden, N, Lawley, E, Gallo, J, Nathan, H, Chappell, L, Sandall, J & Shennan, A 2017, 'Creation of educational films for every cadre of healthcare professional in the CRADLE 3 trial', BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, WILEY, pp. 197-197.
Sandall, JM, Millership, JS, Collier, PS & McElnay, JC 2005, 'Development and validation of an HPLC method for the determination of spironolactone and its metabolites in paediatric plasma samples', JOURNAL OF CHROMATOGRAPHY B-ANALYTICAL TECHNOLOGIES IN THE BIOMEDICAL AND LIFE SCIENCES, 4th International Symposium on Separations in the Biosciences, ELSEVIER SCIENCE BV, Utrecht, NETHERLANDS, pp. 36-44.View/Download from: Publisher's site