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Maternal Health Policy, Systems & Implementation

Maternal Health Policy, Systems and Implementation

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Pregnancy and the early postnatal weeks and months are optimal times to introduce preventative measures which set out to maximise every opportunity that the health service has with a woman to improve general health in pregnancy, birth and beyond. There are inter-generational effects associated with poor maternal outcome, and a life-course approach for women’s health care will ultimately improve maternal and infant outcomes irrespective of her situation in society.
 
Adverse perinatal experiences and morbidity of both parents have a profound effect on maternal and infant health and childhood development. Socio-demographic factors, ethnicity, clinical and social risk, poor lifestyle behaviours and poor quality of care result in inequitable distribution of maternal and infant health outcomes which persist over the life-course of the mother and the child.


NHS maternity care services are unique in that they are the only universal public service for women and their babies during pregnancy and the early period of an infant’s life. There is a substantial body of high quality evidence of what is known to improve health outcomes, but the challenge is translation, implementation, and scale up into frontline primary and secondary care services.

Our strategy assumes a life-course approach which is engaged with basic and clinical science research that has the potential to improve health care quality and outcomes from bench to population health, through policy relevant world class evidence synthesis, implementation and service delivery science. Our group draws on social and health sciences and conducts theoretically informed research into health systems, health outcomes and service delivery. Our group uses a mixed methods approach includes evidence synthesis of qualitative and quantitative data, linking with Cochrane and the Joanna Briggs Institute, modelling and data linkage, clinical trials, hybrid effectiveness trials of complex interventions, qualitative research includes interviews, focus groups and ethnographic methods,  

We bring together academics, clinicians and service users across King’s Faculties of Life Sciences and MedicineIOPPNFlorence Nightingale Faculty of Nursing & Midwifery and King's Health Partners to work towards the improvement of the health of women and their infants in our local, multicultural inner-city population and worldwide. Jane Sandall is a member of the senior leadership team in the Centre for Implementation Science and NIHR CLAHRC South London leading capacity building, education and training and the maternity and women’s health theme. Jane Sandall also leads a programme of research in King’s Improvement Science which funds 12 Post-Doctoral Fellows to work on implementation and improvement research.  Debra Bick is Editor in Chief of the journal ‘Midwifery’.

We contribute social and implementation science theoretical perspectives and research methodologies to programmes of research led by Lucilla Poston, Lucy Chappell, Andrew Shennan and Louise Howard and lead our own programmes on service delivery and health system research. We are actively engaged with the policy community and sit on DH, NHS England and NICE advisory groups, on local London and maternity networks. Such work raises unanswered questions and informs new research, and offers opportunities for our research to inform policy. We work with a range of existing third sector partners including Tommy’s, National Childbirth Trust, Fatherhood Institute, APEC, and we have a memorandum of understanding with NCT researchers.

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Our strategy is currently focusing on two areas: healthcare quality and safety with a focus on novel technologies, and health system and service delivery with a focus on disparities in health and women with social and medical complexity. Cross cutting themes include assessment of improvement and implementation initiatives in clinical trials, and system level evaluation, and evidence synthesis. 

Healthcare Quality and Safety and New Technologies

Completed Research Current Research

Implementation of innovative safety technologies and practices and role of
service users and families

Dr Nicola Mackintosh

Professor Jane Sandall                    

Evaluation of implementation of telemedicine in intensive care  

Dr Nicola Mackintosh

Professor Jane Sandall

Early recognition and response to maternal complications during pregnancy
and in the postnatal period among women with perinatal mental health problems

Dr Abigail Easter

Professor Jane Sandall

King's Improvement Science Team

 

Health System and Service Delivery 

Completed Research
Workforce
 
Service Delivery
 

Implementation

 
Current Research
We are contributing to research of complex interventions where we are leading process evaluations and implementation research.
MRC Joint Health Systems Research Initiative, Integrating places of worship (PoW) into the primary care pathway to prevent and control non-communicable diseases (NCDs) in the Caribbean, 2016-2019         

Professor Seeromanie Harding

(Professor Jane Sandall)

NIHR Programme Grant, Optimising the monitoring and management of raised blood pressure during and after pregnancy,2016-2021

Professor Jane Sandall

Professor Lucy Chappell

MRC/DFID/DBT Global Research Programme, Evaluation of the introduction of a novel device in the management of hypertension and shock in pregnancy in low-resource settings, 2015-2018 

Professor Andrew Shennan

(Professor Jane Sandall)

Bill and Melinda Gates Foundation Grand Challenge Explorations, CRADLE: Community Blood Pressure Monitoring in Rural Africa, 2013-2016

Professor Andrew Shennan

(Professor Jane Sandall)

PHOENIX, Planned Delivery for Pre-eclampsia between 34 and 37 weeks of gestation, 2013-2019

Professor Andrew Shennan

Professor Lucy Chappell

(Professor Jane Sandall

King's Improvement Science: Using a health systems approach to evaluate the implementation of integrated care pathways for frail elderly people in Lambeth and Southwark, South London

Dr Euan Sadler

Professor Jane Sandall

King's Improvement Science: Influence of outer contextual factors on implementing policies in emergency care

Alexandra  Zeiman 

Professor Jane Sandall

King's Improvement Science: Developing a targeted, theory-informed implementation intervention to increase uptake of delayed cord clamping NICE guidelines

Dr James Harris

Professor Jane Sandall

NIHR CLAHRC: Supporting women who are likely to give birth 

Professor Jane Sandall

NIHR CLAHRC:  Improving postnatal planning, management and shorter and longer-term physical and psychological health outcomes for women who experience medically complex pregnancies

Professor Debra Bick 

CLAHRC South London -Improving postnatal care  

Birthplace Choices Qualitative Evidence Synthesis

What influences birth place preferences, choices and decision making amongst healthy women with straightforward pregnancies in the UK? A qualitative evidence synthesis using a 'best-fit' framework approach.

This is a component study of the 'Birthplace Choices' work. Based at the Policy Research Unit in Maternal Health and Care, NPEU, University of Oxford

Dr Kirstie Coxon 

 

Project team for Birthplace Choices:

Dr Jennifer Hollowell (Principal Investigators, NPEU)

Dr Rachel Rowe (NPEU)

Dr Kirstie Coxon (King’s College London)

Dr Lisa Hinton*(Health Experiences Research Group)

Miranda Dodwell*(BirthChoiceUK)                                                                                                                                

NIHR Public Health Research Programme: A two arm feasibility trial of lifestyle information and Slimming World groups to promote weight management and positive lifestyle behaviour in postnatal women (the SWAN feasibility study).  Professor Debra Bick    
Daiwa Anglo-Japanese Foundation Award. Debra Bick (joint PI), Developing a collaborative research programme to support breastfeeding in UK and Japan.  Professor Debra Bick
Stefanou Foundation: Healthy Relationships: Healthy Baby (HRHB) programme.  K.Trevallion (PI), L.Howard, D.Bick, S.Byford, M.Hesslin. Professor Debra Bick
The Burdett Trust for Nursing: Empowering midwives and health visitors to reduce maternal and child obesity through tailored breastfeeding support: a co-designed pilot study. Funded by The Burdett Trust for Nursing Maternal and Childhood Obesity Empowerment Programme. Professor Debra Bick
NIHR Programme Grant for Applied Research: Antenatal Prophylactic Pelvic floor Exercises And Localisation (APPEAL) Programme.  Professor Debra Bick
BIG Lottery: Fulfilling Lives: A Better Start: Evaluation and Learning Contract.  Professor Debra Bick
NIHR Programme Grant for Applied Research: The effectiveness and cost effectiveness of perinatal mental health services.   Professor Debra Bick

Research infrastructure programmes include:

Guy’s and St Thomas and Maudsley Charity, King’s Improvement Science Capacity Building Programme, 2014-2019

Professor Jane Sandall

King's Improvement Science Team

NIHR South London Collaboration for Leadership in Applied Health Research and Care, 2014-2019

Improving the management of medical problems in pregnancy, and preterm labour where the overarching goal is to assess the effectiveness and implementation of new care pathways, technologies to improve overall outcomes for pregnant women and their children. 

 Professor Jane Sandall                                                                                                                                       

 

 

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Professor Jane Sandall
Ms Annette Briley
Professor Debra Bick
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Dr Nicola Mackintosh

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Dr Abigail Easter
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Dr James Harris
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Dr Euan Sadler

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Dr Alexandra Zeimann

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Professor Andrew Shennan
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Professor Susan Bewley

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Professor Lucy Chappell

Professor Seeromanie Harding

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Dr Rachel Tribe

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Paul Seed

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Dharmintra Pasupathy

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Doctoral Students
 

Supervised by Professor Jane Sandall

Supervised by Professor Debra Bick

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We already have a substantial track record of policy engagement and related research impact in maternal health. For example, our research on maternal postnatal health which includes (for example) identification and management of commonly experienced maternal morbidity, revisions to models of care leading to more clinically and cost effective outcomes of community based midwifery-led postnatal care,  increased uptake of evidence into practice to manage perineal trauma and use of mobile epidurals in labour to increase spontaneous vaginal birth, has influenced policy and practice in the UK and internationally, including NICE and WHO guidance. We were the first to demonstrate how postnatal health problems affected women and how clinical care could be improved and costs reduced by redesigning community services  (i) . Our guidelines on postnatal health have been translated into several languages. Several members of group were involved in the recent MOH report on Women’s Health focusing on the importance of a life course approach (ii)(iii).  Our work to support implementation of evidence-based management of birth related perineal trauma (MaternityPEARLS) is a core e-learning module hosted by The Royal College of Obstetricians and Gynaecologists and The Royal College of Midwives. Debra Bick is leading a work group to support postnatal care for the NHS England Strategic Clinical Network for London.  

Our Cochrane review on midwife-led models of continuity of care for childbearing women and their infantsc (iv) is the 7th most cited Cochrane review, was identified as a priority review by WHO and has informed changes in policy and services in UK Policy Reviews and NHS guidelines and reviews of maternity services in the USA, Brazil and Australia and Canada which suggest a scale-up of models of midwife-led care on the grounds of improved quality and safety. The review was drawn upon by the Better Birth Initiative led by the Royal College Midwives, the Ministerial group developing a new 10 year maternity strategy for Ireland, by the NHS England five year forward view maternity strategy and was cited in both publications. Sandall leads a workgroup developing a toolkit and metric to measure on continuity of care rolled out by NHS England Strategic Clinical Network for London in June 2015 based on the above evidence. Our research on maternity staffing and skill mix was a major evidence source cited in NICE guideline NG4 Safe midwifery staffing for maternity settings. Lancet series on Midwifery which aimed to inform future workforce and health system development MDG plans for the future. The review informs our programme of work in CLAHRC South London regarding improving outcomes for Women with social and medical complexity and ongoing research and modelling of longer term economic impact on preterm birth prevention (v).

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Outreach

Working with the public through charities 

Project Re-Assure : Emboldening women to share their safety concerns about life threatening illness, and enabling maternity response

  • PI Nicola Mackintosh
  • CI Jane Sandall
  • James Harris

Funded by King’s Cultural Institute, we are working with an artist to develop an animation helping women to speak up about safety concerns in pregnancy and after childbirth. Sands and Tommy’s are supporting the project and have been helping us to recruit women to the workshops to help develop the storyboard for the film. APEC and Mama Academy have also posted information about our project on their facebook pages and helped us to recruit women.


 

PPI groups

The CLAHRC Maternity and Women’s Health theme supports engagement activities led by Mary Newburn (Theme PPI lead). We link with specialist PPI groups focusing on hypertension and preterm birth research and liaise with MSLC and Healthwatch England representatives in South London. CLAHRC have also supported setting up a South London MSLC facebook group.

Other work streams which have active research in progress, including the SWAN feasibility trial and the Burdett Trust breastfeeding study have the support of Expert PPI groups which work alongside the core project teams.


 

Voluntary work

Jane Sandall:

  • Deputy Chair, and elected member of the RCM Board and Trustees
  • NCT Research advisory group member
  • Associate Editor, Midwifery
  • Editorial board member, Birth:Issues in Perinatal Care
  • Associate editor, BMC Pregnancy and Birth
  • Editorial board member, Reproductive BioMedicine and Society

Debra Bick

  • Advisory Group member, National and Perinatal Independent Audit 
  • Editor in Chief, Midwifery journal 
  • Editorial board member.World, Views in Evidence Based Nursing
  • Deputy Chair ‘HealthWatch’: an independent charity for science and integrity in medicine
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Working with... 

International Collaborators

 

 Jane Sandall

  • Adjunct Professor, Faculty of Nursing, Midwifery and Health, University of Technology, Sydney
  • Senior Advisor Centre for Cultures of Reproduction, Technologies and Health, Sussex University
  • Department of Maternal and Child Health Public Health School, University of San Paulo, Brazil
  • National School of Public Health, Oswaldo Cruz Foundation, Ministry of Health, Rio, Brazil.

Debra Bick

  • School of Nursing, University of Sao Paulo
  • School of Public Health, University of Sao Paulo
  • Department of Nursing, Kyoto University
  • School of Nursing and Midwifery, University of Western Sydney                                                      

 

 

 

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