Sarah Chapman introduces Maternity Matters, Cochrane UK’s special series of blogs and other resources on women’s and babies’ health, during and after pregnancy and childbirth. Read the rest of the blogs in the ‘Maternity Matters’ series here.
Today we’re launching Maternity Matters, which will put the spotlight throughout August on some of the latest evidence on women’s and babies’ health, and on women’s experiences, from pregnancy through to the early days after birth. With ‘Maternity’ an NHS clinical priority, the series touches on some of the areas highlighted in Better Births and the NHS Long-Term Plan. We hope the blogs and other resources will be of particular interest to midwives and other healthcare professionals who care for women through pregnancy, childbirth and in the early days after birth; the women themselves, and the friends or family members who support them.
Professor Catherine Swann (@cjswannPHE), Deputy Director of Maternity and Community at Public Health England, has welcomed the series:
“Basing maternity practice and policy on the best available evidence is vital for everyone. Evidence-based decisions help to ensure better outcomesOutcomes are measures of health (for example quality of life, pain, blood sugar levels) that can be used to assess the effectiveness and safety of a treatment or other intervention (for example a drug, surgery, or exercise). In research, the outcomes considered most important are ‘primary outcomes’ and those considered less important are ‘secondary outcomes’. for mums and babies, and knowing that practice is making appropriate use of current evidence will assure professionals and providers about the quality of their services. This series of blogs aims to highlight key evidence in a clear, accessible way and makes a helpful contribution to evidence-based maternity care.”
Charlene Cole (@charlMidwife), one of three midwives who co-ordinate the @WeMidwives tweetchats, has also commented on the importance of sharing and discussing the best available evidence and its implications for practice:
“The care that we give to women and their families must be infused with kindness and compassion, and underpinned by a sound, high quality evidence-base. Evidence-based practice is the foundation of excellent maternity services and ensures that women receive the most effective care. Adapting to change and keeping up to date with the latest evidence is a crucial part of the midwife’s role.”
We’re looking forward to co-hosting a tweetchat with @WeMidwives at 8pm BST on Tuesday 3rd September, inviting reflections on the series. Details coming soon.
What’s coming up on the blog?
It’s the start of World Breastfeeding Week, so tomorrow we’ll share Cochrane evidenceCochrane Reviews are systematic reviews. In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. on supporting breastfeeding through blogs, blogshots (mini-infographics), podcasts and other resources. Collected together on one page, here on Evidently Cochrane, you’ll find evidence on support and care for breastfeeding women, including treatmentSomething done with the aim of improving health or relieving suffering. For example, medicines, surgery, psychological and physical therapies, diet and exercise changes. of breastfeeding associated problems; health promotion and an enabling environment; and breastfeeding babies with additional needs.
Next week we are turning our attention to the devastating experience of baby loss. Sarah Bailey blogs about her recent research on women’s experiences of early pregnancy after recurrent miscarriage, work undertaken as part of developing a supportive service designed around their needs. Susannah Hopkins Leisher reflects on the trauma of her first child, Wilder, being stillborn and the impact on her subsequent pregnancies. Together with researcher Aleena Wojcieszek, they look at gaps in the evidence on how to care for such women and their families. We realise that some people may find the content upsetting but feel that discussing baby loss and highlighting where evidence exists and where it is lacking is important. Listening to women and their families and learning from their experiences is essential for improving care. We are grateful to Susannah for sharing her story here and to the women who agreed to be interviewed by Sarah and her colleagues.
We couldn’t have a series on maternity without addressing the crucial topic of continuity of care. We will have a blog from researcher and midwife Jane Sandall, lead author of the influential Cochrane Review on midwife-led continuity models versus other models of care on how midwife-led continuity of care helps women and babies and what some of the challenges are. Researcher Meghan Bohren will also be looking at implementation in her blog on labour companionship.
New evidence has been published recently on promoting smoking cessation in pregnancy, adding to earlier reviews about different approaches, and Cochrane authors Jonathan Livingstone-Banks and Catherine Chamberlain will be writing about these. There is also new evidence on vitamin D supplementation in pregnancy and Emily Carter, obstetrician and gynaecology specialist registrar, looks at this in her blog.
Finally, midwife and researcher Linda Biesty, blogs about the latest Cochrane evidence on managing the third stage of labour and whether it’s better to offer active or expectant management of care.
We’ll be publishing blogs on Fridays and Tuesdays from 1st to 27th August and sharing lots of relevant evidence summaries on social media throughout the month. Do join in the conversation, by leaving comments on the blogs or talking to us on Twitter @CochraneUK #MaternityMatters.
Looking forward to joining in the conversation. #MaternityMatters
Be great for some more info and stats surrounding VBAC, particularly following 2 previous Caesarean births. This is a topic that my area are currently struggling with support of from the obstetric team.
Thank you for your comment. Informed counselling for women considering VBAC is essential so that they are aware of both the risks and benefits of VBAC vs elective Caesarean section. There may be factors which increase the chance of successful vaginal birth, and other factors which increase the risk of uterine rupture, both of which are specific to the woman’s obstetric history. Therefore it is important to discuss your individualised risk with your obstetrician.
It is true that there is less evidence available for women who have undergone two Caesarean sections. Whist we know the risks of rupture are higher, and chance of success may be lower, again this is likely to depend somewhat on your obstetric history, risk factors, and whether you have ever achieved a vaginal birth before. Because we don’t have robust evidence to confirm its safety, in practice, obstetricians may counsel for caesarean section in this circumstance. However this is a discussion to be had face to face with an expert and it is always the mother’s final decision.
It is also true that women who labour spontaneously have higher chances of achieving a vaginal birth than those who are induced.
There is a very useful patient information leaflet from the RCOG on this topic:
And the full VBAC guideline from the RCOG: