Browsing by Author "NMPA Project Team"

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    Blood stream infections in NHS Maternity and Perinatal Care for women and their babies: a feasibility report of linking maternity, neonatal and infection datasets in England. London: RCOG; 2023
    (Royal college of Obstetrics and Gynaecology, 2023-02-27) Webster, K.; NMPA Project Team
    The aim of this report was to link datasets that contain information about mothers, their babies, and infection data. The NMPA has been unable to obtain linked datasets within the timeframe of the audit programme contract, which ended on 31 December 2022. Therefore, this report focusses on how important it is to join together the datasets that hold different information about infections during and after pregnancy in women and birthing people and their babies. For example, data collected about pregnancy, labour and birth, information about infections and data about admissions to hospital. Had the joined dataset been available, this could have been used to look at aspects of maternity care and outcomes specifically for women and birthing people who had a bloodstream infection during pregnancy or in the six weeks after birth; and for babies who had a bloodstream or CSF infection in the first 3 days of life. Ongoing linkage of these datasets could be used for longer term surveillance of infection and antimicrobial use in women and birthing people, and babies
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    National Maternity and Perinatal Audit. Ethnic and Socio-economic inequalities in NHS maternity and perinatal care for women and their babies. Assessing care using data from births between 1 April 2015 and 31 March 2018 across England, Scotland and Wales.
    (RCOG, 2021-11-18) NMPA Project Team; Webster, K.; Carroll, F.; Coe, M.; Dunn, G.; Fremeaux, A.; Gurol-Urganci, I.; Jardine, J.; Karia, A.; Muller, P.; Relph, S.; Waite, L.; Harris, Tina; Hawdon, J.; Oddie, S.; Khalil, A.; van der Meulen, J.
    Executive summary Introduction The purpose of this report is to describe inequalities in maternity and perinatal care for women and their babies in England, Scotland and Wales during the period 1 April 2015 to 31 March 2018. Using routinely collected data, care and outcomes experienced by women and babies using NHS maternity services are measured and stratified by ethnicity and by Index of Multiple Deprivation (IMD), a proxy for socio-economic deprivation. This report focuses on the following maternal measures: ● caesarean birth (presented as elective, emergency and both combined) ● birth without intervention ● major postpartum haemorrhage (1500 ml or more) and the following perinatal measures: ● an Apgar score of less than 7 at 5 minutes ● breast milk at first feed ● neonatal unit admission at term. Methods This report uses existing NMPA linked datasets. Ethnicity is coded using the Office for National Statistics (ONS) 2001 census categorisation of 16+1 codes for ethnicity,2 grouped into white, South Asian, Black and Other (comprising ‘Mixed’ and ‘Other’ combined). Socio-economic deprivation is measured using the Index of Multiple Deprivation (IMD), an area-based measurement of multiple deprivation calculated for each lower-layer super output area (LSOA) in England and Wales, and data zone in Scotland.3 IMD is based on residential postcode and grouped into quintiles of national distribution (quintile 1 = least deprived to quintile 5 = most deprived) for analysis. Results for each maternal and perinatal measure are reported by the mother’s ethnic group and IMD quintile. The results presented in this report are crude and therefore descriptive. The results do not take into account the interactions that contributory factors, such as parity, age, pre-existing co-morbidities, ethnicity and deprivation may have on each other, the complexities of which are not easily interpreted in an audit report such as this. An advisory group comprising professionals and a diverse range of service user representatives with experience of accessing maternity care was involved in the sprint audit. The advisory group was involved in the choice of measures for inclusion in this report, interpretation of results, identifying key messages, and reviewing the draft report and recommendations. Key findings Our results demonstrate differences in outcomes of maternity and perinatal care among women and birthing people, and their babies, via comparisons between those living in the most deprived and the least deprived areas in Great Britain, and in those from ethnic minority groups versus white ethnic groups. Women from South Asian and Black ethnic groups and those from the most deprived areas had higher rates of hypertension and diabetes when compared with women from white ethnic groups and those in the least deprived areas. Smoking was considerably higher among women and birthing people from white ethnic groups and those in the most deprived quintile. Women from Black ethnic groups had a higher rate of experiencing a birth without intervention. While this may be desirable in many situations, it may also represent circumstances where interventions are desired or indicated but do not occur. Rates of caesarean birth (both elective and emergency combined) and rates of emergency caesarean birth were highest for women from Black ethnic groups and higher for women from South Asian groups when compared with those from white ethnic groups. Women and birthing people from Black ethnic groups had higher rates of major postpartum haemorrhage (1500 ml or more) when compared with women and birthing people from white ethnic groups. In contrast to the usual association of increased deprivation with increased morbidity, a decreasing trend for major postpartum haemorrhage (1500 ml or more) was observed from the least to most deprived. Babies born to women from South Asian ethnic groups were less likely to have an Apgar score of less than 7 at 5 minutes but were more likely to be admitted to a neonatal unit at term when compared with babies born to women from white ethnic groups. Babies born to women from Black ethnic groups were more likely to be assessed as having an Apgar score of less than 7 at 5 minutes and were more likely to be admitted to a neonatal unit at term when compared with babies born to women from white ethnic groups. Rates of receiving breast milk at their first feed were significantly lower for babies born to white women and to those living in the most deprived areas. We also found areas of concern with regard to data completeness and rates of missing data by ethnic group and IMD. Our results show 1 in 10 women and birthing people in Great Britain (1 in 5 in Scotland) did not have their ethnic group recorded, and IMD was missing for 6%. Recommendations R1 Target efforts for a life-course approach to improve the health of people, addressing the wider social determinants of health as well as specific health-related risk factors. Offer individualised preconception and antenatal information tailored to their circumstances, including BMI, smoking, pre-existing comorbidities (hypertension and type 2 diabetes) and whether this is their first birth or they have previously had a caesarean birth. (Audience: Healthcare professionals working in maternity services, maternity services providers, general practitioners, primary care providers, public health policy makers) R2 Target efforts to reduce smoking. Audit rates of carbon monoxide testing and referrals for smoking cessation for women during pregnancy, and audit compliance with monitoring for fetal growth restriction. (Audience: Healthcare professionals working in maternity services, maternity services providers, general practitioners, primary care providers, stop smoking services, public health policy makers) R3 Support research and investigation into why women from ethnic minority groups and more deprived areas have higher rates of stillbirth, taking into consideration differences in care, specific risk factors and the wider determinants of health. (Audience: National Institute for Health Research, Health and Care Research Wales and NHS Research Scotland in consultation with the Royal College of Obstetricians and Gynaecologists and policy makers, service planners/commissioners, service managers and healthcare professionals working for maternity services) R4 Improve availability and quality of information about choices during pregnancy and labour, with particular attention to the development of evidence-based shared decision-making tools for place, mode and timing of birth and pain relief options. Consider using the IDECIDE tool (when available). (Audience: Healthcare professionals working in maternity services, maternity services providers, NHS England, NHS Scotland, NHS Wales) R5 Avoid term admissions to a neonatal unit through improving transitional care provision, by establishing facilities where they are not currently available; or in hospitals that do have transitional care facilities, by expanding cot space availability and increasing numbers of appropriately trained staff. (Audience: Maternity and neonatal services providers) R6 Offer all women breastfeeding information and support, and target support in specific areas where breastfeeding rates are lowest (see also Priority 4c, intervention 3 of the Equity and Equality: Guidance for Local Maternity Systems). (Audience: Healthcare professionals working in maternity services, health visitors, primary care providers, maternity care services) R7 Review equality and diversity training provision and update to include the risks associated with deprivation, and how to recognise and avoid unconscious bias (see also Priority 4d, intervention 1 of the Equity and Equality: Guidance for Local Maternity Systems). (Audience: Local trusts and health boards, medical Royal Colleges, Royal Colleges of Nursing and Midwifery, General Medical Council, Nursing and Midwifery Council, Health and Care Professions Council, higher education institutions) R8 Ethnicity should be asked of and accurately recorded for all pregnant people using agreed ethnic group coding systems that should be updated regularly in accordance with the most current census groups. Consideration should be given to methods for self-reporting of ethnicity whenever possible (see also Priority 3, intervention 1 of the Equity and Equality: Guidance for Local Maternity Systems). (Audience: Healthcare professionals working in maternity services, maternity service providers, general practitioners, primary care providers, NHS England, NHS Scotland, NHS Wales) R9 Review the ethnic diversity and rates of socio-economic deprivation in the local area of each NHS trust or board and consider ways to reduce inequalities in healthcare outcomes (see also Priority 4, intervention 1 of the Equity and Equality: Guidance for Local Maternity Systems). (Audience: Local trusts and health boards, primary care providers, public health bodies, local government) R10 Prioritise further research in NHS maternity and perinatal care that could improve outcomes for women, and their babies, from ethnic minority groups and those in the most deprived areas. Undertaking quantitative analysis to investigate ethnic and socio-economic inequalities and report on the mediating factors and causal pathways; along with qualitative research to include exploring the experiences of people accessing maternity care. (Audience: National Institute for Health Research, UK Research and Innovation, Health and Care Research Wales and NHS Research Scotland in consultation with the Royal College of Obstetricians and Gynaecologists and policy makers, service planners/commissioners, service managers and healthcare professionals working for maternity services
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    Technical Report: Feasibility of evaluating perinatal mental health services using linked national maternity and mental health data sets, based on births between 1 April 2014 and 31 March 2017 in Scotland
    (RCOG, 2021-01-14) Langham, J; Gurol-Urganci, I; Dunn, G; Harris, Tina; Hawdon, J; Pasupathy, D; van der Meulen, J; NMPA Project Team
    Introduction In this short report, we describe the feasibility of using linked national data sets to evaluate perinatal mental health services. Perinatal mental health conditions are common. About 10% of pregnant women and 13% of women who have just given birth experience a mental health problem. Some perinatal mental health problems can, if not adequately treated, have significant and long-lasting effects on a woman and her baby. For this report, we only used Scottish data sources. The data sets include episodes of admission to secondary care, including hospital admission for perinatal mental health conditions. The results based on Scottish data are expected to inform future analyses of similar data from England and Wales. Specific data sets on mental health services in Wales were not yet available at the time of this study. The report consists of three parts. First, we describe the data sets that were used and how they were linked. Second, we present a grouping of mental health diagnoses that are similar with respect to their prognosis and treatment (to maximise the clinical relevance) while limiting the number of diagnosis groups (to maximise statistical power). Third, we use the results of this preparatory work to demonstrate the clinical relevance of the linked data sets by describing a number of clinical outcomes according to the timing of the perinatal mental health admissions. Methods We used linked national maternity and mental health data for Scotland on all births that took place between 1 April 2014 and 31 March 2017, and inpatient admissions for mental health conditions between 1 April 2000 and 31 March 2018. Births records were identified in the National Records of Scotland (NRS). These records were used as a ‘spine’ against which records from all other Scottish Morbidity Record (SMR) data sets were linked: general/acute inpatient records (SMR-01), maternity inpatient records (SMR-02), mental health inpatient records (SMR-04) and the Scottish Birth Record (SBR). Women who had a mental health admission were identified in SMR-04 data as well as in SMR-01 data if their admission record contained a diagnosis code from Chapter V (‘Mental and behaviour disorders’) of the International Classification of Disease, 10th Revision (ICD-10). Findings Both mental health inpatient data (SMR-04) and general/acute inpatient data (SMR-01) need to be used to identify women who had a hospital admission for mental health indications. We identified 3457 births in women who had a mental health admission. About two-thirds of the mental health admissions were identified in SMR-04 and about one-third in SMR-01. 163109 births were identified. 3043 (2.1%) of these births were in women with a prepregnancy history of a mental health admission. 176 (5.8%) of the women with prepregnancy mental health admission were also admitted during the perinatal period (during pregnancy or in the first year after giving birth). In comparison, only 414 (0.3%) of the 160066 births of women without a prepregnancy mental health admission had a perinatal mental health admission. Therefore, in the majority of cases Evaluating perinatal mental health services using linked national maternity and mental health data sets – 414 of the 590 perinatal mental health admissions (70.2%) – the perinatal mental health admission was a women’s first mental health admission. Diagnostic codes were grouped into eight diagnosis groups aiming to maximise the clinical relevance and statistical power. Based on this grouping, we found that major depressive disorders were the most frequently observed diagnoses (22.9%) among the 590 women with a perinatal mental health admission, followed by admissions for anxiety and post-traumatic stress disorders (19.3%). However, if we only considered the 176 women who had a perinatal mental health admission after a prepregnancy mental health admission, the most frequently observed diagnoses were related to psychoactive substance use (25.0%). Following this preparatory work, we demonstrated the clinical relevance of these data. Babies born to women with a prepregnancy history of perinatal health admission were found to be more likely to be preterm (12.0% born before 37 weeks), to have low birthweight (4.3% with birthweight below 2500 g in term babies) or to need some medical help (2.6% with an Apgar score less than 7 at 5 minutes after birth) than babies born to women without such a history (7.1%, 2.0%, and 1.7%, respectively). Outcomes in babies of women who had a perinatal mental health admission (590) were similar to those of women with a prepregnancy history of mental health admission (3043). Admission to an inpatient psychiatric mother-and-baby unit (MBU) was most frequent in women who had a mental health admission in the first 12 weeks after giving birth (79.5%) and considerably lower in women who had a mental health admission during pregnancy (23.7%) or between 13 and 52 weeks after giving birth (38.1%). Conclusions This study demonstrates the feasibility as well as the clinical relevance of using linked national maternity and mental health data sets from Scotland to assess the care that women with perinatal mental health problems receive. Despite only identifying women with severe perinatal mental health conditions, linkage of data sets of secondary care admission will offer an important opportunity to monitor the impact of national initiatives to improve perinatal mental health services in all four nations of the UK.
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    Waterbirth: a national retrospective cohort study of factors associated with its use among women in England
    (BMC Pregnancy and Childbirth, 2021-03-26) Aughey, H.; Jardine, J.; Moitt, N.; Fearon, Kriss; Jawdon, J.; Pasupathy, D.; Urganci, I.; NMPA Project Team; Harris, Tina
    Background Waterbirth is widely available in English maternity settings for women who are not at increased risk of complications during labour. Immersion in water during labour is associated with a number of maternal benefits. However for birth in water the situation is less clear, with conclusive evidence on safety lacking and little known about the characteristics of women who give birth in water. This retrospective cohort study uses electronic data routinely collected in the course of maternity care in England in 2015–16 to describe the proportion of births recorded as having occurred in water, the characteristics of women who experienced waterbirth and the odds of key maternal and neonatal complications associated with giving birth in water. Methods Data were obtained from three population level electronic datasets linked together for the purposes of a national audit of maternity care. The study cohort included women who had no risk factors requiring them to give birth in an obstetric unit according to national guidelines. Multivariate logistic regression models were used to examine maternal (postpartum haemorrhage of 1500mls or more, obstetric anal sphincter injury (OASI)) and neonatal (Apgar score less than 7, neonatal unit admission) outcomes associated with waterbirth. Results 46,088 low and intermediate risk singleton term spontaneous vaginal births in 35 NHS Trusts in England were included in the analysis cohort. Of these 6264 (13.6%) were recorded as having occurred in water. Waterbirth was more likely in older women up to the age of 40 (adjusted odds ratio (adjOR) for age group 35–39 1.27, 95% confidence interval (1.15,1.41)) and less common in women under 25 (adjOR 18–24 0.76 (0.70, 0.82)), those of higher parity (parity ≥3 adjOR 0.56 (0.47,0.66)) or who were obese (BMI 30–34.9 adjOR 0.77 (0.70,0.85)). Waterbirth was also less likely in black (adjOR 0.42 (0.36, 0.51)) and Asian (adjOR 0.26 (0.23,0.30)) women and in those from areas of increased socioeconomic deprivation (most affluent versus least affluent areas adjOR 0.47 (0.43, 0.52)). There was no association between delivery in water and low Apgar score (adjOR 0.95 (0.66,1.36)) or incidence of OASI (adjOR 1.00 (0.86,1.16)). There was an association between waterbirth and reduced incidence of postpartum haemorrhage (adjOR 0.68 (0.51,0.90)) and neonatal unit admission (adjOR 0.65 (0.53,0.78)). Conclusions In this large observational cohort study, there was no association between waterbirth and specific adverse outcomes for either the mother or the baby. There was evidence that white women from higher socioeconomic backgrounds were more likely to be recorded as giving birth in water. Maternity services should focus on ensuring equitable access to waterbirth.
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    Waterbirth: characteristics and outcomes in low risk women and babies: a retrospective population cohort study in England 2015/16.
    (Trinity Health and Education International Research Conference 2020 (THEconf2020). Integrated Healthcare: Developing Person-centred Health Systems. March 4-5th 2020 Dublin, Ireland . Trinity College, Dublin, 2020-03-05) Aughey, Harriet; Jardine, Jen; Blotkamp, Andrea; Harris, Tina; NMPA Project Team
    Background Little is known about the incidence of delivery in water and concerns have been raised about the effects of waterbirth on women and their babies as it becomes more popular. Aims and objectives of the study To identify the proportion of low risk women who give birth in water. To compare the characteristics and outcomes of low risk women and their babies who give birth in water with women who do not. Methods Ethical approval was not required as data from maternity information systems was linked to Hospital Episode Statistics for births in England from 1/4/15 -31/3/16. The cohort was restricted to singleton, term vaginal livebirths without instrument, in women with no risk factors requiring obstetric care, in trusts with complete data for birth in water. Multivariate logistic regression models were used to examine maternal characteristics and outcomes (PPH ≥1500ml, OASI) and neonatal outcomes (Apgar <7 at 5 mins, NNU admission). Findings Of 52,476 births, 7099 (13.5%) were recorded as having occurred in water. Water birth was more likely in older women (adjOR for age group 30-34 1.3, 95% CI (1.2,1.5), 35-39 1.3 (1.1,1.4)) and less likely in women of black (adjOR 0.42 (0.35, 0.94)) or Asian (0.26 (0.23, 0.31)) ethnicity, or of lower socioeconomic status (lowest quintile, adjOR 0.50 (0.45-0.55)). There was no association between delivery in water and low Apgar score (adjOR 0.99 (0.70,1.39)) or OASI (adjOR 1.09 (0.94,1.28)). There was a small association with reduced admission to a NNU (adjOR 0.91 (0.84,0.99)) and PPH (adjOR 0.69 (0.53,0.89)); however, in a subset who gave birth in a midwife-led setting, this effect did not persist. Conclusions and implications There is no evidence of harm to the mother (PPH, OASI) or the baby (low Apgar, NNU admission) from waterbirth. Small differences in rates of admission to NNU and PPH may be explained by unmeasured confounding variables from events during labour. Why some groups of women are less likely to experience waterbirth may reflect women‘s choice, or inequitable access.