REF2021 03Z_ICS_B: Complex and Multiple Birth: Enhancing guidance, practice and understanding

    Impact: Health impacts, Quality of life impacts, Public Policy or Services impacts

    Description of impact

    Birmingham City University’s research on complex and multiple birth experiences enhanced clinical care guidance and practice. The first (2017) NICE guidance on preterm birth follow-up care cites BCU research to improve care for the estimated 95,000 babies admitted to a neonatal unit in the UK. The research led to improved care pathways for multiple birth families at one NHS Trust and to a 10% reduction in post-caesarean section infection rates at another. It featured in a BBC video on caesarean sections with over 1.7 million views worldwide and raised public understanding about multiple birth families through the Library of Birmingham’s “Multiple Realities” exhibition seen by an estimated 78,750 visitors.

    Details of Impact

    Preterm Births: Enhancing National Clinical Guidance
    Harvey’s ePrime research informed (2017) NICE guidance, the NG72: Developmental Follow-up of Children and Young People Born Preterm [S01]. Extensively citing R01, the NG72 recommends health practitioners support parents by providing information about “the unit and routine neonatal intensive care unit care,” “care of the infant,” and “long-term prognosis” of babies, as well as by “giving the right amount of information” (to not ‘overwhelm’ parents) [S01: p. 468-493]. The Chief Executive of Bliss, a charity for babies born premature or sick and a named supporting organisation in the NG72 quality standard (QS169), states, “Professor Harvey’s ePrime study informs guidance on the information provision to parents and carers… Babies born premature have the best long-term outcomes when their parents are fully informed about, and involved in, their decision-making and care, both during their time on the neonatal unit and in the years afterwards. Having access to clear, evidence-based information is key to parents being able to fulfil this role” [S02]. The NG72, the first of guidance of its kind, provides clear and comprehensive evidence to inform quality standards, setting out a framework for consistent high-quality follow-up care for the estimated 95,000 babies born preterm every year in the UK.

    Preterm Births: Enhancing Professionals’ Understandings and Practice
    Blackburn and Harvey disseminated pre-published [R02] findings at the (July 2017) BCU conference, ‘Born Early: Early Care and Education Experience of Children Born Prematurely,’ attended by health and education professionals. Anonymous survey feedback reflects professionals’ enhanced understandings of the needs of children born preterm and subsequent practice change [S03]. A Perinatal Clinical Psychologist reported they would use their enhanced knowledge to “ease transitions between ICU, HDU and Special Care or to Paediatric ICU” [Survey Response A16 in S03]. An education practitioner stated, “As a team we will ask all parents about whether their child was premature, and we will work with schools to educate them more fully about the impact of prematurity on their pupils with physical and neurological disorders” [Survey Response A10 in S03].

    Caesarean Section Births: Enhancing Clinical Practice and Public Understandings
    PREPS findings informed Reducing Infections in Obstetrics (RIO), Birmingham Women and Children’s Hospital’s (BWC) quality improvement initiative [S04]. The BWC Specialty Obstetrics and Gynaecology Registrar involved in the initiative, states the “RIO, informed by findings from PREPS (PI: Prof K Morris, University of Birmingham; Co-I’s Dr A Weckesser, Birmingham City University and Dr V Hodgetts Morton, BWC), entailed the implementation of an ‘Infection Prevention Bundle’” [S05]. PREPS evidence on the use of chlorhexidine in vaginal cleansing procedures [R03] and patients’ need for written information on preventing infection post caesarean section (CS) [R04] was incorporated into the Infection Prevention Bundle [S04: p.2]. BWC implemented the RIO from January 2019 and “by January 2020 the SSI (surgical site infection) rate had decreased by 10%” [ibid.]. A reduction of significance as the hospital’s SSI rate (21.08%) was twice that of the national average (9.6%) in 2018 [S04: p.1]. BWC delivers an average of 8,200 babies a year; approximately 30% of deliveries are by CS as the hospital attracts high-risk pregnancies from across the region. SSIs contribute to maternal morbidity and mortality and disrupt postnatal recovery, breastfeeding and infant-parent attachment. Reduced SSI rates are key to improving maternal health and neonatal wellbeing.

    Weckesser featured in a BBC educational video [S06], ‘C-Section Guilt: I felt like I’d failed’, sharing PREPS findings [R04] on women’s experiences of stigma and guilt following caesarean section. The BBC’s Senior Broadcast Journalist who produced the video states: “[The BBC] measures success with the discussion arising from the content as this means the audience was really engaged with the video. There were thousands of comments from women who said this video changed their perspective and made them feel less alone” [S07]. In September 2020, the video broadcasted on the BBC website, News Channel and social media outlets and “received 1,761,400 views across the BBC UK and international facing website, Facebook, Twitter and Instagram” [ibid.].

    Multiple Births: Enhancing Training, Practice and Understandings
    BCU research [R05-06 and more] led to, and forms the curriculum basis for, ‘The Individualised Care of Multiple Birth Families from Conception to 1 Year,’ CPD module for health professionals (Levels 6 &7). As a result of the module, an East & North Hertfordshire Trust (ENHT) Midwife created a continuous support pathway for women experiencing a multiple pregnancy within her Trust, for which she won the Chief Midwifery Officer Silver Award (2020) and was shortlisted for the Royal College of Midwives’ (2020) Johnson's Excellence in Maternity Care & Innovation [S08]. The ENHT Midwife states that “the research informed module has been significant in the success in improving our understanding of the unique support required by families of multiples, and has helped to shape and inform how we deliver our provision for these families” [ibid.].

    BCU multiple births research [R05-06 and more] led to the “Multiple Realities” photography exhibition. For the month of September 2019, the Library of Birmingham hosted the exhibition in the main entrance hall, through which approximately 78,750 visitors pass monthly. Anonymous attendee surveys demonstrate the exhibit improved understandings of the challenges faced by multiple birth families by those who do not have multiples in their immediate family [S09]. “[T]he exhibition made me think about the difficulties of raising twins and the loss involved with multiple births...” [Survey Response P26 in S09].

    BCU research [R05-06 and more], undertaken with the Elizabeth Bryan Multiple Births Centre (EBMBC) founded with the Multiple Births Foundation (an international authority on multiples) informed the (March 2020) Supporting Multiple Birth Families: Establishing an Evidence-Base to Inform Health Visitor Practice. The CEO of Twins Trust, the only UK-wide charity dedicated to supporting families of multiples, states “research by Professor Harvey and colleagues identified the need for Standards for Healthcare Specialists for Multiple Births to improve the quality of care provided to families. Their work ensures that the views and experiences of families are included within evidence based guidance” [S10].
    Impact date20112020
    Category of impactHealth impacts, Quality of life impacts, Public Policy or Services impacts