National Childbirth Trust

Objectives: To understand differences between birth expectations and experiences, and to explore possible reasons for mismatches. Design: Online survey Setting: UK Population: Postnatal primiparous (PP) and multiparous (MP) women within 5 years of a birth Methods: Survey advertised on social media, Participants completed questions relating to birth expectations, experience and preparedness. Data were analysed descriptively and presented overall and by parity. Results: Of the 819 women, 40% expected birth to be straightforward [PP 29% vs MP 51%], 20% anticipated difficulty [PP 22% vs MP 19%], and 40% [PP 51% vs MP 30%] were unsure. Among the 737/819 whose birth was not exactly as expected, 44% [PP 30% vs MP 47%] found it better than expected, while 56% [PP 66% vs MP 38%] found it more difficult. Unplanned births were higher in those with difficult experiences, particularly for primiparous women [PP 58% vs MP 23%]. Women cited quicker births, fewer complications, and better coping as reasons for positive experiences, while complications, pain, and slower labour contributed to difficulties. Overall, 77% (633/819) [PP 64% vs MP 80%] of women felt very or somewhat prepared for birth. Among them, 76% (484/633) [PP 88% vs MP 69%] had attended antenatal education. However similarly, 75% (130/174) [PP 80% vs MP 66%] of those who felt less prepared had also attended antenatal education. Conclusions: Most women have an element of expectation-experience mismatch. Over half in the found birth more difficult than expected, this suggests current approaches to birth preparation may be inadequate. Further research into reducing the expectations-experience gap is needed.

The ROTATE trial is a multi-centre randomised controlled trial of manual versus instrumental rotation of the fetal head in malposition at birth, to evaluate if manual compared with instrumental rotation reduces the risk of severe maternal perineal trauma, without increasing caesarean birth rates. ROTATE internal pilot phase ran from June 2022 to June 2023 with an embedded qualitative process evaluation (QPE). The QPE aimed to explore the feasibility, acceptability, and appropriateness of the trial for parents and healthcare professionals (HCPs). ROTATE had a two-stage consent process where verbal assent was sought prior to randomisation, and written consent was gained and recorded after the birth. This paper reports a secondary analysis of ROTATE QPE data focusing on gaining informed consent to trial entry in time-pressured maternity settings. Secondary analysis of data from semi-structured interviews with women (n = 9), their birth partners (n = 3), and HCPs (n = 11). Data were analysed using codebook thematic analysis. Parents and HCP reported that offering a clinical trial at late-stage labour added additional complexities and challenges at a time-pressured period of their labour and birth. Using a layered approach to trial offering, where the trial information was shared prior to full eligibility, and discussed with multiple trusted HCPs, meant clinical trial approaches in late-stage labour can be anticipated. HCPs were concerned whether parents would recall conversations and decision-making about trial entry when they had been under physical and psychological stress in the second stage of labour. The two-stage consent process for ROTATE, using pre-randomisation verbal assent, with post-randomisation and post-birth written consent was considered acceptable to parents and pragmatic for HCPs delivering the trial. Gaining subsequent written consent, combined with appropriate birth partner support at the time of trial approach, was considered supportive of autonomous decision-making for women/birthing parents. Clinical trial approaches in time-pressured maternity settings may be ethically challenging and add additional complexities at an already stressful time. A two-stage consent process, and early, layered information about the potential for participation in intrapartum clinical trials, supported informed consent and autonomous decision-making for women/birthing parents. ISRCTN10193017. Registered on 24 November 2022.

Abstract Background Pre-eclampsia is a multisystem disorder affecting 2.8% of pregnancies in the UK. It usually presents after 20-week gestation with new-onset high blood pressure and proteinuria. Complications include eclampsia, stroke, and HELLP syndrome for the mother and preterm birth, fetal growth restriction, and stillbirth for the baby. Delivery is the only definitive cure, with antenatal care focusing on early detection and management of complications and optimising timing of delivery. Previous studies have shown calcium supplementation may reduce the risk of pre-eclampsia, but findings are driven by large effects seen in small trials that have not been replicated in larger trials. Subgroup analysis suggests benefits may only be seen in women with low dietary calcium intake, so findings may not be applicable to populations with adequate dietary calcium. Although the largest benefits appear to be in high-risk women, data are very limited, with no large trials conducted. Methods CaPE is a two-arm parallel triple-blinded, placebo-controlled, multicentre, superiority randomised controlled trial testing the hypothesis that in pregnant women at increased risk, calcium supplementation is effective in reducing the occurrence of pre-eclampsia. The study will recruit 7756 women from approximately 60 obstetric units in hospitals across the UK. Women with a confirmed viable pregnancy, with gestation 22 + 0 weeks or less and deemed eligible for aspirin therapy based on either NICE guideline criteria (at least one high-risk factor or two or more moderate risk factors) or the Fetal Medicine Foundation (FMF) algorithm will be eligible to be randomised in a 1:1 ratio to receive either 2 g per day of calcium supplementation or placebo taken from 12 to 22 weeks, up to birth. The primary outcome is clinician diagnosis of pre-eclampsia, based on the ISSHP definition. Key secondary outcomes are severe pre-eclampsia index and preterm birth < 37 weeks; other secondary outcomes include the Pre-eclampsia Core Outcome Set (COS). Discussion Calcium supplementation in high-risk women is an attractive intervention due to its potential efficacy, low cost, and safety profile, but a definitive trial is required to confirm benefits. Trial registration ISRCTN 12033893. Registered on 25 May 2021.

INTRODUCTION:Antenatal education (ANE) equips pregnant women with knowledge and skills for pregnancy, birth, and the postnatal period. It should facilitate preparation for the whole spectrum of the maternal journey and empower women to make informed decisions. This study aimed to explore the antenatal education needs and preferences of women who are currently pregnant or planning a pregnancy. METHODS:A UK wide cross-sectional survey was conducted (September 2019 to July 2020), recruiting women living in the UK, above 16, who were currently pregnant or planning a pregnancy. The survey gathered demographic information, details of current or planned class attendance, preferred ANE providers and desired skills and information. Quantitative data were analysed descriptively, and free-text responses underwent thematic analysis. RESULTS:Of 553 participants included in the analyses, 77% preferred free National Health Service (NHS) classes and 60% planned to attend multiple class types, including paid options. Participants valued practical skills, particularly for labour and the postpartum period, and actively sought perinatal social networks. Multiparous women were less likely to attend classes, citing prior experience or practical barriers. Despite high interest in NHS classes, regional variations in availability and limited accessibility were noted. CONCLUSION:NHS antenatal classes are a trusted source of ANE, forming a core element of many women's antenatal journey. However, inconsistent provision highlights the need for a standardised, comprehensive curriculum. Flexible delivery models and tailored content are crucial to address diverse needs, particularly for multiparous women and underrepresented groups. Enhanced accessibility could reduce inequalities in ANE provision and improve maternal outcomes.

Introduction It is unclear whether routine testing of women for group B streptococcus (GBS) colonisation either in late pregnancy or during labour reduces early-onset neonatal sepsis, compared with a risk factor-based strategy.Methods and analysis Cluster randomised trial.Sites and participants 320 000 women from up to 80 hospital maternity units.Strategies Sites will be randomised 1:1 to a routine testing strategy or the risk factor-based strategy, using a web-based minimisation algorithm. A second-level randomisation allocates routine testing sites to either antenatal enriched culture medium testing or intrapartum rapid testing. Intrapartum antibiotic prophylaxis will be offered if a test is positive for GBS, or if a maternal risk factor for early-onset GBS infection in her baby is identified before or during labour. Economic and acceptability evaluations will be embedded within the trial design.Outcomes The primary outcome is all-cause early (<7 days of birth) neonatal sepsis, defined as either a positive blood/cerebrospinal fluid culture, early neonatal death from infection or a negative/unknown culture status with ≥3 agreed clinical signs or symptoms, who receive intravenous antibiotics ≥5 days. All women giving birth ≥24 weeks’ gestation, regardless of mode of birth, and all her babies will be included in the dataset. Cost-effectiveness will be expressed in terms of incremental cost per case of early neonatal sepsis avoided and incremental cost per quality-adjusted life-year associated with each strategy.Ethics and dissemination The trial received a favourable opinion from Derby Research Ethics Committee on 16 September 2019 (19/EM/0253). The allocated testing strategy will be adopted as standard clinical practice by the site. Women in the routine testing sites will give verbal consent for the test. The trial will use routinely collected data retrieved from National Health Service databases, supplemented with limited participant-level collection of process outcomes. Individual written consent will not be sought. The trial results, and parallel economic, qualitative, implementation and methodological results, will be published in the journal Health Technology Assessment.Trial registration number ISRCTN49639731.