Research group lead: Professor Christine McCourt
Our research focuses on evaluating models of maternity, child and family services and care. Our work aims to improve care through rigorous studies using a range of methodologies with an emphasis on evidence-based care, appropriate uses of technology, service change and development and professional and user experience issues. This theme also has a strong inter-disciplinary thread of applying social science concepts and epidemiological approaches to clinical and organisational issues. Much of our work adopts a critical theory perspective and takes account of the complexity of healthcare interventions and contexts.
We are currently involved in a range of research projects and programmes on issues such as implementation of evidence based practice in maternity care, implementing NICE guidance on birth in different settings, factors influencing the uptake of midwifery units, trialling of home monitoring of blood pressure, development and trial of a group model of ante- and postnatal care – Pregnancy Circles (see projects), inter-professional relationships and retention in midwifery and health visiting (COPE study – see projects) and analysis of maternity outcomes by time of day and day of the week. Areas of interest within the group include concepts of choice, risk and safety and their relationship with service delivery and change, professionalisation processes and experiences, gender and healthcare and concepts of motherhood, childhood and the family. Our work is funded by a range of sources, including the National Institute for Health Research, the European Union and the Medical Research Council.
Our findings have been published in high impact journals and presented at conferences around the world. We have established links with a range of user, professional and policy organisations and university departments at local, national and international levels. Our work has influenced the development of maternity services throughout the United Kingdom (UK) and internationally, and has influenced health policy and guidelines in this area.
For more information these projects please visit the Centre for Maternal and Child Health Research blog.
This research programme, funded by the National Institute for Health Research, is investigating whether giving pregnant women the means to monitor their own blood pressure and urine safely from home, in addition to the usual clinic monitoring, can result in an earlier diagnosis of raised blood pressure and pre-eclampsia. We are also investigating the acceptability and practicality of this approach from women’s and professionals’ viewpoints and any impact on women’s experiences of their pregnancy.
The rationale of this study derives from the reported low percentage of women having their babies in midwifery units (MU) despite the good evidence that suggests for women with uncomplicated pregnancies, having a baby in a MU results in better outcomes and is cheaper in comparison to having a baby on a traditional labour ward. Therefore, this study aimed to explore factors influencing the utilisation of midwifery units (MU) in England. This projected is now completed and findings will be published in 2019. Two articles on aspects of the findings were published in 2018.
The Research for Equitable Antenatal Care and Health (REACH) Pregnancy Circles study is the largest randomized controlled trial of group antenatal care undertaken internationally to date, and is the first to take place in the NHS. It aims to explore whether group antenatal care can improve the outcomes and the wellbeing of mothers and babies and is due to report findings in 2022. City, University of London is involved in the implementation of the trial and is leading on the process evaluation. A number of City Masters and PhD students have worked with the REACH team and City has also developed training in group care facilitation for midwives both as stand-alone workshops and a Masters module.
Hunter L, Da Motta G, McCourt C, Wiseman O, Rayment J, Haora P, Wiggins M and Harden A (2018). 'It makes sense and it works': maternity care providers' perspectives on the feasibility of group antenatal care (Pregnancy Circles). Midwifery 66 (2018) 56-63
Hunter L, Da Motta G, McCourt C, Wiseman O, Rayment J, Haora P, Wiggins M and Harden A (2018). Better together: a qualitative exploration of women’s perceptions and experiences of group antenatal care. Women and Birth 32 (2019) 336–345.
Wiseman O, Hunter L, Robinson H, Leap N, Mackeith N on behalf of the REACH Pregnancy Programme team (2017) Advancing Practice: Facilitating group antenatal care: a new way of working. The Practising Midwife 20(9):18-20
The aim of this study is to develop and evaluate a theoretically informed knowledge implementation pathway that service providers and commissioners can use as a guide to implement evidence on birthplace into NHS services which require complex organisational and professional practice change.
This study has been completed and is in the analysis stage.
The aim of this project is to enhance collaboration amongst healthcare professionals delivering care for women and their families during and after pregnancy.
Prostaglandin insert (Propess) versus trans-cervical balloon catheter for out-patient labour induction: A Randomized Controlled Trial of Feasibility (PROBIT – F)
This is a study of the feasibility and implications of conducting full-scale randomised controlled trial of an innovative method of induction of labour. Women who are booked for induction are randomised to receive either a prostaglandin pessary or a trans-cervical balloon catheter to start the induction of labour process. The aim is to compare how well these methods of labour induction work, which is the safest and least expensive method, and which is more acceptable to and favoured by women.
As part of this project, a systematic review has also been conducted of women’s experiences of induction of labour:
Coates, R, Cupples, G, Foya V, McCourt C, Scamell M. 2018. Women's experiences of induction of labour: qualitative systematic review and thematic synthesis. Midwifery, 2018-10.
Eating and Moving in Adolescent Pregnancy (EMAP)
This is a qualitative study involving interviews with healthcare professionals to understand their experiences of working with young mothers. Furthermore, with young mothers to understand their experiences in eating and moving during and after pregnancy.
Screening for Tuberculosis in Pregnancy Study (STOP)
This study is an observational feasibility study with a nested qualitative study, taking place in antenatal clinics. The aims and objectives of this study are to assess whether it is feasible and acceptable to screen an at-risk migrant population for LTBI at routine antenatal booking visits in secondary care, using opt-out IGRA testing. Secondly, to develop a definitive large scale cluster RCT to evaluate the effectiveness of acceptable interventions to maximise migrant screening for LTBI in pregnancy and to increase uptake of treatment postpartum. Pregnant migrants from high TB-incidence countries will be recruited, collecting data using interviews and focus groups of migrants and LTBI knowledge questionnaires.
Cervical Ripening at Home or In-Hospital - prospective cohort study and process evaluation (CHOICE Study)
The CHOICE Study is a NIHR-funded research project, led by the University of Edinburgh,investigating the safety, effectiveness, cost-effectiveness and acceptability of home cervical ripening during induction of labour (IOL). The process evaluation (qCHOICE) explores contextual influences on implementation of cervical ripening protocols and outcomes,women’s experiences of IOL and acceptability of home cervical ripening to women, their families, and other key stakeholders, and is being jointly conducted by City, University of London and University of Stirling.CHOICE began in December 2019, and will run for 36 months.
Research group lead: Professor Susan Ayers
Our research focuses on the mental health and psychological wellbeing of mothers, their partners and children. Our work has three key areas: risk and resilience factors in perinatal mental health; assessment of perinatal mental health; and innovations in the delivery of perinatal mental health care and treatment.
This multidisciplinary group comprises 8 academic and research staff and 4 doctoral students working on projects ranging from national studies of mental health assessment to international studies of perinatal mental health. Current and recent research includes perinatal mental health in women in low and middle income countries; assessment of birth trauma and post-traumatic stress; evaluations of innovative interventions for perinatal mental health such as peer support interventions and development of local services.
We have established links with NHS Trusts and user-representative organisations in the UK, as well as international links with researchers in Europe, America, and Australasia. This includes the International Network for Perinatal PTSD Research, an international research initiative which is run by members of this group.
Example Research projects
For more information on the research projects, please visit the Centre for Maternal and Child Health Research blog.
This study aims to identify the most effective, acceptable and feasible method for assessing anxiety in women during pregnancy and after birth. This will be achieved through 3 work packages (WP) that compare 4 different tools for assessing anxiety: 2 anxiety-specific measures and 2 mental health measures (GAD-7, SAAS, CORE-10, Whooley questions) selected on the basis of research and clinical evidence that suggest they may be effective. It will be conducted in NHS services in England and Scotland.
This review aims to identify the barriers and facilitators to perinatal mental health assessment, care and treatment for women, at individual, relational (e.g. women-healthcare professional), organisation, and systemic levels; and determine how these can be used to inform and improve perinatal mental healthcare services. This evidence synthesis will be conducted in three phases.
This project aims to identify barriers to service improvement, and to inform and support effective solutions. Consequently, leading to good quality, evidence-based care pathways at the right time for all mums who need it. This project supports local leaders in four sites of England – Blackpool, Haringey, Southend and Gloucestershire, to improve the care and quality of life for mums with mental health problems during pregnancy and the first year of life, and their babies.
Caesareans performed late in labor, where the mother’s cervix is fully open and her baby’s head has entered her pelvis, can be complicated. If the baby’s head is deeply wedged in the woman’s pelvis, it can be difficult to lift it up to enable the baby to be born. This is called an impacted fetal head. There are a number of different techniques that can be used in this situation, however it is not clear which is the best or most effective. This project is looking at whether it would be possible to do a clinical trial to test these different techniques. The research team will conduct surveys and interviews with parents, obstetricians, anesthetists and midwives to gather their views and experiences of these births.
Mums on the Run
This study involves a group of Australian researchers assisting women with depressive symptoms to increase their physical and mental wellbeing with physical activity.
Attachment in Fetal Imaging (AFI) Study
This is a mixed methods study exploring first time mothers' and fathers' eperiences of fetal imaging (ultrasound and MRI) , and the effect it may have on the developing parent-fetal relationship. Currently in its first year, the project has received funding from the College of Radiographers and the Reseacrh Sustainability Fund at City, University of London. This project is a collaboration between two London universities; bringing together the work of the CMCHR at City, University of London and the Perinatal Imaging Department at King's College London. It is being supervised by Prof.Susan Ayers, Dr.Christina Malamatenious and Prof.Mary Rutherford.
Parent Infant Foundation Evaluation
This project involves the evaluation of a parent infant therapy service being set up in Essex.
This collaboration with colleagues in Brazil looks at women’s perinatal mental health as part of the Birth in Brazil II Study of 20,000 women giving birth in Brazil. This study will help better understand risk factors, birth factors, and symptoms of depression, anxiety and PTSD in Brazilian women. This collaboration combines City’s expertise on perinatal mental health assessment, birth trauma, models of care and associated outcomes, with Brazilian expertise in perinatal epidemiology, evaluation and surveillance of public health interventions. It will improve understanding of perinatal mental health issues affecting women in Brazil and facilitate recognition and treatment of perinatal mental health problems.
Research Group Lead: Dr Ellinor Olander
Our research focuses on population health, preventive action and health care for women and children including socially and economically marginalised groups, including issues of equity of access to and quality of care. We aim to describe inequalities in maternal and child health outcomes to inform public health policies and improve services for women, children and their families. Research includes young teenage parenting, mothering and feeding children with neurodisability, maternal and child health in relation to HIV/AIDS, and the health of homeless and migrant populations, obesity in pregnancy and in children, sickle cell and female genital mutilation. We are currently working on projects ranging from locally focussed studies in East London to national studies, such as on prevalence of FGM and the timing of birth and its outcome by time of day and day of the week and international comparisons of perinatal indicators. We use a range of methodological approaches including quantitative and qualitative methods and linkage and secondary analysis of national and linked datasets.
We have well established links with Barts Health NHS Trust, Homerton University Hospital NHS Trust and public health departments in East London as well as with the Department of Health, Home Office, the Office for National Statistics and non-governmental organisations such as Maternity Action and the NCT and international networks such as ROAM (Reproductive Outcomes and Migration) and Euro-Peristat. Our work has informed the development of maternal and child healthcare services and policy in England and internationally
For more information these projects please visit the Centre for Maternal and Child Health Research blog.
Young People Carers and Professionals Views, Experiences and Expectations of Services to Support Young People with Sickle Cell Anaemia
This a co-design study, involving 3 groups of people – carers, healthcare professionals and young people, looking at different interventions of sickle cell anaemia. The aim is to develop an intervention to enhance and improve health care provision of sickle cell anaemia.
Health policies and sociocultural diversity: a comparative study on childbirth services
The general objective is to understand the relationship between medical teams in maternity services and people (users) with a non-western cosmology. The project will illuminate this issue through cross- cultural comparison. In the Brazilian context the focus is on the encounters of indigenous women with health services, while in the UK the focus will be on those of refugees and recent immigrants. A same question will constitute the background of these two studies: how public health policies can account for the cultural diversity in a way that provide adequate care without disrespecting other world logics? The Brazilian part of the research will essentially consist in data analysis of an almost already completed fieldwork, while the UK part will give rise to rapid ethnographic case studies, supplemented by bibliographic and documentary data.
This study aims to improve the way that positive newborn screening results for conditions such as sickle cell disease and cystic fibrosis are communicated to parents by health professionals. With the expansion of newborn screening in England, the importance of delivering screening results appropriately to minimize any long-term negative health and psychological consequences is vital; this project aims to develop interventions to improve such communication. It involves four phases and as a part of the project, the researchers will work with parent representatives for each screened condition covered by newborn screening who will form an advisory group to assist the research team, provide feedback on each phase of the project and monitor its progress.
Evaluation of Child Nursing Programme - Student Views and Experiences on Peer Mentoring
This study will evaluate child nursing student views and experiences on peer mentoring and understanding how to train them as peer mentors, in addition to assisting them in mentoring other colleagues as well.
Developing an Educational Pack for Student Nurses based on Adult and Young Peoples’ Perspectives on Sickle Cell Anaemia
This study involves interviewing young people, carers and parents of those diagnosed with sickle cell anaemia to assist in the development of an educational pack for student nurses. This pack should include all necessary information of what a student nurse should know in regards to this illness.
Research Group Lead: Dr Susan Bradley
A developing strand of our work is addressing quality of MCH care globally, including in low and middle-income countries. This strand builds on a series of doctoral projects addressing subjects as diverse as HIV, female genital mutilation, health system stewardship, maternal health and respectful maternity care. Our work is now focused on the implementation of high quality and respectful care, goals that are now reflected in World Health Organisation policies and in the Sustainable Development Goals. We explore how structural factors and the organisation and models of care can influence maternal and child health and wellbeing, positively or negatively. We are focused on translation of international evidence on the value of midwife-led care in a range of contexts. Aspects of our work also bring lessons for improving maternal health and care from low-income countries to higher income settings like the UK, through community-based interventions and women’s groups – for example in models such as group care (see projects).
Recent support from the Global Challenge Research Fund has enabled us to:
- Develop a network of partners in low- and middle-income countries with an interest in midwifery-led care and to successfully apply for further funding to continue on the IMaGINE study.
- Carry out research on adolescent sexual and reproductive health in Ghana and The Gambia
- Explore the role of midwives in efforts to end female genital cutting in an Ethiopian village.
We draw on critical realist approaches, post-colonial and de-colonising theories to provide a critical analysis of the forces influencing quality, safety and experience of care, including cultural safety. We also use implementation science theory to inform our thinking about how to implement change, but with a strong focus on social and structural approaches which take into account the
This is a Horizon 2020 project funded by the European Commission. It aims to develop a systematic and in-depth understanding of acceptable, feasible and sustainable strategies to integrate group care into health systems for antenatal and postnatal care during the first 1000 days. It will use demonstration sites in 4 LMICs (Ghana, Suriname, South Africa, Kosovo), and 3 high-income countries (The Netherlands, Belgium, UK). GC_1000’s focus is on setting the groundwork for sustained service delivery, creating country-specific blueprints for scale-up, and using cross-country synthesis to develop a global implementation strategy toolbox. The toolbox will encourage adaptation, implementation and scale up of facilitated group care within the first 1000 days, particularly to reach the most vulnerable groups of women and girls globally.
Implementing Midwifery-units – a Global INnovation and Evaluation programme (IMaGINE)
This is an on-going research and development programme to test whether the introduction of midwifery units (MUs), staffed by dedicated midwives, can improve the birth environment and experience of care for women and midwives in low- and middle-income countries (LMIC). IMaGINE focuses on the potential of midwifery-led care and services to address the complex, multi-faceted problems of widespread disrespect and abuse during birth, lack of evidence-based practice, and women’s reluctance to engage with facility-based birth. While we have robust evidence from high-income countries on the benefits of midwife-led care models (for women and midwives), such evidence is lacking from resource-constrained contexts. The initial stages of our programme were supported by Global Challenge Research Funding. This enabled us to establish a network of actors from Malawi, Sudan, Brazil and India and to work together to carry out a systematic review/ meta-synthesis of current evidence on the impact of midwifery units in LMICs. We have also undertaken key stakeholder workshops and situational analyses in three of the four partner countries. Future plans involve identifying pilot project sites to carry out implementation and evaluation of MUs in these contexts.
Conducting a cross comparison between countries: looking at women's choices on place of birth
This is an ethnographic study, exploring the complexity of social processes on decision-making related to the universe of meanings, reasons, beliefs, values and attitudes that influence women’s birthplace choice.
Birth in Brazil
City, University of London has formed a partnership with a Brazilian institution. This project is exploring maternity care in Brazil including a national survey of obstetric units, midwifery units and surveying over 20000 women.
Respectful care in maternity (doctoral project)
This study explored midwives’ perspectives on the practice, impact and challenges of delivering respectful maternity care in Malawi, highlighting the considerable challenges facing staff in this context. Prior to this, much of the research had focussed on women’s experiences. This work aimed to include the voice of the midwife.
Two systematic reviews were conducted to understand the broader drivers of disrespectful care during birth in sub-Saharan Africa. One explored women’s experiences; the second focussed on midwives perspectives.
Clinical outcomes and women’s decision making in Brazilian birth centres
This study aims to show the optimum maternal and perinatal outcomes in Midwifery Units, explore the reasons for why majority of women with uncomplicated pregnancies give birth in obstetric units when there is no clinical indication and the reasons behind choosing this environment against the evidences on places of birth.
Research Group Lead: Dr Lucia Rocca-Ihenacho
Implementing evidence on birth place into policy, provision and practice in Europe
The Midwifery Units (MU) Standards were developed by a team led by Dr Rocca-Ihenacho as part of her NIHR Knowledge Mobilisation Fellowship, thus being translational. The aim of the standards was to support the implementationof the evidence produced by our prior research on place of birth and particularly to support maternity units planning to open new MUs or improving existing ones.
The MU Standards were launched during the second MUNet Conference at City in July 2018 and we now want to develop indicators and an assessment tool in order to further develop impact. The Standards document includes 27 standards under 10 themes that capture the evidence base, translating it into more practical guidance. At present the Standards do not include indicators for users to benchmark where their service is in relation to the Standards or any improvements achieved. The number of indicators is expected to be approximately 50.
We propose to create indicators and a self-assessment tool for users to assess their own services against each of the published Standards. This can also hold future income generating opportunities for MUNet in terms of creating an accreditation system.