RCM Annual Conference

The sessions listed below will take place on Friday 5 October. These sessions are aimed at midwives, students and MSW’s.

Please note if you are aiming on attending sessions across multiple programmes you will need to select those that do not have conflicting timeslots.

Event Timeslots (6)

ABSTRACTS DAY 2
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ABSTRACT SESSION 6 - PARTNERSHIP

Chair: Julie Richards, chair, RCM board

Multiples matter: a multidisciplinary team approach to personalised care
Kathryn Harper, multiple births midwife, Leeds Teaching Hospital Trust

Multiple pregnancy is associated with higher risks for the mother and babies, including miscarriage, anaemia, hypertensive disorders, haemorrhage, operative delivery, mental health problems and postnatal illness. Maternal mortality is 2.5 times higher than in singleton births; the stillbirth rate is higher; and the risk of preterm birth is higher, occurring in 50% of twin pregnancies. NICE guidance (2011) recommends specialist teams care for multiple pregnancies, however, only a small percentage of units have specialist midwives (18%) and sonographers (28%), and 30% of multiple mothers do not have care from a specialist consultant (Tamba/NCT Maternity Report, 2015). In our unit, women were seen in a consultant-led twin clinic but received most of their care from their local midwife at their GP practice. In May 2014 we developed a multidisciplinary team multiples service, providing expert advice and specialist, personalised care consistent between the hospital and community setting and working collaboratively with fetal medicine, outreach and neonatal staff, children’s centres, Tamba, social media and external agencies such as Home-Start. An external audit by Tamba in 2017 identified lower than average stillbirth and emergency intrapartum CS rates. Feedback from patients has been overwhelmingly positive.

The development and feasibility testing of a midwife-facilitated intervention to support women with mild to moderate anxiety in pregnancy
Kerry Evans, clinical academic midwife, University of Nottingham, School of Health Sciences

Many women experience symptoms of anxiety during pregnancy. Severe anxiety is associated with negative health outcomes for women and babies, and psychological interventions may be beneficial for pregnant women with mild to moderate symptoms. The aim of the study was to develop an intervention that could be facilitated by midwives. An intervention was developed according to the Medical Research Council theoretical and modelling phases for developing complex interventions, and delivered in three components: a one-to-one pre-group meeting with the midwife; four group sessions facilitated by the midwife and MSW; and self-help materials to be accessed between group sessions. All nulliparous women in two study locations who were 16-25 weeks pregnant between April and May 2016 were invited to participate. The GAD-2 (generalised anxiety disorder) scale was administered by the community midwife to assess eligibility. Data collection comprised baseline and post-intervention self-report anxiety measures and semi-structured interviews to determine feasibility and acceptability post-intervention. Data analysis used descriptive statistics for quantitative data and template analysis for qualitative data. This study established the feasibility of providing an intervention for pregnant women with mild to moderate anxiety, facilitated by midwives, that is acceptable to women, with no negative impacts.

The parents study: parental involvement in the perinatal review process following the loss of their baby
Mary Lynch, midwife, North Bristol NHS Trust

There are approximately 4500 stillbirths and neonatal deaths at age under seven days (perinatal mortality) in the UK each year. This equates to around seven in every 1000 births. The perinatal mortality review meeting (PNMR) that takes place post-death can provide answers to parents and vital lessons on improving care for women and their families. Unfortunately, evidence suggests that parents are unaware of this formal review, and many would welcome the opportunity to participate. We considered that parental involvement in the PNMR would have potential to improve patient satisfaction, drive improvements in patient safety, and promote an open culture. Women and their partners were invited to participate in the study if they experienced a perinatal death within a six-month pilot period. They were asked to complete a PNMR parent feedback form, developed from a consensus meeting of national experts, during a home visit from the research midwife. This allowed them to submit questions, comments or views that are then discussed in a standardised format at the PNMR, with each feedback comment addressed and any salient learning points clearly documented. Results to date are encouraging, although the full suite of follow-up measures is not yet complete.

Effective partnership: how collaborative working improves care of women with perinatal mental health disorders
Daisy Kelly, specialist midwife for perinatal mental health, Kings College NHS Foundation Trust

Deaths from psychiatric causes remain the leading cause of maternal death in the year following birth (MBRRACE, 2014), unchanged over 21 years. There is clear evidence to demonstrate the significant morbidity associated with poor perinatal mental health, largely experienced by the infant and thereby affecting our future society. Effective mental healthcare must be holistic, especially in the perinatal period, when a woman’s life inevitably becomes more complex. Professionals must liaise regularly to ensure seamless care. In our large and diverse borough, we have achieved this. There is a weekly meeting attended by a minimum of five different organisations, all working towards a shared goal of improving perinatal mental health. The woman and family are kept central in all discussions, and partnership with housing, the Child and Adolescent Mental health Services and family support workers ensure that social needs are also attended to. A weekly multidisciplinary clinic is held, staffed by a specialist midwife, perinatal nurse, perinatal pharmacist, perinatal psychiatrist and consultant obstetrician. More recently, the multidisciplinary team has offered a perinatal training day. The success of the team has been rewarded with an award for ‘Best mental health team’ across three large boroughs. This was largely as a result of outstanding feedback from service users.

ABSTRACTS DAY 2
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SPONSOR SESSION
Reflection on the NIPT roll out in NHS Wales
Speaker: Sarah Anderson,all Wales genetic service, Institute of Medical Genetics, University of Wales

NHS Wales rolled out Non-Invasive Prenatal Testing (NIPT) in April this year as part of their national screening programme. The first presentation by Sarah Anderson, from the genetics lab in Cardiff and Wales University hospital, reflects on the first 6-months of implementation in Wales and discusses the importance of working with a multi-disciplinary team, involving the lab performing the assay, the local genetics team, the midwives, the screening co-ordinators and the obstetricians. It will highlight NIPT uptake in Wales and the initial results so far.

NIPT perspectives from the voice of the genetic counsellor
Speaker: Christin Coffeen, senior genetic counsellor, Illumina Inc

In the second part of the workshop, you will hear from Christin Coffeen, currently a genetic counsellor at Illumina and a former clinical prenatal genetic counsellor. Christin will reflect on important counselling considerations as health care professionals speak with patients about NIPT. It will highlight an educational tool available for health professionals to share with their patients.

ABSTRACTS DAY 2
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ABSTRACT SESSION 7 - LEADERSHIP

Chair: Pauline Twigg, board member, RCM

Collaborative learning in practice models: the dynamic learning and care environment
Elizabeth Crisp, midwife & midwifery lecturer, Staffordshire University and
Susan Jackson, midwife & midwifery lecturer, Staffordshire University.

Education for healthcare professionals has undergone significant changes over the past three decades, while safe learning and care environments remain a consistent requirement; increases in patient dissatisfaction, waiting times and staff attrition must be addressed in the further evolution of education for healthcare provision (Health Education England, 2015). In this current climate of staff shortages, increasing workloads and financial pressure, the collaborative learning in practice model can improve both student and staff experience. Lord Francis (2013) is often referred to by proponents as a key driver for the implementation of the collaborative learning model. However, a strong link to the Francis Inquiry is difficult to identify; other than to recognise that the past 35 years of development of nurse education has been in the absence of primary consideration of service users, which arguably has resulted in a unsatisfactory culture within care provision. Students’ pre-registration journey is not without challenges, which can directly influence their practice learning experiences and the practice-learning environment. Contemporary challenges, such as the removal of student bursaries resulting in self-funding of tuition fees, have the potential to impact on recruitment to health professional courses, consequently resulting in staff workforce shortages in specific healthcare fields.

Rethinking inductions of labour
Sally Goodwin, lead midwife for inductions, Sherwood Forest Hospitals Foundation Trust and Susie Al-Samarrai, consultant obstetrician, Sherwood Forest Hospitals Foundation Trust

In 2016, we were challenged to question if women were being induced appropriately (induction of labour (IOL) rate >35%). We had formal and informal complaints about patient experience, length of process and delays. And staff and patients were frustrated by daily firefighting to triage/prioritise the most appropriate inductions. A concept was developed to review all IOL requests centrally, allowing prioritisation of urgent cases and consensus opinion on more challenging cases. A year’s secondment was introduced for a Band 6 midwife to develop, introduce and embed a new pathway for inductions. New guidelines were produced, along with patient information leaflets and a referral form. IOL slots were changed from PM to AM to ensure inductions were part of the ward round. There was also a focus on optimising chances of labour, including relaxation, aromatherapy, mobilisation and use of water. Women now feel ‘more cared for’ and ‘more involved in decision-making’, while staff no longer feel pressured in clinic or on the labour ward to accept and book inductions. Service flow improved and more women are birthing less than 24 hours after administration of Propess®, and there is a reduction in the use of a second Propess®, as well as oxytocin infusions and epidurals.

Multiprofessional human factors training within maternity improves safety culture
Malissa Rayfield, simulation fellow and clinical midwife, Norfolk & Norwich University Hospital

Human factor training within maternity is now identified as a major area for development and has been recommended by several major reports, including MBRRACE (2017) and the RCOG\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\'s (2015) Each Baby Counts. Human factors is a broad term, exploring why an event happened as opposed to simply what happened. For example, why did this midwife incorrectly interpret a CTG, as opposed to simply what was wrong with her interpretation. This concept allows midwives and the whole maternity team to unpick why many of our errors happen, and, with this knowledge, we are training our team on how to prevent them. We have trained a team of 17 faculty members to support the implementation of human factors teaching to all maternity staff. We have embraced the recommendations of MBRRACE and Each Baby Counts and have developed a national film explaining how to improve situational awareness. We run weekly in-situ simulations to embed human factor knowledge and are rolling out a monthly two-hour teaching session in which we embrace formal teaching, forum theatre and storytelling to highlight how human factors affect safety. All of our 350 maternity staff will be trained in human factors by December 2018.

ABSTRACTS DAY 2
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ABSTRACT SESSION 8 - SAFETY

Chair: Kate Evans, board member, RCM

I\\\'m in labour. I\\\'m telling you I am in labour.’ What is the experience of being a pregnant woman in prison? Findings of an ethnographic study
Dr Laura Abbott, senior lecturer, University of Hertfordshire

The UK has the highest incarceration rate in Western Europe, with pregnant women making up around 6% of the female prison population. There are limited qualitative studies published that document the experiences of pregnancy while serving a prison sentence. My doctoral study presents a qualitative, ethnographic interpretation of pregnancy experience in English prisons. The study took place during 2015-16 and involved semi-structured interviews with 28 female prisoners who were pregnant or had recently given birth, 10 members of staff, and 10 months of non-participant observation. This presentation focuses on how ‘institutional thoughtlessness’ in a patriarchal system can lead to dangers for perinatal women. From missed medication and a lack of basic provisions to inappropriate diagnosis of women in labour – my talk will bring this groundbreaking research to RCM members through the voices of women. The main frustration that was articulated by all participants was not receiving basic rights and entitlements, with inconsistencies across prisons, often dependent on individual staff knowledge. This research has given voice to pregnant imprisoned women and highlighted gaps in existing policy guidelines. In this sense, the study has the potential to springboard future inquiry and to be a vehicle for positive reform.

Fetal movements matter: using forum theatre in the co-production of a care pathway for women who experience reduced fetal movements
Dr Helen Baston, consultant midwife: public health, Sheffield Teaching Hospitals NHS Foundation Trust

This project focuses on the care of pregnant women with reduced fetal movements (RFM). Fetal activity is used by midwives and mothers as a sign of wellbeing, and a reduction in movements is often associated with fetal compromise and stillbirth (Stacey et al, 2011). We know from analysis of local data that 42% of the women who experienced stillbirth in our unit identified a preceding change in the pattern of fetal movements. Of the women who ring our antenatal contact centre, the fourth highest reason is RFM. Inconsistent advice can lead to a delay in the reporting of RFM and consequently a delay in its management. Women seek and receive information from a range of sources, however, advice regarding what to do if they notice a difference in their baby’s activity is variable and confusing (Warland and Glover, 2016). As a large, tertiary maternity unit that employs over 300 midwives, ensuring that all professionals provide consistent, evidence-based advice was our challenge. We used the ‘forum theatre’ methodology to identify facilitators and barriers to undertaking and embedding practice change (Kontos and Poland, 2009), and will share excerpts from the production to demonstrate how this can lead to workable solutions.

The Warm Bundle: reducing hypothermia in term and near-term newborn infants
Chistina Smith, charge midwife, Greater Glasgow and Clyde

Neonatal hypothermia is widely recognised as a contributor to newborn morbidity and mortality. The neonatal period is crucial in the mother/baby bonding process and separation should be minimised. A retrospective review of unplanned admissions to the neonatal unit (NNU) within this service highlighted a significant problem with admissions of term and near-term (35-42 weeks’ gestation) newborn babies with hypothermia (temperature <36.5⁰C) and related morbidities. The project aimed to reduce admissions of newborns with hypothermia by 30% in 12 months. A cross-speciality, multidisciplinary team was set up, and the Warm Bundle educational package was developed to standardise and enhance processes for thermal care. This included a poster teaching the WHO warm chain, and introduction of a standardised process checklist for every delivery. Quality improvement methodology was used, with monthly measurement of process and outcomes over three years. Although process compliance was achieved, outcome data demonstrated the need for additional environmental interventions, including raising the temperature of delivery rooms and introducing warm cots and warm linen supplies. The project was a huge success, with a 58% reduction in the annual number of hypothermia-associated NNU admissions, and the Warm Bundle has been adopted in several hospitals in the UK.

ABSTRACTS DAY 2
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ABSTRACT SESSION 9 - PARTNERSHIP

Chair: Kate Evans, board member, RCM

Partnership in practice, baby steps towards big changes?
Sonia Wilson, midwife/baby steps health practitioner, Leeds Teaching Hospital and Victoria Ward-Joel, baby steps implementation manager, NSPCC

This evidence-based perinatal education programme for families experiencing adversity or vulnerability was developed in partnership with the NSPCC in response to gaps in antenatal education in the perinatal period (McMillan et al, 2009). It builds on the Preparation for birth and beyond framework, incorporating the latest findings from research into infant mental health, strengthening relationships and improving outcomes. The NSPCC has been working with early adopter partners to introduce the programme within mainstream public services, and we became an early adopter in 2014. The overall aim is to optimise parents’ and babies’ health and wellbeing and promote sensitive parenting and secure attachment. We run nine sessions throughout the antenatal and postnatal periods, and visit the parents at home beforehand. Following the baby’s arrival, practitioners film the interaction between parent and baby. We encourage fathers and partners to attend the programme, while encouraging single mothers to bring a friend or family member to the group. The programme is facilitated by a midwife or health visitor and a family support practitioner. The same two co-facilitators deliver all the home visits and weekly sessions, bringing skills and expertise that can help parents through both the physical and emotional aspects of becoming a parent.

Together we are more than the sum of our parts: perspectives on partnership in practice – a collaborative journey to implement the recommendations in Better births
Helen Maric, midwife transformation project manager, North West London Local Maternity System and Nicky Wilkins, consultant midwife, North West London Local Maternity Team

We work across eight clinical commissioning groups, four hospital trusts, six maternity units, 40 community clinics and employ more than 1000 midwives to improve maternity services for 30,000 women and families. We have been working to establish partnership networks to enable us to achieve increased continuity of carer, improved postnatal care and improved consistency of information. Our achievements include: • Developing four new models of care, tested across sectors in a variety of approaches • Recruiting to and launching two new caseloading teams for midwife-led pregnancies and for women with previous gestational diabetes. Two further teams for women with multiple pregnancies and women with social complex needs are to be launched • Expanding existing caseloading teams for women with social complex needs • Designing and delivering new models of caseloading out of birth centres • Reconfiguring community midwifery services to improve continuity • Co-producing information packs and discharge letters to ensure a sector-wide approach • Introducing and standardising a personalised postnatal care plan for all women • Producing a cross-sector maternity app; facilitating choice and rich in content • Working towards harmonising MSW job roles • Nurturing supportive links with maternity transformation programmes • Sharing our learning at midwifery forums across the country • Invigorating and embedding all Maternity Voices Partnerships.

Neonatal transitional care education programme for midwives
Joanna Greenock, practice development midwife, Greater Glasgow and Clyde and Tom McEwan, lecturere in midwifery, University of the West of Scotland

Minimising separation of mothers and babies underpins The best start – a five-year forward plan for maternity and neonatal care in Scotland. The availability of neonatal transitional care (NTC), which supports a resident carer, usually the mother, to care for a baby with requirements in excess of normal newborn care but not requiring neonatal admission is pivotal in achieving this aim. In October 2017, we set out a plan for how NTC could be provided to families across this health board. One of the needs identified was midwifery staff education. An NTC education group was convened to plan, deliver and evaluate a programme to ensure that midwives understood the benefits of caring for babies within NTC settings, were confident in delivering, and supported a family-centred approach to care, and were responsive to emerging family needs. The NTC concept was then promoted locally and 14 places on a pilot programme were offered to midwives interested in working in this setting. Participants indicated a marked increase in perceived ability, and we concluded that high-quality education is essential to ensure consistent delivery of high-quality NTC. This pilot has enabled NTC education for midwives to be developed, delivered, tested and amended for further implementation.

ABSTRACTS DAY 2
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ABSTRACT SESSION 10 - SAFETY

Chair: Tracy Miller, board member, RCM

#TheatreCapChallenge: improving safety and creating better birthing experiences for women in theatre
Alison Brindle, student midwife, Lancashire Teaching Hospitals Trust and Emma Gornall, delivery suite manager, Lancashire Teaching Hospitals Trust

Medical error is reported to be the third leading cause of death in the US. The World Health Organization (2000) report An organisation with a memory estimated 850,000 adverse events per year were happening within NHS hospitals, equivalent to 10% of hospital admissions. Human factors are considered to be one of the main causes behind medical errors, and 50% to 70.2% of harm can be prevented through comprehensive, systematic approaches to patient safety (WHO, 2018). One area where improvement needs to be made is within the maternity theatre setting, where, often, women do not recognise their own midwife among the sea of blue scrubs and theatre caps. This can make women feel vulnerable, but improving patient safety while improving their experience is difficult. We discovered a way to tackle both issues with the simple act of writing names and roles on theatre caps. This improves women’s birthing experiences in theatre but also helps to overcome communication barriers across the team. To raise awareness, we launched the #TheatreCapChallenge campaign across social media. Many healthcare workers and theatre teams are now adopting this simple idea, not only in the UK but also in countries such as Australia, Spain and the US.

Service redesign for women at risk of Gestational Diabetes Mellitus (GDM)
Noreen Dunnachie, lead midwife for diabetes, NHS Ayrshire and Aran

The number of women diagnosed with gestational diabetes mellitus (GDM) has increased threefold, from 7% in 2010 to 22% in 2016, peaking at 25% in 2015. This has resulted in an unsustainable service with heavily oversubscribed clinics, and infrequent, inconsistent specialised care. Part of the first-stage service improvements focused on improving women’s satisfaction with their care. Plan, Do, Study, Act cycles were used to collect data and feedback. Following a diagnosis of GDM, each woman attended a one-hour meter demonstration and education appointment, providing one-to-one tailored advice. Introduction of a telephone clinic allowed weekly diary reviews of blood glucose levels, facilitating dietary changes without attending hospital and enabling women to retain community-led midwifery care. This has significantly reduced the number of clinic appointments and medical input. Consequently, the number of women able to manage their diabetes with diet control alone has significantly increased. In addition, our data has shown a reduction in the mean birthweight of babies born to women with GDM. Women’s satisfaction has improved significantly. A new designated OGTT clinic was also set up, using the two-hour wait between blood samples to provide expert education on diet and lifestyle choices for all women, not just those with an impaired result.

Information behaviour: an ethnographic exploration of midwives accessing and using information for practice in the labour ward
Elinor Jenkins, midwife, Isle of Wight NHS Trust

As maternity care becomes more complex, midwives need to use information at the point of care on the labour ward. Understanding how midwives use information could improve the information environment. This was a qualitative study using the principles of ethnography. Twenty-one purposively sampled midwives were observed providing high-risk care to women in the labour ward of an English tertiary referral hospital with a delivery rate of 6000+ births per annum. Ten of the observed midwives were purposively sampled for interview. Data was collected and analysed between October 2011 and November 2014. Ethical approval was obtained from the National Research Ethics Service. Thematic analysis using open and focused coding revealed that midwives identified information needs when they recognised limitations in their knowledge. Information sources used by midwives were usually verbal or documented and included maternity notes, guidelines, equipment, computers, colleagues, women and the environment. Accessibility, usability and approachability were key. As information for care can change relatively quickly, it is essential that midwives are able to seek and use information successfully. Educating midwives about information excellence, creating more user-friendly guidelines and improving search techniques for electronic information could support improved information access and improve safety and quality of clinical care.