Helen Spiby

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• Professor in Midwifery at University of Nottingham

Objectives The COVID-19 pandemic has led to increased use of digital clinical consultations (phone or video calls) within UK maternity services. This project aimed to review the evidence on digital clinical consultations in maternity systems to illuminate how, for whom and in what contexts, they can be used to support safe, personalised and equitab...

It is widely agreed that collaboration with people with lived experience of specific health conditions or health services is both a moral imperative and a utility to improve research quality, validity and impact. However, there is little agreement about how to practise public involvement. In this article, we describe the formation and work of the N...

The burden of iron-deficiency anemia remains significant during pregnancy. Oral iron is first-line medication, but there is uncertainty about a range of factors including adherence and side-effects of different doses. We conducted a pilot randomized trial to investigate the impact of different doses of oral iron supplementation started early in pre...

Background Health care for women with Female Genital Mutilation/Cutting (FGM/C) in the Global North is often described as sub-optimal and focused on maternity care. Specialist FGM/C services have emerged with little empirical evidence informing service provision. The objective of this scoping review is to identify the key features of FGM/C speciali...

This article aims to illuminate the little-studied phenomenon of asylum-seeking child-bearing women in the UK, survivors of violence and human trafficking. This is a significant issue in terms of the proportion of women affected and the paucity of care and support currently available to them as mother survivors. This study looked to examine the fro...

Background The COVID pandemic prompted an increase in the use of digital clinical consultations (telephone or video calls) within midwifery and nursing care. This paper reports on a realist review project related to maternity care that seeks to illuminate for whom such consultations can safely and acceptably be used, how, for what purposes and in w...

Responsive infant feeding is a key strategy for childhood obesity prevention. Responsive feeding involves caregivers responding to infant hunger and satiety cues in a timely and developmentally appropriate manner. There is a dearth of evidence-based information and guidance for caregivers on how to responsively feed their infants. The aim of this r...

Background The prevalence of mental health and well-being issues among young women is increasing. Pregnancy is a time when new mental health challenges may arise, or existing conditions can be exacerbated. This project presents preparatory work on how nature-based interventions may help to support the mental health and well-being of young pregnant...

Green prescribing is gaining in popularity internationally for the promotion of mental wellbeing. However, the evidence base is limited, particularly in young pregnant women, a population with known risk factors for anxiety and depression. The aim of this mixed-methods study was to provide insights into the availability, processes, and suitability...

Background Birth companions can have a positive effect on women's experiences in labor. However, companions can feel unprepared and need professional guidance to help them feel involved and provide effective support. Methods A convergent segregated mixed‐methods systematic review was conducted to explore women's, companions’, and midwives’ experie...

Background Antenatal preparation is commonly offered to women in pregnancy in the United Kingdom, but the content is highly variable, with some programmes orientated towards ‘normal birth’, whilst others may incorporate information about complications and procedures (broader focus). However, the impact of this variability on birth experience has no...

Background Disadvantaged populations (such as women from minority ethnic groups and those with social complexity) are at an increased risk of poor outcomes and experiences. Inequalities in health outcomes include preterm birth, maternal and perinatal morbidity and mortality, and poor-quality care. The impact of interventions is unclear for this pop...

Background - Modern slavery is a largely hidden crime disproportionately affecting women and girls, with 71% of the world's enslaved people being female and approximately one third estimated to be pregnant. Healthcare professionals experience difficulties in caring for mothers affected by modern slavery, including asking appropriate questions and i...

Problem: Women in early labour are typically encouraged to delay admission to the maternity unit, but they may find this challenging without appropriate professional support. Background: Prior to the pandemic, research conducted with midwives and women showed positivity towards using video-technology for early labour, with concerns raised about...

Background/Aims The provision of high-quality antenatal care improves maternal and child health outcomes. Pastoralist communities face unique challenges in accessing healthcare associated with a nomadic, marginalised lifestyle, and have high rates of maternal morbidity and mortality. There is minimal evidence on antenatal care use globally among th...

Problem: Women in early labour are typically encouraged to delay maternity unit admission, but they may find this challenging without appropriate professional support. Background: Despite pre-pandemic research which identified potential advantages of video-calling in early labour, implementation of such service has not been reported. Aim: To e...

Objectives To explore the events perceived as traumatic by obstetricians and gynaecologists (O&G), and to examine factors contributing to the perception of trauma. Design Mixed methods: cross-sectional survey and in-depth interviews. Sample and setting Fellows, members and trainees of the Royal College of Obstetricians and Gynaecologists (RCOG)....

Objectives Compassion in nursing and interventions to support it are of international relevance and concern. Prior care experience as a prerequisite for entry into pre-registration nurse education is suggested as a means of improving compassion. The impact of prior care experience has not been comprehensively reviewed, therefore the potential effec...

Introduction Many women experience symptoms during pregnancy. Elevated and prolonged anxiety can have negative effects on the woman and baby. The RAPID intervention aims to provide suitable, timely support for women with mild-moderate anxiety. The RAPID intervention is based on social support, relational continuity, psychological and relaxation res...

Introduction One of the most commonly reported COVID-19-related changes to all maternity services has been an increase in the use of digital clinical consultations such as telephone or video calling; however, the ways in which they can be optimally used along maternity care pathways remain unclear. It is imperative that digital service innovations...

Background The RAPID-2 intervention has been developed to support women with symptoms of mild-to-moderate anxiety in pregnancy. The intervention consists of supportive discussions with midwives, facilitated discussion groups and access to self-management materials. This paper reports the development of a training programme to prepare midwives and m...

Background Birth environments can help support women through labour and birth. Home-like rooms which encourage active birthing are embraced in midwifery-led settings. However, this is often not reflected in obstetric settings for women with more complex pregnancies. Aim To investigate the impact of the birth environment for women with complex preg...

Background: Symptoms of anxiety are common in pregnancy, with severe symptoms associated with negative outcomes for women and babies. Low-level psychological therapy is recommended for women with mild to moderate anxiety, with the aim of preventing an escalation of symptoms and providing coping strategies. Remotely delivered interventions have bee...

Objectives To explore and understand perspectives of women expecting their first child and why they wanted to attend NHS antenatal education. This included what worries and concerns they wanted to be addressed and why this would be beneficial. It also included what they wanted their partners to be able to gain from attending classes. Design A long...

Background Contemporary higher education requires that all midwifery students have insight and understanding of global health practice and demonstrate intercultural sensitivity. However, the mobility models currently offered do not often fit the lives of large numbers of midwifery students. Objectives To investigate midwifery students' internation...

Iron deficiency and anaemia are global health problems and major causes of morbidity in women. Current definitions of anaemia in women are historic and have been challenged by recent data from observational studies. Menstrual loss, abnormal uterine bleeding and pregnancy put women at risk of developing iron deficiency which can result in severe fat...

( BJOG . 2020;127:600–608) The impact of adverse mental health has been recognized as a major contributing factor in decreasing an individual’s productivity and career satisfaction across both working class and professional individuals. Physicians are not exempt from this phenomenon and, in fact, are often at high risk of experiencing work-related...

Aims and objective: The aim of this study was to explore midwives’ experiences and perspectives of current approaches to midwifery care for women with pre-labour or early labour spontaneous rupture of membranes (SROM), with a focus on the potential use of reagent pads by women with SROM. Design: A qualitative methodology using five digitally record...

BACKGROUND Symptoms of anxiety are common in pregnancy, with severe symptoms associated with negative outcomes for women and babies. Low level psychological therapy is recommended as first line treatment options for women with mild to moderate anxiety, with the aim to prevent an escalation of symptoms and provide women with coping strategies. Remot...

The purpose of this project was to identify gaps in the current evidence base and to identify research priorities in the local context during the Covid-19 pandemic. This paper reports on the application and adaptation of the CHNRI methodology which follows a series of criteria setting, filtering and scoring exercises. The views of maternity care pr...

Background To design and develop an intervention to support women with symptoms of mild to moderate anxiety in pregnancy. Methods The development followed the MRC framework for complex interventions, utilising psychological theory, review level evidence and professional and public involvement. Two systematic reviews were completed which helped ide...

Aims To evaluate the effectiveness of non‐pharmacological non‐invasive supportive interventions for impacts on women's comfort and well‐being during induction of labour. Design A quantitative systematic review without meta‐analysis. Data Sources Databases were searched for primary research published in English between 2000–2019: AMED, CINAHL, Med...

Review question: To systematically identify and evaluate the current evidence available related to health and social care service interventions in high-income countries (HICs) to reduce health inequalities experienced by women and their babies.

Objectives: To investigate midwifery students’ experiences of viewing childbirth on mainstream factual television and to explore implications for student career intentions and potential pedagogical uses of television excerpts in midwifery education. Design: Twenty-two undergraduate midwifery students at one of two universities took place in focus...

Aims: To investigate childbearing women's views, experiences and decision-making related to epidural analgesia in labour. Design: Mixed-methods systematic review. Data sources: A comprehensive literature search was implemented across Medline, CINAHL and EMBASE from 2000 to September 2018. The literature search was undertaken in January 2018 an...

This educational project aimed at involving undergraduate midwifery students as co-investigators in research studies, with the primary aim of acquiring first-hand experience of operationalising fundamental aspects of the research process by working with established researchers. The secondary aim of the project was to evaluate students' experience o...

Aim: The aim of the study was to determine the acceptability and feasibility of an intervention to support women with mild to moderate anxiety in pregnancy. Design: The intervention development and feasibility testing followed the MRC guidelines for complex interventions. A feasibility study was conducted between April - May 2016. Methods: Qualitat...

Aim: To design and develop an intervention to support women with symptoms of mild to moderate anxiety in pregnancy. Methods: The development followed the MRC framework for complex interventions, utilising psychological theory, review level evidence and professional and public involvement. Two systematic reviews were completed which helped identify...

Aim: To design and develop an intervention to support women with symptoms of mild to moderate anxiety in pregnancy. Methods: The development followed the MRC framework for complex interventions, utilising psychological theory, review level evidence and professional and public involvement. Two systematic reviews were completed which helped identify...

Background: To design and develop an intervention to support women with symptoms of mild to moderate anxiety in pregnancy. Methods: The development followed the MRC framework for complex interventions, utilising psychological theory, review level evidence and professional and public involvement. Two systematic reviews were completed which helped id...

Background: To design and develop an intervention to support women with symptoms of mild to moderate anxiety in pregnancy. Methods: The development followed the MRC framework for complex interventions, utilising psychological theory, review level evidence and professional and public involvement. Two systematic reviews were completed which helped id...

Background: To design and develop an intervention to support women with symptoms of mild to moderate anxiety in pregnancy. Methods: The development followed the MRC framework for complex interventions, utilising psychological theory, review level evidence and professional and public involvement. Two systematic reviews were completed which helped id...

Background Midwifery-led units (MUs) are recommended for ‘low-risk’ births by the National Institute for Health and Care Excellence but according to the National Audit Office were not available in one-quarter of trusts in England in 2013 and, when available, were used by only a minority of the low-risk women for whom they should be suitable. This s...

Background: Post-traumatic stress disorder (PTSD) can develop after a traumatic childbirth. Objective: To test if providing psychological self-help materials would significantly lower the incidence of PTSD at 6-12 weeks postnatally. Design: Open label, randomised controlled trial, blinded outcome assessment. Setting: Community midwifery serv...

To assess women’s views on the acceptability of and satisfaction with non-pharmacological interventions to reduce the symptoms of anxiety in pregnant women. A systematic review and narrative synthesis (Prospero protocol number CRD42015017841). Fourteen included studies were conducted in Australia, Canada, Germany, New Zealand, UK and USA. Intervent...

Objective To identify factors influencing the provision, utilisation and sustainability of midwifery units (MUs) in England. Design Case studies, using individual interviews and focus groups, in six National Health Service (NHS) Trust maternity services in England. Setting and participants NHS maternity services in different geographical areas of...

Objectives: To explore obstetricians' and gynaecologists' experiences of work-related traumatic events, to measure the prevalence and predictors of post-traumatic stress disorder (PTSD), any impacts on personal and professional lives, and any support needs. Design: Mixed methods: cross-sectional survey and in-depth interviews. Sample and settin...

Objective: To explore and synthesise evidence of women's information needs, decision-making and experiences of membrane sweeping to promote spontaneous labour. Design: A systematic review following the Joanna Briggs Institute (JBI) meta-aggregative approach to qualitative evidence synthesis. Relevant databases were searched for literature publis...

Background: Early labour care presents a challenge for maternity services and is a cause of dissatisfaction for women planning birth in an obstetric or midwifery unit who may feel unsupported or unwelcome at their planned place of birth. Little is known about the perspectives of men who support their partner during early labour. Methods: Opportu...

Background: Internet-based research is increasing in popularity, but concerns remain about ethical issues and guidance is sparse in relation to generating data using online forums. Aim: To describe and discuss ethical considerations concerning the collecting of data through online forums by using the authors' research exploring women's views and...

Problem: Despite clinical guidelines and policy promoting choice of place of birth, 14 Freestanding Midwifery Units were closed between 2008 and 2015, closures reported in the media as justified by low use and financial constraints. Background: The Birthplace in England Programme found that freestanding midwifery units provided the most cost-eff...

Background: Midwives can experience events they perceive as traumatic when providingcare. As a result, some will develop post-traumatic stress disorder (PTSD), with adverse implications for their mental health, the quality of care provided for women and the employing organizations. POPPY (Programme for the prevention of PTSD in midwifery) is a pack...

Background Midwifery students can experience events on clinical placements that they perceive to be traumatic. There is currently no requirement to provide training about the nature of trauma, normal responses, or the most helpful ways of self-managing these. The POPPY programme, developed for qualified midwives, incorporates educational (the POPPY...

Introduction This qualitative research study explored the research question of whether midwives in the United States and the United Kingdom see potential benefits and challenges of using video‐calling technology to assess and support women in early labor. Early labor calls to maternity units are a locus of dissatisfaction for childbearing women. Al...

This paper explores birth representations through a content analysis of two seasons of the UK program, One Born Every Minute (Channel 4, 2010- ) (OBEM). Reality television (RTV) has been a fertile ground for the mediation of birth but has also stoked controversy among feminist critics and the birth community about how birth is represented and the i...

Effective communication, respectful language and compassionate behaviour are vital elements within maternity care for midwives to develop trusting relationships with childbearing women and their families. This paper reports examples of midwives’ negative language and behaviour during childbirth, that were perceived as uncaring by first-time mothers...

Background Decisions made in early labor influence the outcomes of childbirth for women and infants. Telephone assessment during labor, the current norm in many settings, has been found to be a source of dissatisfaction for women and can present challenges for midwives. The aim of this qualitative study was to explore midwives’ views on the potenti...

Objective: To explore first-time mothers' expectations of labour and birth, coping strategies they adopt during pregnancy towards childbirth and coping strategies they expect to use during labour and birth. Design: A qualitative Straussian grounded theory methodology was adopted, with data collected through semi-structured interviews in the thir...

Aims and objectives To examine how the concept of compassion is socially constructed within UK discourse, in response to recommendations that aspiring nurses gain care experience prior to entering nurse education. Background Following a report of significant failings in care, the UK government proposed prior care experience for aspiring nurses as...

Aims To explore factors associated with, and predictors of, posttraumatic stress symptoms in midwives. To explore factors associated with, and potential moderating effects of, trait emotional intelligence. Secondary analysis explored predictors of resilience. Background Midwives may experience vicarious trauma responses due to exposure to certain...

Background Over recent years there has been criticism within the United Kingdom’s health service regarding a lack of care and compassion, resulting in adverse outcomes for patients. The impact of emotional intelligence in staff on patient health care outcomes has been recently highlighted. Many recruiters now assess emotional intelligence as part o...

Background: Over recent years there has been criticism within the United Kingdom’s health service regarding a lack of care and compassion, resulting in adverse outcomes for patients. The impact of emotional intelligence in staff on patient health care outcomes has been recently highlighted. Many recruiters now assess emotional intelligence as part...

Effective communication, respectful language and compassionate behaviour are vital elements within maternity care for midwives to develop trusting relationships with childbearing women and their families. This paper reports examples of midwives’ negative language and behaviour during childbirth, that were perceived as uncaring by first-time mothers...

Background Child maltreatment is a significant public health problem. Group Family Nurse Partnership (gFNP) is a new intervention for young, expectant mothers implemented successfully in pilot studies. This study was designed to determine the effectiveness and cost-effectiveness of gFNP in reducing risk factors for maltreatment with a potentially v...

Objectives: to examine evidence of women's, labour companions' and health professionals' experiences of management of early labour to consider how this could be enhanced to better reflect women's needs. Design: a systematic review of qualitative evidence. Setting and participants: women in early labour with term, low risk singleton pregnancies...

Background Family Nurse Partnership (FNP) is a home-based nurse home-visiting programme to support vulnerable parents. Group Family Nurse Partnership (gFNP) has similar aims and materials and was demonstrated to be feasible in implementation evaluations. Objectives To determine whether or not gFNP, compared with usual care, could reduce risk facto...

Childbirth is highly visible on television at a time when few people see birth in the family or community and access to antenatal education is declining. One Born Every Minute (OBEM) is the most high-profile example of this programming in the United Kingdom. Now on its ninth series, the series won a BAFTA in its first year and now exports programme...

Background and rationale. The latent phase of labour is recognised as a period of uncertainty for women and midwives. There is evidence from the literature of considerable variation in labour definitions and practice. Stimulated by discussion at an international maternity research conference, the authors set out to explore opinions regarding the ne...

Aim: To assess the effectiveness of non-pharmacological interventions for pregnant women with symptoms of mild to moderate anxiety. Background: Many pregnant women experience mild to moderate symptoms of anxiety and could benefit from additional support. Non-pharmacological interventions have been suggested for use during pregnancy. Design: A...

Objective: to describe the configuration of midwifery units, both alongside&free-standing, and obstetric units in England. Design: national survey amongst Heads of Midwifery in English Maternity Services SETTING: National Health Service (NHS) in England PARTICIPANTS: English Maternity Services Measurements descriptive statistics of Alongside Mid...

Objective To explore women’s views of birth plans, and experiences of their completion and use. Design A qualitative, descriptive study, using Internet-mediated research methods. Setting The discussion boards of two well-known, UK-based, online parenting forums, where a series of questions relating to birth plans were posted. Participants Member...

Aims: To explore first time mothers' expectations and experiences regarding rupture of membranes at term and their views on the potential use of reagent pads that detect amniotic fluid. Background: There is little information available on women's experiences of spontaneous rupture of membranes, or interest in using methods to confirm rupture of...

Aim: To explore first-time pregnant women's expectations and factors influencing their choice of birthplace. Background: Although outcomes and advantages for low-risk childbearing women giving birth in midwifery-led units and home compared with obstetric units have been investigated previously, there is little information on the factors that inf...

AIM: To explore first-time mothers’ expectations and experiences of being cared for by an unknown midwife and their perceptions around continuity of carer during childbirth. DESIGN: Qualitative Straussian grounded theory methodology. SETTING: Three National Health Service Trusts in England providing maternity care that offered women the possibility...

Objective: To explore women’s experience of anxiety in pregnancy and views on the use of anxiety instruments in antenatal care. Background: Anxiety in pregnancy is associated with adverse birth outcomes, developmental and behavioural problems in infants and postnatal depression. Despite recommendations for routine psychological assessment in pregna...

Background: Support from a doula is known to have physical and emotional benefits for mothers, but there is little evidence about the experiences of volunteer doulas. This research aimed to understand the motivation and experiences of volunteer doulas who have been trained to support women during pregnancy, birth and the postnatal period. Methods...

( BJOG. 2015; 122:1226–1234) There has been a rising demand from the parturient population for alternative forms of labor pain relief beyond epidural analgesia. One of these alternatives, hypnosis, might be able to reduce the use of epidural analgesia for labor and potentially decrease the need for interventions (eg, instrumental birth, neonatal an...

Objective: There is potential for midwives to indirectly experience events whilst providing clinical care that fulfil criteria for trauma. This research aimed to investigate the characteristics of events perceived as traumatic by UK midwives. Methods: As part of a postal questionnaire survey conducted between December 2011 and April 2012, midwives...

'Doulas' (lay women who are trained to support other women during pregnancy, birth and postnatally) can improve outcomes for disadvantaged mothers and babies. This Realist Evaluation study uses qualitative interviews to explore the views of staff, commissioners and local champions about the processes of establishing and sustaining five volunteer do...

'Doulas' (lay women who are trained to support other women during pregnancy, birth and postnatally) can improve outcomes for disadvantaged mothers and babies. This Realist Evaluation study uses qualitative interviews to explore the views of staff, commissioners and local champions about the processes of establishing and sustaining five volunteer do...

Postnatal depression (PND) is a major depressive disorder in the year following childbirth, which impacts on women, their infants and their families. A range of interventions has been developed to prevent PND. Objectives To (1) evaluate the clinical effectiveness, cost-effectiveness, acceptability and safety of antenatal and postnatal intervention...

Background: The diagnosis of labor onset has been described as one of the most important judgments in maternity care. There is compelling evidence that the duration of both latent and active phase labor are clinically important and require consistent approaches to measurement. In order to measure the duration of labor phases systematically, we nee...

Disadvantaged childbearing women experience barriers to accessing health and social care services and face greater risk of adverse medical, social and emotional outcomes. Support from doulas (trained lay women) has been identified as a way to improve outcomes; however, in the UK doula support is usually paid-for privately by the individual, limitin...

OBJECTIVE: To describe and summarize the current body of evidence on the subject of birth plans to develop a research agenda. METHOD: A narrative review was undertaken to offer a comprehensive overview of themes emerging from previous research in this area. FINDINGS: Thirty-five papers from 33 studies were retrieved and grouped into three main them...