Julia Sanders

• RN, RM, MPH, LLM, PhD.
• Consultant at Cardiff University

Background During pregnancy, labour and early motherhood, most women in the UK receive care from different midwives. NHS policy change in England sought to introduce a model of care whereby each woman is cared for by the same midwife throughout antenatal, intrapartum and postnatal periods, supported by a small team of midwives to cover off-duty per...

Background Midwifery continuity of carer (MCoC) is a model of care in which the same midwife or small team of midwives supports women throughout pregnancy, birth and the postnatal period. The model has been prioritised by policy makers in a number of high-income countries, but widespread implementation and sustainability has proved challenging. Me...

Objective Warm water immersion during labour provides women with analgesia and comfort. This cohort study aimed to establish among women using intrapartum water immersion analgesia, without antenatal or intrapartum risk factors, whether waterbirth is as safe for them and their babies as leaving the water before birth. Design Cohort study with non‐...

Introduction It is well documented that many women do not desire a short interpregnancy interval. Medical societies, government agencies and leaders in the field recommend that contraception should be part of maternity care. Short spaced and unplanned pregnancies increase the chances of mortality and morbidity in the mother and child. The WHO recom...

Background Using routinely collected clinical data for observational research is an increasingly important method for data collection, especially when rare outcomes are being explored. The POOL study was commissioned to evaluate the safety of waterbirth in the UK using routine maternity and neonatal clinical data. This paper describes the design, r...

Objectives: To explore women's experiences of over-the-counter and prescription medication advice and use during pregnancy. Design: A study design consisting of an online survey and nested in-depth interviews with a subsample of participants. We analysed data from survey free-text responses and in-depth interviews using thematic analysis. Quanti...

Background: Women with overweight (a body mass index of ≥ 25 kg/m2) or obesity (a body mass index of ≥ 30 kg/m2) are at greater risk of experiencing complications during pregnancy and labour than women with a healthy weight. Women who remove their long-acting reversible contraception (i.e. coils or implants) are one of the few groups of people who...

Objective Women of reproductive age who have autoimmune rheumatic diseases [ARDs] have expressed a need to be better supported with making decisions about pregnancy. Women with ARDs want their motherhood identities and associated preferences to be taken into account in decisions about their healthcare. The aim of this study was to explore the inter...

Background Having a body mass index (BMI) which is classified as overweight (BMI ≥ 25) or obese (BMI ≥ 30) increases the risk of complications during pregnancy and labour. Weight-management interventions which target excess gestational weight gain during pregnancy have had limited success. Women who use long-acting reversible contraception (LARC) a...

Objectives The Family Nurse Partnership (FNP) is an intensive home visiting service for teenage first-time mothers, developed/trialled in the US and adapted/trialled across Europe. The Scottish Government aims to build on and supplement the existing evidence base for FNP, to assess effectiveness of the programme, for future improvement work in Scotla...

Background Women receive many public health messages relating to pregnancy which are intended to improve outcomes for babies and mothers. However, negotiating the risk landscape and maternity care system can feel confusing and disempowering. Relationships between women and their healthcare providers are paramount, but they can be adversely affected...

Objectives Measure effectiveness of family nurse partnership (FNP) home-visiting programme in reducing maltreatment and improving maternal health and child health, developmental and educational outcomes; explore effect moderators, mediators; describe costs. Design Follow-up of BB:0–2 trial cohort (ISRCTN:23019866) up to age 7 years in England usin...

Objective The COVID-19 pandemic saw universal, radical, and ultra-rapid changes to UK National Health Services (NHS) maternity care. At the onset of the pandemic, NHS maternity services were stripped of many of the features which support woman and family centred care. In anticipation of unknown numbers of pregnant women and maternity staff potentia...

Background: The UK print and online media is an important channel by which scientific research is communicated to the public. Media risk messages relating to pregnancy or fertility contribute to the context of reproductive decision making, but their fidelity to the underlying science has been questioned. Method: We measured the volume, distribution...

Background Women receive many public health messages relating to pregnancy which are intended to improve outcomes for babies and mothers. However, negotiating risk and the maternity system can feel confusing and dis-empowering. Relationships between women and their carers are central to maternity care trajectories but can be adversely affected by i...

Background The short-term effectiveness (to 24 months post partum) of a preventative home-visiting intervention, the Family Nurse Partnership, was previously assessed in the Building Blocks trial (BB:0–2). Objectives The objectives were to establish the medium-term effectiveness of the Family Nurse Partnership in reducing maltreatment and improvin...

Trauma to the labia occurs in up to 49% of vaginal births¹. Trauma to the perineal body resulting from childbirth is well defined using widely used categories, and recommended management of perineal body trauma is based on high level evidence. Currently no similar evidence exists to inform the classification or management of labial trauma. This is...

Background: Currently, pregnant women are screened using ultrasound to perform gestational aging, typically at around 12 weeks' gestation, and around the middle of pregnancy. Ultrasound scans thereafter are performed for clinical indications only. Objectives: We sought to assess the case for offering universal late pregnancy ultrasound to all nu...

Background: Women with obesity are at a greater risk of experiencing complications during the antenatal, intrapartum and postpartum periods. Despite many studies of weight management interventions in pregnancy, systematic reviews have demonstrated limited effectiveness, demonstrating a need to increase the focus on preconception health and build a...

Introduction Approximately 60 000 (9/100) infants are born into water annually in the UK and this is likely to increase. Case reports identified infants with water inhalation or sepsis following birth in water and there is a concern that women giving birth in water may sustain more complex perineal trauma. There have not been studies large enough t...

Background: Water immersion during labour can provide benefits including reduced need for regional analgesia and a shorter labour. However, in the United Kingdom a minority of women use a pool for labour or birth, with pool use particularly uncommon in obstetric-led settings. Maternity unit culture has been identified as an important influence on p...

Background: Complex health and social care interventions impact on a multitude of outcomes. One such intervention is the Family Nurse Partnership (FNP) programme, which was introduced to support young, first-time mothers. Our study quantified the relative values that the general public place on the outcomes of FNP, as they were identified and measu...

Visual timeline methods have been used as part of face-to-face qualitative interviewing with vulnerable populations to uncover the intricacies of lived experiences, but little is known about whether visual timelines can be effectively used in telephone interviews. In this article, we reflect on the process of using visual timelines in 16 telephone...

Around half of pregnant women in the United Kingdom are overweight or obese. The antenatal period provides an opportunity for encouraging women to adopt positive lifestyle changes, and in recent years, this has included development of strategies to support women in avoiding excessive gestational weight gain. The objective of this interventional coh...

Introduction: Individual, social and economic circumstances faced by young mothers (19 years or under) can challenge a successful start in life for their children. Intervening early might enhance life chances for both mother and child. The Family Nurse Partnership (FNP) is an intensive nurse-led home visiting programme developed in the US which ai...

Abstract Background Although adverse event (AE) monitoring in trials focusses on medical events, social outcomes may be important in public or social care trials. We describe our approach to reporting and categorising medical and other AE reports, using a case study trial. We explore predictors of medical and social AEs, and develop a model for con...

BackgroundPOOL is a cohort study designed to establish whether waterbirth, compared to leaving a pool prior to birth, is as safe for mothers and infants. It is a novel case study using routine maternity and neonatal data for research purposes, including the adaptation and addition of locally collected electronic data at sites. AimWe aimed to establ...

Objective: To identify factors influencing the use of birth pools. Design: Online discussion groups and semi-structured interviews, analysed thematically. Setting: United Kingdom. Participants: 85 women and 21 midwives took part in online discussion groups; 14 medical staff participated in interviews. Findings: Factors influencing the use of bi...

Background: The Family Nurse Partnership (FNP) is a licensed intensive home visiting intervention programme delivered to teenage mothers which was originally introduced in England in 2006 by the Department of Health and is now provided through local commissioning of public health services and supported by a national unit led by a consortium of part...

Introduction: Reducing smoking in pregnancy was a primary outcome in our Building Blocks trial of the Family Nurse Partnership[1]. We calibrated maternal reports of smoking using cotinine values derived from urine samples to assess tobacco use [2]. This involves identifying the extent to which an individual accurately reports smoking and requires...

Introduction The Family Nurse Partnership(FNP) is an intensive home-visiting service for teenage first-time mothers (and children), developed/trialled in the US and adapted/trialled across Europe.The Scottish Government(SG) aims to build on and supplement the existing national/international evidence base for FNP, to assess effectiveness and opportu...

An uncontrolled study with process evaluation was conducted in three UK community maternity sites to establish the feasibility and acceptability of delivering a novel breastfeeding peer‐support intervention informed by Motivational Interviewing (Mam‐Kind). Peer‐supporters were trained to deliver the Mam‐Kind intervention that provided intensive one...

Abstract Background Autoimmune rheumatic diseases (ARDs) such as inflammatory arthritis and Lupus, and many of the treatments for these diseases, can have a detrimental impact on fertility and pregnancy outcomes. Disease activity and organ damage as a result of ARDs can affect maternal and foetal outcomes. The safety and acceptability of hormonal c...

Background:Women with autoimmune rheumatic diseases (ARDs) find it difficult to get information and support with family planning, pregnancy, and early parenting. A systematic approach to prioritising research is required to accelerate development and evaluation of interventions to meet the complex needs of this population. Methods:A Nominal Group...

Objectives: We compared the US-derived Family Nurse Partnership (FNP) home visiting programme when added to usually provided health and social care for first-time teenage mothers, to usual care alone. We aimed to: establish the nature of usual care, measure service usage and assess performance bias in core usual care services. Design: Within tri...

Rationale aims and objectives: Motivational Interviewing (MI) is an individual-level approach to behaviour change that has been evaluated in over 600 randomised clinical trials across multiple settings. Increasingly, research efforts focus on how MI works and how it can best be integrated into public health and clinical programmes. As the applicat...

Background: Many women in the UK stop breastfeeding before they would like to, and earlier than is recommended by the World Health Organization (WHO). Given the potential health benefits for mother and baby, new ways of supporting women to breastfeed for longer are required. The purpose of this study was to develop and characterise a novel Motivat...

The World Health Organisation guidance recommends breastfeeding peer support (BFPS) as part of a strategy to improve breastfeeding rates. In the UK, BFPS is supported by National Institute for Health and Care Excellence guidance and a variety of models are in use. The experimental evidence for BFPS in developed countries is mixed and traditional me...

Background In total, 81% of women in the UK start breastfeeding, but fewer than half continue beyond 6 weeks. Peer support in the early postnatal period may encourage women to breastfeed for longer. Objective To develop a breastfeeding peer-support intervention based on motivational interviewing (MI) for breastfeeding maintenance and to test the f...

Background: Postpartum haemorrhage (PPH) can be exacerbated by haemostatic failure. Based on data from trauma studies, empirical infusions of fresh frozen plasma (FFP) are often given during severe PPH if coagulation tests are unavailable. This study observed a cohort of women with moderate/severe PPH in whom FFP infusion was guided by the use of...

Background: Postpartum haemorrhage (PPH) can be exacerbated by haemostatic failure. We hypothesized that early fibrinogen replacement, guided by viscoelastometric testing, reduces blood product usage and bleed size. Methods: Women with PPH 1000-1500 ml were enrolled. If Fibtem A5 was ≤15 mm and bleeding continued, subjects were randomized to fib...

Rational, aims, and objectives: The Family Nurse Partnership (FNP) is a licensed intensive home visiting intervention developed in the United States. It has been provided in England by the Department of Health since 2006. The Building Blocks trial assessed the effectiveness and cost-effectiveness of FNP in England. Methods: We performed a cost-u...

Peer-support is recommended by the World Health Organisation for the initiation and continuation of breastfeeding, and this recommendation is included in UK guidance. There is a lack of information about how, when and where breastfeeding peer-support is provided in the UK. We aimed to generate an overview of how peer-support is delivered in the UK...

Introduction Child maltreatment involves acts of omission (neglect) or commission (abuse) often by caregivers that results in potential or actual harm to a child. The Building Blocks trial (ISRCTN23019866) assessed the short-term impact of an intensive programme of antenatal and postnatal visiting by specially trained nurses to support young pregna...

Background The benefits of breastfeeding for the health of babies and mothers are well known, but in the UK less than half of the 81% of women who start breastfeeding continue beyond 6 weeks. WHO recommends 6 months' exclusive breastfeeding. Breastfeeding peer-support was found to be effective for breastfeeding maintenance in low or middle income c...

Background Motivational Interviewing (MI) is a person-centred counselling approach to behaviour change which is increasingly being used in public health settings, either as a stand-alone approach or in combination with other structured programmes of health promotion. One example of this is the Family Nurse Partnership (FNP) a licensed, preventative...

Abstracted from Lancet 2016;387:146–155 Individual, social, and economic circumstances faced by teenage mothers can challenge a successful start for children and interrupt mothers' long-term socioeconomic stability. The Family-Nurse Partnership (FNP) is a licensed intensive home-visiting intervention developed in the United States and introduced in...

Background: midwives have traditionally had an important role in providing public health messages to women. The range and diversity of the public health remit within maternity services has expanded rapidly over the past decade and maternity support workers as well as midwives are now engaged in public health work in many areas. Given these changes...

Background: Many countries now offer support to teenage mothers to help them to achieve long-term socioeconomic stability and to give a successful start to their children. The Family Nurse Partnership (FNP) is a licensed intensive home-visiting intervention developed in the USA and introduced into practice in England that involves up to 64 structu...

Postpartum haemorrhage (PPH) is a major cause of maternal morbidity. Bleeding is caused by a combination of physical causes, such as failure of the uterus to contract or operations, and is made worse by impairment of the blood clotting system. A number of studies have shown that low levels of the blood clotting factor fibrinogen are associated with...

This prospective, observational study investigated the utility of Fibtem A5 and Clauss fibrinogen as predictors of progression of postpartum hemorrhage (PPH). A consecutive cohort of 356 women experiencing 1000 to 1500 mL PPH was recruited. Fibtem and fibrinogen were measured and subsequent transfusions, invasive procedures, and bleed volume record...

Background We set out to validate the accuracy of gravimetric quantification of blood loss during simulated major postpartum haemorrhage and to evaluate the technique in a consecutive cohort of women experiencing major postpartum haemorrhage. The study took part in a large UK delivery suite over a one year period. All women who experienced major po...

Building Blocks is a randomised controlled trial evaluating the effectiveness of the Family Nurse Partnership (FNP) programme in 18 sites in England. FNP is a home visiting intervention aiming to address social exclusion and health disadvantage. Participants were 1600 teenage mothers, living in often challenging social circumstances. Recruitment us...

The Nurse Family Partnership programme was developed in the USA where it is made available to pregnant young mothers in some socially deprived geographic areas. The related Family Nurse Partnership programme was introduced in England by the Department of Health in 2006 with the aim of improving outcomes for the health, wellbeing and social circumst...

The Family Nurse Partnership (FNP) Programme is a structured intensive home visiting programme delivered by trained family nurses to nulliparous teenagers throughout pregnancy and until their child is two years old. Currently FNP is provided in over 60 primary healthcare sites in England with a planned capacity increase to 13,000 concurrent clients...

Postpartum haemorrhage is an important cause of maternal morbidity and mortality. It is associated with haemostatic impairment which may exacerbate bleeding. All deliveries over a 3-year period in a large UK unit were reviewed and cases of haemorrhage of 1500 mL or more identified. Laboratory records were reviewed and the lowest value for haemoglob...

Women planning spontaneous vaginal delivery often are not offered analgesia for perineal pain while in the second stage of labor. Midwives, however, sometimes apply various substances, including lidocaine, in an attempt to limit postpartum perineal pain. This study was a randomized, controlled trial comparing a topically applied local anesthetic sp...

To evaluate the effectiveness and acceptability of a lidocaine spray in reducing perineal pain during spontaneous vaginal delivery. Randomised controlled trial. Consultant led obstetric unit. 185 women who had a spontaneous vaginal delivery without epidural analgesia. Topically applied local anaesthetic spray (93 women) and placebo spray (92 women)...

Objective To assess the expectations of antenatal care of pregnant women at the outset of pregnancy. Design Questionnaire study within a randomised controlled trial, comparing traditional antenatal care with a more flexible schedule. Setting Eleven primary care centres providing midwifery care in Avon. Population Five hundred and ninety-three pregn...

To investigate use of pharmacological and non-pharmacological methods of perineal analgesia used by midwives during the second stage of labour and perineal repair in the UK. Postal survey. Self-complete questionnaires were sent to Heads of Midwifery in all 219 maternity units in the UK. Information was requested on the number and type of deliveries...

The amount of pain women experience during perineal suturing is previously unreported, although anecdotal evidence suggests that the procedure can be associated with considerable pain. Of 68 women who participated in this descriptive study, 16.5% reported 'distressing', 'horrible' or 'excruciating' pain while receiving perineal sutures. Contrary to...

To assess the expectations of antenatal care of pregnant women at the outset of pregnancy. Questionnaire study within a randomised controlled trial, comparing traditional antenatal care with a more flexible schedule. Eleven primary care centres providing midwifery care in Avon. Five hundred and ninety-three pregnant women at low risk of obstetric c...

To assess changes in satisfaction associated with a flexible approach to antenatal care schedules offered to women at low obstetric risk. Randomised controlled trial. Eleven primary care centres providing midwifery care in Avon. Six hundred and nine women at low risk of obstetric complications presenting for antenatal care. A standard antenatal car...

Objective To assess changes in satisfaction associated with a flexible approach to antenatal care schedules offered to women at low obstetric risk. Design Randomised controlled trial. Setting Eleven primary care centres providing midwifery care in Avon. Participants Six hundred and nine women at low risk of obstetric complications presenting for an...

To explore the views of midwives towards traditional and flexible schedules of antenatal attendance for women at low risk. A qualitative approach using focus groups. Three NHS Trusts providing maternity care in and around Bristol. 14 midwives who had provided antenatal care to women participating in the Bristol Antenatal Care Study. Midwives genera...