Valerie Smith

• Doctor of Philosophy
• Professor of Midwifery at University College Dublin

Objective To explore health outcomes up to 5 years of age, according to mode of birth, in a large cohort of Swedish children who were born as a second child to women who had a caesarean section (CS) in their first pregnancy. Design Retrospective population-based register study. Population All children (n=94 498) who were born as a second child (o...

Background Equality, diversity and inclusion (EDI) has gained discursive momentum across multiple arenas, including in maternal health research. As a preliminary exploration for future discussion and development, we undertook a scoping review to identify the types, frequency, and extent of EDI characteristics that were measured and reported in rand...

Introduction The chronic shortage of registered midwives and nurses is a serious global problem. However, current recommendations regarding midwifery staffing do not address operational staffing difficulties that arise from wide variations in care demand. The aim of this study was to describe shift-level care demand and available staffing resources...

Background Equality, diversity and inclusion (EDI) has gained discursive momentum across multiple arenas, including in maternal health research. As a preliminary exploration for future discussion and development, we undertook a scoping review to identify the types, frequency, and extent of EDI characteristics that were measured and reported in rand...

Background Healthcare providers working in hospitals have significant exposure to patients with palliative care needs. For many patients, these needs often reflect non-specialist rather than specialist palliative care needs. Embedding a palliative care approach in acute hospital-based care however is challenging. Aim To identify core indicators fo...

Problem and background During the COVID-19 pandemic, there was substantial reconfiguration of maternity care services, affecting both users and healthcare providers (HCPs), in the United Kingdom (UK) and globally. Aim To further our understanding of the impact of maternity service reconfigurations in the UK, from the perspective of maternity HCPs....

Background Care bundles, introduced in 2001, are described as a set of at least three evidence-based healthcare interventions delivered together in a clinical care episode by all healthcare providers. Although widely implemented in some healthcare areas, care bundle use in maternity care appears relatively recent. To identify the types of care bund...

Background The involvement of husbands and male partners in childbirth no longer ceases at conception and pregnancy, rather fathers wish to be more involved in supporting their partners during childbirth. This aligns with the World Health Organization's (WHO) call for promoting male participation in childbirth, emphasising the benefits of support a...

Background Maternity care services in the United Kingdom have undergone drastic changes due to pandemic-related restrictions. Prior research has shown maternity care during the pandemic was negatively experienced by women and led to poor physical and mental health outcomes in pregnancy. A synthesis is required of published research on women’s exper...

Background People with intellectual disabilities have poorer health and die earlier than their peers without identified disabilities. This difference represents a significant inequality. Until recently, it was considered that cancer was less common in this population, mainly because they did not live long enough to develop age-related cancers. Howe...

Background Core outcome sets (COS) represent agreed-upon sets of outcomes, which are the minimum that should be measured and reported in all trials in specific health areas. Use of COS can reduce outcome heterogeneity, selective outcome reporting, and research waste, and can facilitate evidence syntheses. Despite benefits of using COS, current use...

Background Suboptimal or slow recruitment affects 30–50% of trials. Education and training of trial recruiters has been identified as one strategy for potentially boosting recruitment to randomised controlled trials (hereafter referred to as trials). The Training tRial recruiters, An educational INtervention (TRAIN) project was established to devel...

Background: Dementia with Lewy bodies (DLB) is an important cause of dementia with a range of clinical manifestations, including motor, neuropsychiatric, and autonomic symptoms. Compared with more common forms of dementia such as Alzheimer’s disease, DLB has been the focus of significantly fewer treatment studies, often with diverse outcome measure...

Background : Patient and public involvement (PPI) has the potential to improve the relevance of trial outcomes and improve participant recruitment within clinical trials. However, the literature on PPI approaches, outcomes, and attitudes towards PPI in specific clinical research areas is limited. We are interested to know the current approaches to...

Background: People with intellectual disabilities have poorer health and die earlier than their peers without identified disabilities. This difference represents a significant inequality. Until recently, it was considered that cancer was less common in this population, mainly because they did not live long enough to develop age-related cancers. How...

Objective This study aimed to create core outcome sets (COSs) for use in research studies relating to the awareness and clinical management of reduced fetal movement (RFM). Design Delphi survey and consensus process. Setting International. Population A total of 128 participants (40 parents, 19 researchers and 65 clinicians) from 16 countries. M...

Purpose This study aims to explore how the COVID-19 pandemic has impacted parents of autistic children and their families in Ireland. Design/methodology/approach A qualitative thematic analysis methodology was applied using semi-structured interviews. A total of 12 parents (ten mothers, one father and one grandfather speaking on behalf of a mother...

Background : Patient and public involvement (PPI) has the potential to improve the relevance of trial outcomes and improve participant recruitment within clinical trials. However, the literature on PPI approaches, outcomes, and attitudes towards PPI in specific clinical research areas is limited. We are interested to know the current approaches to...

This period, especially after the first childbirth, is the litmus test of young parenthood. On the one hand, the combination of birth, perineal damage, breastfeeding, sleeplessness, and hormonal changes can strongly influence postpartum sexuality. On the other hand, the new baby has suddenly changed the dyad into a triad and is simultaneously a sou...

The first birth is a major life event for all involved parties: woman, partner (and couple). This chapter will address the relevant elements that together shape parenthood and couplehood. That process is somewhat different for the average woman and the average man. Many men more or less tend to return to their pre-pregnancy level of sexual desire r...

Problem Maternal perception of reduced fetal movements (RFM) is identified as an important alarm signal for possible risk of impending adverse perinatal outcomes. Background Perinatal outcomes associated with RFM are increasingly being investigated in non-randomised studies with several associated outcomes, including stillbirth, preterm birth, fet...

Objective: The objective of this scoping review is to identify and describe the extent and type of the available evidence on simulation-based education for nurse and midwife advanced practitioner education. Introduction: Simulation-based education is widely adopted in undergraduate nurse and midwife education, but the extent of the use, format,...

This study provides evidence- and consensus-based recommendations for the instruments to measure the five Pelvic Girdle Pain Core Outcome Set (PGP-COS): pain frequency, pain intensity/severity, function/disability/activity limitation, health-related quality of life and fear avoidance. Studies evaluating measurement properties of instruments measuri...

Background: Dementia with Lewy bodies (DLB) is an important cause of dementia with a range of clinical manifestations, including motor, neuropsychiatric, and autonomic symptoms. Compared with more common forms of dementia such as Alzheimer’s disease, DLB has been the focus of significantly fewer treatment studies, often with diverse outcome measure...

Objective: This scoping review will identify the existence and type of care bundles developed, evaluated, or used by health care professionals in providing maternity care to women during pregnancy, labor/birth, and postpartum. Introduction: Care bundles consist of at least 3 to 5 evidence-based health care interventions that are implemented toge...

Objective To investigate neonatal outcomes within 28 days in the subsequent birth in women who gave birth to their first baby by caesarean section (CS). Design and setting National retrospective population-based register study. A cohort of 94 451 neonates who were born in Sweden between 1999 and 2015 as a second child to a mother who had her first...

Objective To gain insight and understanding, from the perspective of maternity care providers, on the use and application of maternity early warning systems (MEWS) in clinical practice. Design A qualitative evidence synthesis was conducted. MEDLINE, CINHAL, Web of Science Core Collection and Maternity and Infant Care (MIDIRS), from inception to Ma...

Background As COVID-19 continued to impact society and health, maternity care, as with many other healthcare sectors across the globe, experienced tumultuous changes. These changes have the potential to considerably impact on the experience of maternity care. To gain insight and understanding of the experience of maternity care during COVID-19, fro...

Background Caesarean section rates continue to rise in most parts of the world. While CS is a lifesaving procedure there is evidence that, beyond a certain threshold, CS rates may contribute to increased maternal and perinatal morbidity. This study aimed to elicit the views of pregnant women’s and clinicians’ on how CS rates might be reduced. Meth...

Background Several studies exploring the associations of reduced fetal movements (RFM) with adverse perinatal outcomes have been published in recent years. Objectives To synthesise the evidence on pregnancy, birth and neonatal outcomes in women who presented with RFM to ascertain associations between RFM and pregnancy outcomes. Search Strategy PubM...

Background: The International Committee of Medical Journal Editors (ICMJE) requires trials submitted for publication to be registered before recruitment of the first participant; however, there is ambiguity around the definition of recruitment and in anchoring the trial start date, end date, and recruitment, or as often interchangeably referred to,...

Background: Core outcome sets (COS) represent agreed-upon sets of outcomes, which are the minimum that should be measured and reported in all trials in specific health areas. Use of COS can reduce outcome heterogeneity, selective outcome reporting, and research waste, and can facilitate evidence syntheses. Despite benefits of using COS, current use...

Introduction: Formally counting fetal movements in pregnancy is one of the oldest methods to assess fetal well-being. Although not routinely recommended in contemporary maternity care, due to a lack of evidence of its effectiveness, formal fetal movement counting is still practiced in many birth settings. Requesting women to formally count their f...

Background Water immersion during labour and birth has been acknowledged worldwide as a safe option for low-risk pregnant women. The extent of use of water immersion in the Republic of Ireland, however, is largely limited, as few maternity units have installed birthing pools. To explore women's experience of water immersion during labour and birth...

Problem A worldwide increase of caesarean section (CS) rates has been estimated at a rate of 4% per year and numerous interventions to reduce the rates have not been successful, perhaps because they are not acceptable to clinicians. Background A caesarean section (CS) can be a life-saving operation, but has been associated with short- and long-ter...

Background Concerns regarding reduced fetal movements (RFM) are reported in 5–15% of pregnancies, and RFM are associated with adverse pregnancy outcomes including fetal growth restriction and stillbirth. Studies have aimed to improve pregnancy outcomes by evaluating interventions to raise awareness of RFM in pregnancy, such as kick counting, evalua...

Purpose of Review This paper explores the complexities of postpartum sexual health. It answers the question on what should be considered normal sexual health after birth and what should be considered abnormal. Recent Findings Many women experience physical sexual health issues in the months after birth, such as dyspareunia, lack of vaginal lubrica...

Background A series of changes in maternity care provision were implemented internationally in response to the COVID-19 pandemic. This study aimed to assess the impact of COVID-19 on maternal clinical outcomes, resulting from these changes to care provision. Methods A before and during comparative study of maternal pregnancy, childbirth, and postp...

Objectives To examine current practices in late-phase trials published in major medical journals and examine trialists’ views about core outcome set (COS) use. Design and Setting A sequential multi-methods study was conducted. We examined late-phase trials published between October 2019 and March 2020 in JAMA, NEJM, The Lancet, BMJ, and Annals of...

Objective : To identify women's help-seeking behaviour in relation to sexual health issues after the birth of their first baby. Design : A mixed methods sequential explanatory study design was utilised. Phase one of the study consisted of a prospective cohort study to identify the help-seeking behaviour of women experiencing sexual health issues a...

Background: A considerable challenge for maternity care providers is recognising clinical deterioration early in pregnant women. Professional bodies recommend the use of clinical assessment protocols or evaluation tools, commonly referred to as physiological track-and-trigger systems (TTS) or early warning systems (EWS), as a means of helping mate...

Background Although caesarean section (CS) is a life-saving intervention when medically indicated, the growth in CS rates is causing concern. In reducing unnecessary CS, it is important to understand clinicians’ attitudes towards CS so that these might be understood contextually. Objective To explore clinicians’ attitudes towards CS in Ireland. M...

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. To assess the effect of interventions to improve awareness and detection of fetal movements and interventions to address the clinical management of decreased fetal movements on maternal, perinatal and childhood outcomes. Copyright © 2021 The Cochran...

Objective : To gain insight and understanding of women's views and experiences of maternity care during the COVID-19 pandemic in Ireland. Design : A qualitative descriptive study using semi-structured interviews. Due to social distancing and associated COVID-19 restrictions at the time of the study, the interviews were held remotely via telephone....

In recent years there has been an explosion of interest in Artificial Intelligence (AI) both in health care and academic philosophy. This has been due mainly to the rise of effective machine learning and deep learning algorithms, together with increases in data collection and processing power, which have made rapid progress in many areas. However,...

Background: Family members, or others, often assume the role of informal (unpaid) carers of people with chronic illnesses. Care-giving, however, can impact profoundly on the quality of life of carers and can cause carer worry, stress and guilt. Implementing interventions that positively affect the lives of carers is important; however, carers as a...

Background: Early warning systems (EWS) have been widely adopted for use in maternity settings internationally. The idea in using these systems is early recognition of potential or actual clinical deterioration in pregnant or postpartum women, and escalation of care. Barriers to successful implementation and use of EWS, however, have been identifie...

Background Research investigating exercise interventions in oesophagogastric cancer survivors is sparse, and the outcomes are varied. The aim of this systematic review is to identify the domains and outcomes reported in exercise interventions in oesophagogastric cancer survivors to be included in a Delphi study, with a view to informing the develop...

Background Raising awareness of the importance of fetal movements (FMs) and advising women on the appropriate action to take if they experience reduced FMs, is important for minimising or avoiding adverse perinatal outcomes. To gain insight and understanding of women’s perspectives of assessing FMs in pregnancy, we conducted a qualitative evidence...

Background Inconsistent reporting of outcomes in clinical trials of women with Pelvic Girdle Pain (PGP) hinders comparison of findings and the reliability of evidence synthesis. A core outcome set (COS) can address this issue as it defines a minimum set of outcomes that should be reported in all clinical trials on the condition. The aim of this stu...

Background: Considerable changes in maternity care provision internationally were implemented in response to COVID-19. Such changes, often occurring suddenly with little advance warning, have had the potential to affect women’s and maternity care providers experience of maternity care, both positively and negatively. For this reason, to gain insigh...

Background: Outcome heterogeneity, selective reporting, and choosing outcomes that do not reflect needs and priorities of stakeholders, limit the examination of health intervention effects, particularly in late phase trials. Core outcome sets (COS) are a proposed solution to these issues. A COS is an agreed-upon, standardised set of outcomes that s...

Background: Many women experience perineal pain after childbirth, especially after having sustained perineal trauma. Perineal pain-management strategies are an important part of postnatal care. Non-steroidal anti-inflammatory drugs (NSAIDs) are a commonly-used type of medication in the management of postpartum pain, and their effectiveness and saf...

Background As the development of core outcome sets (COS) increases, guidance for developing and reporting high-quality COS continues to evolve; however, a number of methodological uncertainties still remain. The objectives of this study were: (1) to explore the impact of including patient interviews in developing a COS, (2) to examine the impact of...

Background: The International Committee of Medical Journal Editors (ICMJE) requires trials submitted for publication to be registered before recruitment of the first participant; however, there is ambiguity around the definition of recruitment and in anchoring the trial start date, end date, and recruitment, or as often interchangeably referred to,...

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the strain of coronavirus that causes coronavirus disease 2019 (COVID-19) can cause serious illness in some people resulting in admission to intensive care units (ICU) and frequently, ventilatory support for acute respiratory failure. Evaluating ICU care, and what is effecti...

Background: Raising awareness of the importance of fetal movements (FMs) and advising women on the appropriate action to take if they experience reduced FMs, is critical for minimising or avoiding adverse perinatal outcomes. To gain insight and understanding of women’s perspectives of assessing FMs in pregnancy, we conducted a qualitative evidence...

Background: Family members, or others, often assume the role of informal (unpaid) carers of people with chronic illnesses. Care-giving, however, can impact profoundly on the quality of life of carers and can cause carer worry, stress and guilt. Implementing interventions that positively affect the lives of carers is important; however, carers as a...

Objective To offer insight and understanding on the perspectives of the partners of mothers who experience postnatal mental distress. Background Partners have an important role in identifying postnatal mental distress, supporting the mother, and encouraging help-seeking behaviours that may help reduce the associated long-term consequences on the m...

Introduction: Failure to provide adequate discharge advice to patients on leaving the emergency department can lead to poor understanding of and noncompliance with discharge instructions and consequently postdischarge complications or hospital readmissions. The use of pictographs to complement discharge advice has the potential to enhance patient...

Background: Outcome heterogeneity, selective reporting, and choosing outcomes that do not reflect needs and priorities of stakeholders, limit the examination of health intervention effects, particularly in late phase trials. Core outcome sets (COS) are a proposed solution to these issues. A COS is an agreed-upon, standardised set of outcomes that s...

Background: Population prevalence estimates by the World Health Organisation suggest that 1 in 160 children worldwide has an Autism Spectrum Disorder (ASD). Accessing respite care services for children with an ASD can often be a daunting and exhaustive process, with parents sometimes forced to access acute hospital services as an initial point of c...

Background: Population prevalence estimates by the World Health Organisation suggest that 1 in 160 children worldwide has an Autism Spectrum Disorder (ASD). Accessing respite care services for children with an ASD can often be a daunting and exhaustive process, with parents sometimes forced to access acute hospital services as an initial point of...

Background Healthcare providers working in hospitals are frequently exposed to patients with palliative care needs. For most patients, these reflect non-specialist rather than specialist palliative care needs. Embedding palliative care principles early in patients’ disease trajectories within acute care delivery in hospitals, however, is a challeng...

Background As the development of core outcome sets (COS) increases, guidance for developing and reporting high-quality COS continues to evolve; however, a number of methodological uncertainties still remain. The objectives of this study were: (1) to explore the impact of including patient interviews in developing a COS (2) to examine the impact of...

Background: As the development of core outcome sets (COS) increases, guidance for developing and reporting high-quality COS continues to evolve; however, a number of methodological uncertainties still remain. The objectives of this study were: (1) to explore the impact of including patient interviews in developing a COS, (2) to examine the impact o...

Background: As the development of core outcome sets (COS) increases, guidance for developing and reporting high-quality COS continues to evolve; however, a number of methodological uncertainties still remain. The objectives of this study were: (1) to explore the impact of including patient interviews in developing a COS, (2) to examine the impact o...

Background: Studies within trials (SWATs) present an opportunity to examine design factors that may impact on the successful delivery of trials. One area in need of research is trial recruitment. Recruiting patients to trials is a major challenge facing trialists. Failure to meet recruitment targets can result in delays and underpowered studies. Th...

Background Despite evidence supporting the safety of vaginal birth after caesarean section (VBAC), rates are low in many countries. Methods OptiBIRTH investigated the effects of a woman-centred intervention designed to increase VBAC rates through an unblinded cluster randomised trial in 15 maternity units with VBAC rates < 35% in Germany, Ireland...

Maternal perception of reduced fetal movements (RFM) in pregnancy is a common reason for referral to maternity services. This systematic review synthesised the evidence from studies on pregnancy, birth and neonatal outcomes in women who presented with RFM in pregnancy to ascertain associations between RFM and potential adverse outcomes, and to info...

Methods Pubmed, Embase, CINAHL and PsycINFO were systematically searched using a systematic review search protocol that was developed to support the search strategy. The search strategy also targeted unpublished studies and 'grey literature' to help minimize the risk of missing unpublished studies. No limitation was placed on the age of the data. D...

Background: Family members, or others, often assume the role of informal (unpaid) carers of people with chronic illnesses. Care-giving, however, can impact profoundly on the quality of life of caregivers and can cause carer worry, stress and guilt. Implementing interventions that positively affect the lives of carers is important, however, carers a...

( BJOG . 2019;126:114–121) To identify which deliveries might be at greater risk of intrapartum fetal compromise and therefore may benefit from continuous cardiotocography (cCTG) during labor, either intermittent auscultation (IA) or admission cardiotocography (ACTG) is performed on women upon admission with possible labor onset. Current guidelines...

Concern has been expressed globally over rising caesarean birth rates. Recently, the International Federation of Gynaecology and Obstetrics (FIGO) called for help from governmental bodies, professional organisations, women’s groups, and other stakeholders to reduce unnecessary caesareans. As part of a wider research initiative, we conducted an over...

Background Healthcare providers working in acute care hospitals have significant exposure to cancer patients with palliative care needs, and for the majority of patients these reflect non-specialist rather than specialist palliative care needs. Embedding non-specialist palliative care in acute hospital-based care is challenging. The aim of this pap...

Maternal perception of reduced fetal movements (RFM) is an important clinical marker to identify women at higher risk of adverse perinatal outcomes. Preventing and reducing stillbirths can only be achieved through better detection and management of women with RFM, however the characteristics of women who present with RFM in pregnancy vary. A system...

Objective To review systematically the evidence on the costs and cost-effectiveness of deinstitutionalisation for adults with intellectual disabilities. Design Systematic review. Population Adults (aged 18 years and over) with intellectual disabilities. Intervention Deinstitutionalisation, that is, the move from institutional to community settin...

Background: Measuring care processes is an important component of any effort to improve care quality, however knowing the appropriate metrics to measure is a challenge both in Ireland and other countries. Quality of midwifery care depends on the expert knowledge of the midwife and her/his contribution to women and their babies' safety in the healt...

Background Building palliative care capacity among all healthcare practitioners caring for patients with chronic illnesses, who do not work in specialist palliative care services (non-specialist palliative care), is fundamental in providing more responsive and sustainable palliative care. Varying terminology such as ‘generalist’, ‘basic’ and ‘a pal...

Background: Maintaining care for ill persons in the community is heavily dependent on support from unpaid caregivers. Many caregivers, however, find themselves in a caring role for which they are ill prepared and may require professional support. The telephone is an easily accessible method of providing support irrespective of geographical locatio...

Objective: The objective of this study was to examine the effectiveness of education and training interventions on recruitment to randomized and non-randomized trials. Study design and setting: A systematic review of the effectiveness of education and training interventions for recruiters to trials. The review included randomized and non-randomi...

Objective To review systematically the evidence on how deinstitutionalisation affects quality of life (QoL) for adults with intellectual disabilities. Design Systematic review. Population Adults (aged 18 years and over) with intellectual disabilities. Interventions A move from residential to community setting. Primary and secondary outcome meas...

Background The Core Outcome Measures in Effectiveness Trials (COMET) database is a publically available, searchable repository of published and ongoing core outcome set (COS) studies. An annual systematic review update is carried out to maintain the currency of database content. Methods The methods used in the fourth update of the systematic revie...

PRISMA Checklist. PRISMA checklist for content of a systematic review. (DOC)

Table of reports included in updated review (n = 88). (DOCX)

Background Pelvic Girdle Pain (PGP) is an important cause of disability and economic cost worldwide. There is a need for effective preventative and management strategies. Emerging studies measure a variety of outcomes rendering synthesis and translation to clinical practice difficult. A Core Outcome Set (COS) can address this problem by ensuring th...