APPENDIX 47
Memorandum by National Perinatal Epidemiology
Unit (MS 56)
The National Perinatal Epidemiology Unit (NPEU)
was established at Oxford University by the Department of Health
in 1978 and is one of several Department of Health Research Policy
Units in England. The NPEU undertakes research about pregnancy,
childbirth and newborn babies, as well as long term outcomes for
babies and mothers. The Department of Health provides over 50%
to the Unit's annual income, the remainder coming from a variety
of externally funded research projects. Funding of this post comes
from the Unit "envelope" of money from the Department
of Health and is available until December 2005. In 2004 the Unit
will undergo its quinquennial review when a programme of work
will be presented to the Department of Health for the period 2006-10.
THE COLLECTION
OF DATA
FROM MATERNITY
UNITS
The collection of data from maternity units
is of key importance in the provision of a quality service in
maternity care. Current data collection is poor. Maternity care
providers use a variety of different electronic systems for collecting
routine data and then find it difficult to use. As a consequence,
there is no incentive to ensure that the data is entered accurately,
so that even if the completeness of the "maternity tail"
data can be increased, the quality of the data being collected
may be so poor that it makes the data meaningless.
CAESAREAN SECTION
RATES
One consequence of the lack of accurate and
comprehensive routine data about maternity care is that the National
Sentinel Caesarean Section Audit had to be undertaken to answer
pressing but basic questions about the incidence of caesarean
section in the UK and the reasons for the recent increase. If
routine data sources had been reliable much of this audit could
have been achieved using routine data sources at a fraction of
the cost and time. Similarly, if government wishes to continue
to monitor trends in the caesarean section rate over time, further
audits will need to be repeated as routine data sources are still
not adequate to answer these basic questions.
In addition, the collection of routine data
underpins another of the committees questions which relates to
staffing levels and training and the impact of these on the type
of birth a woman has and the health of her baby. In order for
meaningful data to be collected on the type of birth a woman has,
routine data sources need to be accurate. In addition, the "linking"
of mothers birth details to early or later child health is currently
not possible. It is also currently not possible to monitor child
health using routine data sources.
If the influence of quality of care on mother
and baby outcomes is to be monitored in a meaningful way, it is
essential that (a) routine data collected from maternity units
is standardised, (b) the systems used to collect the data are
compatible with each other throughout the country, (c) the data
is checked regularly for quality and completeness and (d) that
there is an incentive for trusts to provide accurate and timely
data to the Office of National Statistics. Equally important,
however, is that data are collated, analysed and the findings
fed back to clinicians in a timely and meaningful way. If the
individuals providing the data do not benefit from its collection
in a tangible way, then it will be extremely difficult to maintain
quality and completeness.
The NPEU has undertaken or is currently undertaking
a number of studies which may be helpful to the committee. These
are:
IN RELATION
TO COMMUNICATION
Reports from a study about stillbirth and infant
death:
Rowe R, Garcia J, Macfarlane A, Davidson L.
(1999) Communication Issues in Stillbirth and Infant Death: a
Review of Communications within the CESDI Framework. National
Perinatal Epidemiology Unit, Oxford.
Rowe R, Garcia J, Macfarlane A, Davidson L.
(2001) Does poor communication contribute to stillbirths and infant
deaths? a review. Journal of Public Health Medicine; 23(1):
23-34
ORGANISATION OF
CARE
Reports for a DH-funded study of maternity care
organisation:
(1) Report on the Research Colloquium, June
2000.
(2) National survey of maternity care organisation,
England 2001 A report to the Department of Health, July 2001.
(3) Research directions: a briefing paper
for the Department of Health, 2002.
INEQUALITIES IN
MATERNITY
Barriers to care for low-income childbearing
women. This is a Community Fund project involving NPEU and
Maternity Alliance which is nearing completion. Reports which
may be relevant include:
— Summary of evidence about existing
inequalities in maternal and child health in England.
— Response to DH consultation "Tackling
Health Inequalities: consultation on a plan for delivery"
(November 2001).
— Paper submitted to Public Health—Social
and ethnic inequalities in access to prenatal screening and diagnosis
in the UK: a systematic review (April 2002).
— Paper submitted to J Public Health
Medicine—Social class, ethnicity and attendance for antenatal
care in the United Kingdom: a systematic review.
— Draft paper—Anti-smoking interventions:
taking account of the views of low-income childbearing women for
UK policy and practice.
— Draft report—Access to care
for very disadvantaged childbearing women. This reports on 16
projects across England aimed at women in three categories—refugees
and asylum seekers, women at risk of domestic violence and women
from non-English speaking backgrounds. It uses the projects as
case-studies to draw out lessons about the particular needs of
those categories of women and to look for common themes.
— Draft reports—evidence of effectiveness
of interventions aimed at limiting the impact of poverty and disadvantage
on the health of mothers and babies. Topics covered: breastfeeding,
immunisation, social support, preventing teen pregnancy, nutrition
and smoking.
February 2003
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