Maternal and Women’s | Maridulu Budyari Gumal

The Maternal and Women’s Clinical Academic Group (MW CAG) of Maridulu Budyari Gumal, the Sydney Partnership for Health, Education, Research and Enterprise (SPHERE) focuses on improving the care women and families receive, based on the best available evidence locally, nationally and internationally. Despite the best efforts of health services, there is significant variation in the standard of care provided. The CAG brings together a multidisciplinary group with expertise across academic, healthcare and community arenas to address this variation and improve the outcomes for women, babies and their families in NSW, Australia and globally. This is being achieved through a broad program of research that takes an inclusive approach in translation to clinical practice, service delivery improvement, education and training, and community and consumer advocacy in collaboration with SPHERE, SPHERE partner organisations, other CAGs, professional and community and consumer groups.

Research

The MW CAG adopts an implementation science/quality improvement methodology and a participatory action research approach to working collaboratively with stakeholders and community and consumer representatives as project partners. MW CAG studies involve a diagnostics phase, a co-design phase to develop solutions, and an implementation and evaluation phase. This flexible and iterative approach ensures changes are coproduced and adapted to respond to complexities and address implementation barriers in the local context. Clinicians and managers are engaged in all research phases and encouraged to drive practice change, while consumers are engaged as research participants and in reference groups in a participatory approach that is critical in supporting stakeholders to own the process and embed and sustain change.

Four priority areas have been identified by the CAG members:

1. Maternal health

The overarching goal of this priority area is to identify and address unwarranted variation in the timing of birth in the case of planned caesarean section and induction of labour. Positive outcomes from these studies are being translated to improvements in clinical practice by piloting and implementing shared decision-making training for midwives and obstetricians working in maternity service planning and delivery. Other priorities of our maternal health researchers include identification and holistic care of high-risk pregnancy (includes collaboration with ELDoH CAGs), and improving maternal and child health after complicated/complex pregnancy.

2. Newborn health, stillbirth prevention

This is a developing priority area that builds on the work in Area 1 (above). We aim to develop opportunities to rigorously assess potential translational research collaborations with partner institutions, such as Neonatology NSW, DOMS and ELDoH CAGs, The Centre for Excellence in Stillbirth, and the Clinical Excellence Commission.

3. Women’s health

This is a developing priority area that also builds on the work in Area 1. Collaboration with The George Institute for Global Health and other organisations, such as the UNSW Women’s Wellbeing Academy.

4. Clinician research training

A key requirement in our projects is mentoring clinicians as they engage in all phases of the research as part of the investigating team. To facilitate this, the MW CAG has initiated a Clinical Research Internship Program as a key research capacity building strategy whereby clinicians providing maternity care develop research skills and literacy by participating in applied research. Since its inception, the program has engaged 21 midwives, medical officers, neonatal nurses and allied health clinicians providing maternity, women’s health or newborn care at South West Sydney and South East Sydney Local Health District hospitals. Interns participate in MW CAG-led translational research projects as co-investigators or are supported to undertake a translational research study of clinical importance in their service. These training and education processes contribute to implementation science and translational research by embedding practices of continuous quality improvement and developing a culture of evidence-based care in health practices.

Partnership

All research is conducted via respected research centres and healthcare service providers, including CAGs (AHW, ELDoH, DOMS, HUE and RSEOH) and SPHERE partners, as follows:

The Maternal and Women’s CAG currently comprises more than 160 members, representing the following external partner organisations:

Australian College of Neonatal Nurses
Australian Global Women’s Health Program
Australian Preterm Birth Prevention Alliance
Burnett Institute
Camden Central Family Practice
Central Coast LHD
Curtin University
HCF Research Foundation
Heart Research Institute
Homebirth Access Sydney
Illawarra Shoalhaven Local Hospital District
Monash University
Neonatology NSW
Royal North Shore Hospital (North Sydney LHD)
NSW Perinatal Services Network
South Western Sydney PHN
Royal Prince Alfred Hospital (Sydney LHD)
St George Private Hospital
Sydney Health Partners
Sydney Institute for Women, Children and their Families
The University of Sydney
University of Newcastle
University of Southern Queensland
University of Toronto

MW CAG Consumer and Community Involvement (CCI)

MW CAG has a close association with Consumer and Community Involvement (CCI) through membership of the Executive Committee and in the design of all CAG seed-funded research projects to empower consumers and the community to contribute to and make a difference to women, newborns and their families. The CAG representative is Annette Ruhotas. Previously this was Dr Natasha Donnolley who had close involvement with the translational research projects, the Timing of Birth study and the Shared Decision-Making Clinician Training Pilot study.

Research Projects and Impact

The MW CAG strategically supports innovative, co-designed translational research projects in the priority areas of maternal and women’s health. We do this by supporting a range of translational research activities, including QI initiatives in our partner hospitals, with a focus on building research capacity in clinicians to support evidence implementation. Projects include:

1. Development, implementation, and evaluation of a shared decision-making (SDM) training intervention in relation to timing of birth (led by A/Prof Amanda Henry, Dr Teena Clerke, Prof Angela Makris, Prof Hannah Dahlen). The project is trialling a SDM clinician training intervention providing maternity care at 3 major maternity hospitals in SWS and SES LHDs, and evaluating its acceptability, feasibility and effectiveness using qualitative and quantitative measures. Outputs will include the development of a SDM training module with a suite of resources (online courses, slide decks, trainer notes, participant handouts, and tailored clinical role-play scenarios).

2. “Best Pregnancy Care Pathways”: The high-risk pregnancy study (led by Prof Virginia Schmied). Co-designed and co-investigated by clinicians from SWSLHD to support translation and develop research capacity, the project aims to co-create models of care and service pathways for women who develop or are at risk of developing physical or mental health problems (e.g. hypertensive disorder of pregnancy) during pregnancy.

3. The Blood Pressure Postpartum (BP²) Study (led by A/Prof Amanda Henry, Mark Brown, Angela Makris, Annemarie Hennessy, Georgina Chambers, CCI Annette Ruhotas). This is a NSW TRGS-funded RCT of follow-up strategies at 6 Sydney hospitals for women with pregnancies complicated by high blood pressure. The aims are to improve women’s cardiovascular health, with a focus on education and lifestyle behaviour change for women 6–12 months postpartum.

4. Knowledge gaps on long term health after preeclampsia or gestational hypertension (led by A/Prof Amanda Henry, Heike Roth (PhD Candidate). The study aims to assess Australian women and relevant healthcare providers’ knowledge of health after a hypertensive pregnancy. It also examines self-reported education and referral practices; and identifies knowledge priorities, timing, and delivery format for women and healthcare practitioners’ needs regarding counselling women on long-term health after hypertensive pregnancy.

5. Perinatal care for migrant and refugee women (led by Helen Rogers and A/Prof Amanda Henry). Through developing, implementing and evaluating a cross cultural workers service at SESLHD, this project aims to support translation by enhancing access to care and health outcomes for pregnant women from migrant and refugee communities. (Aligned with ELDoH CAG).

6. First 2000 days care connect (FDCC) – a holistic first 2000 days model of care for migrant and refugee populations (led by Tania Rimes, A/Prof Sue Woolfenden, A/Prof Amanda Henry, Karen Sorensen, Prof Valsa Eapen). This project aims to evaluate the impact, implementation and cost-effectiveness of the First 2000 days care connect program by comparing it with usual care using a quasi-experimental trial with quantitative (measuring data) and qualitative (interviews) methods and to determine its cost-effectiveness in relation to quality of life and hospital use. (Collaboration with ELDoH CAG).

7. POSA (Pregnancy and Obstructive Sleep Apnoea Study) (led by Prof Angela Makris). Sleep disordered breathing (SDB) prevalence is increasing in the community, and in pregnant women this can cause or be masked by physiological changes that occur during pregnancy, yet its burden and consequences in such women is not well understood. The study will evaluate the accuracy of screening tools in diagnosing SDB in pregnancy; assess the effect of treating diagnosed SDB in early pregnancy on babies and pregnancy-related complications (gestational diabetes, maternal weight gain and hypertensive disorders of pregnancy); and compare the effectiveness of SDB therapies in improving the condition in pregnancy. (Collaboration with RSEOH CAG and WHITU).

8. SCREEN App (led by Prof Angela Makris). Involves a patient-completed electronic app-based questionnaire to risk assess women when booking in. This is being developed because many women with high-risk pregnancies have been unable to book in for early intervention and/or education.

9. Linked data platform for adolescents and young adults diagnosed with cancer: improving survivorship care through population data analytics (led by Prof Georgina Chambers). This is a cross-sectoral, multi-jurisdictional matched cohort study involving linkage between cancer, hospital, emergency department, mental health, perinatal, deaths, medical services, pharmaceutical and social services datasets to improve oncofertility and survivorship care for adolescents and young adults with cancer. (Collaboration with Cancer CAG).

10. BUBS Quit: Smoking cessation study (led by Prof Robyn Richmond, A/Prof Amanda Henry, A/Prof Christine Catling, Prof Angela Makris, Aunty Kerrie Doyle). This study aims to co-design and pilot a smoking cessation intervention for pregnant mothers with midwives and other health care workers and key stakeholders to address the effectiveness, acceptability, sustainability and scalability of the co-designed intervention effective in promoting smoking cessation among pregnant women. (Supported by ELDoH and AHW CAGs).

11. Birth in the time of COVID (led by Prof Hannah Dahlen). The study is exploring the impact of COVID-19 on the pregnancy, birth and early postnatal experiences of women and their main care providers, in particular, the effect of social isolation and changed maternity care practices. The study is being conducted with international collaborators and reproduced in New Zealand.

12. CGM 4 GDM – Continuous glucose monitoring for the diagnosis of Gestational Diabetes Mellitus (CGM 4 GDM) (led by Prof Alec Welsh, Daria Di Filippo, A/Prof Amanda Henry). The project aims to revolutionise the way GDM is diagnosed and managed, reducing its impact on pregnant women and their newborns, promoting a healthier community and alleviating the economic burden associated with GDM. The intention is to establish a national multicentre RCT to test CGM4GDM as an alternative diagnostic tool for GDM on a broader scale.

13. Urbanisation and health during the first 2000 days of life: Building a foundation for health in Sydney’s urban environment (led by Prof Jason Prior, A/Prof Christine Catling). The project aims to develop a data tool from evidence-scoping to provide a platform to drive research, policy and practice on the creation of urban environments supporting the first 2000 days of life to transform the long-term health of Sydney’s population. Translation into practice will occur through the provision of evidence guiding health and urban planning in Sydney. (Collaboration with ELDoH and HUE CAGs).

14. Innovative exergame program to increase physical activity for pregnant women with obesity (led by Dr Deb Fox). This is the first study to evaluate a home-based exergaming intervention to improve health outcomes among pregnant women and meet national guidelines for physical activity and exercise goals throughout pregnancy. Translation to practice will be achieved by using findings to guide future implementation research, provide evidence for designing health policy and recommendations and strengthen linkages between researchers and clinicians.

15. Improving maternity care in Australia, Vietnam and Nigeria: understanding infection, sepsis, antimicrobial resistance and stewardship (led by Kelly Thompson, A/Prof Amanda Henry). This study aims to determine current maternity unit practices around infection prevention and control, routine use of antimicrobials and rates of sepsis and antimicrobial resistance. Data will inform a context adaptable maternity pathway that will improve the quality of maternity care in low, middle and high-income settings and has the potential to reduce maternal death and disability in urban facilities, where over 75% of women give birth.

16. Aboriginal breastfeeding: reclaiming our tradition (led by Annette Wright, Kaarina Paasila, Karen Beetson, Aunty Kerrie Doyle). This project uses traditional stories to re-introduce local language/words in health through yarning, to provide evidence for culturally specific resources to increase the initiation and duration of breastfeeding for Aboriginal women when embedded within Aboriginal antenatal models that will positively impact a child’s development and immunological health, and reduce disease risk. (Supported by AHW CAG).

Impact

The MW CAG was formed in 2018 and has worked on innovative and effective ways to make a positive impact on improving the care and experiences of women and babies. The full impacts of research translation into clinical practice in the areas of maternal and women’s health will mature with time, although 30 scholarly papers have been published between 2019 and early 2021. Some early indications of success include:

1. Timing of Birth (TOB) study (Prof Caroline Homer, Dr Dominiek Coates, A/Prof Amanda Henry; 2018–2019). Our flagship project sought to understand and address unwarranted clinical variation in relation to childbirth practices and support translation into practice. To facilitate stakeholder engagement and translation into clinical practice, the research approach was informed by participatory action research, which is compatible with hospital quality improvement (QI) processes and practices. This involved engagement by clinicians from the eight participating hospitals in SWS and SES LHDs, a maternity lead at the Clinical Excellence Commission and two clinical redesign leaders at the Agency for Clinical Innovation as co-researchers.

Output and impact:

Mapped current practices at participating hospitals against evidence from national and international guidelines to identify where evidence is implemented/not implemented;
Identified variations in practice in relation to induction of labour and planned caesarean section;
Developed an understanding of why clinical variation occurs and identified enablers and barriers to evidence-based practice across the eight sites;
Disseminated findings to hospital co-researchers (16 face-face presentations, individual written reports);
Published 14 scholarly papers; and
Identified a healthcare priority for clinician training in shared decision-making.

2. Living the embedded researcher study (Dr Dominiek Coates; 2018–2019). The study mapped the role of the embedded researcher in Australian healthcare settings and described the diversity of positions, aims, expectations, outcomes, strengths and challenges, and infrastructural supports. The study gained insight into enablers and challenges of the embedded research model/role from the perspective of embedded researchers, defined as someone with research qualifications working for at least 30% of their time in a healthcare organisation with research/research capacity building in their role.

Publications

For a list of publications related to MW CAG projects, please click here.

Team

The MW CAG executive membership comprises senior professionals from applied basic science to clinical practice and health systems and services as well as academics and consumer representatives. Our work combines the intelligence and resources of SWS and SES LHDs, UTS, UNSW and WSU, and is conducted via a number of units with expertise in women’s health, including The National Perinatal Epidemiology and Statistics Unit (The Centre for Big Data Research in Health and UNSW School of Women’s and Children’s Health), UTS Faculty of Health, The Centre for Midwifery, Child and Family Health, the Obstetric Medicine Research Group at St George Hospital, and the Women’s Health Initiative Translational Unit at Liverpool Hospital. Our members are involved in a range of state and national activities and bring this experience and knowledge to our work. This includes the NHMRC Council, NHMRC peer review process, National Pregnancy Guidelines development, membership on national data and perinatal morbidity and mortality committees, workforce planning at a state and national level, and other committees and working parties.

Executive Committee

Professor Kathleen Baird

Associate Professor Christine Catling

Professor Georgina Chambers

Professor Hannah Dahlen

Dr Natasha Donnolley

Associate Professor Amanda Henry

Dr Nicla Lui

Professor Angela Makris

Ms Helen McCarthy

Ms Annette Ruhotas

Dr Tim Schindler