Plain English Summary
Background and study aims
Informed discussion between community midwives and healthy low risk women about their options for giving birth is important in helping parents decide where to give birth. There is evidence to suggest that this discussion does not always take place. A previous study suggested that a knowledge update session together with ongoing support from a Place of Birth lead midwife in each team improved the knowledge and confidence of community midwives. Four maternity units (Royal Wolverhampton NHS Trust, Walsall Healthcare NHS Trust, Dudley Group NHS Foundation Trust, and Sandwell and West Birmingham Hospitals NHS Trust) that make up the Black Country Local Maternity System (LMS) decided to make completing an e-learning session mandatory for all their community midwives. The Black Country LMS Heads of Midwifery were keen to test whether having a place of birth lead midwife further improves fact based knowledge. The aim therefore of the BEEM study is to evaluate whether a Place of Birth lead in community midwifery teams further improves the fact based knowledge of community midwives compared to completing the e-learning session alone. To do this we are undertaking a cluster controlled randomised trial, which takes account of the issue that using a questionnaire in itself before and after training is likely to improve knowledge.
Who can participate?
All community midwives (Band 5, 6 and 7) working in a specified Local Maternity System.
What does the study involve?
Each community midwifery team in the Black Country LMS will be randomly allocated to one of four possible options:
1. Doing the e-learning package and a post-questionnaire to examine fact-based knowledge and confidence of community midwives six months later
2. Doing a pre-questionnaire to examine fact-based knowledge and confidence of community midwives before doing the e-learning package and then another questionnaire six months later
3. Having the Place of Birth lead midwife in the team who will support and encourage the midwives as well as doing the e-learning package and post-questionnaire six months later
4. Having a Place of Birth midwife in the team who will support and encourage the midwives as well as doing a pre-questionnaire to examine the fact-based knowledge and confidence of community midwives before they do the e-learning package and then a post-questionnaire six months afterwards
For those teams randomised to having a Place of Birth team lead will appoint a community midwife from the team who will complete an additional e-learning package to train for the role. They will then be responsible for encouraging midwives in their team to complete the e-learning session and questionnaire(s) as well as support and encourage colleagues to talk to women about their place of birth options. They will use provided materials to facilitate six monthly sessions (10 to 20 minutes each) usually as part of the routine team meeting and remind of the importance of the Place of Birth discussions as well as act as an expert for any queries the midwives have.
For the community teams not randomly allocated to having a place of birth lead, the community midwife team lead will encourage team members to complete the elearning package and relevant questionnaire(s). They will not complete any additional follow up sessions.
Following completion of the study, two focus groups will be conducted in each Trust in order to explore the experiences and practices of community midwives in connection with Place of Birth discussions: one for those who have had a Place of Birth lead and one for those who have not. In addition, a further focus group from across the LMS will be conducted for the Place of Birth leads. Each focus group session will be recorded and conducted by a member of the research team, last approximately 30 to 60 minutes and will have a mixture of closed and open questions.
What are the possible benefits and risks of participating?
The potential benefits are improved knowledge and confidence to discuss place of birth options with mothers. There are no risks to taking part in the study.
Where is the study run from?
1. New Cross Hospital (UK)
2. Manor Hospital (UK)
3. Russells Hall Hospital (UK)
4. Birmingham City Hospital (UK)
When is the study starting and how long is it expected to run for?
March 2020 to May 2021
Who is funding the study?
NIHR Applied Research Collaboration (ARC) West Midlands (UK)
Who is the main contact?
Prof. Sara Kenyon (scientific)
s.kenyon@bham.ac.uk
Fiona Cross-Sudworth (public)
f.cross-sudworth@bham.ac.uk
Study website
Contact information
Type
Scientific
Contact name
Prof Sara Kenyon
ORCID ID
Contact details
University of Birmingham
Institute of Applied Healthcare
Murray Learning Centre
Birmingham
B15 2TT
United Kingdom
+44 (0)121414 9063
s.kenyon@bham.ac.uk
Type
Public
Contact name
Ms Fiona Cross-Sudworth
ORCID ID
http://orcid.org/0000-0002-5223-1789
Contact details
University of Birmingham
Institute of Applied Healthcare
Murray Learning Centre
Birmingham
B15 2TT
United Kingdom
+44 (0)1214158182
f.cross-sudworth@bham.ac.uk
Additional identifiers
EudraCT/CTIS number
Nil known
IRAS number
272343
ClinicalTrials.gov number
Nil known
Secondary identifying numbers
Protocol V 2.0 14.01.2020, IRAS 272343
Study information
Scientific title
Place of Birth choices for healthy low-risk women: A comparison of a standalone E-Learning package or an e-learning package with additional support from a lead midwife to Evaluate the knowledge of community Midwives- a randomised cluster controlled trial incorporating a modified solomon design: The BEEM trial
Acronym
BEEM
Study hypothesis
The objective of this research is to evaluate whether a Place of Birth lead midwife in addition to a mandated e-learning session further improves the fact based knowledge of community midwives.
Ethics approval(s)
1. Approved 04/11/2019, University of Birmingham REC (Sue Cottam – Research Ethics Manager Aston Webb Building, University of Birmingham, Edgbaston B15 2TT, UK; +44 (0)121 414 8825; s.l.cottam@bham.ac.uk), ref: ERN_19-1382
2. Approved 16/01/2020, HRA and Health and Care Research Wales (Health and Care Research Wales Support and Delivery Centre, Castlebridge 4, 15-19 Cowbridge Road East, Cardiff, CF11 9AB, UK; no tel. provided; hra.approval@nhs.net), ref: ERN_19-1382
Study design
Randomized cluster controlled trial incorporating a modified Solomon design with qualitative follow-up
Primary study design
Interventional
Secondary study design
Cluster randomised trial
Study setting(s)
Community
Study type
Other
Patient information sheet
Not available in web format, please use contact details to request a participant information sheet.
Condition
Knowledge of community midwives
Intervention
The intervention is the Place of Birth Lead.
The unit of randomisation will be the community midwifery team within each of the four participating NHS Trusts, stratifying within each to ensure that each Trust has the opportunity to have a Place of Birth lead midwife within a randomised number of teams, as these vary in number and size. Individual randomisation of community midwives to the Place of Birth lead was not feasible due to the nature of the intervention (Place of Birth lead) and risk of contamination during the trial.
To measure the knowledge of the community midwives we will use the same short fact-based questionnaires completed over the three-week period immediately before the e-learning session is undertaken and again six months later. These have been developed by the study team and include key facts which midwives should be aware of in order to speak to healthy low risk women about their place of birth options. The Solomon design has been modified as all teams will complete the e-learning training session.
Each community midwifery team will be randomly allocated to one of four possible arms:
1. Doing the e-learning package and a post-questionnaire to examine fact-based knowledge and confidence of community midwives six months later
2. Doing a pre-questionnaire to examine fact-based knowledge and confidence of community midwives before doing the e-learning package and then another questionnaire six months later
3. Having the Place of Birth lead midwife in the team who will support and encourage the midwives as well as doing the e-learning package and post-questionnaire six months later
4. Having a Place of Birth midwife in the team who will support and encourage the midwives as well as doing a pre-questionnaire to examine the fact-based knowledge and confidence of community midwives before they do the e-learning package and then a post-questionnaire six months afterwards
Qualitative follow-up:
Intervention type
Other
Primary outcome measure
Fact based knowledge of community midwives measured using anonymous completion of a fact-based knowledge questionnaire in a three-week period before the e-Learning session is undertaken and again six months afterwards
Secondary outcome measures
1. Knowledge improvement with E-Learning session alone by anonymous completion of a fact-based knowledge questionnaire in a three-week period before the e-Learning session is undertaken and again six months afterwards
2. Self-rated confidence of community midwives by anonymous completion of a 5 point Likert scale in a three-week period before the e-Learning session is undertaken and again six months afterwards
3. Experiences of community midwives whose teams are randomised to a Place of Birth lead midwife and those who are not by qualitative data obtained from focus groups with community midwives whose teams had a Place of Birth lead and those who are not. Focus groups will be undertaken after the six-month intervention period
4. Experiences of the Place of Birth lead midwives using qualitative data obtained from focus groups with Place of Birth leads undertaken after the 6 month intervention period
5. Responses to the ‘Safety thermometer’ question ‘Did anyone explain your options for where you could give birth?’ This is a set of questions that are routinely given to a sample of women and which will continue over the six-month intervention period. This information is recorded monthly by the Trust and data will be given to UoB after the six month intervention period
Overall study start date
01/02/2020
Overall study end date
31/05/2021
Reason abandoned (if study stopped)
There have now been changes to the community midwifery teams across the participating trusts that do not enable the trial to go ahead as previously planned.
Eligibility
Participant inclusion criteria
All community midwives (Band 5, 6 and 7) working in a specified LMS
Participant type(s)
Health professional
Age group
Adult
Sex
Both
Target number of participants
There are approximately 185 community midwives in the LMS
Participant exclusion criteria
1. Community midwives who are Band 8 and above
2. Student midwives
Recruitment start date
01/07/2020
Recruitment end date
28/02/2021
Locations
Countries of recruitment
England, United Kingdom
Study participating centre
New Cross Hospital
Royal Wolverhampton NHS Trust
Wolverhampton Road
Wolverhampton
WV10 0QP
United Kingdom
Study participating centre
Manor Hospital
Walsall Healthcare NHS Trust
Moat Road
Walsall
WS2 9PS
United Kingdom
Study participating centre
Russells Hall Hospital
Dudley Group NHS Foundation Trust
Pensnett Road
Dudley
DY1 2HQ
United Kingdom
Study participating centre
Birmingham City Hospital
Sandwell & West Birmingham Hospital NHS Trust
Dudley Road
Birmingham
B18 7QH
United Kingdom
Sponsor information
Organisation
University of Birmingham
Sponsor details
Edgbaston
Birmingham
B15 2TT
England
United Kingdom
+44 (0)121 414 8037
researchgovernance@contacts.bham.ac.uk
Sponsor type
University/education
Website
http://www.birmingham.ac.uk/index.aspx
ROR
Funders
Funder type
Government
Funder name
NIHR Applied Research Collaboration (ARC) West Midlands
Alternative name(s)
Funding Body Type
Funding Body Subtype
Location
Funder name
National Institute for Health Research
Alternative name(s)
National Institute for Health Research, NIHR Research, NIHRresearch, NIHR - National Institute for Health Research, NIHR (The National Institute for Health and Care Research), NIHR
Funding Body Type
government organisation
Funding Body Subtype
National government
Location
United Kingdom
Results and Publications
Publication and dissemination plan
The research team will share the outcomes of the evaluation process with the Place of Birth leads and key stakeholders of each Trust. This will describe how the Place of Birth package has been effective with or without the implementation of a Place of Birth lead and any feedback from the Place of Birth leads and Community Midwives will be documented.
Following this, the research team will produce a summary report for the Trusts that will detail the outcomes of the evaluation (effectiveness of the Place of Birth leads for knowledge improvements, feedback from focus groups and safety thermometer question outcomes)- what worked and did not, and any revisions required. A number of reports and publications are anticipated to be produced. Participants will be able to access these publications via the Trust website, or through contacting a member of the research team.
Intention to publish date
31/05/2022
Individual participant data (IPD) Intention to share
No
IPD sharing plan
The datasets generated during and/or analysed during the current study are not expected to be made available due to limited interest.
IPD sharing plan summary
Not expected to be made available
Study outputs
| Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
|---|