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The RETHINK Study - Can we reduce hospital admission in latent labour?

The RETHINK Study

A study which will consider the impact of greater fear and anxiety around pain (pain catastrophising) and how this affects the time when women are admitted to hospital in labour, their labour choices, and birth outcomes.

Aims

  • To assess the prevalence of pain catastrophising among women who are pregnant for the first time and who are experiencing an uncomplicated pregnancy.
  • To determine how pain catastrophising affects the timing of women’s admission to hospital when in labour, and subsequently their birth outcomes.

Method

This is a quasi-experimental study. This means there will be a comparison made between two groups to estimate the possible impact that pain catastrophising has on the timing of admission to hospital when in labour and birth outcomes. In this study the quasi-experimental aspect will occur during analysis of the groups only. The groups will be divided according to those who pain catastrophise and those who do not. There will be no control group and no randomisation. This is consistent with this methodological approach.  

Pregnant women who are eligible to participate will be invited into this study by appropriate staff (midwife or other appropriately trained healthcare worker) at each participating NHS Trust. Data collection will be made on three separate occasions;

  • first, by participants completing an online questionnaire when they are between 25 and 33 weeks pregnant;
  • second, routine birth outcome data will be collected by research midwives at each individual NHS Trust, and;
  • third, at approximately four weeks postnatal participants will be asked to complete a second online questionnaire providing the participant has not met any of the exclusion criteria during the study period.

Quantitative data will be analysed using the statistical software package SPSS (v.26) software. When completing the questionnaires women are invited to provide written comment in response to relevant questions.This qualitative data will be coded and analysed thematically.

Impact

This study has the potential to have high impact. To date, new models designed to support women in early labour have not had clear impact on specified outcomes, and little is known about the best way to support women at this time. Women’s experiences of early labour point to pain as a significant factor for early hospital admission. However, studies have yet to consider the impact of greater fear and anxiety around pain (pain catastrophising) and how this affects the time when women are admitted to hospital in labour, their labour choices, and birth outcomes.

Clinical Pathway

The research project has been peer-reviewed by the Wessex Integrated Clinical Academic Training Programme. This doctoral project is part of the National Institute for Health Research (NIHR) recognised Wessex Academic Clinical Pathway enabling it to be adopted on to the NIHR Clinical Research Network (CRN) portfolio. CRN funding facilitates high-quality research by making accessible the valuable support services of research midwives in participating NHS Trusts.

How you can get involved:

This study is likely to begin in the Autumn of 2020 (subject to Covid-19). It is open to 18 to 40-year-old women who are expecting their first baby, experiencing an uncomplicated singleton pregnancy, will be between 25 and 33 weeks pregnant and planning a hospital birth at one of the participating hospitals. Participants must be able to understand and read English, have internet access and an email address for study correspondence. To get involved women should contact their midwife.

Inclusion criteria

  • Healthy women who are pregnant for the first time and who are experiencing an uncomplicated singleton pregnancy, and who are planning a hospital birth.
  • Women aged 18 to ≤40 years at the time of study.
  • Able to understand and read English.
  • Antenatal women who are between 25 and 33 weeks gestation.
  • Have internet access and an email address for study correspondence

Exclusion criteria

  • Women who are under ongoing care from an obstetrician during their pregnancy.
  • Women who are 41 years or over at the time of childbirth.
  • Women with a current or pre-existing mental health condition requiring current medication and /or care by perinatal mental health team i.e. specialist obstetrician, specialist midwife and/or local mental health services provision.
  • Pregnant women already participating in a different study that is providing support with pain management or a labour support intervention of any kind. This includes the latent, active, second and third phases of labour.

More information:

Should you be likely to fulfil the criteria in the Autumn of 2020 (see above) and would like to express interest or discuss further, please contact the Chief Investigator:

Vanessa Bartholomew 

Faculty of Health and Social Sciences, Bournemouth University, Royal London House, Christchurch Road, Bournemouth BH1 3LT

vbartholomew@bournemouth.ac.uk    

Tel: 07735 388820

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