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MIDWIFERY-RESEARCH  October 2018

MIDWIFERY-RESEARCH October 2018

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Subject:

AW: Responses to the AFFIRM trial

From:

Mechthild Gross <[log in to unmask]>

Reply-To:

A forum for discussion on midwifery and reproductive health research." <[log in to unmask]>, [log in to unmask]

Date:

Fri, 12 Oct 2018 19:12:30 +0000

Content-Type:

text/plain

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Thank you, Alison,  
for putting the current research results into a much bigger shape.   
Kind regards,  
Mechthild 
 
 
Prof. Dr. Mechthild M. Gross, Hebamme 
Head of Midwifery Research and Education Unit 
Department of Obstetrics, Gynaecology & Reproductive Medicine 
Hannover Medical School 
Carl-Neuberg-Str. 1 
D – 30625 Hannover 
Tel: ++49 511 532 6116, Fax: ++49 511 532 6191 
Mobil: ++49 176 1532 6116 
[log in to unmask] 
www.mh-hannover.de/Hebammenwissenschaft.html  
 
Latest publications:  
Weckend MJ, Spineli LM, Grylka-Baeschlin S, Gross MM. Association between increased antenatal vaginal pH and preterm birth rate: a systematic review. J Perinat Med. 2018 Jul 11. pii:/j/jpme.ahead-of-print/jpm-2018-0097/jpm-2018-0097.xml. doi:10.1515/jpm-2018-0097. [Epub ahead of print]  
 
Grylka-Baeschlin S, Meyer T, Lengler L, van Teijlingen E, Pehlke-Milde J, Gross MM. Postnatal quality of life - A content analysis of qualitative results to the Mother-Generated Index. Women Birth. 2018 Jun 21. pii:S1871-5192(18)30057-X. doi: 10.1016/j.wombi.2018.06.003. [Epub ahead of print] 
 
Gross MM, Michelsen C, Vaske B, Helbig S. Intrapartum Care Working Patterns of Midwives: The Long Road to Models of Care in Germany. Z Geburtshilfe Neonatol. 2018 Apr;222(2):72-81. doi: 10.1055/s-0043-122888.  
 
 
 
 
 
 
 
 
 
 
-----Ursprüngliche Nachricht----- 
Von: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] Im Auftrag von Macfarlane, Alison 
Gesendet: Freitag, 12. Oktober 2018 13:30 
An: [log in to unmask] 
Betreff: Re: Responses to the AFFIRM trial 
 
Thanks for the clarification. I scanned Christine's email yesterday very quickly while I was at the meeting to celebrate the 40th anniversary of the National Perinatal Epidemiology Unit. I immediately remembered that Adrian Grant's trial of fetal movement counting was one of the first to be done by the Unit and that it showed no difference, despite which fetal movement counting has continued to be advocated. Appropriately, and this was during Peter Brocklehurst's talk on electronic fetal monitoring. Peter's talk started with reviews of RCTs, of which Adrian Grant's Dublin trial was the largest and went on to more recent research, notably the INFANT trial. He concluded that if Electronic Fetal Monitoring was presented to the National Screening Committee now, it would be rejected as of no value. I suggested to Iain Chalmers that we knew that 40 years ago and he said yes, but there was a lot of money to be made out of technology for EFM. So it's not surprising that it is still in extensive use, despite lack of evidence. 
 
Fetal movement counting may differ in that it doesn't rely on expensive profit making gadgetry, although there are reputations attached to it as a part of the drive to reduce the stillbirth rate, but both of these increase obstetric intervention rates. The next lot of national Maternity HES data for England are due to be published on October 25 and I will be surprised if we don't see yet more rises in induction and caesarean rates. 
 
The late Secretary of State had an ambition to reduce our stillbirth rate to that of Norway. If you look at our Euro-Peristat data, you will see that when measured on a comparable basis, Norway and other Nordic countries had stillbirth and neonatal mortality rates below those of the UK countries. They also had much lower rates of obstetric intervention and of low birthweight and preterm birth. Perhaps there is a public health message here? www.europeristat.com Although these observations are based on data for 2010 and so are quite old, please watch out for our new reports, based on data for 2015, due to be published at the end of November. 
 
It may be that these thoughts belong with the dinosaurs in the Oxford University Museum, where yesterday's meeting was held? 
 
Alison Macfarlane 
 
 
-----Original Message----- 
From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of Mary Ross-Davie 
Sent: 12 October 2018 11:46 
To: [log in to unmask] 
Subject: Re: Responses to the AFFIRM trial 
 
Dear Christine and other Jiscmail members 
I just wanted to write in response to comments about the RCM response to the AFFIRM trial. 
I was the lead author for the RCM for our response, with support from the wider RCM professional team.  I was concerned to read that you felt that our response was unclear.   
We were keen to ensure that we responded quickly to the publication of the study in the Lancet and produced this statement within 24 hours of its publication as we know this is a very important topic for many of our members and for the maternity community. 
I think it is natural that the level of detail that we include in an immediate response statement for the media and our members is less than the publishing academic journal. 
The first line in the statement where we describe the results is this: 
‘ The results of the study are clear:  the package of care did not lead to a statistically significant reduction in the number of stillbirths and led to a significant increase in medical interventions including induction of labour and caesarean section’. 
We go on to say this: 
‘The AFFIRM trial, with its negative result, has made an important contribution to our current knowledge.  Further research into this important topic is always needed’ and then this…’The risks posed by increased interventions need to be balanced by their potential benefits. This study did not demonstrate that the interventions tested provide the benefits sought in relation to reducing stillbirth or perinatal mortality’.  
In our statement we do not talk about any ‘marginal benefits’, which is the description used by the authors.  It appears that the article you have read and link to in your email Christine is a brief article written by one of the journalists who writes for Midwives magazine, who is quoting from the study authors in her article.  This article is the journalist's take on the study. 
Our official RCM response and statement can be read in full here: https://www.rcm.org.uk/news-views-and-analysis/news/rcm-response-to-the-publication-of-the-affirm-trial-in-the-lancet 
  
We have received some direct positive feedback about our response from a number of midwives, they have felt that it provides clarity for them in responding to the results of the AFFIRM trial.  The RCM will be involved in ongoing discussions and work in shaping how maternity services in the UK can best respond to the findings of this trial. 
I am happy to discuss this further through email, 
  
Best wishes 
Mary 
 
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