Cristina Fernandez Turienzo tells us about her PhD on continuity of care
"My PhD thesis was an evaluation of a continuity of midwifery care pathway throughout pregnancy, birth and postpartum for women at increased risk of PTB in South London. This involved exploring implementation, mechanisms of action and women's experiences of care by using mixed methods (e.g. pilot trial, qualitative interviews with women and staff, postnatal survey).
Being awarded the Iolanthe Midwifery Research Fellowship enabled me to buy some time away from my full-time job and focus on the last year of my PhD, giving me the opportunity to have dedicated and protected time for the next six months to write the different chapters of my thesis and submit by January 2020.
High rates of preterm births remain a public health problem in the UK and elsewhere. Preterm birth (PTB) is a major determinant of adverse infant and longer-term outcomes, including survival, quality of life, as well as having psychosocial effects on the family.
A wide range of risk factors have been associated with PTB: from obstetric and medical risk (e.g having a previous PTB, late miscarriage, surgery of the cervix, hypertension, mental illness) social stress and deprivation, smoking, substance misuse and pollution and being of black, Asian of from an ethnic minority. As there are many factors which can have an effect on the likelihood of being at risk from pre-term birth, no single intervention will have an effect on PTB rates.
A Cochrane review found that women who receive continuity of care by a named midwife or a small group of midwives throughout pregnancy, birth and postnatal periods are 24% less likely to experience a PTB and 16% less likely to lose their baby before 24 weeks. At the moment, the reasons for this remain unclear as there is insufficient evidence on the outcomes of continuity models for women with clinical risk factors and complications.
I would like to thank Iolanthe for the support the Midwifery Research Fellowship has given me. "
Please note: the Midwifery Research Fellowship is awarded periodically, subject to availability of funds and at the discretion of the Iolanthe Trustees.
Cristina has also been awarded one of the 2021 King's Outstanding Thesis Prizes. These prizes are nominated by the external examiners who assessed the thesis and are judged by a panel consisting of Dr. Nigel Eady (Director of Research Talent) and Dr. Sandrine Thuret (Chair, Research Degrees Examinations Board.)
Thanks to the financial support from her Iolanthe Midwifery Research Fellowship, Cristina was able to fastrack the writing up of her Ph.D. This has enabled her to publish several articles from her thesis which will be important in informing future planning on continuity of care in England.
Publications to date include:
1. A realist review to explore how midwifery continuity of care may influence preterm birth in pregnant women Fernandez Turienzo, C., Rayment-Jones, H., Roe, Y., Silverio, S. A., Coxon, K., Shennan, A. & Sandall, J., 21 Mar 2021, In: BIRTH 2021; 00: 1– 14.
2. Experiences of maternity care among women at increased risk of preterm birth receiving midwifery continuity of care compared to women receiving standard maternity care: Results from the POPPIE pilot trial Fernandez Turienzo, C., Silverio, S. A., Coxon, K., Brigante, L., Seed, P. T., Shennan, A., Sandall, J. & on behalf of the POPPIE Pilot Collaborative Group, 8 Mar 2021, In: PLOS ONE. 16(4): e0248588
3. Midwifery continuity of care versus standard maternity care for women at increased risk of preterm birth: A hybrid implementation–effectiveness, randomised controlled pilot trial in the UK Fernandez Turienzo, C., Bick, D., Briley, A., Bollard, M., Coxon, K., Cross, P., Silverio, S. A., Singh, C., Seed, P., Tribe, R., Shennan, A., Sandall, J. & on behalf of the POPPIE Pilot Collaborative Group, 6 Oct 2020, In: PLOS Medicine. 17(10): e1003350.
4. POPPIE: Protocol for a randomised controlled pilot trial of continuity of midwifery care for women at increased risk of preterm birth Fernandez Turienzo, C., Bick, D., Bollard, M., Brigante, L., Briley, A., Coxon, K., Cross, P., Healey, A., Mehta, M., Melaugh, A., Moulla, J., Seed, P. T., Shennan, A. H., Singh, C., Tribe, R. M. & Sandall, J., 14 May 2019, In: Trials. 20, 271.
5. Implementation of midwifery continuity of care models for Indigenous women in Australia: Perspectives and reflections for the United Kingdom Fernandez Turienzo, C., Roe, Y., Rayment-Jones, H., Kennedy, A., Forster, D., Homer, C. S. E., McLachlan, H. & Sandall, J., Feb 2019, In: MIDWIFERY. 69, p. 110-112