Guidance
Recommendations for research
Recommendations for research
The guideline committee has made the following recommendations for research.
Key recommendations for research
1 Perineal care
What is the effectiveness of hands on, hands poised or Finnish grip in the second stage of labour for reducing perineal trauma? [2023]
For a short explanation of why the committee made this recommendation for research, see the rationale section on interventions to reduce perineal trauma.
Full details of the evidence and the committee's discussion are in evidence review I: interventions to reduce perineal trauma.
2 Restarting oxytocin
What is the most effective dosage at which oxytocin should be recommenced once stopped in labour because of an abnormal cardiotocography? [2023]
For a short explanation of why the committee made this recommendation for research, see the rationale section on the use of oxytocin in the first or second stage of labour.
Full details of the evidence and the committee's discussion are in evidence review F: oxytocin in the first or second stage of labour.
3 Position of the baby during cord clamping
What is the optimum position for the baby during delayed cord clamping in relation to the mother's uterus? [2023]
For a short explanation of why the committee made this recommendation for research, see the rationale section on position of the baby during cord clamping.
Full details of the evidence and the committee's discussion are in evidence review N: position of the baby during cord clamping.
4 Management of postpartum haemorrhage
What is the impact of pharmacological interventions for the management of postpartum haemorrhage on breastfeeding and women's and their birth companions' experience and satisfaction in the postnatal period? [2023]
For a short explanation of why the committee made this recommendation for research, see the rationale section on the management of postpartum haemorrhage.
Full details of the evidence and the committee's discussion are in evidence review O: pharmacological management of postpartum haemorrhage.
5 Prophylactic antibiotics for birth with forceps or ventouse
What is the effectiveness and cost effectiveness of intravenous compared with oral antibiotics for preventing postnatal infections after birth with forceps or ventouse? [2023]
For a short explanation of why the committee made this recommendation for research, see the rationale section on prophylactic antibiotics for birth with forceps or ventouse.
Full details of the evidence and the committee's discussion are in evidence review J: prophylactic antibiotics for birth with forceps or ventouse.
Other recommendations for research
Effect of information giving on place of birth
How does the provision of accurate, evidence-based information affect women's decision-making processes and choice of place of birth? [2014]
Why this is important
A longitudinal narrative report of pregnant women in 3 maternity services in the UK identifies in detail why women make choices about where to give birth and how these choices can be influenced. Influences may include written and verbal information (both online and from midwives and doctors), previous experience, and word-of-mouth advice from friends and family. The Birthplace study concluded that giving birth outside an obstetric unit is the optimal choice for low-risk women. This finding should be used to restructure the way in which information is provided, so that it is presented in a more accurate, less risk-based way in order to support women's choices. This change should be evaluated in a quantitative observational study and/or qualitative study that records any changes in women's choice-making about place of birth. Outcomes include understanding why and how women make choices about where to give birth and how this can influence the provision of appropriate and accessible information, a measure of informed decision making, and fearfulness and absence of fearfulness when choosing place of birth.
Long-term consequences of planning birth in different settings
What are the long-term consequences for women and babies of planning birth in different settings? [2014]
Why this is important
The long-term consequences of birth experiences and birth outcomes are poorly understood, particularly in relation to place of birth. A large population-based observational study would compare women's experiences and outcomes in different birth settings (with subgroup analysis by mode of birth) in relation to the wellbeing of the women and their children over different periods of time (for example, 2, 5, 10, 15, 20 and 30 years). A secondary analysis could compare different providers where birth philosophies are different. Outcomes would be compared by accessing medical records and through qualitative interviews. Primary outcomes are long-term physical morbidity, pain after birth, readmission to hospital, infection, psychological morbidity (for example, postnatal depression, bonding, relationship breakdown with partner, fear of giving birth in future) and breastfeeding rates. Secondary outcomes are impact on attachment between mother and child, obesity in children, autoimmune disease, chronic illness, educational achievement and family functioning.
Oxytocin in the first stage of labour
What is the effectiveness of altering the dose of intravenous oxytocin to reduce excessive frequency of uterine contractions? [2023]
For a short explanation of why the committee made this recommendation for research, see the rationale section on the use of oxytocin in the first or second stage of labour.
Full details of the evidence and the committee's discussion are in evidence review F: oxytocin in the first or second stage of labour.
Postpartum haemorrhage
What is the most effective treatment for primary postpartum haemorrhage? [2014]
Why this is important
There is uncertainty about the most effective drug treatments and dosage regimes, and about which other treatments should be used, for women who develop a postpartum haemorrhage. The most effective sequencing of interventions is also uncertain. The psychological impact of postpartum haemorrhage for women can be significant, and identifying the approach that minimises this impact is important. Randomised controlled trials comparing different dosage regimes for oxytocin and misoprostol, as well as comparisons with ergometrine and carboprost, are needed. Trials of mechanical measures such as intrauterine balloons or interventional radiology as early second-line treatment (rather than an alternative drug treatment) are also needed. Alternatively, a trial comparing the effectiveness of a complex intervention (for example, an educational component, sequence of interventions, immediate feedback and quality improvements) compared with standard care could be undertaken. Important outcomes include blood and blood product transfusion, need for further intervention, need for hysterectomy and psychological outcomes for the woman.