The MacMidwifery Research Unit is organized into 4 broad areas:
- Health Services Research
- Clinical Epidemiology
- Bench-to-Bedside Research
- Education and Knowledge Translation
Health Services Research
Health services research is a multidisciplinary scientific field that examines how people get access to health care providers and services, the costs of care, and what happens to patients as a result of this care. Studies investigate how social factors, health policy, financing systems, organizational structures and processes, medical technology, and personal behaviors affect access to health care, the quality and cost of health care, and quantity and quality of life.
Ontario Midwifery Program Data
The Ontario Midwifery Program (OMP) with the Ministry of Health and Long Term Care has collected administrative and clinical data on all women and their infants in midwifery care in Ontario since 2003. These data have remained in large part unanalysed yet represent baseline of the profession’s care in Canada. Using the OMP database, our work has focussed on determining the safety of home compared to hospital midwifery birth, describing midwifery clients and care received and exploring socioeconomic status of midwifery clients and their related outcomes of care. With the migration of OMP data collection under the Better Outcomes and Registry Network (BORN) Ontario, work continues in collaboration with BORN to analyse midwifery outcomes in Ontario.
Planned Place of Birth
Dr. Hutton has published two seminal studies in Canada that examine the safety of home compared to hospital births led by midwives in Ontario using OMP data from the period 2003 to 2006 and 2006 to 2009.
Hutton EK, Cappelletti A, Reitsma AH, Simioni J, Horne J, McGregor C, Ahmed RJ. Outcomes associated with planned place of birth among women with low-risk pregnancies. CMAJ. 2016 Mar 15;188(5):E80-90. doi: 10.1503/cmaj.150564. Epub 2015 Dec 22.
Hutton EK, Reitsma AH, Kaufman K. Outcomes associated with planned home and planned hospital births in low-risk women attended by midwives in Ontario, Canada, 2003-2006: a retrospective cohort study. Birth. 2009 Sep;36(3):180-9.
Studies describing characteristics of midwifery clients and patterns of midwifery care received in Ontario from 2006 to 2009 and any relation to the socioeconomic status of midwifery clients are anticipated to published soon.
Systematic Review: Outcomes of Planned Home Compared to Planned Hospital Birth
There has been a renewed interest in the place of birth, including intended home birth, for low risk women. In the absence of adequately-sized randomised controlled trials, a recent Cochrane review recommended that a systematic review and meta-analysis, including observational studies, be undertaken to inform this topic. This review is being done by a group of researchers from McMaster University (Dr. Eileen Hutton, Dr. Karyn Kaufman and Ms. Angela Reitsma) and the University of London (Dr. Ginny Brunton). The objective is to determine if women intending at the onset of labour to give birth at home are more or less likely to experience a foetal or neonatal loss compared to a cohort of women who are comparable to the home birth cohort on the absence of risk factors but who intend to give birth in a hospital setting. This protocol was registered with PROSPERO (Registration number: CRD42013004046) and can be found here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4046441/
The DELIVER Study
Up to now in the Netherlands, scientific research to support evidence-based practice in primary care midwifery has been sparse. It is essential to accomplish more research that evaluates the maternity care system and practice, in order to develop a better understanding of the maternity system and to provide scientific knowledge for improvement.
Led by the Academy of Midwifery Amsterdam-Groningen (AVAG), the Netherlands Institute for Health Services Research (NIVEL), and the EMGO Institute for Health and Care Research of VU University Medical Centre, the DELIVER study (Dutch acronym for data primary care midwifery, Data EersteLIjns VERloskunde) aims to gain insight into the quality, organisation and accessibility of midwifery care in the Netherlands through a multicentre prospective descriptive study to answer how primary care midwifery is organised, what is the accessibility of primary care midwifery, and what is the quality of primary care midwifery. Results of the Deliver study should further improve midwifery care in the Netherlands and contribute to evidence-based practice.
Design paper: Manniën J, Klomp T, Wiegers T, Pereboom M, Brug J, de Jonge A, van der Meijde M, Hutton E, Schellevis F, Spelten E. Evaluation of primary care midwifery in the Netherlands: design and rationale of a dynamic cohort study (DELIVER). BMC Health Services Research201212:69
Organization of Maternity Care
Research on the effectiveness of various models in delivering maternity care is central to midwifery at the local, provincial, national and international level.
Gray M, Malott A, Davis BM, Sandor C. A scoping review of how new midwifery practitioners transition to practice in Australia, New Zealand, Canada, United Kingdom and The Netherlands. Midwifery. 2016 Sep 28;42:74-79. doi: 10.1016/j.midw.2016.09.018. Review. PMID: 27769012
Malott AM, Kaufman K, Thorpe J, Saxell L, Becker G, Paulette L, Ashe A, Martin K, Yeates L, Hutton EK; Models of Organization of Maternity Care (MOM-Care) Group. Models of organization of maternity care by midwives in Canada: a descriptive review. J Obstet Gynaecol Can. 2012 Oct;34(10):961-70.
Malott AM, Davis BM, McDonald H, Hutton E. Midwifery care in eight industrialized countries: how does Canadian midwifery compare? J Obstet Gynaecol Can. 2009 Oct;31(10):974-9.
A New Approach to Studying Retention: Following the Professional Journey of Midwives in Canada
Dr. Derek Lobb’s research focuses on midwifery retention across Canada. Midwifery as a regulated, licensed profession is a new addition to our health care system. It has proven to bring many benefits to women and their newborns and is much less costly than physician provided maternity care. At the same time there has been a significant reduction in the number of doctors providing maternity services, so we are facing a significant shortfall in women’s health care delivery in Canada. Midwifery is part of the solution to address this critical gap. The number of births in Canada continues to grow, but the numbers of trained maternity health care providers, especially midwives are not keeping up. This is due in large part to an alarmingly high attrition rate among midwifery trainees (close to 25%) and working midwives (20% in some provinces). Retention of health care professionals is critical for Canadian policy makers and governments.
Led by Dr. Derek Lobb and funded by the Canadian Institutes of Health Research, this study in progress will provide information needed to make the changes that will retain workers and sustain our health care system. The goal of this research is to examine the workforce trends of Canadian midwives in order to improve retention. We need to understand the workplace experiences of Canadian midwives from their initiation to the profession in university, up to and including 10+ years in actual practice. This study is a pan-Canadian on-going survey following the students at the seven national midwifery schools as well as all practicing midwives at important steps in their careers. It will allow us to understand how different stages impact the available workforce and to understand how these women maintain their work-life balance while managing their career and personal life. This research will recommend policy changes that will ultimately increase the number of working midwives and provide improved maternity care to Canadian women.
Wilson R, Eva K, Lobb DK. Student attrition in the Ontario midwifery education programme.
Midwifery. 2013 Jun;29(6):579-84.
The term “clinical epidemiology” was first used 50 years ago by John R. Paul, who defined it as “a marriage between quantitative concepts used by epidemiologists to study disease in populations and decision- making in the individual case which is the daily fare of clinical medicine.” It typically involves randomized controlled trials (RCTs) that examine clinical practices that directly impact how care is delivered. Dr. Eileen Hutton has led several and co-led several RCTs, tutored the Health Research Methodology graduate course on randomized controlled trials, and mentors residents in the Department of Obstetrics and Gynecology. Dr. Beth Murray Davis has been instrumental in the qualitative analysis of women’s experiences participating in trials. Ms. Angela Reitsma led a seminal study the examined how differing care at participating hospitals can affect a trial’s conclusion, and Mr. Rashid Ahmed has led the economic evaluation of two obstetrical trials.
The Early External Cephalic Version (ECV) Pilot and Full Scale (EECV2) Trials
The EECV and EEV2 trials are multicentre randomized controlled trials in 68 centres in 21 countries that investigated whether initiating external cephalic version (ECV) earlier in pregnancy (between 330/7 356/7 weeks’ gestation) or later in pregnancy (after 370/7 weeks) might increase the incidence of successful ECV procedures, and be more effective in decreasing the incidence of non-cephalic presentation at birth and of caesarean section.
Main results: Hutton EK, Hannah ME, Ross SJ, Delisle MF, Carson GD, Windrim R, Ohlsson A, Willan AR, Gafni A, Sylvestre G, Natale R, Barrett Y, Pollard JK, Dunn MS, Turtle P; Early ECV2 Trial Collaborative Group. The Early External Cephalic Version (ECV) 2 Trial: an international multicentre randomised controlled trial of timing of ECV for breech pregnancies. BJOG. 2011 Apr;118(5):564-77. https://www.ncbi.nlm.nih.gov/pubmed/21291506
Centre effect: Reitsma A, Chu R, Thorpe J, McDonald S, Thabane L, Hutton E. Accounting for center in the Early External Cephalic Version trials: an empirical comparison of statistical methods to adjust for center in a multicenter trial with binary outcomes. Trials. 2014 Sep 26;15:377. https://www.ncbi.nlm.nih.gov/pubmed/25257928
Qualitative research: Murray-Davis B. et al. Women’s experiences of participating in the early external cephalic version 2 trial. Birth. 2012 Mar;39(1):30-8.
Health economics: Ahmed RJ, Gafni A, Hutton EK. The Cost Implications in Ontario, Alberta, and British Columbia of Early Versus Delayed External Cephalic Version in the EECV2 Trial. J Obstet Gynaecol Can. 2016 Mar;38(3):235-245.
The Twin Birth Study (TBS)
Led by Dr. Jon Barret, Principal Investigator at the University of Toronto, with Dr. Eileen Hutton,
the Twin Birth Study is a multicentre randomized controlled trial that examined whether planned Caesarean section results in a lower risk of adverse outcomes than planned vaginal delivery in twin pregnancy.
Main article: Barrett JF, Hannah ME, Hutton EK, Willan AR, Allen AC, Armson BA, Gafni A, Joseph KS, Mason D, Ohlsson A, Ross S, Sanchez JJ, Asztalos EV; Twin Birth Study Collaborative Group. A randomized trial of planned cesarean or vaginal delivery for twin pregnancy.N Engl J Med. 2013 Oct 3;369(14):1295-305. doi: 10.1056/NEJMoa1214939.
Maternal outcomes at 3-month follow-up: Hutton EK, Hannah ME, Ross S, Joseph KS, Ohlsson A, Asztalos EV, Willan AR, Allen AC, Armson BA, Gafni A, Mangoff K, Sanchez JJ, Barrett JF; Twin Birth Study Collaborative Group. Maternal outcomes at 3 months after planned caesarean section versus planned vaginal birth for twin pregnancies in the Twin Birth Study: a randomised controlled trial. BJOG. 2015 Nov;122(12):1653-62. doi: 10.1111/1471-0528.13597. Epub 2015 Aug 20.
Qualitative research: Murray-Davis B, McVittie J, Barrett JF, Hutton EK; Twin Birth Study Collaborative Group. Exploring Women’s Preferences for the Mode of Delivery in Twin Gestations: Results of the Twin Birth Study. Birth. 2016 Jun 20. doi: 10.1111/birt.12238. [Epub ahead of print]
The Control of Hypertension in Pregnancy Study (CHIPS)
Led by Dr. Laura Magee, Principal Investigator at St. George’s, University of London, UK, with Dr. Eileen Hutton, the CHIPS trial is an open, international, multicenter trial involving women with nonproteinuric preexisting or gestational hypertension randomly assigned to less-tight control (target diastolic blood pressure, 100 mm Hg) or tight control (target diastolic blood pressure, 85 mm Hg) to determine the effect on pregnancy loss or high-level neonatal care for more than 48 hours during the first 28 postnatal days.
Main paper: Magee LA, von Dadelszen P, Rey E, Ross S, Asztalos E, Murphy KE, Menzies J, Sanchez J, Singer J, Gafni A, Gruslin A, Helewa M, Hutton E, Lee SK, Lee T, Logan AG, Ganzevoort W, Welch R, Thornton JG, Moutquin JM. Less-tight versus tight control of hypertension in pregnancy. N Engl J Med. 2015 Jan 29;372(5):407-17. doi: 10.1056/NEJMoa1404595.
Health economics: Ahmed RJ, Gafni A, Hutton EK, Hu ZJ, Pullenayegum E, von Dadelszen P, Rey E, Ross S, Asztalos E, Murphy KE, Menzies J, Sanchez JJ, Ganzevoort W, Helewa M, Lee SK, Lee T, Logan AG, Moutquin JM, Singer J, Thornton JG, Welch R, Magee LA. The Cost Implications of Less Tight Versus Tight Control of Hypertension in Pregnancy (CHIPS Trial). Hypertension. 2016 Oct;68(4):1049-55. doi: 10.1161/HYPERTENSIONAHA.116.07466. Epub 2016 Aug 22.
Bench-to-bedside research applies findings from basic science to enhance human health and well-being. It aims to “translate” findings from laboratory experiments into clinical practice and meaningful health outcomes, through new drugs, devices, and treatment options for patients.
Baby & Mi
The Baby & Mi cohort began as a pilot in 2012, funded by the Hamilton Academic Health Sciences Organization, with the goal of enrolling 80 mother-infant pairs from midwifery practices in Hamilton, Ontario and following them to 1 year postpartum. The purpose of the study is to determine the relationship between various birth experiences, early life exposures, diet and the infant gut microbiome. In 2014, the team was awarded additional funding from the Canadian Institutes of Health Research to expand the cohort to 240 mother-infant pairs and to follow them to 3 years of age. The study is currently enrolling pregnant women who are receiving midwifery care in Hamilton, Burlington, Brantford or the Niagara Region. The study team is led by Dr. Eileen Hutton (Department of Obstetrics & Gynecology, McMaster University) and Dr. Katherine Morrison (Department of Pediatrics, McMaster University). Co-investigators include: Dr. Alison Holloway, Ms. Helen McDonald (Midwifery), Dr. Andrea Mousseau, Dr. Elyanne Ratcliffe, Dr. Jonathan Schertzer, Dr. Jennifer Stearns, Dr. Michael Surette and Dr. Lehana Thabane.
Baby & Pre-Mi
Led by Dr. Eileen Hutton in 2015, investigators from studies in Canada (Baby & Mi), The Netherlands (LucKi) and Germany (PAPS) received funding from the Joint Program Initiative: A Healthy Diet for a Healthy Life to form a consortium. The objective is to unravel the influence of the timing and nature of solid food introduction and cessation of breastfeeding on the succession and stability of the gut microbiome and subsequent health outcomes among both term and preterm infants. The project was awarded a total of $XXX from CIHR and $XXX under the European Union project “From infancy to childhood: the intersection of gastrointestinal microbial communities, diet and health (GI-MDH)”.
Education and Knowledge Translation
Educational research involves a variety of methods in which different aspects of education are evaluated, including student learning, teaching methods, teacher training, and classroom dynamics, including knowledge translation. The Canadian Institutes of Health Research (CIHR) defines knowledge translation as “a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically-sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system.” It essentially involves activities that move research from the scientist into the hands of people and organizations who can put it to practical use.
Led by Dr. Murray Davis, the Standardized Clinical Outcome Review (SCOR) study piloted a novel computer tool among an interprofessional team of obstetricians, neonatologists, obstetrical nurses and midwives to review adverse obstetric events that occurred at a tertiary care hospital to determine if it was a feasible, acceptable, and appropriate strategy for improving patient safety through improved review of incidents.
Murray-Davis B, McDonald H, Cross-Sudworth F, Dore S, Marrin M, DeSantis J, Sabatino L, DeFrance B, Leyland N, Gardosi J, Hutton E, McDonald S. Implementation of an Interprofessional Team Review of Adverse Events in Obstetrics Using a Standardized Computer Tool: A Mixed Methods Study. J Obstet Gynaecol Can. 2016 Feb;38(2):168-76.
Physical Assessment of the Well Woman and Newborn
Dr. Beth Murray-Davis, Dr. Bruce Wainman (Associate Professor, Pathology and Molecular Medicine, Director, Education Program in Anatomy, Associate Member, Obstetrics and Gynecology and Midwifery Education Program) and Ms. Helen McDonald (Associate Professor, Midwifery Education Program) published two interactive e-books entitled “Pharmacology Revealed” and “Physical Assessment of the Well Woman and Newborn”. Designed for anyone studying primary care obstetrics, including physician assistants, nurses, midwives, nurse practitioners and family medicine and obstetric residents, both e-books are now the core text for midwifery students at McMaster and Ryerson University.
“Textbooks for midwifery have always been a challenge to secure – we are a small profession with a narrow but deep focus on the materials that we need to understand,” said Dr. Eileen Hutton, Assistant Dean of the Midwifery Education Program. “This means that often texts from other professions are either too broad or don’t cover the material in enough detail. Having our own midwifery-specific textbooks at a very reasonable cost of $40 each is an enormous benefit to our students and course tutors.” E-books feature pop-up boxes on definitions, facts and quizzes, videos embedded in text, links to notes, questions and resources, case studies, interactive demonstration videos on topics such as how to do a blood pressure assessment, full newborn assessment and feel the position of the baby. The project was funded in part by the McMaster Institute for Innovation and Excellence in Teaching and Learning and by the Gender and Health Education Initiative Program. From Amanda Boundris; read more at http://dailynews.mcmaster.ca/article/two-new-midwifery-e-books-are-works-of-art/. Available at https://gumroad.com/bcw