title: The UK Midwifery Study System (UKMidSS): a programme of work to establish a research infrastructure to carry out national studies of uncommon conditions and events in midwifery units.
abstract: BACKGROUND
  Midwifery-led care during labour and birth in the UK is increasingly important given national commitments to choice of place of birth, reduction of unnecessary intervention and improving women's experience of care, and evidence on safety and benefits for 'low risk' women. Further evidence is needed on safety and potential benefits of midwifery-led care for some groups of 'higher risk' women and about uncommon adverse outcomes or 'near-miss' events. Uncommon obstetric events and conditions have been investigated since 2005 using the UK Obstetric Surveillance System. This programme of research will establish the UK Midwifery Study System (UKMidSS) in all UK alongside midwifery units (AMUs) and carry out the first two UKMidSS studies investigating: (i) outcomes in severely obese women admitted to AMUs, and (ii) risk factors for neonatal unit admission following birth in an AMU.
  
  
  METHODS
  We will carry out national cohort and case-control studies using UKMidSS, a national data collection platform which we will establish to collect anonymised information from all UK AMUs. Reporting midwives in each AMU will actively report cases or nil returns in response to monthly notification emails. Denominator data on the number of women admitted to and giving birth in each AMU will also be collected. Anonymised data on risk factors, management and outcomes for cases and controls/comparators as appropriate for each study, will be collected electronically using information from medical records. We will calculate incidence and prevalence with 95% confidence intervals (CIs), tabulate descriptive data using frequencies and proportions, and use logistic regression to estimate odds ratios with 95% CIs comparing specific outcomes in case and comparison women and to investigate risk factors for conditions or outcomes.
  
  
  CONCLUSIONS
  As the first national infrastructure facilitating research into uncommon events and conditions in women starting labour in midwifery-led settings, UKMidSS builds on the success of other national research systems. UKMidSS studies will extend the evidence base regarding the quality and safety of midwifery-led intrapartum care and investigate extending the benefits of midwifery-led care to more women. As a national collaboration of midwives contributing to high quality research, UKMidSS will provide an infrastructure to support midwifery research capacity development.
authors.affiliation: National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK. rachel.rowe@npeu.ox.ac.uk.
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Rowe
authors.affiliation: National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Kurinczuk
authors.affiliation: National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hollowell
authors.affiliation: National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK.
authors.forename: Marian
authors.initials: M
authors.lastname: Knight
mesh_terms: D035843:Biomedical Research / Q000379:methods*; D016550:Birthing Centers / Q000706:statistics & numerical data; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D008880:Midwifery / Q000706:statistics & numerical data*; D000067491:Near Miss, Healthcare / Q000706:statistics & numerical data; D009767:Obesity, Morbid / Q000150:complications; D007744:Obstetric Labor Complications / Q000453:epidemiology* / Q000209:etiology; D011159:Population Surveillance / Q000379:methods*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D012107:Research Design; D006113:United Kingdom / Q000453:epidemiology
keywords: Birth centre; Midwifery; Neonatal unit admission; Obesity