Involving the public with an analysis of daily, weekly, and yearly cycles of births using linked data
Authors: Miranda Scanlon, Mary Newburn, Rachel Plachcinski, and Alison Macfarlane (City, University of London)
Date: August 2020
This project involved maternity service users in discussions about the creation of a new linked dataset, the City Birth Cohort and in the formulation of research questions. In doing this, the research team were able to demonstrate the acceptability of using health records for research, which provided new insights into the timing of births and their outcomes. By bridging the gap between data research and lived experience, the research findings contain implications for the planning of staffing in maternity services and helping the NHS maintain a ‘24-hour health service’.
With funding from the National Institute for Health Research (NIHR), researchers from City, University of London and UCL brought together three key health datasets – the Maternity Hospital Episode Statistics for England, birth registration and birth notification data for England and Wales – and linked corresponding hospital data for Wales to birth registration and notification. Using the ONS Secure Research Service, linked birth cohorts were created for England and for Wales and used to conduct novel analyses of births and their outcomes by time of day, and day of the week.
The three sources of data used were:
- MaternityHospital Episode Statistics for England: a database containing details of births in NHS hospitals in England. These data are used to monitor NHS hospital activity, document delivery of care in maternity units and research health trends. The team also linked the corresponding data for Wales.
- Birth registration in England and Wales: ONS data collected as part of civil registration, which provides information on live births and stillbirths that occur in, and are registered in, England and Wales.
- Birth notifications: operational data from the system used to notify births to the NHS, allocate NHS numbers to babies and send birth details to directors of public health and health visiting services.
This project involved experienced service user representatives, with experience of representing maternity service users and their families. This group formed a Public and Patient Involvement group throughout the research lifecycle, from design to dissemination. Two service user co-investigators from established childbirth organisations, the National Childbirth Trust and BirthChoiceUK, assisted in the design of the study and contributed to data analysis and interpretation.
This data linkage study brought together ONS birth registration and notification data from 2005 to 2014 with Maternity Hospital Episode Statistics delivery and birth records. Researchers were then able to undertake cross-sectional analyses to create datasets following the daily and weekly timings of births in England and in Wales.
Overview of datasets for England used in the study, showing types of data held within each dataset and how they were linked.
Following the creation of the linked birth cohorts, engagement workshops for larger groups of recent maternity service users were held. This ensured analysis and interpretations of the study data were relevant and grounded in user experiences. The workshops included discussions on data privacy and consent, along with presentations of preliminary results from the data analyses.
The success rate for linking Maternity Hospital Episode Statistics delivery records to birth records was 95% for records for the birth of only one child during a single delivery and 93% for records of the birth of two or more children during the same delivery. Cross-sectional analyses of all births in England and in Wales showed a regular weekly cycle. Numbers of daily births increased from Mondays to Fridays, while weekends and public holidays had the lowest numbers of births. Births peaked between 9.00am and 12.00pm, with elective caesarean births concentrated on weekday mornings.
Engagement with maternity service users was found to benefit the study in multiple ways. Participants demonstrated a broad acceptance of the use of administrative health data to further research, with contributions to research dissemination improving the accessibility of research findings to users. The service user co-investigators were able to act as knowledge intermediaries, successfully bridging the gap between the project team and recent maternity service users.
This project was able to successfully demonstrate the acceptability of using health records for research providing insights into the timing of births and their outcomes. By linking data research and lived experiences the findings of this project can help improve the planning of staffing in maternity services and therefore help the services given by the NHS.
The findings of this project have unlocked opportunities for other researchers who have now already begun to use the new data. With further funding to develop and update the linked birth cohort this will expand analyses in the area and develop public engagement to increase the trust for use of sensitive health records for research.
Publications and reports
- International Journal of Population Data Science paper, August 2020: Involving service users in Births and their outcomes: a retrospective birth cohort data linkage study analysing daily, weekly and yearly cycles and their implications for the NHS
- Health Services and Delivery Research report, May 2019: Births and their outcomes by time, day and year: a retrospective birth cohort data linkage study
- PLOS ONE paper, June 2018: Timing of singleton births by onset of labour and mode of birth in NHS maternity units in England, 2005–2014: A study of linked birth registration, birth notification, and hospital episode data
- BMJ Open paper, February 2018: Linkage of Maternity Hospital Episode Statistics data to birth registration and notification records for births in England 2005-2014: methods. A population-based birth cohort study
Blogs, news posts, and videos
- City, University of London article: Involving service users in the Birth Timing Study
- National Childbirth Trust (NCT) article: Birth timing study
- City, University of London article, October 2021: City maternal health researchers receive award from the Office for National Statistics
Awards and presentations
- Linked Administrative Data Award, ONS Research Excellence Awards 2021
- International Normal Labour and Birth Research Conference, Best Oral Presentation (December 2020)
About the ONS Secure Research Service
The ONS Secure Research Service (SRS) is an accredited trusted research environment, using the Five Safes Framework to provide secure access to de-identified, unpublished data. If you would like to discuss writing a future case study with us, please get in touch: firstname.lastname@example.org