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Dr Tina Harris

Job: Associate Professor

Faculty: Health and Life Sciences

School/department: Research

Research group(s): Centre for Reproduction Research

Address: De Montfort University, The Gateway, Leicester, LE1 9BH.

T: +44 (0)116 257 7804

E: tiharris@dmu.ac.uk

W: https://www.dmu.ac.uk/hls

 

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Personal profile

Tina Harris is an Associate Professor within the Faculty of Health and Life Sciences and a registered midwife with an NMC recognised teaching qualification.  She is also seconded to the role of Senior Clinical Lead (Midwifery) for the National Maternity and Perinatal Audit at the Royal College of Obstetrics and Gynaecology.

Tina completed her nursing and midwifery training in the early eighties and then worked in hospital and community posts as a midwife. She completed an Advanced Diploma in Midwifery in 1986 and, following a three year period working in parent education in the USA, completed her honours degree in education in 1993. At this time she moved into an academic post as a midwifery lecturer.

In 2005 Tina successfully defended her PhD thesis, a grounded theory study which explored practice variation and decision making in third stage care among midwives. Her academic interests are now focused on research, leadership, and supporting PhD students.

Tina’s research interests focus on practice variation, working with large national datasets relevant to maternity care processes and outcomes and driving quality improvement through the production of audit and research publications relevant to the care of women and babies.

Research group affiliations

Centre for Reproduction Research

Publications and outputs

  • Obstetric interventions and pregnancy outcomes during the COVID-19 pandemic in England: A nationwide cohort study.
    Obstetric interventions and pregnancy outcomes during the COVID-19 pandemic in England: A nationwide cohort study. Gurol-Urganci, I.; Waite, L.; Webster, K.; Jardine, J.; Carroll, F.; Dunn, G.; Fremeaux, A.; Harris, Tina; Hawdon, J.; Muller, P.; van der Meulen, J.; Khalil, A. Abstract Background The COVID-19 pandemic has disrupted maternity services worldwide and imposed restrictions on societal behaviours. This national study aimed to compare obstetric intervention and pregnancy outcome rates in England during the pandemic and corresponding pre-pandemic calendar periods, and to assess whether differences in these rates varied according to ethnic and socioeconomic background. Methods and findings We conducted a national study of singleton births in English National Health Service hospitals. We compared births during the COVID-19 pandemic period (23 March 2020 to 22 February 2021) with births during the corresponding calendar period 1 year earlier. The Hospital Episode Statistics database provided administrative hospital data about maternal characteristics, obstetric inventions (induction of labour, elective or emergency cesarean section, and instrumental birth), and outcomes (stillbirth, preterm birth, small for gestational age [SGA; birthweight < 10th centile], prolonged maternal length of stay (≥3 days), and maternal 42-day readmission). Multi-level logistic regression models were used to compare intervention and outcome rates between the corresponding pre-pandemic and pandemic calendar periods and to test for interactions between pandemic period and ethnic and socioeconomic background. All models were adjusted for maternal characteristics including age, obstetric history, comorbidities, and COVID-19 status at birth. The study included 948,020 singleton births (maternal characteristics: median age 30 years, 41.6% primiparous, 8.3% with gestational diabetes, 2.4% with preeclampsia, and 1.6% with pre-existing diabetes or hypertension); 451,727 births occurred during the defined pandemic period. Maternal characteristics were similar in the pre-pandemic and pandemic periods. Compared to the pre-pandemic period, stillbirth rates remained similar (0.36% pandemic versus 0.37% pre-pandemic, p = 0.16). Preterm birth and SGA birth rates were slightly lower during the pandemic (6.0% versus 6.1% for preterm births, adjusted odds ratio [aOR] 0.96, 95% CI 0.94–0.97; 5.6% versus 5.8% for SGA births, aOR 0.95, 95% CI 0.93–0.96; both p < 0.001). Slightly higher rates of obstetric intervention were observed during the pandemic (40.4% versus 39.1% for induction of labour, aOR 1.04, 95% CI 1.03–1.05; 13.9% versus 12.9% for elective cesarean section, aOR 1.13, 95% CI 1.11–1.14; 18.4% versus 17.0% for emergency cesarean section, aOR 1.07, 95% CI 1.06–1.08; all p < 0.001). Lower rates of prolonged maternal length of stay (16.7% versus 20.2%, aOR 0.77, 95% CI 0.76–0.78, p < 0.001) and maternal readmission (3.0% versus 3.3%, aOR 0.88, 95% CI 0.86–0.90, p < 0.001) were observed during the pandemic period. There was some evidence that differences in the rates of preterm birth, emergency cesarean section, and unassisted vaginal birth varied according to the mother’s ethnic background but not according to her socioeconomic background. A key limitation is that multiple comparisons were made, increasing the chance of false-positive results. Conclusions In this study, we found very small decreases in preterm birth and SGA birth rates and very small increases in induction of labour and elective and emergency caesarean section during the COVID-19 pandemic, with some evidence of a slightly different pattern of results in women from ethnic minority backgrounds. These changes in obstetric intervention rates and pregnancy outcomes may be linked to women’s behaviour, environmental exposure, changes in maternity practice, or reduced staffing levels. open access journal
  • Maternal and perinatal outcomes of pregnant women with SARS-CoV-2 infection at the time of birth in England: national cohort study
    Maternal and perinatal outcomes of pregnant women with SARS-CoV-2 infection at the time of birth in England: national cohort study Gurol-Urganci, I; Jardine, J; Carroll, F; Draycott, T; Dunn, G; Fremeaux, A; Harris, Tina; Hawdon, J; Morris, E; Muller, P; Waite, L; Webster, K; van der Meulen, J; Khalil, A ABSTRACT Objective: The aim of this study was to determine the association between SARS-CoV-2 26 infection at the time of birth and maternal and perinatal outcomes. 27 28 Methods: This is a population-based cohort study in England. The inclusion criteria were women with a recorded singleton birth between 29th May 2020 and 31st 29 January 2021 in a 30 national database of hospital admissions. Maternal and perinatal outcomes were compared 31 between pregnant women with a laboratory-confirmed SARS-CoV-2 infection recorded in the 32 birth episode and those without. Study outcomes were fetal death at or beyond 24 weeks’ 33 gestation (stillbirth), preterm birth (<37 weeks gestation), small for gestational age infant (SGA; birthweight <10th centile), preeclampsia/eclampsia, induction of labor, mode of birth, specialist neonatal care, composite neonatal adverse outcome indicator, maternal and neonatal length of hospital stay following birth (3 days or more), 28-day neonatal and 42-day maternal hospital readmission. Adjusted odds ratios (aOR) and their 95% confidence interval (CI) for the association between SARS-CoV-2 infection status and outcomes were calculated using logistic regression, adjusting for maternal age, ethnicity, parity, pre-existing diabetes, pre-existing hypertension and socioeconomic deprivation measured using Index of Multiple Deprivation 2019. Models were fitted with robust standard errors to account for hospital-level clustering. The analysis of the neonatal outcomes was repeated for those born at term (≥ 37 weeks’ gestation) since preterm birth has been reported to be more common in pregnant women with SARS-CoV-2 infection. Results The analysis included 342,080 women, of whom 3,527 had laboratory-confirmed SARS-CoV-2 infection. Laboratory-confirmed SARS-CoV-2 infection was more common in women who were younger, of non-white ethnicity, primiparous, residing in the most deprived areas, or had comorbidities. Fetal death (aOR, 2.21, 95% CI 1.58-3.11; P<0.001) and preterm birth (aOR 2.17, 95% CI 1.96-2.42; P<0.001) occurred more frequently in women with SARS-CoV-2 infection than those without. Risk of preeclampsia/eclampsia (aOR 1.55, 95% CI 1.29-1.85; P<0.001), birth by emergency Cesarean delivery (aOR 1.63, 95% CI 1.51-1.76; P<0.001) and prolonged admission following birth (aOR 1.57, 95%CI 1.44-1.72; P<0.001) were significantly higher for women with SARS-CoV-2 infection than those without. There were no significant differences in the rate of other maternal outcomes. Risk of neonatal adverse outcome (aOR 1.45, 95% CI 1.27-1.66; P<0.001), need for specialist neonatal care (aOR 1.24, 95% CI 1.02-1.51; P=0.03), and prolonged neonatal admission following birth (aOR 1.61, 95% CI 1.49-1.75; P<0.001) were all significantly higher for infants with mothers with laboratory-confirmed SARS-CoV-2 infection. When the analysis was restricted to pregnancies delivered at term (≥37 weeks), there were no significant differences in neonatal adverse outcome (P=0.78), need for specialist neonatal care after birth (P=0.22) or neonatal readmission within four weeks of birth (P=0.05). Neonates born at term to mothers with laboratory-confirmed SARS-CoV-2 infection were more likely to have prolonged admission following birth (21.1% compared to 14.6%, aOR 1.61, 95% CI 1.49-1.75; P<0.001). Conclusions SARS-CoV-2 infection at the time of birth is associated with higher rates of fetal death, preterm birth, preeclampsia and emergency Cesarean delivery. There were no additional adverse neonatal outcomes, other than those related to preterm delivery. Pregnant women should be counseled regarding risks of SARS-COV-2 infection and should be considered a priority for vaccination.
  • NHS Maternity Care for Women with a Body Mass Index of 30 kg/m2 or Above: Births between 1 April 2015 and 31 March 2017 in England, Wales and Scotland.
    NHS Maternity Care for Women with a Body Mass Index of 30 kg/m2 or Above: Births between 1 April 2015 and 31 March 2017 in England, Wales and Scotland. Relph, S; Coe, M; Carroll, F; Gurol-Urganci, I; Webster, K; Jardine, J; Dunn, G; Harvey, A; Harris, Tina; Hawdon, J; Khalil, A; Pasupathy, D; van der Meulen, J Introduction This report focuses on the maternal and neonatal outcomes of pregnant women with body mass index (BMI) of 30 kg/m2 or above who gave birth between 1 April 2015 and 31 March 2017, compared with those of women with BMI in the range 18.5–24.9 kg/m2 . Methods This study uses existing NMPA linked datasets to explore the characteristics and outcomes of women and babies according to category of maternal BMI at booking with the maternity service provider. Women are grouped by BMI according to established World Health Organization (WHO) categories. The association between maternal BMI and each maternal or neonatal measure is represented using line graphs, stratified by maternal parity (nulliparous, multiparous with previous vaginal births only, multiparous with a previous caesarean birth). We also explored the feasibility of stratifying the outcomes according to the woman’s risk status at the time of labour and birth (as defined by the National Institute of Health and Care Excellence (NICE) Intrapartum Care for Healthy Women and Babies guideline). Finally, we described the type of maternity units in which the women gave birth, by maternal BMI. A lay advisory group was involved at all stages of this sprint audit, including discussing the choice of outcomes, interpreting the results, and reviewing the draft report and recommendations. Key findings For the period 1 April 2015 to 31 March 2017, we estimate that 21.8% of women giving birth had a BMI of 30 kg/m2 or above; however, 16.9% of women did not have a BMI (or height and weight) recorded. The likelihood of a woman experiencing an intrapartum intervention or adverse maternal outcome, or her baby experiencing very serious complications following birth, increases as BMI increases. We do not know whether this is because women with higher BMI are more likely to develop complications requiring intervention or because of differences in the clinicians’ threshold to intervene. However, those women with a BMI of 30 kg/m2 or above who have previously had at least one vaginal birth (and no caesarean births) are almost as likely to have another unassisted vaginal birth as multiparous women with a BMI in the range 18.5–24.9 kg/m2 who have also not previously had a caesarean birth. Babies born to women with a BMI of 30 kg/m2 or above are less likely to receive skin-to-skin contact within 1 hour of birth or breast milk for their first feed than babies born to women with a lower BMI. The proportion of women giving birth in a freestanding midwifery unit, or at home, decreases as BMI increases, although 1.7% of women with a BMI of 35.0–39.9 kg/m2 and 1.1% of women with a BMI of 40 kg/m2 or above did give birth in one of these settings. The lay advisory group requested that we also measure access to birth in water, monitoring of fetal growth by ultrasound, access to perinatal mental health services and prevention of venous thromboembolism in women with a BMI of 30 kg/m2 or above. We currently do not have sufficient information in the NMPA dataset to assess these. Presentation of maternal or neonatal outcomes by maternal BMI, parity and risk status (as assessed at admission for birth) is both feasible and likely to be useful to support informed decision making. It is limited by uncertainty with less common outcomes (particularly those indicating poor condition of the baby at birth), more so when these are estimated in smaller groups of women. Recommendations R1 Audit local rates of missing data on BMI (or height and weight) before the end of the 2021/22 reporting year, and commence local initiatives to improve electronic recording of this where it is low. (Audience: Maternity service providers) R2 Commence by the end of June 2023 the production of, or include in updates to existing documents, detailed guidance on the antenatal and intrapartum care offered to women who are suspected to have a large-for-gestational-age baby, including whether the guidance should differ for women with a BMI of 30 kg/m2 or above. (Audience: National organisations responsible for publishing guidance on maternity care) R3 Support research and investigation into why women with a BMI of 30 kg/m2 or above have a higher risk of stillbirth, in order to inform clinical care which aims to reduce this risk. (Audience: National Institute for Health Research, Health and Care Research Wales and NHS Research Scotland in consultation with the Royal College of Obstetricians and Gynaecologists and policy makers, service planners/commissioners, service managers and healthcare professionals working for maternity services) R4 Ensure that women with a BMI of 30 kg/m2 or above are given preconception and antenatal information tailored to their individual circumstances (including their BMI and whether this is their first birth or they have previously had a caesarean birth). To support women in their decision making, this should include information from this report on their risk of the following: ● birth interventions ● major postpartum blood loss ● postnatal readmission to hospital ● very serious complications for their baby following birth. (Audience: Healthcare professionals working in maternity services, general practitioners) R5 Identify common causes for readmission to the maternity unit following birth specifically for women with a BMI of 40 kg/m2 or above, and commence local quality improvement initiatives to reduce the risk of readmission. (Audience: Maternity service providers) R6 Support all women and babies to experience skin-to-skin contact with one another within 1 hour of birth should they choose to and regardless of the woman’s BMI, unless it is unsafe to do so because either the woman or baby requires immediate medical attention. (Audience: Healthcare professionals working in maternity services) R7 Offer all women breastfeeding information and support during pregnancy and again shortly after the birth. Women with a BMI of 30 kg/m2 or above may require support to be tailored to their specific needs and to be provided by a healthcare professional who is trained to adapt breastfeeding techniques for women with a higher BMI. (Audience: Healthcare professionals working in maternity services) R8 Incorporate information on antenatal assessment of fetal growth status (suspected SGA or LGA) and on venous thromboembolism risk scores and prophylaxis in future trust/board and national maternity dataset specifications. (Audience: Maternity service providers, the Data and Intelligence Division of Public Health Scotland, the National Welsh Informatics Service) R9 Assess the quality of data on labour or birth in water, and where completeness is low, commence initiatives to improve it. (Audience: Maternity service providers)
  • Waterbirth: a national retrospective cohort study of factors associated with its use among women in England
    Waterbirth: a national retrospective cohort study of factors associated with its use among women in England Aughey, H; Jardine, J; Moitt, N; Fearon, K; Jawdon, J; Pasupathy, D; Urganci, I; NMPA Project Team; Harris, Tina Background Waterbirth is widely available in English maternity settings for women who are not at increased risk of complications during labour. Immersion in water during labour is associated with a number of maternal benefits. However for birth in water the situation is less clear, with conclusive evidence on safety lacking and little known about the characteristics of women who give birth in water. This retrospective cohort study uses electronic data routinely collected in the course of maternity care in England in 2015–16 to describe the proportion of births recorded as having occurred in water, the characteristics of women who experienced waterbirth and the odds of key maternal and neonatal complications associated with giving birth in water. Methods Data were obtained from three population level electronic datasets linked together for the purposes of a national audit of maternity care. The study cohort included women who had no risk factors requiring them to give birth in an obstetric unit according to national guidelines. Multivariate logistic regression models were used to examine maternal (postpartum haemorrhage of 1500mls or more, obstetric anal sphincter injury (OASI)) and neonatal (Apgar score less than 7, neonatal unit admission) outcomes associated with waterbirth. Results 46,088 low and intermediate risk singleton term spontaneous vaginal births in 35 NHS Trusts in England were included in the analysis cohort. Of these 6264 (13.6%) were recorded as having occurred in water. Waterbirth was more likely in older women up to the age of 40 (adjusted odds ratio (adjOR) for age group 35–39 1.27, 95% confidence interval (1.15,1.41)) and less common in women under 25 (adjOR 18–24 0.76 (0.70, 0.82)), those of higher parity (parity ≥3 adjOR 0.56 (0.47,0.66)) or who were obese (BMI 30–34.9 adjOR 0.77 (0.70,0.85)). Waterbirth was also less likely in black (adjOR 0.42 (0.36, 0.51)) and Asian (adjOR 0.26 (0.23,0.30)) women and in those from areas of increased socioeconomic deprivation (most affluent versus least affluent areas adjOR 0.47 (0.43, 0.52)). There was no association between delivery in water and low Apgar score (adjOR 0.95 (0.66,1.36)) or incidence of OASI (adjOR 1.00 (0.86,1.16)). There was an association between waterbirth and reduced incidence of postpartum haemorrhage (adjOR 0.68 (0.51,0.90)) and neonatal unit admission (adjOR 0.65 (0.53,0.78)). Conclusions In this large observational cohort study, there was no association between waterbirth and specific adverse outcomes for either the mother or the baby. There was evidence that white women from higher socioeconomic backgrounds were more likely to be recorded as giving birth in water. Maternity services should focus on ensuring equitable access to waterbirth. open access article
  • Technical Report: Feasibility of evaluating perinatal mental health services using linked national maternity and mental health data sets, based on births between 1 April 2014 and 31 March 2017 in Scotland
    Technical Report: Feasibility of evaluating perinatal mental health services using linked national maternity and mental health data sets, based on births between 1 April 2014 and 31 March 2017 in Scotland Langham, J; Gurol-Urganci, I; Dunn, G; Harris, Tina; Hawdon, J; Pasupathy, D; van der Meulen, J; NMPA Project Team Introduction In this short report, we describe the feasibility of using linked national data sets to evaluate perinatal mental health services. Perinatal mental health conditions are common. About 10% of pregnant women and 13% of women who have just given birth experience a mental health problem. Some perinatal mental health problems can, if not adequately treated, have significant and long-lasting effects on a woman and her baby. For this report, we only used Scottish data sources. The data sets include episodes of admission to secondary care, including hospital admission for perinatal mental health conditions. The results based on Scottish data are expected to inform future analyses of similar data from England and Wales. Specific data sets on mental health services in Wales were not yet available at the time of this study. The report consists of three parts. First, we describe the data sets that were used and how they were linked. Second, we present a grouping of mental health diagnoses that are similar with respect to their prognosis and treatment (to maximise the clinical relevance) while limiting the number of diagnosis groups (to maximise statistical power). Third, we use the results of this preparatory work to demonstrate the clinical relevance of the linked data sets by describing a number of clinical outcomes according to the timing of the perinatal mental health admissions. Methods We used linked national maternity and mental health data for Scotland on all births that took place between 1 April 2014 and 31 March 2017, and inpatient admissions for mental health conditions between 1 April 2000 and 31 March 2018. Births records were identified in the National Records of Scotland (NRS). These records were used as a ‘spine’ against which records from all other Scottish Morbidity Record (SMR) data sets were linked: general/acute inpatient records (SMR-01), maternity inpatient records (SMR-02), mental health inpatient records (SMR-04) and the Scottish Birth Record (SBR). Women who had a mental health admission were identified in SMR-04 data as well as in SMR-01 data if their admission record contained a diagnosis code from Chapter V (‘Mental and behaviour disorders’) of the International Classification of Disease, 10th Revision (ICD-10). Findings Both mental health inpatient data (SMR-04) and general/acute inpatient data (SMR-01) need to be used to identify women who had a hospital admission for mental health indications. We identified 3457 births in women who had a mental health admission. About two-thirds of the mental health admissions were identified in SMR-04 and about one-third in SMR-01. 163109 births were identified. 3043 (2.1%) of these births were in women with a prepregnancy history of a mental health admission. 176 (5.8%) of the women with prepregnancy mental health admission were also admitted during the perinatal period (during pregnancy or in the first year after giving birth). In comparison, only 414 (0.3%) of the 160066 births of women without a prepregnancy mental health admission had a perinatal mental health admission. Therefore, in the majority of cases Evaluating perinatal mental health services using linked national maternity and mental health data sets – 414 of the 590 perinatal mental health admissions (70.2%) – the perinatal mental health admission was a women’s first mental health admission. Diagnostic codes were grouped into eight diagnosis groups aiming to maximise the clinical relevance and statistical power. Based on this grouping, we found that major depressive disorders were the most frequently observed diagnoses (22.9%) among the 590 women with a perinatal mental health admission, followed by admissions for anxiety and post-traumatic stress disorders (19.3%). However, if we only considered the 176 women who had a perinatal mental health admission after a prepregnancy mental health admission, the most frequently observed diagnoses were related to psychoactive substance use (25.0%). Following this preparatory work, we demonstrated the clinical relevance of these data. Babies born to women with a prepregnancy history of perinatal health admission were found to be more likely to be preterm (12.0% born before 37 weeks), to have low birthweight (4.3% with birthweight below 2500 g in term babies) or to need some medical help (2.6% with an Apgar score less than 7 at 5 minutes after birth) than babies born to women without such a history (7.1%, 2.0%, and 1.7%, respectively). Outcomes in babies of women who had a perinatal mental health admission (590) were similar to those of women with a prepregnancy history of mental health admission (3043). Admission to an inpatient psychiatric mother-and-baby unit (MBU) was most frequent in women who had a mental health admission in the first 12 weeks after giving birth (79.5%) and considerably lower in women who had a mental health admission during pregnancy (23.7%) or between 13 and 52 weeks after giving birth (38.1%). Conclusions This study demonstrates the feasibility as well as the clinical relevance of using linked national maternity and mental health data sets from Scotland to assess the care that women with perinatal mental health problems receive. Despite only identifying women with severe perinatal mental health conditions, linkage of data sets of secondary care admission will offer an important opportunity to monitor the impact of national initiatives to improve perinatal mental health services in all four nations of the UK.
  • Associations between ethnicity and admission to intensive care among women giving birth: a cohort study
    Associations between ethnicity and admission to intensive care among women giving birth: a cohort study Jardine, J; Gurol-Urganci, I; Harris, Tina; Hawdon, J; Pasupathy, D; van der Meulen, J; Walker, K Abstract Objective: To determine the association between ethnic group and likelihood of admission to intensive care in pregnancy and the postnatal period. Design: Cohort study. Setting: Maternity and intensive care units in England and Wales. Population or Sample: 631 851 women who had a record of a registerable birth between 1st April 2015 and 31st March 2016 in a database used for national audit. Methods: Logistic regression analyses of linked maternity and intensive care records, with multiple imputation to account for missing data. Main Outcome Measures: Admission to intensive care in pregnancy or postnatal period to six weeks after birth. Results: 2.24 per 1000 maternities were associated with intensive care admission. Black women were more than twice as likely as women from other ethnic groups to be admitted (OR 2.21 (1.82, 2.68). This association was only partially explained by demographic, lifestyle, pregnancy and birth factors (adjOR 1.69 (95% CI 1.37, 2.09)). A higher proportion of intensive care admissions in Black women were for obstetric haemorrhage than in women from other ethnic groups. Conclusions: Black women have an increased risk of intensive care admission which cannot be explained by demographic, health, lifestyle, pregnancy and birth factors. Clinical and policy intervention should focus on the early identification and management of severe illness, particularly obstetric haemorrhage, in Black women, in order to reduce inequalities in intensive care admission. Funding: This study was funded by a programme grant from the Healthcare Quality Improvement Partnership. The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.
  • Rapid Response: Re:Risk of complicated birth at term in nulliparous and multiparous women using routinely collected data in England: cohort study. Rapid Response
    Rapid Response: Re:Risk of complicated birth at term in nulliparous and multiparous women using routinely collected data in England: cohort study. Rapid Response Pasupathy, D.; Jardine, J.; Harris, Tina; Hawdon, J.; Blotkamp, A.; Knight, H.; Gurol-Urganci, I.; Walker, K.; van der Meulen, J. De Jonge et al express concerns about the use of the term 'trial of labour' and our interpretation of the results.
  • Risk of complicated birth at term in nulliparous and mutiparous women using routinely collected maternity data in England: cohort study
    Risk of complicated birth at term in nulliparous and mutiparous women using routinely collected maternity data in England: cohort study Jardine, Jennifer; Blotkamp, Andrea; Gurol-Urganci, Ipek; Knight, Hannah; Harris, Tina; Hawdon, Jane; van der Meulen, Jan; Walker, Kate; Pasupathy, Dharmintra Abstract Objectives To determine the rate of complicated birth at term in women classified at low risk according to the National Institute for Health and Care Excellence guideline for intrapartum care (no pre-existing medical conditions, important obstetric history, or complications during pregnancy) and to assess if the risk classification can be improved by considering parity and the number of risk factors. Design Cohort study using linked electronic maternity records. Participants 276 766 women with a singleton birth at term after a trial of labour in 87 NHS hospital trusts in England between April 2015 and March 2016. Main outcome measure A composite outcome of complicated birth, defined as a birth with use of an instrument, caesarean delivery, anal sphincter injury, postpartum haemorrhage, or Apgar score of 7 or less at five minutes. Results Multiparous women without a history of caesarean section had the lowest rates of complicated birth, varying from 8.8% (4879 of 55 426 women, 95% confidence interval 8.6% to 9.0%) in those without specific risk factors to 21.8% (613 of 2811 women, 20.2% to 23.4%) in those with three or more. The rate of complicated birth was higher in nulliparous women, with corresponding rates varying from 43.4% (25  805 of 59 413 women, 43.0% to 43.8%) to 64.3% (364 of 566 women, 60.3% to 68.3%); and highest in multiparous women with previous caesarean section, with corresponding rates varying from 42.9% (3426 of 7993 women, 41.8% to 44.0%) to 66.3% (554 of 836 women, 63.0% to 69.5%). Conclusions Nulliparous women without risk factors have substantially higher rates of complicated birth than multiparous women without a previous caesarean section even if the latter have multiple risk factors. Grouping women first according to parity and previous mode of birth, and then within these groups according to presence of specific risk factors would provide greater and more informed choice to women, better targeting of interventions, and fewer transfers during labour than according to the presence of risk factors alone. open access article
  • NHS Maternity Care for Women with Multiple Births and Their Babies A study on feasibility of assessing care using data from births between 1 April 2015 and 31 March 2017 in England, Wales and Scotland.
    NHS Maternity Care for Women with Multiple Births and Their Babies A study on feasibility of assessing care using data from births between 1 April 2015 and 31 March 2017 in England, Wales and Scotland. Relph, Sophie; Gurol-Urganci, Ipek; Blotkamp, Andrea; Dunn, George; Harris, Tina; Hawdon, Jane; Pasupathy, Dharmintra; van der Meulen, Jan Introduction This report focuses on the maternity care for women with multiple births during the period 1 April 2015 to 31 March 2017 and their babies. The purpose of this report is to describe the feasibility of assessing maternity care for women with multiple births and their babies, using routinely collected data. Methods This study examines the feasibility of using existing data sources and linkages within NMPA to report the characteristics and outcomes of twin pregnancy and birth and to assess the care of women with multiple birth. National guidelines from the National Institute for Health and Care Excellence (NICE) and the Royal College of Obstetricians and Gynaecologists (RCOG) and recommendations from Twins Trust and the Multiple Births Foundation were consulted in the development of audit measures. Maternal outcomes were reported per pregnancy. Perinatal outcomes were reported per pregnancy or per baby, as appropriate. The characteristics and outcomes of higher order births were assessed and reported separately from those of twins. Given that many of the national guidelines referred to local service configuration, an evaluation of the availability of specific services for women with multiple birth was conducted, by linking the results of the NMPA Organisational Survey 2017 with the location of birth of the women with multiple pregnancy.2 Key findings We have demonstrated that an audit of maternity and neonatal care for women and babies affected by multiple birth is feasible using NMPA methodology and data sources, but such an audit will be limited by data availability and quality issues. We identified 41608 babies born from multiple pregnancies in 20 655 women from England, Scotland and Wales. When compared with the number of multiple births reported in data from the Office for National Statistics, this represented an estimated case ascertainment of 89.5%, compared with case ascertainments of 92% in 2015/16 and 97% in 2016/17 for singleton births. Case ascertainment is affected by inaccuracies in the recorded number of infants born to each woman and by unavailability of data on the number of fetuses identified in the first trimester of pregnancy. Only two of 174 clinical guideline statements can be directly assessed using NMPA methods. These relate to recommendations that mothers should be supported to breastfeed and that neonatal networks should aim to reduce term neonatal admissions. The most common reason that recommendations or clinical guideline statements cannot be assessed isthe absence of information on chorionicity and amnionicity in the data. This information is not routinely collected in maternity datasets. Challenges were also identified in classifying caesarean section into categories according to whether the procedure was planned or the procedure was urgent or an emergency, particularly in the context of risk of spontaneous preterm labour in multiple pregnancies in women with planned caesarean birth. It is also not possible to assess provision of specialist services for twin babies with fetal complications (e.g. twin-to-twin transfusion syndrome) because these diagnoses and related therapeutic procedures are poorly recorded in the data. Assessing maternity care for women with multiple births: feasibility study viii Case mix adjustment using standard NMPA methods is more complex for women with twin births, compared with those with singleton births. For each pregnancy, a choice has to be made which of the two birthweights need to be included in the case mix adjustment. There is also a small number of women affected by less common comorbidities (e.g. hypertension) and antenatal complications (e.g. placenta praevia), usually included in the established NMPA adjustment method. A study of variation in measures of maternity care between NHS trusts or boards, or between hospital sites, is only possible for measures where the outcome is common (e.g. prelabour caesarean birth). When relevant features of care or outcomes are rare, maternity and neonatal care can only be assessed at regional or national level. For the evaluation of maternity and neonatal care that is specific to those babies admitted to a neonatal unit, successful linkage of NMPA maternity data with the NNRD was slightly lower for twin births before 32+0 weeks of gestation than the existing linkage of singleton neonates. For example, the linkage rate at 30+0 to 31+6 weeks of gestation was 87.7% for liveborn twins compared with 94.9% for all liveborn babies. This was particularly noted at gestations less than 28+0 weeks. The most likely explanation for this lower linkage rate is less complete and maybe less accurate data entry, including possible errors or omissions with neonatal NHS numbers. It is possible to assess the availability of specialist services at the level of NHS trust or board, or hospital site, for women giving birth following multiple pregnancy. However, this can currently only be studied according to the place of birth, as information on where antenatal care was received is not available. It should be noted that a similar problem exists for singleton births. Recommendations R1 Maternity service providers should consider the local reasons for inaccuracies in the recording of ‘number of infants’ at birth and work to correct these by the end of the 2020/21 reporting year. This might require auditing local data, mandating the ‘number of infants’ data item and checking data download reports for national datasets to ensure that ‘birth order’ has not been mislabelled as ‘number of infants’. R2 Maternity service providers and national organisations responsible for collating and managing maternity datasets should request/record data on the number of fetuses in the first trimester of pregnancy, in addition to number at birth, for women with multiple pregnancy, and should plan to be compliant with this for the next version of the national data specification. R3 Maternity service providers and national organisations responsible for collating and managing maternity datasets should make chorionicity and amnionicity a compulsory data item in maternity information systems and national datasets for women with multiple pregnancy. This should be implemented in the next version of the national data specification. R4 Maternity service providers who offer specialist fetal procedures, such as intrauterine fetal laser therapy, should work with their coding departments to ensure that the fetal complications and procedures are properly coded into HES, SMR and PEDW by the end of the 2020/21 reporting year. R5 Maternity service providers and national organisations responsible for collating and managing maternity datasets should work to include a compulsory field on planned mode of birth, to enable distinction between those women who have an urgent caesarean birth following labour onset for new clinical reasons and those who have planned caesarean birth. This should be implemented in the next version of the national data specification. R6 Maternity service providers should put local systems in place by the end of the 2020/21 reporting year to ensure that the NHS number for every newborn baby is stored in the maternity information system and linked to the mother’s number. Particular care must be taken to ensure that the baby’s NHS number is not linked to the baby record of the other twin.
  • Waterbirth: characteristics and outcomes in low risk women and babies: a retrospective population cohort study in England 2015/16.
    Waterbirth: characteristics and outcomes in low risk women and babies: a retrospective population cohort study in England 2015/16. Aughey, Harriet; Jardine, Jen; Blotkamp, Andrea; Harris, Tina; NMPA Project Team Background Little is known about the incidence of delivery in water and concerns have been raised about the effects of waterbirth on women and their babies as it becomes more popular. Aims and objectives of the study To identify the proportion of low risk women who give birth in water. To compare the characteristics and outcomes of low risk women and their babies who give birth in water with women who do not. Methods Ethical approval was not required as data from maternity information systems was linked to Hospital Episode Statistics for births in England from 1/4/15 -31/3/16. The cohort was restricted to singleton, term vaginal livebirths without instrument, in women with no risk factors requiring obstetric care, in trusts with complete data for birth in water. Multivariate logistic regression models were used to examine maternal characteristics and outcomes (PPH ≥1500ml, OASI) and neonatal outcomes (Apgar <7 at 5 mins, NNU admission). Findings Of 52,476 births, 7099 (13.5%) were recorded as having occurred in water. Water birth was more likely in older women (adjOR for age group 30-34 1.3, 95% CI (1.2,1.5), 35-39 1.3 (1.1,1.4)) and less likely in women of black (adjOR 0.42 (0.35, 0.94)) or Asian (0.26 (0.23, 0.31)) ethnicity, or of lower socioeconomic status (lowest quintile, adjOR 0.50 (0.45-0.55)). There was no association between delivery in water and low Apgar score (adjOR 0.99 (0.70,1.39)) or OASI (adjOR 1.09 (0.94,1.28)). There was a small association with reduced admission to a NNU (adjOR 0.91 (0.84,0.99)) and PPH (adjOR 0.69 (0.53,0.89)); however, in a subset who gave birth in a midwife-led setting, this effect did not persist. Conclusions and implications There is no evidence of harm to the mother (PPH, OASI) or the baby (low Apgar, NNU admission) from waterbirth. Small differences in rates of admission to NNU and PPH may be explained by unmeasured confounding variables from events during labour. Why some groups of women are less likely to experience waterbirth may reflect women‘s choice, or inequitable access. Tina Harris is the Senior Clinical Lead (Midwifery) for the National Maternity and Perinatal Audit and is Senior Author on this paper.

Click here to view a full listing of Tina Harris' publications and outputs.

Research interests/expertise

  • Midwifery practice
  • Midwifery education
  • Decision making in clinical care
  • Practice variation
  • Care of childbearing women from ethnic minority and migrant backgrounds
  • Parent education
  • Obesity.
  • Waterbirth
  • Inequalities in maternity care processes and outcomes
  • Birth without intervention
  • Grounded theory
  • Qualitative methodologies

Areas of teaching

  • NURS3001 Dissertation Module
  • REST7016 Introduction to the Faculty of health and Life Sciences for postgraduate research students.
  • Supervision of undergraduate students completing their dissertations
  • Supervision of postgraduate students completing their dissertations
  • Supervision of MPhil and PhD students
  • Undergraduate and post graduate teaching in midwifery.

Qualifications

PhD, RN, RM, ADM Recordable Teaching Qualification

BSc Hons Education Studies (Midwifery) 1st Class

Courses taught

  • BSc Hons Midwifery
  • BSc Hons Midwifery (shortened)
  • MSc Midwifery Practice

Membership of external committees

  • Member of validation panel as external reviewer for Masters in Midwifery programme at Liverpool John Moores University 2004
  • External advisor on research project at Liverpool John Moores University with Irene Walton: A study of the decision making processes of the midwife in the care of low risk women in labour 2005-2007
  • Member of the LME Strategic Reference Group at the NMC 2006-2015
  • Member of panel for revalidation of curriculum at University of Manchester on 2 occasions as external reviewer 2008/2009
  • Participant in NMC consultation on changes to the constitution rules 2008
  • External examiner University of Bedfordshire 2007-2009
  • External examiner University of Bournemouth 2009-2013
  • External advisor for periodic review at University of Manchester 2009
  • External Specialist advisor for revalidation of graduate degree and postgraduate diploma in midwifery. University of Hull 2009
  • Leader for Initial and Higher Education Group of the Education Standing Committee for the International Confederation of Midwives 2009-2015
  • Member of Leading Midwifery Services Programme Advisory Panel NHS East Midlands Strategic Health Authority 2010
  • Expert Advisor to the NHS Evidence (NICE) specialist collection on ethnicity and health 2011-2014
  • Member of ICM Midwifery Research Advisory Network 2003 to date
  • Member of ICM Midwifery Education Advisory Network 2008 to 2017
  • Member of ICM Education Standing Committee 2011 - 2017
  • Specialist member of validation panel for revalidation of curricular Edgehill 11/3/11
  • Specialist member of validation panel for revalidation of midwifery curriculum Liverpool John Moores University 30/6/11
  • Member of Leicester University Board of Studies 2013
  • CQC Clinical Specialist Advisor 2014-2017
  • Registrant member of the Midwifery Committee, Nursing and Midwifery Council 2014- 2017
  • External examiner Trinity College, Dublin (pre-registration midwifery programme) 2014 to 2019
  • National Maternity and Perinatal Audit Programme Senior Clinical Lead (Midwifery) 2016 – date

Membership of professional associations and societies

  • CMB/UKCC/NMC 1982 to date
  • RCM 1982 to date
  • NATFE which became UCE 1996 to date
  • ILT which became HEA 2000 to date
  • ICM Midwifery Research Advisory Network 2003 to date
  • ICM Midwifery Education Advisory Network 2008 to 2017
  • ICM Education Standing Committee 2008-2017
  • Member of the LME strategic reference group NMC 2006-2015
  • Registrant member of the Midwifery committee NMC

Professional licences and certificates

  • Registered Midwife – Nursing and Midwifery Council 1982-date 
  • Advanced Diploma in Midwifery Birmingham Maternity Hospital (ADM) 1986
  • Registered Midwife with a recordable Teaching Qualification, 1993 - Nursing and Midwifery Council
  • Certificate in Research Supervision De Montfort University, Leicester June 2003

Conference attendance

  • Harris T (2000) Oral presentation “Midwifery Practice in the third stage of labour” Midwives Marking the Millennium: the diversity of Practice. Two day International Conference 8-9 June, Highcliffe Hotel, Bournemouth.
  • Crompton A and Harris T (2000) Oral presentation “Defining and understanding birth to skin-to-skin” Are Midwives losing the art of keeping birth normal? Conference 27 November Hayes Conference Centre, Swanwick, Derbyshire.
  • Harris T (2001) Oral presentation “The use of an egalitarian paradigm in a qualitative research project entitled Midwifery Practice in the Third Stage of Labour” 2nd International Qualitative Evidence-Based Practice Conference 14-16 May 2001 Coventry.
  • Harris T (2002) Lecture "Midwifery practice in the third stage of labour" International Confederation of Midwives 26th triennial Congress April 14-18 2002 Vienna Austria Centre, Vienna.
  • Harris T (2002) Oral presentation "The use of qualitative research to inform midwifery practice" International Confederation of Midwives 26th triennial Congress April 14-18 2002 Vienna Austria Centre, Vienna.
  • Harris T (2002) Poster presentation."Normality for the third stage of labour" International Confederation of Midwives 26th triennial Congress April 14-18 2002 Vienna Austria Centre, Vienna.
  • Harris T (2002) Oral presentation “Deciding what we mean by active and expectant management of the third stage of labour” 1st Normality in Midwifery Conference. 29th October 2002 University of Central Lancashire, Preston .
  • Harris T (2002) Oral presentation. “The use of qualitative research to inform midwifery practice on the third stage of labour”. 3rd Annual International Research Conference: Transforming healthcare through research, education and technology 13-15 November 2002. University of Dublin Trinity College, Dublin
  • Harris T (2002) Oral presentation. “Practice variation among midwives during the third stage of labour”. 3rd Annual International Research Conference: Transforming healthcare through research, education and technology 13-15 November 2002. University of Dublin Trinity College, Dublin.
  • Harris T (2002) Poster presentation. “Normality for the third stage of labour: a critique of active management in women at low risk”. 3rd Annual International Research Conference: Transforming healthcare through research, education and technology 13-15 November 2002. University of Dublin Trinity College, Dublin.
  • Harris T (2006) Poster presentation “Midwives decision making in third stage care” RCM annual conference 9-12 May 2006 Riviera International Conference Centre, Torquay.
  • Harris T (2006) Oral presentation “An explanation for third stage practice variation: the theory of contingent decision making Normal Labour and Birth: 3rd Research Conference 7-9 June 2006Grange Hotel, Grange-over-Sands.
  • Harris T (2006) Oral presentation in concurrent session “Midwifery practice in the third stage of labour”. 6th European Qualitative Research Conference in Health and Social Care 4-6 September 2006 : Bournemouth University, Bournemouth .
  • Harris T (2006) Oral presentation in maternity care stream “Models of care among midwives and their influence on the management of the third stage of labour: results from a grounded theory study”. 7th Annual Interdisciplinary Research Conference: transforming healthcare through research, education and technology. 8-10 November 2006.
  • Doughty R, Harris T and McLean M (2006) Oral presentation at concurrent workshop “Tripartite Assessment of Learners during Practice Placements in Midwifery Pre-Registration Programmes”. UVAC Annual Conference. 30/11/06-1/12/06. Royal York Hotel, York.
  • Harris T ( 2008) Third stage practice variation-midwives individualising care? ARM Annual conference. Mencap: Sheffield. Keynote speaker.
  • Muxlow A, Harris T (2008) Aspects of organisational culture which enable midwifery practice. ICM 28th Triennial Congress: Midwifery: A worldwide commitment to women and the newborn. 1-5 June 2008: Glasgow SEEC Oral presentation within concurrent session.
  • Harris T, Doughty R, Addo A, Mee K (2008) The return of the midwifery viva: an innovation to assess fitness for practice. ICM 28th Triennial Congress: Midwifery: A worldwide commitment to women and the newborn. 1-5 June 2008: Glasgow SEEC Oral presentation within concurrent session.
  • Harris T and Garratt R (2008) Grading of practice at De Montfort University. LME workshop on grading clinical practice. Invited speaker. City University, London. 30 September 2008.
  • Bawadi H, Culley L, Harris T (2008) Migrant Arab Muslim women’s experience of childbirth in the UK. Concurrent paper 11th Annual conference. Making midwives and women’s health matter. 2 October 2008. Liverpool Women’s Hospital.

  • Harris T, Nyombi S, Doughty R, Norrie P (2012) An evaluation of student midwife knowledge of breast feeding following involvement in a student led activity in the community. NICER Conference Nottingham 7/8 September 2012 University of Nottingham

  • Harris T (2012) The quest for graduate education has led to the demise of the midwifery profession and the loss of the essence of being with woman”. RCM Debate Invited speaker. 30th April 2012 National Liberal Club London – presented opposing the motion.

  • Harris T, Doughty R, Norrie P, and Nyombi S (2012) Student midwives making a difference in the local community supporting breast feeding; a De Montfort University Square Mile project. Invited speaker. RCM Annual Conference 13th-14th November 2012 Brighton.

  • Harris T, Anthony D, Doughty R and Fowler J (2012) Two’s company. Three’s a crowd? The assessment of practice in midwifery. Invited Speaker. RCM Annual Conference 13th-14th November 2012 Brighton.

  • S. Nyombi, T. Harris, R. Doughty.  (2014) Service learning with student midwives: giving something back. The breast feeding baby on the go square mile project at DMU. ICM 30th Triennial Congress 1-5th June 2014. Prague. Concurrent paper

  • G. Mulheron and T. Harris. (2014). A grounded theory study of midwives experiences of supporting women to have a lotus birth.  ICM 30th Triennial Congress 1-5th June 2014. Prague. Concurrent paper

  • Harris, T., (2017) A typology for categorising management of the third stage of labour. Accepted abstract for oral presentation. ICM 31st Triennial Congress 18-22nd June 2017 Toronto, Canada. Dora identifier:http://hdl.handle.net/2086/16884

  • Forrester, M., and Harris, T., (2018) National Maternity and Peinatal Audit. RCM Annual Conference. Manchester Central 4-5 October 2018

  • Jardine., J, Aughey, A., Blotlkamp. A., Knight, H., Hawdon, J., NMPA Project Team Pasupathy, D., (2019) Epidemiology of preterm birth in England. Eposter. RCOG World Congress. 17-19th June 2019. ExCel, London.

  • Aughey, H., Jardine, J., Blotkamp A., Pasupathy, D., Harris T., NMPA Project Team,  Giving birth in water in England; a National retrospective cohort study of factors associated with its use in 50,482 women. Eposter. RCOG World Congress. 17-19th June 2019. ExCel, London. https://rcog2019-rcog.ipostersessions.com/default.aspx?s=8A-F7-8A-16-B3-B0-94-93-81-FA-22-66-29-40-B8-38&guestview=true     https://dora.dmu.ac.uk/handle/2086/19270

  • Harris, T., (2019) There is substantial variation in maternity care processes and outcomes among maternity care providers. What can midwives do with the evidence from the 2016/17 clinical report from the NMPA. International Maternity Expo. 12-13thNovember 2019. London, Millenium Gloucester Hotel. https://dora.dmu.ac.uk/handle/2086/19491

  • Aughey, H., Jardine, Jen., Blotkamp, A., Harris T., (Presenter) NMPA Project Team (2020) Waterbirth: characteristics and outcomes in low risk women and babies: a retrospective population cohort study in England 2015/16.  Trinity Health and Education International Research Conference 2020 (THEconf2020). Integrated Healthcare: Developing Person-centred Health Systems. March 4-5th 2020 Dublin, Ireland. Accepted as an oral presentation. https://dora.dmu.ac.uk/handle/2086/19271

Recent research outputs

Harris, T (2015) Grounded Theory. Nursing Standard. 29(35) 37-43. 29th April.

Harris T and Blotkamp A (2016) “Noting midwives’ notes”. Midwives. 19(4);Winter. 48-49 Project identification code: HQIPNCA170 FIND: ISSN 1479-2915 Dora Identifier: http://hdl.handle.net/2086/16913

Harris T and Blotkamp A (2017) “Evaluating the care we provide: the role of the National Maternity and Perinatal Audit.” Midwifery Matters. Issue 152: 8-9. Spring. ISSN 0961-1479 Dora identifier: http://hdl.handle.net/2086/16878

Harris T (2017) “Care in the third stage of labour”. in Mayes’ Midwifery: a textbook for midwives 15th edition.  Chapter 39: 646-663. London: Elsevier. ISBN 0702062111, 9780702062117 Dora Identifier: http://hdl.handle.net/2086/16877

Blotkamp, A, Cromwell, D, Dumbrill, B, Gurol-Urganci I, Harris T, Hawdon J, Jardine, J, Knight H, MacDougal L, Moitt N, Pasupathy D, van der Meulen J on behalf of the NMPA Project Team (2017) National Maternity and Perinatal Audit: Organisational Report 2017. RCOG, London. Project Identification Code: HQIPNCA170. Dora Identifier: http://hdl.handle.net/2086/16876

Blotkamp A and Harris T (2017) “The maternity map”. Midwives. (Autumn) 20(3), 50-53 ISSN 1479-2915 Dora identifier: http://hdl.handle.net/2086/16880

Blotkamp A and Harris T (2017) “Making comparisons”. Midwives (winter) 20(4), 48-51 Dora identifier: http://hdl.handle.net/2086/16883

Blotkamp, A, Cromwell, D, Dumbrill, B, Gurol-Urganci I, Harris T, Hawdon J, Jardine, J, Knight H, MacDougal L, Moitt N, Pasupathy D, van der Meulen J on behalf of the NMPA Project Team (2017) National Maternity and Perinatal Audit: Clinical Report 2017. RCOG, London. Project Identification Code: HQIPNCA170 

Blotkamp, A, Cromwell, D, Dumbrill, B, Gurol-Urganci I, Harris T, Hawdon J, Jardine, J,Knight H, MacDougal L, Moitt N, Pasupathy D, van der Meulen J on behalf of the NMPA  Project Team. National Maternity and Perinatal Audit: Clinical Report –revised version 2017. RCOG London, 2018  Project Identification Code: HQIP : HQIPNCA170 Dora Identifier: http://hdl.handle.net/2086/16874

Jardine, J, NMPA Project Team (Aughey, H., Blotkamp, A., Carroll, F., Cromwell, D., Gurol-Urganci, I., Harris, T., Hawdon, Jane., Knight, H., Mamza, L., Moitt, N., Pasupathy, D., van der Meulen, J., (2019) Maternity admissions to intensive care in England, Wales and Scotland in 2015/16: A report from the National Maternity and Perinatal Audit. London : RCOG. Dora Identifier: https://dora.dmu.ac.uk/handle/2086/18610

Aughey H, NMPA Project Team (Blotkamp, A., Carroll, F., Cromwell, D., Gurol-Urganci, I., Harris, T., Hawdon, J., Jardine, J., Knight, H., Mamza, L., Moitt, N., Pasupathy, D., van der Meumen, J., (2019) Technical Report: Linking the National Maternity and Perinatal Audit Data Set to the National Neonatal Research Database for 2015/16. London: RCOG; 2019. Dora Identifier: https://dora.dmu.ac.uk/handle/2086/18609

Blotkamp, A, NMPA Project Team (Aughey, H., Carroll, F., Gurol-Urganci, I., Harris, T., Hawdon, Jane., Heighway, E., Jardine, J., Knight, H., Mamza, L., Moitt, N., Pasupathy, D., Thomas, N., Thomas, L., van der Meulen, J) (2019) National Maternity and Perinatal Audit: Organisational Report 2019. London, RCOG. Project Identification code: HQIP: HQIPNCA170. Dora Identifier: https://www.dora.dmu.ac.uk/handle/2086/18237

NMPA Project Team (Aughey, H., Blotkamp, A., Carroll, F.,  Geary, Rebecca., Gurol-Urganci, I., Harris, T., Hawdon, J., Heighway, E., Jardine, J., Knight, H., Mamza, L., Moitt, N., Pasupathy, D., Thomas, N., Thomas, L., van der Meulen, J., (2019) National Maternity and Perinatal Audit: Clinical Report 2019. Based on births in NHS maternity services between 1 April 2016 and 31 March 2017. London : RCOG. Dora identifier: https://dora.dmu.ac.uk/handle/2086/18616

Relph S, NMPA Project Team (including Gurol-Urganci, I., Blotkamp, A., Dunn, G., Harris, T., Hawdon, J., Pasupathy, D., van der Meulen, J.,(2020) NHS Maternity Care for Women with Multiple Births and Their Babies A study on feasibility of assessing care using data from births between 1 April 2015 and 31 March 2017 in England, Wales and Scotland. London : RCOG. Project Identification code: HQIP: NCA170. Dora identifier: https://dora.dmu.ac.uk/handle/2086/20366

Jardine, J., Blotkamp, A., Gurol-Urganci, I., Knight, H., Harris, T., Hawdon, J., Pasupathy, D., van der Meulen, J., Walker, K (2020) Risk of complicated birth at term in nulliparous and multiparous women using routinely collected maternity data in England: cohort study. British Medical Journal. 371 doi https://doi.org/10.1136/bmj.m3377 (Published 01 October 2020)

https://dora.dmu.ac.uk/handle/2086/20232

Key articles information

Harris T (2005) “ Midwifery practice in the third stage of labour” PhD thesis. Leicester : De Montfort University

Doughty R, Harris T, McLean M (2007) “Tripartite Assessment of Learners during Practice Placements in Midwifery Pre-Registration Programmes Education and Training Volume 49 Issue 3 p227-235

Khodayar Oshvandi1, Vahid Zamanzadeh, Fazlollah Ahmadi,

Eskandar Fathi-Azar, Denis Anthony andTina Harris (2008) “Barriers to Nurse Job motivation”. Research Journal of Biological Sciences 3(4) 426-434

Harris T (2011) “Care in the third stage of labour” in Mayes’ Midwifery: a textbook for midwives 14th edition. Edinburgh : Bailliere Tindall 

Harris, T (2015) Grounded Theory. Nursing Standard. 29(35) 37-43. 29th April.

Harris T and Blotkamp A (2016) “Noting midwives’ notes”. Midwives. 19(4);Winter. 48-49

Project identification code: HQIPNCA170          FIND:  ISSN 1479-2915 Dora Identifier: http://hdl.handle.net/2086/16913

Harris T and Blotkamp A (2017) “Evaluating the care we provide: the role of the National Maternity and Perinatal Audit.” Midwifery Matters. Issue 152: 8-9. Spring. ISSN 0961-1479 Dora identifier: http://hdl.handle.net/2086/16878

Harris T (2017) “Care in the third stage of labour”. in Mayes’ Midwifery: a textbook for midwives 15th edition.  Chapter 39: 646-663. London: Elsevier. ISBN 0702062111, 9780702062117 Dora Identifier: http://hdl.handle.net/2086/16877

Blotkamp, A, Cromwell, D, Dumbrill, B, Gurol-Urganci I, Harris T, Hawdon J, Jardine, J, Knight H, MacDougal L, Moitt N, Pasupathy D, van der Meulen J on behalf of the NMPA Project Team (2017) National Maternity and Perinatal Audit: Organisational Report 2017. RCOG, London. Project Identification Code: HQIPNCA170. Dora Identifier: http://hdl.handle.net/2086/16876

Blotkamp A and Harris T (2017) “The maternity map”. Midwives. (Autumn) 20(3), 50-53 ISSN 1479-2915 Dora identifier: http://hdl.handle.net/2086/16880

Blotkamp A and Harris T (2017) “Making comparisons”. Midwives (winter) 20(4), 48-51 Dora identifier: http://hdl.handle.net/2086/16883

Blotkamp, A, Cromwell, D, Dumbrill, B, Gurol-Urganci I, Harris T, Hawdon J, Jardine, J, Knight H, MacDougal L, Moitt N, Pasupathy D, van der Meulen J on behalf of the NMPA Project Team (2017) National Maternity and Perinatal Audit: Clinical Report 2017. RCOG, London. Project Identification Code: HQIPNCA170

Blotkamp, A, Cromwell, D, Dumbrill, B, Gurol-Urganci I, Harris T, Hawdon J, Jardine, J, Knight H, MacDougal L, Moitt N, Pasupathy D, van der Meulen J on behalf of the NMPA  Project Team. National Maternity and Perinatal Audit: Clinical Report –revised version 2017. RCOG London, 2018  Project Identification Code: HQIP : HQIPNCA170 Dora Identifier: http://hdl.handle.net/2086/16874

 Jardine, J, NMPA Project Team (Aughey, H., Blotkamp, A., Carroll, F., Cromwell, D., Gurol-Urganci, I., Harris, T., Hawdon, Jane., Knight, H., Mamza, L., Moitt, N., Pasupathy, D., van der Meulen, J., (2019) Maternity admissions to intensive care in England, Wales and Scotland in 2015/16: A report from the National Maternity and Perinatal Audit. London : RCOG. Dora Identifier: https://dora.dmu.ac.uk/handle/2086/18610

Aughey H, NMPA Project Team (Blotkamp, A., Carroll, F., Cromwell, D., Gurol-Urganci, I., Harris, T., Hawdon, J., Jardine, J., Knight, H., Mamza, L., Moitt, N., Pasupathy, D., van der Meumen, J., (2019) Technical Report: Linking the National Maternity and Perinatal Audit Data Set to the National Neonatal Research Database for 2015/16. London: RCOG; 2019. Dora Identifier: https://dora.dmu.ac.uk/handle/2086/18609

Blotkamp, A, NMPA Project Team (Aughey, H., Carroll, F., Gurol-Urganci, I., Harris, T., Hawdon, Jane., Heighway, E., Jardine, J., Knight, H., Mamza, L., Moitt, N., Pasupathy, D., Thomas, N., Thomas, L., van der Meulen, J) (2019) National Maternity and Perinatal Audit: Organisational Report 2019. London, RCOG. Project Identification code: HQIP: HQIPNCA170. Dora Identifier: https://www.dora.dmu.ac.uk/handle/2086/18237

NMPA Project Team (Aughey, H., Blotkamp, A., Carroll, F.,  Geary, Rebecca., Gurol-Urganci, I., Harris, T., Hawdon, J., Heighway, E., Jardine, J., Knight, H., Mamza, L., Moitt, N., Pasupathy, D., Thomas, N., Thomas, L., van der Meulen, J., (2019) National Maternity and Perinatal Audit: Clinical Report 2019. Based on births in NHS maternity services between 1 April 2016 and 31 March 2017. London : RCOG. Dora identifier: https://dora.dmu.ac.uk/handle/2086/18616

Relph S, NMPA Project Team (including Gurol-Urganci, I., Blotkamp, A., Dunn, G., Harris, T., Hawdon, J., Pasupathy, D., van der Meulen, J.,(2020) NHS Maternity Care for Women with Multiple Births and Their Babies A study on feasibility of assessing care using data from births between 1 April 2015 and 31 March 2017 in England, Wales and Scotland. London : RCOG. Project Identification code: HQIP: NCA170. Dora identifier: https://dora.dmu.ac.uk/handle/2086/20366

Jardine, J., Blotkamp, A., Gurol-Urganci, I., Knight, H., Harris, T., Hawdon, J., Pasupathy, D., van der Meulen, J., Walker, K (2020) Risk of complicated birth at term in nulliparous and multiparous women using routinely collected maternity data in England: cohort study. British Medical Journal. 371 doi https://doi.org/10.1136/bmj.m3377 (Published 01 October 2020)

https://dora.dmu.ac.uk/handle/2086/20232

Consultancy work

Tina has a number of years experience successfully supervising and examining PhD students. She has been a specialist advisor on research projects with other Universities and has worked collaboratively across institutions on research projects. Tina is regularly invited to examine doctoral research students in the UK who have undertaken research using qualitative research methodologies or research in the following areas: midwifery care and practice, practice variation, decision making in healthcare, ethnic minority research and women’s health. She is a reviewer for a number of journals, including the Journal of Advanced Nursing, Nurse Researcher, Midwifery, Nursing Inquiry, 

As an experienced midwifery academic with an NMC recordable teaching qualification, Tina is regularly invited to be a member of revalidation and periodic review panels for midwifery programmes across the UK. She also has extensive experience as an external examiner for midwifery programmes both nationally and internationally. She is also a member of a number of national and international committees relating to midwifery research, audit, and practice:

National Maternity and Perinatal Audit Programme (Senior Clinical Lead (Midwifery), Royal College of Obstetricians and Gynaecologists 2016 to date

Research Advisory Network (ICM) 2003-date

Registrant member of the midwifery committee, Nursing and Midwifery Council 2014-2017

External examiner for Trinity College, Dublin (pre-registration midwifery programmes) 2014-2019

Tina is available as a consultant in the following areas:

  • National audit
  • Midwifery education
  • Midwifery practice
  • Midwifery research (including PhD supervision and examining)
  • Qualitative research methodologies, particularly grounded theory
  • Practice variation in clinical care
  • Decision making in clinical care

Externally funded research grants information

Midwifery Practice in the third stage of labour
  • NHS Executive (Trent) Training Award for MPhil study 1996-9
  • NHS Executive (Trent) Training Award for PhD study 1999-2001

An evaluation of the effect of NHS Trust financial support on pre-registration mentorship and preceptorship in midwifery – a collaborative project with Nottingham University and University of Northampton   East Midlands Healthcare Workforce Deanery funded project 2008                 

National Maternity and Perinatal Audit – a collaborative project between the RCOG, RCM, RCPCH and LSHTM. A HQIP commissioned project funded by NHWS England and the Scottish and Welsh governments. I am the Senior Clinical Lead for Midwifery on this project. 2016-2019

National Maternity and Perinatal Audit – a collaborative project between the RCOG, RCM, RCPCH and LSHTM. A HQIP commissioned project funded by NHS England and the Scottish and Welsh governments. I am the Senior Clinical Lead for Midwifery on this project. 2019-2021, with a further extension to funding July 2021 to December 2022

Internally funded research project information

  • Women’s views and experiences of care provided by case holding student midwives Teaching Quality and Enhancement Fund (TQEF)Award     2007
  • Breast feeding baby ‘on the go’ – A De Montfort University funded project as part of the University Square Mile project. 2011 
  • Evaluation of the tripartite assessment process in midwifery A De Montfort University funded project £1500 2012-2013

Professional esteem indicators

  • Reviewer for Journal of Advanced Nursing 2003-date
  • Reviewer for Nurse researcher 2009-date
  • Reviewer for Midwifery 2009-date
  • Reviewer for Nursing Inquiry 2010 - date
  • Reviewer of ICM abstracts for Triennial ICM Congresses 2005-date
  • Chairing activities: 
  • Invited speaker at the following events:
    • Harris, T (2012) “Student midwives making a difference in the local community supporting breast feeding; a De Montfort University Square Mile project”. Masterclass at the RCM Annual Conference 2012 Brighton. 
    • Harris, T., (2016) The new National Maternity and Perinatal Audit for England, Scotland and Wales. Heads of Midwifery meeting. RCM event 8/12/16. Raddisson Blu Edwardian Grafton Hotel, London.
    • Harris, T., (2017) “The drive for quality improvement and the National Audit programme”. Wigan ARM 13th Annual study day National Meeting: Midwifery a profession under threat. Trinity Reformed Church, Wigan, 18th March 2017
    • Harris, T., (2017) “NMPA Organisational Survey results”. RCM Midwifery Leaders meeting. 13th September 2017, Doubletree Hilton, Leeds.
    • Harris, T., Pasupathy, D., Hawdon, J., (2017)“What do the results mean for our professions and those we care for?” Panel Q and A. National Maternity and Perinatal audit (NMPA) Annual Report Launch. 9th November 2017. RCOG, London.
    • Harris T (2017) “What have we learned about the organisation of care?”. National Maternity and Perinatal Audit Annual report launch Scotland. 17th November 2017. Golden Jubilee Conference Hotel, Glasgow.
    • Harris, T., Pasupathy, D., Hawdon, J., (2017)“What do the results mean for our professions and those we care for?” Panel Q and A. National Maternity and Perinatal audit (NMPA) Annual Report Launch Scotland. 17th November 2017. Golden Jubilee Conference Hotel, Glasgow.
    • Harris, T., on behalf of the National Maternity and Perinatal Audit (2018) “The National Maternity and Perinatal Audit”. Midlands Maternity and Midwifery Festival. Edgbaston Cricket Ground. 25th April 2018 (invited speaker) Dora Identifier: http://hdl.handle.net/2086/16870
    • Harris T., on behalf of the National Maternity and Perinatal Audit (2018) National Maternity and Perinatal Audit. RCM Conference, Manchester Central, Manchester.Dora identifier: 
    • http://hdl.handle.net/2086/16914
    • Harris, T., on behalf of the NMPA team (2019) The National Maternity and Perinatal Audit: recent findings. CMO and HOMS meeting Scotland. Edinburgh, Scottish Health Service Centre. 23rd October 2019
    • Harris, T., on behalf of the NMPA team(2019) The National Maternity and Perinatal Audit: An update on recent NMPA publications. RCM Midwifery Leaders Forum. London, Danubius Hotel. 10th December 2019
    • Invited to chair concurrent session on decision making at ICM 28th Triennial Congress: Midwifery: A worldwide commitment to women and the newborn. 1-5 June 2008: Glasgow. 
    • Invited to chair concurrent sessions G09 Approaches to Clinical Education at ICM 31st Triennial Congress 18-22nd June 2017: 
    • RCM debate “The quest for graduate education has led to the demise of the midwifery profession and the loss of the essence of being with woman”. 30 April 2012 National Liberal Club London – presented opposing the motion

Research students

Tina has supported a number of research students to successful completion of their PhD/MPhil studies including,

  • Rowena Doughty  - The experience of obesity in childbearing
  • Aveen Haji Mam  - The effects of an antenatal education programme for obese women on pregnancy outcomes.
  • Azza Alqaabi - Factors which influence the choice of health care careers among Emeratis.
  • Nicky Genders - 30 years of Learning disabilities nursing in England: a narrative study
  • Hala Bawadi – Childbirth experience of migrant Arab Muslim women in the UK
Tina Harris