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

 

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

Publications and outputs

  • National Maternity and Perinatal Audit Clinical Report 2022. Based on births in NHS maternity services in England and Wales Between 1 April 2018 and 31 March 2019.
    National Maternity and Perinatal Audit Clinical Report 2022. Based on births in NHS maternity services in England and Wales Between 1 April 2018 and 31 March 2019. Carroll, F; Dunn, G; Fremeaux, A; Gurol-Urganci, I; Heighway, E; Indusegaran, B; Karia, A; Khalil, A; Muller, P; Oddie, S; Thomas, L; Waite, L; Webster, K; van der Meulen, J; Harris, Tina Executive summary Introduction to the NMPA The National Maternity and Perinatal Audit (NMPA) is a large-scale project established to provide data and information to those working in and using maternity services. The NMPA helps us understand the maternity journey by bringing together information about maternity care and information about hospital admissions. This NMPA clinical audit report is an important step forward in understanding the way in which NHS maternity services care for women and birthing people, and it provides information on a number of measures, based on births in England and Wales from April 2018 to March 2019. This report follows on from the previous NMPA clinical audit reports and is one strategy used by the audit team to understand the care and outcomes experienced by women and birthing people, and to highlight areas of potential service improvement. Data Data for births in England are provided by NHS Digital’s Maternity Services Data Set (MSDS) version 1.5 as well as by Hospital Episode Statistics (HES) records. Data for births in Wales are provided by Digital Health and Care Wales’s Maternity Indicators dataset (MIds), the Initial Assessment (IA) dataset, as well as Admitted Patient Care records from the Patient Episode Database for Wales (PEDW), and some data fields from the National Community Child Health Database (NCCHD). The NHS trusts and boards included in the audit provided maternity care at one or more hospital sites.* This report captures 89% of eligible births (88% in England and 97% in Wales). Data are included from over half a million women and birthing people, and their babies, born between 1 April 2018 and 31 March 2019 in England and Wales. Key findings One-third of women and birthing people with singleton pregnancies at term in England and Wales underwent an induction of labour. Of all women and birthing people experiencing an instrumental birth by forceps, as many as 1 in 20 did so without an episiotomy; of these, 31% experienced a third- or fourth-degree tear. Of the women and birthing people opting for a vaginal birth after a previous caesarean birth, the proportion who experienced a vaginal birth was 61%. This is over 10 percentage points lower than overall proportions reported in national guidance (72–75%). Postnatal readmission rates were higher * Where possible, site-level results are available on the NMPA website. Guidance on using the data on the NMPA website can be found on the Resources page and in the Frequently Asked Questions. A list of organisations and useful publications are also available within the NMPA Quality Improvement page to support those improving the quality of care locally. The NMPA is committed to engagement with anyone accessing the audit’s outputs and we welcome feedback on how these can be made more useful (contact nmpa@rcog.org.uk). ix following a caesarean birth compared with a vaginal birth in both England (4.3% vs 2.9%) and Wales (4.7% vs 3.3%). Of the women and birthing people experiencing their first birth, 23% had an instrumental birth, 23% had an emergency caesarean birth and 44% of those who had a vaginal birth had an episiotomy. Around half of babies born small for gestational age (SGA) were born after their due date. This is in contrast to national guidance recommending earlier induction be offered if there are concerns about a baby being small. Data completeness issues remain for many NMPA measures, especially for anaesthesia, augmentation (helping the progress of labour), labour onset, episiotomy, maternal ethnicity, body mass index (BMI) and smoking status at birth. From our dataset, it is not always possible to tell which type of pain relief a woman or birthing person received during labour or whether they had an epidural or spinal, or general anaesthetic. National datasets in both England and Wales under-report rates of pre-pregnancy conditions such as high blood pressure. Recommendations R1 Improve the availability and quality of information about possible interventions during labour and birth, by offering individualised evidence-based information in a language and format which is accessible and tailored to each woman or birthing person’s circumstances. Consider using the IDECIDE decision-making and consent tool (when available). R2 All women and birthing people should be routinely counselled and offered an episiotomy prior to experiencing a forceps-assisted birth, to reduce the chance of an OASI. R3 Further information is required to better understand the underlying causes and patterns of variation in measures. Use local audit of measures to investigate differences in practice that may contribute to observed variation in rates. R4 Review all cases of postnatal maternal readmission to understand common indications, and identify changes in practice that may decrease the chance of readmission, especially among those having a caesarean birth. R5 Conduct reviews of data completeness, data capture software and practices including mandatory field requirements. Utilise user feedback to identify patterns in missing data and opportunities to support healthcare professionals to provide complete data without compromising clinical care. R6 Amend data fields to: ● collect the availability and timeliness of epidural anaesthesia ● separate the recording of intrapartum analgesia by type for both England and Wales ● collect analgesia and anaesthesia into two separate fields and enhance anaesthesia coding granularity to capture epidural, spinal or general anaesthesia separately in Wales. R7 Develop strategies to ensure harmonisation between national maternity datasets, in particular that data are collected to: ● record pre-existing conditions in the Welsh Initial Appointment dataset ● include a ‘number of infants’ variable in the English MSDS v2.0 ● prevent the under-reporting of all diagnoses within HES and PEDW. R8 Review the appropriateness of routine perinatal and postnatal data to obtain a meaningful measure of care, such as duration of skin-to-skin, who with and reasons for non-occurrence NMPA Project Team, Carrol, F., Dunn, G., Frémeaux, A., Gurol-Urganci I., Harris, T., Heighway, E., Undusegaran, B., Karia, A., Khalil, A., Muller, P., Oddie, S., Thomas, L., Waite, L., Webster, K., van der Meulen, J. (2022) National Maternity and Perinatal Audit: Clinical Report 2022. Based on births in NHS maternity services in England and Wales between 1 April 2018 and 31 March 2019. London: RCOG
  • Use of induction of labour and emergency caesarean section and perinatal outcomes in English maternity services: a national hospital-level study
    Use of induction of labour and emergency caesarean section and perinatal outcomes in English maternity services: a national hospital-level study Gurol-Urganci, I; Jardine, J; Carroll, F; Dunn, G; Fremeaux, A; Muller, P; Relph, S; Waite, L; Webster, K; Oddie, S; Hawdon, J; Harris, Tina; Khalil, A; van der Meulen, J ABSTRACT Objectives – To assess the association between hospital-level rates of induction of labour and emergency caesarean section, as measures of “practice style”, and rates of adverse perinatal outcomes. Design – National study using electronic maternity records. Setting – English National Health Service. Participants – Hospitals providing maternity care to women between April 2015 and March 2017. Main outcome measures – Stillbirth, admission to a neonatal unit, and babies receiving mechanical ventilation. Results – Among singleton term births, the risk of stillbirth was 0.15%; of admission to a neonatal unit 5.4%; and of mechanical ventilation 0.54%. There was considerable between-hospital variation in the induction of labour rate (minimum 17.5%, maximum 40.7%) and the emergency caesarean section rate (minimum 5.6%, maximum 17.1%). Women who gave birth in hospitals with a higher induction of labour rate had better perinatal outcomes. For each 5%-point increase in induction, there was a decrease in the risk of term stillbirth by 9% (OR 0.91; 95% CI 0.85 to 0.97) and mechanical ventilation by 14% (OR 0.86; 95% CI 0.79 to 0.94). There was no significant association between hospital-level induction of labour rates and neonatal unit admission at term (p>0.05). There was no significant association between hospital-level emergency caesarean section rates and adverse perinatal outcomes (p always >0.05). Conclusions – There is considerable between-hospital variation in the use of induction of labour and emergency caesarean section. Hospitals with a higher induction rate had a lower risk of adverse birth outcomes. A similar association was not found for caesarean section. 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. Gurol-Urganci, I., Jardine J., Carroll, F., Dunn, G., Frémeaux A., Muller, P., Relph, S., Waite, L., Webster, K.,, Oddie, S., Hawdon, J., Harris T., Khalil, A., van der Meulen, J. (2022) Use of induction of labour and emergency caesarean section and perinatal outcomes in English maternity services: a national hospital-level study. BJOG
  • Adverse pregnancy outcomes attributable to socio economic and ethnic inequalities in England: a national cohort study
    Adverse pregnancy outcomes attributable to socio economic and ethnic inequalities in England: a national cohort study Jardine, J; Walker, T; Gurol-Urganci, I; Webster, K; Muller, P; Hawdon, J; Khalil, A; van der Meulen, J; Harris, Tina Adverse pregnancy outcomes attributable to socioeconomic and ethnic inequalities in England: a national cohort study Background Socioeconomic deprivation and an ethnic minority background are known risk factors for adverse pregnancy outcomes. However, there is a lack of evidence on the strength of these risk factors and on the scale of their impact. Aims/objectives We quantified the magnitude of adverse pregnancy outcomes attributable to socioeconomic and ethnic inequalities at population level in England Methods (including research design, sample, analysis and ethical approval) We used administrative hospital data to evaluate stillbirth (SB), preterm birth (PTB) and fetal growth restriction (FGR) in England between 1/4/15-31/3/17 by socioeconomic deprivation quintiles and ethnic group. Attributable fractions (AF) for the entire population and specific groups compared to least deprived and/or White women were calculated without and with adjustment for smoking and body mass index (BMI). This study was exempt from ethical review as we used routinely collected data; personal data used without individual consent was approved by the NHS Health Research Authority. Findings 1 155 981 women with a singleton birth were included. There were 4505 stillbirths (0·4%). Of liveborn babies, 69175 (6·0%) were PTBs and 22 679 (2·0%) births with FGR. 24% of SBs, 19% of PTBs, and 31% of FGR could be attributed to socioeconomic inequality. These population AFs were substantially reduced with adjustment for ethnic group, smoking and BMI (12%, 10% and 17%, respectively). 12% of SBs, 1.2% of PTBs and 17% of FGR could be attributed to ethnic inequality. Adjustment for socioeconomic deprivation, smoking and BMI had only a small impact on these ethnic group AFs (13%, 2.6% and 19%, respectively). Group-specific AFs were especially high in the most socioeconomically deprived South-Asian women and Black women for SB (54% and 64%, respectively) and FGR (72% and 55%, respectively). Conclusions. Reducing FGR, SB and PTB rates can only realistically be achieved with midwives, obstetricians, public health professionals and politicians working together to reduce such inequalities in outcome for the most vulnerable. Jardine, J., Walker, K., Gurol-Urganic, I., Webster, K., Muller, P., Hawdon, J., Khalil, A., Harris, T (presenter)., van der Meulen, J. (2022) Adverse pregnancy outcomes attributable to socio economic and ethnic inequalities in England: a national cohort study. Oral presentation at THeConf: Trinity Health and Education International Research Conference 8-10 March 2022. Presented on 9th March 2022, Trinity College, Dublin.
  • 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 Gurol-Urganci, I., Waite, L., Webster, K., Jardine, J., Carroll, F., Dunn, G., Fremeaux A., Harris T., Hawdon, J., Muller, P., van der Meulen, J., Khalil, A (2022) Obstetric interventions and pregnancy outcomes during the COVID-19 pandemic in England: A nationwide cohort study. PLOS Medicine,
  • Risk of postpartum haemorrhage is associated with ethnicity: A cohort study of 981 801 births in England
    Risk of postpartum haemorrhage is associated with ethnicity: A cohort study of 981 801 births in England Jardine, J.; Gurol-Urganci, I.; Harris, Tina; Hawdon, J.; Pasupathy, D.; van der Meulen, J.; Walker, K.; the NMPA Project Team Women with an ethnic minority background giving birth in England have an increased risk of postpartum haemorrhage, even when characteristics of the mother, the baby and the care received are taken into account. 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. Jardine, J., Gurol-Urganci, I., Harris, T., Hawdon, J., Pasupathy, D., van der Meulen, J., Walker, K., the NMPA Project Team. (2021) Risk of postpartum haemorrhage is associated with ethnicity: A cohort study of 981 801 births in England. BJOG, 129 (8), pp. 1269-1277
  • National Maternity and Perinatal Audit. Ethnic and Socio-economic inequalities in NHS maternity and perinatal care for women and their babies. Assessing care using data from births between 1 April 2015 and 31 March 2018 across England, Scotland and Wales.
    National Maternity and Perinatal Audit. Ethnic and Socio-economic inequalities in NHS maternity and perinatal care for women and their babies. Assessing care using data from births between 1 April 2015 and 31 March 2018 across England, Scotland and Wales. NMPA Project Team; Webster, K.; Carroll, F.; Coe, M.; Dunn, G.; Fremeaux, A.; Gurol-Urganci, I.; Jardine, J.; Karia, A.; Muller, P.; Relph, S.; Waite, L.; Harris, Tina; Hawdon, J.; Oddie, S.; Khalil, A.; van der Meulen, J. Executive summary Introduction The purpose of this report is to describe inequalities in maternity and perinatal care for women and their babies in England, Scotland and Wales during the period 1 April 2015 to 31 March 2018. Using routinely collected data, care and outcomes experienced by women and babies using NHS maternity services are measured and stratified by ethnicity and by Index of Multiple Deprivation (IMD), a proxy for socio-economic deprivation. This report focuses on the following maternal measures: ● caesarean birth (presented as elective, emergency and both combined) ● birth without intervention ● major postpartum haemorrhage (1500 ml or more) and the following perinatal measures: ● an Apgar score of less than 7 at 5 minutes ● breast milk at first feed ● neonatal unit admission at term. Methods This report uses existing NMPA linked datasets. Ethnicity is coded using the Office for National Statistics (ONS) 2001 census categorisation of 16+1 codes for ethnicity,2 grouped into white, South Asian, Black and Other (comprising ‘Mixed’ and ‘Other’ combined). Socio-economic deprivation is measured using the Index of Multiple Deprivation (IMD), an area-based measurement of multiple deprivation calculated for each lower-layer super output area (LSOA) in England and Wales, and data zone in Scotland.3 IMD is based on residential postcode and grouped into quintiles of national distribution (quintile 1 = least deprived to quintile 5 = most deprived) for analysis. Results for each maternal and perinatal measure are reported by the mother’s ethnic group and IMD quintile. The results presented in this report are crude and therefore descriptive. The results do not take into account the interactions that contributory factors, such as parity, age, pre-existing co-morbidities, ethnicity and deprivation may have on each other, the complexities of which are not easily interpreted in an audit report such as this. An advisory group comprising professionals and a diverse range of service user representatives with experience of accessing maternity care was involved in the sprint audit. The advisory group was involved in the choice of measures for inclusion in this report, interpretation of results, identifying key messages, and reviewing the draft report and recommendations. Key findings Our results demonstrate differences in outcomes of maternity and perinatal care among women and birthing people, and their babies, via comparisons between those living in the most deprived and the least deprived areas in Great Britain, and in those from ethnic minority groups versus white ethnic groups. Women from South Asian and Black ethnic groups and those from the most deprived areas had higher rates of hypertension and diabetes when compared with women from white ethnic groups and those in the least deprived areas. Smoking was considerably higher among women and birthing people from white ethnic groups and those in the most deprived quintile. Women from Black ethnic groups had a higher rate of experiencing a birth without intervention. While this may be desirable in many situations, it may also represent circumstances where interventions are desired or indicated but do not occur. Rates of caesarean birth (both elective and emergency combined) and rates of emergency caesarean birth were highest for women from Black ethnic groups and higher for women from South Asian groups when compared with those from white ethnic groups. Women and birthing people from Black ethnic groups had higher rates of major postpartum haemorrhage (1500 ml or more) when compared with women and birthing people from white ethnic groups. In contrast to the usual association of increased deprivation with increased morbidity, a decreasing trend for major postpartum haemorrhage (1500 ml or more) was observed from the least to most deprived. Babies born to women from South Asian ethnic groups were less likely to have an Apgar score of less than 7 at 5 minutes but were more likely to be admitted to a neonatal unit at term when compared with babies born to women from white ethnic groups. Babies born to women from Black ethnic groups were more likely to be assessed as having an Apgar score of less than 7 at 5 minutes and were more likely to be admitted to a neonatal unit at term when compared with babies born to women from white ethnic groups. Rates of receiving breast milk at their first feed were significantly lower for babies born to white women and to those living in the most deprived areas. We also found areas of concern with regard to data completeness and rates of missing data by ethnic group and IMD. Our results show 1 in 10 women and birthing people in Great Britain (1 in 5 in Scotland) did not have their ethnic group recorded, and IMD was missing for 6%. Recommendations R1 Target efforts for a life-course approach to improve the health of people, addressing the wider social determinants of health as well as specific health-related risk factors. Offer individualised preconception and antenatal information tailored to their circumstances, including BMI, smoking, pre-existing comorbidities (hypertension and type 2 diabetes) and whether this is their first birth or they have previously had a caesarean birth. (Audience: Healthcare professionals working in maternity services, maternity services providers, general practitioners, primary care providers, public health policy makers) R2 Target efforts to reduce smoking. Audit rates of carbon monoxide testing and referrals for smoking cessation for women during pregnancy, and audit compliance with monitoring for fetal growth restriction. (Audience: Healthcare professionals working in maternity services, maternity services providers, general practitioners, primary care providers, stop smoking services, public health policy makers) R3 Support research and investigation into why women from ethnic minority groups and more deprived areas have higher rates of stillbirth, taking into consideration differences in care, specific risk factors and the wider determinants of health. (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 Improve availability and quality of information about choices during pregnancy and labour, with particular attention to the development of evidence-based shared decision-making tools for place, mode and timing of birth and pain relief options. Consider using the IDECIDE tool (when available). (Audience: Healthcare professionals working in maternity services, maternity services providers, NHS England, NHS Scotland, NHS Wales) R5 Avoid term admissions to a neonatal unit through improving transitional care provision, by establishing facilities where they are not currently available; or in hospitals that do have transitional care facilities, by expanding cot space availability and increasing numbers of appropriately trained staff. (Audience: Maternity and neonatal services providers) R6 Offer all women breastfeeding information and support, and target support in specific areas where breastfeeding rates are lowest (see also Priority 4c, intervention 3 of the Equity and Equality: Guidance for Local Maternity Systems). (Audience: Healthcare professionals working in maternity services, health visitors, primary care providers, maternity care services) R7 Review equality and diversity training provision and update to include the risks associated with deprivation, and how to recognise and avoid unconscious bias (see also Priority 4d, intervention 1 of the Equity and Equality: Guidance for Local Maternity Systems). (Audience: Local trusts and health boards, medical Royal Colleges, Royal Colleges of Nursing and Midwifery, General Medical Council, Nursing and Midwifery Council, Health and Care Professions Council, higher education institutions) R8 Ethnicity should be asked of and accurately recorded for all pregnant people using agreed ethnic group coding systems that should be updated regularly in accordance with the most current census groups. Consideration should be given to methods for self-reporting of ethnicity whenever possible (see also Priority 3, intervention 1 of the Equity and Equality: Guidance for Local Maternity Systems). (Audience: Healthcare professionals working in maternity services, maternity service providers, general practitioners, primary care providers, NHS England, NHS Scotland, NHS Wales) R9 Review the ethnic diversity and rates of socio-economic deprivation in the local area of each NHS trust or board and consider ways to reduce inequalities in healthcare outcomes (see also Priority 4, intervention 1 of the Equity and Equality: Guidance for Local Maternity Systems). (Audience: Local trusts and health boards, primary care providers, public health bodies, local government) R10 Prioritise further research in NHS maternity and perinatal care that could improve outcomes for women, and their babies, from ethnic minority groups and those in the most deprived areas. Undertaking quantitative analysis to investigate ethnic and socio-economic inequalities and report on the mediating factors and causal pathways; along with qualitative research to include exploring the experiences of people accessing maternity care. (Audience: National Institute for Health Research, UK Research and Innovation, 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 Webster, K, NMPA Project Team (2021) Ethnic and socio-economic inequalities in NHS maternity and perinatal care for women and their babies: Assessing care using data from births between 1 April 2015 and 31 March 2018 across England, Scotland and Wales. London; RCOG.
  • Adverse pregnancy outcomes attributable to socioeconomic and ethnic inequalities in England: a national cohort study
    Adverse pregnancy outcomes attributable to socioeconomic and ethnic inequalities in England: a national cohort study Jardine, J.; Gurol-Urganci, I.; Webster, K.; Muller, P.; Hawdon, J.; Khalil, A.; Harris, Tina; van der Meulen, J. Background Socioeconomic deprivation and an ethnic minority background are known risk factors for adverse pregnancy outcomes. We quantified the magnitude of these socioeconomic and ethnic inequalities at population level in England. Methods We evaluated stillbirth, preterm birth (< 37 weeks gestation), and fetal growth restriction (FGR; liveborn with birthweight <3rd centile) in England between 1st April 2015 and 31st March 2017 by socioeconomic deprivation quintiles and ethnic group. Attributable fractions (AF) for the entire population and specific groups compared to least deprived and/or White women were calculated without and with adjustment for smoking and body mass index (BMI). Findings 1 155 981 women with a singleton birth were included. 4 494 births were stillbirths (0·4%). Of the 1 151 487 liveborn babies, 71 398 (6·2%) were preterm births and 23 526 (2·0%) births with FGR. 24% of stillbirths, 19% of preterm births, and 31% of FGR could be attributed to socioeconomic inequality. These population AFs were substantially reduced with adjustment for ethnic group, smoking and BMI (8%, 13% and 19%, respectively). 12% of stillbirths, 1% of preterm births and 17% of FGR could be attributed to ethnic inequality. Adjustment for socioeconomic deprivation, smoking and BMI only had a small impact on these ethnic group AFs (13%, 3% and 19%, respectively). Group-specific AFs were especially high in the most socioeconomically deprived South-Asian women and Black women for stillbirth (54% and 64%, respectively) and FGR (72% and 55%, respectively). Interpretation Socioeconomic inequalities account for a quarter of stillbirths, a fifth of preterm births, and a third of births with FGR. The largest inequalities were seen in the most deprived Black and South-Asian women. Prevention should target the entire population as well as particular high-risk ethnic minority groups, addressing specific risk factors and the wider determinants of health. 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. Jardine, J., Walker, K., Gurol-Urganci, I., Webster, K., Muller, Patrick., Hawdon, J., Khalil, A., Harris, T., van der Meulen, J. (2021) Adverse pregnancy outcomes attributable to socioeconomic and ethnic inequalities in England: a national cohort study. The Lancet, 398 (10314), pp. 1905-1912
  • Clinical Report 2021: Based on births in NHS maternity services in England, Scotland and Wales between 1 April 2017 and 31 March 2018
    Clinical Report 2021: Based on births in NHS maternity services in England, Scotland and Wales between 1 April 2017 and 31 March 2018 Carroll, F.; Coe, M.; Dunn, G.; Fremeaux, A.; Gurol-Urganci, I.; Harris, Tina; Hawdon, J.; Heighway, E.; Karia, A.; Khalil, A.; Muller, P.; Thomas, L.; Waite, L.; Webster, K.; van der Meulen, J. Executive summary Introduction Maternity and perinatal services in the UK are currently subject to a number of maternity and neonatal review programmes, including quality monitoring and improvement initiatives. These programmes focus attention on the quality of care provided by maternity services in the UK at both a national level and the individual trust or board level.1–3 In parallel to the improvement initiatives for clinical care, there are ongoing improvements in the collation and processing of maternity and neonatal data, including improved capture of detailed information about demographics of birthing people and care episodes occurring along the maternity continuum of care. These data are critical to enable evaluation and implementation of improvement strategies. The National Maternity and Perinatal Audit (NMPA) uses these data to produce information that can support the improvement of maternity and perinatal care. In this report, for the first time, the NMPA is using a new centralised data source (MSDS v1.5) for births in England, while continuing to use the established centralised maternity datasets in Scotland and Wales. This report presents measures of maternity and perinatal care based on births in English, Scottish and Welsh NHS services between 1 April 2017 and 31 March 2018. The report also provides contextual information describing the characteristics of women and babies cared for during this time period and whose data have been included in this report. The limitations of MSDS mean that for births in England the key findings and recommendations made in this report are specific to data quality only. There are insufficient data to draw clinical conclusions. For births in Scotland and Wales, the consistency of the data sources used means that clinical key findings are possible in this report. However, clinical recommendations are avoided for all countries in this report. This is because the NMPA’s next clinical report for births in 2018/19 is expected to be published in early 2022 and will use MSDS data with improved completeness; as a result, it will be able to provide a more comprehensive picture of variation of care across the three countries. Throughout this document we use the term ‘birthing people’ as well as ‘women’. It is important to acknowledge that it is not only people who identify as women who access maternity and gynaecology services. Methods The analysis in this report is based on 304 518 births in NHS maternity services in England, Scotland and Wales between 1 April 2017 and 31 March 2018.* The report is estimated to have captured 41.5% of eligible births in this time period (34% of births in England, 97% of births in Wales and 100% of births in Scotland). The NMPA makes use of data collected electronically through healthcare information systems and national datasets. Data for births in England are provided by NHS Digital’s Maternity Services Data Set version 1.5 (MSDS v1.5) as well as by Hospital Episode Statistics (HES) records. * The time lag between the period covered by this report and its publication is due to the delayed receipt of the MSDS dataset for England. National Maternity and Perinatal Audit: Clinical Report 2021 xi Data for births in Scotland are provided by Public Health Scotland Data and Intelligence (formerly the Information Services Division, ISD), based on data from the Scottish Birth Record and Scottish Morbidity Records (SMR-01 and SMR-02). Linkages to records from the National Records of Scotland (NRS) are also made for births, deaths and stillbirths. Data for births in Wales are provided by the Maternity Indicators dataset (MIds), a dataset managed by the NHS Wales Informatics Service (NWIS), as well as Admitted Patient Care (APC) records from the Patient Episode Database for Wales (PEDW), and some fields from the National Community Child Health Database (NCCHD). In order to compare like with like, the majority of measures are restricted to singleton term births. As a general principle, the denominator for each measure is restricted to women or babies to whom the outcome or intervention of interest is applicable; for example, third or fourth degree tears are only measured among women who have experienced a vaginal birth. Rates of measures are also adjusted for risk factors that are beyond the control of the maternity service, such as age, parity, previous caesarean birth and clinical risk factors that may explain variation in results between organisations. The NHS trusts and boards included in the audit provided intrapartum maternity care at one or more sites. Where possible, site-level results are available on the NMPA website. Carroll, F., Coe, M., Dunn, G., Fremeaux, A., Gurol-Urganci, I., Harris, T., Hawdon, J., Heighway, E., Karia, A., Khalil, A., Muller, P., Thomas, L., Waite, L., Webster, K., van der Meulen, J. (2021) National Maternity and Perinatal Audit: Clinical Report 2021. Based on births in NHS maternity services in England, Scotland and Wales between 1 April 2017 and 31 March 2018. London: RCOG.
  • 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. GUROL-URGANCI I, JARDINE JE, CARROLL F, DRAYCOTT T, DUNN G, FREMEAUX A, HARRIS T, HAWDON J, MORRIS E, MULLER P, WAITE L, WEBSTER K, VAN DER MEULEN J, KHALIL A, (2021) Maternal and perinatal outcomes of pregnant women with SARS-CoV-2 infection at the time of birth in England: national cohort study. American Journal of Obstetrics and Gynecology (2021), doi: https://doi.org/10.1016/j.ajog.2021.05.016
  • 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) Relph, S. NMPA Project Team (2021) 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. London: RCOG; 2021.

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