27th February 2025
Taking a Welsh childbirth improvement programme nationwide
Dr Sarah Bell, consultant anaesthetist at Cardiff and Vale University Health Board, has always been dedicated to improving patient care. She pursued a career in obstetric anaesthesia training to care for pregnant women during childbirth which eventually led her to an impactful career in research.
The research journey begins
During her training, Dr Bell joined a research group led by Professor Peter Collins and Professor Rachel Collis who were interested in looking at postpartum haemorrhage (PPH), a dangerous condition where women lose excessive blood after childbirth, to inform how patients are looked after. Inspired by their work, she worked with them again in analysing a series of cases between 2008 and 2010 to collect data from women in these situations. This found several cases of women with dangerously low fibrinogen (a protein in the blood that helps form clots to stop bleeding) levels during childbirth and that an intervention of administering fibrinogen concentrate appeared to be beneficial.
She then went on with her anaesthetic training, rotating around hospitals in South Wales, with a real interest in quality improvement and improving the way that providers look after patients, including women during childbirth.
Towards the end of her training, she joined Professors Collins and Collis’s research team again. By this stage they had introduced bedside blood-clotting tests which eliminated delays caused by laboratory processing and were looking at the best ways to use these tests. Dr Bell said:
“Before that test was available, we had to send the tests off to the lab and wait 90 minutes to get a result.
“The bedside test only takes 10 minutes to provide results and if the results confirm low fibrinogen levels we can administer treatment immediately.”
Dr Bell added:
“Whilst we were doing these studies, we realised we had started assessing women for their risk of bleeding earlier in a much more standardised way.”
Becoming a Consultant and the Obstetric Bleeding Strategy (OBS) Cymru
Dr Bell became a consultant in 2015 and officially joined the obstetric anaesthesia team in Cardiff. Based on the initial research she participated in and the need for further intervention, the OBS Cymru project was created, it was supported by Improvement Cymru, Welsh Government and Werfen (an industry partner).
The OBS Cymru treatment programme introduced the use of a new checklist requiring midwives to measure blood loss. This process means midwives know as soon as a patient is bleeding abnormally, enabling early interventions to prevent the need for a blood transfusion. So far in Wales, it has led to a 29% reduction in massive postpartum haemorrhage, with 160 women per year avoiding the need for a blood transfusion after birth.
Due to its success, OBS Cymru has been adopted into the All Wales Postpartum Haemorrhage Guidelines. Midwives, obstetricians, anaesthetists, haematologists and health care assistants throughout health boards in Wales now follow the same process for the management of blood loss during childbirth. In 2021, OBS Cymru was awarded the Health and Care Research Wales Research Impact Award.
Dr Bell said:
“This all started in Cardiff and then the idea came together as OBS Cymru. We recognised that we were doing more than just bedside blood-clotting tests. We were changing an entire care package for women giving birth.”
Expanding nationwide with the launch of the OBS UK
Building on the success of OBS Cymru, the research team set out to research this package of care further. While the programme showed promising results in Wales, they wanted to know whether the improvements stemmed from the new care model or increased awareness. To investigate this, Dr Bell, Professor Collins and the study team worked with the Centre for Trials Research, part of the Health and Care Research Wales funded community to secure £3.65 million from the National Institute for Health and Care Research (NIHR) to launch OBS UK.
Dr Bell said:
Thanks to the Health and Care Research Wales personal award I had the time to develop the OBS UK application.”
OBS UK launched in February 2024 and will run for 30 months, involving over 190, 000 women across 36 maternity units in England, Scotland and Northern Ireland. In addition to clinical, psychological and economic outcomes, the study will examine the impact of social and ethnic factors on postpartum haemorrhage.
Dr Bell as clinical researcher
At first, Dr Bell only saw herself as a hands-on clinician rather than a researcher, using research findings to improve treatment rather than conducting studies herself. However, as she progressed in her career she began to recognise the overlap between quality improvement and research. Over time, Dr Bell’s role evolved from a clinician focused on quality improvement to a fully-fledged clinical researcher. She said:
“Health and Care Research Wales has been completely pivotal in that.
“Thanks to Clinical Research Time Award I had the time to secure funding for the OBS UK Trial and shortly complete my PhD.”
What started as a passion for improving patient care led her to groundbreaking studies that are transforming maternity care across the UK. If you’re inspired to turn your passion for helping others into impactful research, Health and Care Research Wales Faculty can help. With funding, mentorship and resources, the Faculty can help you at every stage of your journey.