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Two of our research midwives have been labelled 'star recruiters' for their work towards a University of Nottingham study into helping women stop smoking during pregnancy.

Nerea Rodal-Prieto and Komal Lal have been consistently praised by the university for their role in finding women willing to partake in the study and the pair recently received special recognition in the form of certificates and chocolates for their contribution to the trial.

The SNAP3 (Smoking, Nicotine and Pregnancy) Trial is looking to find out if three ways (listed below) of using Nicotine Replacement Therapy (NRT) in pregnancy can help women stop smoking, when compared to usual care: 

• NRT use for preloading before quit date (QD)
• NRT use in recovery from brief lapses (slip-ups) to smoking 
• NRT use for smoking reduction, with the aim to induce cessation in those unable to quit.

We caught up with Nerea and Komal to talk about their work for the SNAP 3 Trial.

Tell us about the trial and how you got involved...

Nerea: "When we do research and are choosing the right studies for us, we do a feasibility analysis and this study was a good fit. We get approached by the sponsor, we read the protocol and we look at the stats. We had enough stats for us to be successful in terms of getting a good amount of recruits and based on that, we went forward with this study.

"The sponsor is the University of Nottingham and they provided us with some training and then after some analysing, it gets green lighted by the research and development manager, and we start recruiting. What we aim is to prove that nicotine replacement therapies such as patches or inhalers are useful for pregnant women to stop smoking because there is evidence for the general population, but not for that particular group (pregnant women)."

How long do these sorts of trials take?

Nerea: "It is over quite a long period. Maybe three to five years...it depends. It might increase, it might decrease. Depending on how well they're doing or not, they also need a minimum of people for the study to go forward, because otherwise you're investing resources and you're not going to get your outcome."

Can you tell us about the recognition you have received from the University of Nottingham?

Nerea: "We are star recruiters. We are doing really well to be honest. The study opened in May 2022 in Hillingdon and we've been leading with regards to recruitment, so that is contributing to their objective so they're really happy with us.

"We also attend their forums that they usually hold monthly so we give tips to other hospitals to help with recruitment and I also have to highlight the contribution of the digital midwife [at Hillingdon] Sarah Maskell because she helped us to narrow down and make the process more comfortable for us in terms of recruitment.

"At the beginning it was us checking records all the time and it was a bit more lengthy whereas she suggested to use a digital platform so we can get to our target much easier than if we had to check all the records ourselves. That is one of the tips that we have advised other [hospital] Trusts - to get in contact with their digital midwives because it does make things easier."

How much have you enjoyed being part of the trial?

Kamal: "We've actually really enjoyed this one because it's something that we've nailed on the head. We've looked at different methods of trying to recruit and and we work so well together. You use different strategies to try and get women [to take part] and all the angles are covered.

"We've got good midwives - they refer on to us and once we recruit, then we know what we're doing. It works really well and we enjoy recruiting so many ladies. We have a towpath team and they have quite a few referrals for us as well. We check through the bookings and use databases.

"We are situated well in west London where we do have a lot of smokers around and we know how to approach them and speak to them so it works well."

Are people willing to help?

Nerea: "Every member of staff that helps us with recruitment...we do highlight them in the newsletter that we produce and they can use that for their CPD (Continuing Professional Development) for revalidation, as good feedback and they can also use it for their CVs as participating in research.

"We have had some interest from staff where we have one of the midwives now that has helped us greatly in one of the studies that we recently opened. She became an associate PI (Principal Investigator), helping us with recruitment and the conduction of the study.

"I also would like to highlight there is a day that we hold in maternity. Kamal and I organise it and it's for the international clinical trials day. It's for all the staff to come. We do a breakfast, we give away chocolates, we do games so we basically try and make people guess or ask questions about the studies that we have going on. We try to involve staff and try to promote research as much as we as we can."

Are you involved in any other trials coming up, or are you planning to get involved in something else at all?

Nerea: "We have a couple of trials going on. We had 'Craft', which was about cesarean section, the effects of having a cesarean section in labour and how it influences your next pregnancy. We have [a trial with] pregnancy in overweight women that's in collaboration with Chelsea (and Westminster Hospital NHS Foundation Trust) and it's about how ladies that have undergone bariatric surgery, how metabolically, how their pregnancies go and the implications for the baby and the size of the baby.

Komal: "We have 'Chapter' too which is an observational study, so it's recording data collection about women that have had any sort of perennial trauma delivery. We categorise tears as in 3rd and 4th degree so we want to know why some women were going on to have complications, things like infection and bleeding, having difficulty passing urine...all those sort of things and we want to improve our care.

"So what we're trying to do is recruit these women and record some data about their stitches, what tool they use, the methods used to stitch and then follow them up with a couple of questions at six weeks, six months and then 12 months. It's if they've got any concerns to let us know about those and just make sure that we are doing our job properly, not missing out anything. And also just knowing their view, so what they go through physically, emotionally and mentally and record all those and just get more of an insight."

Nerea: "We also have 'Wheat', which is about necrotizing enterocolitis and feeding or not feeding the babies during blood transfusions and it's to determine if the practice of withholding these enteral feeds during a blood transfusion compared to continuing the feeds reduces the incident of necrotizing enterocolitis.

"We have our hands full but we are always looking for new studies. If the fit is right for us, and if we can achieve the targets the sponsors have, we're on the lookout for more research."

How would people get involved in trials if they are interested?

Nerea: "To give an example, one of the staff that got involved did it through the associate PI scheme. The PI is the person that needs to make sure that the study runs correctly and as it should. I am the PI for the childbirth perineal trauma study and I have to mentor the associate API.

"I give her an insight into how to recruit, I coached her on what she has to do and there are meetings that we have to do. I still need to go through  data entry and the databases with her but that's the best way to learn and to get involved.

"There are also people that get involved just by referring the patients so they learn about the studies and how they can contribute. We do appreciate it because clinical staff are overloaded with a lot of clinical work so we try to make it as easy as we can for them, but I would say the associate PI scheme is the best way to get involved. We are always open to giving people opportunities and to collaborate with us or if any staff come across any studies that they think are worth looking at.

"I wanted to add that it is great to participate in research because you see that it changes practice. Recently, I was in the results discussion conference for one study and it's great to see that your work is going to contribute for for improvements in practice. That's the great thing about research - you'll be able to see change."

Komal: "It [Participating in trials] is a great avenue to go down after clinical work and the jigsaw pieces fit together - we realise what we do and why we do everything in clinical practice is because of this. It's great to be a part of it and actually make a difference, and also just gain trust with the patients who are very willing to participate."