WG4 report February 2018

WG4’s aim – To examine organizational characteristics, contexts, cultures and economic costs of variation in rates of interventions in childbirth in different socio-political contexts.                                                                                                

WG4’s 58 members are from a range of disciplines including midwifery, obstetrics, management, architecture, psychology, sociology, anthropology, epidemiology, bioethics and law.

WG4’s has 5 sub-groups;

Sub-group 1. Variations in intervention rates between countries – influencing factors and mode of birth outcomes.

This sub-group aims to explore the variation in intervention rates within and between countries, identify the factors associated with caesarean section in each country. The group will attempt to distil a core dataset that can be used for comparisons.

Sub-group 2. Obstetric violence

This subgroup will map the social, cultural and historical debate on obstetric violence in order to present a broad and coherent interdisciplinary perspective. The work will raise social awareness and trigger a political debate on violation of human rights in childbirth.

Sub-group 3. Organisation of care.

This sub-group aims to explore the elements of organisational culture that impact on intrapartum intervention rates.

Sub-group 4. Midwives’ contribution to normal childbirth (MidCon Birth study)

Midwives’ contribution to normal childbirth care: Cross-sectional study in public hospitals in Catalonia (ISRCTN14062994 DOI 10.1186/ISRCTN14062994) (September 2015-December 2017).

www.llevadora.eu

Sub-group 5. A review of review National and local guidelines and/or protocols on oxytocin infusion for induction/augmentation of labour in Europe and worldwide

The progress reports are below.

Update on work of sub-groups:

Sub-group 1 – Variations in intervention rates between countries – influencing factors and mode of birth outcomes (Ank)

February 2018

(i) A review of data from different national datasets or datasets representative for the total national population.

The sub-group’s work is being led by Anna Seijmonsbergen-Schermers and Ank de Jonge (the Netherlands).

  • Methods paper Variations in childbirth interventions in high-income countries: protocol for a multi-national cross-sectional study has been published in BMJ Open – Seijmonsbergen-Schermers et al (2018) Variations in childbirth interventions in high-income countries: protocol for a multinational cross-sectional study. (Available at: http://bmjopen.bmj.com/content/8/1/e017993). The COST Action has been acknowledged.

Data on patient level are analysed, and we have data of women who gave birth in 2013 in seven countries: Norway, Iceland, Ireland, the Netherlands, Malta, the USA and Chile. We are still waiting to receive data of Belgium. When these data are analysed, we can conduct the multivariable analyses. In the meantime, instructions will be send to receive aggregated data from another three countries: Denmark, England and Germany.

(a) A second article on data on interventions looking at associations between social vulnerability and ethnicity and rates of medical interventions is planned (led by Katrien)

(b) A paper on differences in length of maternity and paternity leave in the different countries (led by Carina Lan)

(ia) Economic analysis

  • This will be included alongside Ramon’s study on ‘Mapping maternity care systems in Europe’. The study will identify the differences in maternity care systems information on costs per baby born and type of financing system for maternity care. It will examine whether or not we can come up with an average cost per baby born per country and cost per medical intervention (led by Patrick)

February 2018

Comparing the cost of delivery in different countries – Patrick Moran

  • Preliminary work on identifying the required dataset and analytical approach has been carried out using Irish data – Pat drafting email for circulation to all
  • A paper on associations between type of organisation of maternity care and financing system in a country and the rate of medical interventions will be drafted
  • A scoping review on economic evaluations in childbirth is in progress (Elske)

 

 

(ii) The prevalence of maternal request for caesarean section: a systematic review and meta-analysis (DD)

February 2018

Selection by title and abstract is complete, and full text review (of all available texts) is complete – currently writing to authors of missing full-texts. Members are from Bulgaria, Chile, Ireland, Norway, Spain and Switzerland, South Africa.

(iii) An analysis of caesarean sections according to Robson’s groups (Paul)

We received the data for all Norwegian maternity units for the years 1999-2014, and have data from Malta and from half (n=9) of the maternity units in Ireland. We hope to get data from Denmark, Portugal and Romania. The website for uploading and entering the data is developed (http://robson10gcs.ucc.ie/).

February 2018 – Data collection from different countries is ongoing. Data from Belgium (Flanders) and Denmark will be collected and analysed for comparison with other countries in April 2018.

Sub-group 2 – Obstetric violence (Jette)

(i) The social, cultural and historic origins of obstetric violence

(ii) Final output – Article on Hidden practices in midwifery and obstetrics

Patricia Gillen – STSM: Home birth in Denmark: knowledge translation and research to inform Homebirth Guidelines in Northern Ireland. The development of Guidelines  for planning homebirth are underway and are being co-designed and produced with women and men who have experience of or a view on Homebirth.

 

Dr Maria Healy and Dr Patricia Gillen were awarded £8000 to carry out a survey of attitudes and experiences of Homebirth in NI.

 

  • Alena Parizkova – STSM: came to Copenhagen. Jette and Alena worked on analysis on data for article on women that travel long distance

 

  • Jette Clausen – Participation in seminar on obstetric violence in Denmark

 

  • Paper – Parizkova A and Clausen JA. Women on the move. Why do women and midwives travel long distance (for Women and Birth). Awaiting acknowledgement from the Danish National Ethic committee that ethical approval is not required.

 

Other publications

  • Ruiz-Berdún, Dolores and Martín-Alcaide, Rosario (2018) The importance of gender in the history of delivery care: the incorporation of men to midwifery profession in Spain. Accepted by Journal of Spanish Association of History of Science and Technology
  • Ruiz-Berdún, Dolores and Martín-Alcaide, Rosario (2018) The importance of gender in the history of delivery care: the incorporation of men to midwifery profession in Spain. Accepted by Journal of Spanish Association of History of Science and Technology
  • Ruiz-Berdún, Dolores. Controversies over phisiological childbirth in Spain in the early 20th century. Chapter accepted for publication in book: Maternidades, experiencias y narraciones. Tarragona: University Rovira i Virgili Publications. Ed. by Dr. Serena Brigidi and Dr. Coral Cuadrada.
  • Ruiz-Berdún, Dolores and Martín-Alcaide, Rosario. Three generations at Santa Cristina’s Midwifery school. Chapter accepted to be published in book: Science and Technic at the University, to be published in 2018 by the University of Alcalá Publications. Ed. Dolores Ruiz-Berdún
  • Palomar-Ruiz, Laura; Escuriet-Peiró, Ramón and Ruiz-Berdún, Dolores. The obssesion for a healthy baby: pregnancy hygiene in Spain throughtout the 20th century. Chapter accepted to be published in book: Science and Technic at the University, to be published in 2018 by the University of Alcalá Publications. Ed. Dolores Ruiz-Berdún
  • Ruiz-Berdún, Dolores. “Risky business: to be a midwife in Spain after the Spanish Civil War. Conference presentation accepted in CfP: E​uropean ​S​ocial ​S​cience ​H​istory ​C​ongress​ 2018 Panel: Midwives and midwifery at the nexus between state interest, women’s health, and the decline in infant mortality https://esshc.socialhistory.org/esshc-user/programme?day=60
  • Olza Fernández, Ibone; Ruiz-Berdún, Dolores and Villarmea Requejo, Stella (2017). Maternal Guilt: How to Promote Breastfeeding. Published in Dilemata nº 25: http://www.dilemata.net/revista/index.php/dilemata/article/view/412000143/523

(iii) Study on ‘Out of hospital births in Europe’ planned (Mario)

A call for experts was sent round to some of our COST colleagues, a data collection tool has been finalised, and the questionnaire will be send out February 2018.

  • Santos M. STSM on “Home birth, gender, and the state: comparing knowledge, power and practices in Portugal and Israel” (9 to 27 of November 2017).
  • Santos M. Oral presentation “Portuguese maternity care from the users point of view: conclusions from the Babies Born Better survey” [in Portuguese] (27 of October 2017)
  • Santos M. Organization of the scientific event “Childbirth and other debates: gender, parenthood and child-raising” [in Portuguese and Spanish, with the participation of Sara Cohen Shabot as keynote speaker] (27 of November 2017)

(iv) (a) Bullying

Leader – Patricia Gillen

Patricia has completed work with…

Ramon translating the tool into Spanish

(b) Midwives emotional wellbeing

Deirdre D and Patricia are going to seek funding to conduct a study on the emotional wellbeing of midwives on the island of Ireland.

Sub-group 3 – Organisation of care.

(i) Elements of organisational culture that impact on intrapartum intervention rates (Sara and Laura). To be submitted by end of March 2018

(ii) A paper titled ‘The delivery scene: childbirth throughout the centuries in a multidisciplinary perspective’ has been drafted by Sandra Morano, Mariarosaria Di Tommaso and Laura Lannuzzi and others, Donatella Lippi, Fani Vavili. To be submitted by end March 2018.

(ii) Birth settings from an architectural perspective (Nicoletta, Grazia and Liv)

The study is being planned, and four papers are planned:

  • Childbirth environment. Reviewing architecture impact on maternity care
  • Environment and intervention rate in childbirth: an architectural, anthropological and midwifery approach
  • Space analysis in childbirth environment. Study of European layouts in maternity care.
  • Giving birth in different cultures/countries: women accounts of the role of physical environment

Architectural plans have been collected from Spain (2), Germany (1), Norway (2), Ireland (1), Italy (2), UK (4), Belgium (1) thanks to COST members.

 

These papers will lay the groundwork for a further study on the impact of birth space on intervention rates through organisational behaviour.

 

Grant awarded: Nicoletta Setola – awarded €54,000 funding for a 2 years post-doc position on the topic of birth spaces (From Tuscany Region, Italy).

The project is about Inclusive design and technologies development for the spaces of care in the mother-child path and will start in April 2018.
The research project aims to promote a training and knowledge path by developing an integrated design experience that involves: the study of spaces for women and children within health facilities taking into account the maternal-child path in particular in the pre and post-natal moment, and with focus on birth spaces; the integrated design of an environment prototype or sensory stimulation and regulation systems based on the management and the personalized control according to the user’s sense-perceptive profile; experimentation on pilot cases; and the evaluation of the effects involving the users.

 

Sub-group 4 – Midwives’ contribution to normal childbirth (MidCon Birth study) (Ramon)

The first phase in Catalonia has finished, and results are being analysed. 30 hospitals from hospitals in Catalonia (Spain).

Second phase ongoing: 13 hospitals from Madrid, Valladolid, Palencia, Valencia and Galicia (Spain), one hospital from Rep. of Ireland joining soon and one expected from Iceland.

The English translation of the web platform for data register is finished.

Outputs:

Results from individual hospitals are being disseminated and presented in different congresses (Spanish Midwives conference in Canary Islands (5-7 October 2017)):

Publications:

  • Midwives’ contribution to normal childbirth care: Cross-sectional study in public health settings, the MidconBirth Study protocol. European J Midwifery

http://www.europeanjournalofmidwifery.eu/Midwives-contribution-to-normal-childbirth-care-Cross-sectional-study-in-public-health,76820,0,2.html

  • A critical review of the birth plan use in Catalonia. Sexual & Reproductive Healthcare.

http://www.sciencedirect.com/science/article/pii/S1877575616301586

Vaginal delivery care, episiotomy performance and examination of severe perineal tears. Obstetric & Gynecology International Journal. http://medcraveonline.com/OGIJ/OGIJ-07-00270.pdf

  • Title:  Health policies for the reduction of obstetric interventions in singleton full-term births in Catalonia. Journal:  Health Policy (IP 2.119) Maria Jesus Pueyo, MD;  Ramon Escuriet, RM, PhD; Mercedes Perez-Botella, RM; Inmaculada de Molina, RM, PhD; Dolores Ruiz-Berdun, RM, PhD; Saul Albert-Mallebrera, RM; Sandra Diaz-Torres, RM; Peter Torres-Capcha, RM, PhD Student; Vicente Ortún, PhD

 

  • Marta Benet, Ramon Escuriet, Manuela Alcaraz, Sandra Ezquerrae, Margarida Pla. Alcance de la implementación en Catalunya de las estrategias de salud reproductiva (2008-2017).

Journal: Gaceta Sanitaria (IP 1.77)

 

Seminar 25 January 2018

  • Dr Lucy Frith presented a session on ‘Culture, childbirth and ethical decision-making’

(ii) Study on ‘Mapping maternity care systems in Europe’ planned (Ramon, Katrien B from February 2018 onwards))

The survey is being drafted.

Sub-group 5 – A review of review National and local guidelines and/or protocols on oxytocin infusion for induction/augmentation of labour in Europe and worldwide (DD)

(i) Variations in oxytocin regimens

We have data from Austria, Belgium, Cyprus, Denmark, Germany, Ireland, Norway, South Africa, Sweden and Switzerland (separate data for the German and Italian, and French regions).

(i) Data from all university hospital in Germany submitted as a separate paper. Cost Action acknowledged

(ii) Italy will send data from one hospital/region

(iii) Analysis of data from other countries is in progress, and background paper drafted. Cost Action will be acknowledged

February 2018 – data analysed by Karin and colleagues in SA and Kerstin advising on how best to present data

 

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