WG4: Organizational perspectives


Working group four
Organizational perspectives

Organizational characteristics, contexts, cultures and economic costs of variation in rates of interventions in childbirth.

Chair: Deirdre Daly dalyd8@tcd.ie
Co-chair: Laura Lanuzzi laura.iannuzzi@unifi.it

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

WG4 has 44 members and is one of the largest groups in this COST action. Twenty two members from a variety of professions including midwifery, nursing, obstetrics, architecture, epidemiology and medical anthropology, joined WG4 for some or all of the meetings in Barcelona.

Prior to the meeting, members submitted their research interests and priorities, and whilst topics were diverse, three sub-groups, each focusing on a different topic related to the overall aim, were formed.

The sub-groups are:

Sub-group 1: Variations in intervention rates between countries – influencing factors and mode of birth outcomes
Sub-group 2: Obstetric violence
Sub-group 3: Organisation of care
Sub-group 4: MidconBirth Study
Sub-group 5: Oxytocin infusion protocols

Progress to date:

WG4 sub-group 1: Variations in intervention rates between countries – influencing factors and mode of birth outcomes

The sub-group aims to describe variations in the use of childbirth interventions between the following thirteen countries: Finland, Norway, Denmark, Sweden, Iceland, Ireland, England, the Netherlands, Belgium, Hesse (province of Germany), Malta, the USA and Chile. Childbirth interventions such as induction and augmentation of labour, caesarean section, artificial rupture of membranes, intrapartum antibiotics, pharmacologcial pain relief, episiotomy, and instrument-assisted vaginal birth, are investigated.

The incidence of interventions for each country is described, and multivariable analyses are performed to adjust intercountry variation for baseline characteristics.

Missing data of cases or variables are described. Participating countries are also asked to record the definitions of the variables so that differences between countries can be identified. Data of most countries have now been gathered and analyzed.

Subgroup 2: Obstetric violence

Obstetric violence is a concept that refers to the existing situations of abuse and disrespect of women in the context of maternity care. It encompasses issues relating to violation of women’s rights, dehumanised treatment in any form, abuse in any form, being denied information and loss of autonomy, amongst others.

The sub-group aims to map the social cultural and historical debate on obstetric violence, gather the current research on this issue, and publish findings.

Sub-group 3: Organizational perspectives – the effect of organizational contexts and cultures on variation in rates of childbirth interventions.

This sub-group plans to identify specific elements of organisational culture and identify the impact they may have on intrapartum intervention rates. The first phase of the sub-group’s work is to conduct a systematic review on one aspect of organisational culture.

Sub-group 4: This link shows some of the work of MidconBirth Study www.llevadora.eu

WG4 News

WG4 members have had a report published in MedCrave, the Obstetrics & Gynecology International Journal.

Vaginal Delivery Care, Episiotomy Performance and Examination of Severe Perineal Tears: Cross-Sectional Study in 43 Public Hospitals

You can download a pdf of the report here.

WG4 member Ramón Escuriet has contributed to a new paper accepted entitled A critical review of the birth plan use in Catalonia. Read about it on ScienceDirect here.

It will be in the Sexual & Reproductive Healthcare publication which is available online June 11, 2017.

The contributors are: Herminia Biescas , Marta Benet,  Maria J. Pueyo, Anna Rubio, Margarita Pla, Mercedes Pérez-Botella and Ramón Escuriet.

Article (in Portuguese) by Mario Santos: “If everything was fine, why should I have gone to an obstetrician?”: identity, risk and consumption of medical technology in home births in Portugal.

Contemporary home births are rare and quite invisible phenomena, and quite unexplored as an empirical field. From interviewing women and couples who experienced a planned home birth, this article aims to give an initial sociological portrait of this phenomenon in Portugal. It is shown to be not a return of the traditional or a search for a mystical experience, but rather a physical and concrete happening, strongly shaped by scientific and medical knowledge, within a search for identity coherence. Several social and medical risk perceptions emerged, as well as a reflexive consumption of medical technologies framed by these same perceptions. Despite the fact that home birth detracts the relevance of medicine during pregnancy and birth, it is not possible to frame it as a phenomenon of demedicalisation. Read it here.

The first national survey on obstetric violence in Italyhas been published. The report was coordinatored by Elena Skoko and Alessandra Battisti. Download a pdf of the report here.

Observatories on Obstetric Violence (March 2016)

As activists, we suggest to post the link to the first international meeting of Observatories on Obstetric Violence in March 2016 which resulted in the InterOvo 2016 statement. The text and statement is available here (in English).

Working group 4 – sub-group 2 on obstetric violence. Link to the El Parto es Nuestro website (Spanish language) https://www.elpartoesnuestro.es/

Two members of Working Group 4 (sub-group 2) presented a workshop Obstetric Violence at the COST Action meeting in Bergen in March 2016.

You can see Michelle Sadler and Ibone Olza Fernandez’s workshop here (and below)

International Week of Respectful Chilbirth, Chile

There ws a celebration of the International week of a Respectful Childbirth which took place at the Faculty of Medicine, University of Chile. Read the article here (Spanish language).

Elena Skoko did an interview with Ibone Olza Fernández about her activism. Read it here (Italian language).

Useful links

Not all countries have access to Cochrane analysis. Here is a link to hospital versus home birth.  The full review is also available as PDF (external site): Planned hospital birth versus planned home birth.

Human Rights in Childbirth.

Birth Rights



[NOTE: You can read all the reports from all the working groups on the Publications & Outputs page here]

WG4 (Sept 2016): Download report as a pdf.

WG4: Organizational perspectives

General WG4 report (Published April 2016) Download the updated report here.

Report on obstetric violence: “Moving beyond disrespect and abuse: addressing the structural dimensions of obstetric violence.” Read it online here or download the pdf here.

(Spanish language) Vi Jornadas Internacionais de Historia da psiquiatria e Saude Mental. Download the pdf here.

Study on patient information on induction of labour in Denmark, written by Eva Rydahl and Jetta Aaroe Clausen. Read the report on the BMJ website here. Or. you can download the pdf here.

Not all countries have access to Cochrane analysis. Here is a link to hospital versus home birth. The full review is also available as PDF (external site): Planned hospital birth versus planned home birth.

Human Rights in Childbirth.

Birth Rights

The Past and the Present of Obstetric Violence in Spain. Download the pdf here.

Study on patient information on induction of labour in Denmark, written by Eva Rydahl and Jetta Aaroe Clausen. Read the report on the BMJ website here. Or you can download the pdf here.

Mario Santos has  published a report on the history of home births in Denmark. It is based on the work I cared out in an STSM in the previous COST Action IS0907. Here is a link to the report.

Lucy Frith has produced a PowerPoint presentation titled: New insights into socio-cultural phenomenon that contextualize labour and birth, including marginalized groups and migrant women. You can download it here.

STSM report (Nov 2017): Mario Santos’ report – Home births, gender, and the state: Comparing knowledge, power, and practices in Portugal and Israel. Download the pdf here.

Variations in childbirth interventions in high-income countries: protocol for a multinational cross-sectional study. You can download a pdf of it here.

Elena Skoko, Onde progressiste, COST Action BIRTH a Firenze, October 9-11, 2017, Link

Deirdre Daly, Factors influencing decision-making for caesarean section in Sweden – a qualitative study, BMC Pregnancy and Childbirth, 18:377, 2018, Download pdf.

Mario Santos, From Birth to Health Conference (Lisbon) scientific report, Sept 17-18, 2018, download pdf.

Santos, MJSS (2018), “Institutionalisation and professional dynamics in home births: insights from a STSM comparing Israel and Portugal”, CIES e-Working Papers, Lisboa, CIES-IUL. Download pdf here.

Seijmonsbergen-Schermers A, de Jonge A, van den Akker T, et al. Variations in childbirth interventions in high-income countries: protocol for a multinational cross-sectional study. BMJ Open 2018;8:e017993. doi:10.1136/bmjopen-2017-017993.

Lola Ruiz Berdún, Rosario Martin-Alcaide, La Importancia Del Genero en la Historia de la Atencion al Parto: La Incorporacion de los Hombres a la Profesion de Matrona en Espana. LLULL, Vol. 41 (N.º 85) 2018 – ISSN: 0210-8615, pp. 191-216, dolores ruiz-berdún y rosario martín-alcaide, pdf

Lola Ruiz Berdún, Ciencia y Técnica en la Universidad, Trabajos de Historia de las Ciencias y de las Técnicas Volumen II. Universidad de Alcalá, 2018, pdf

Nicoletta Setola, Eletta Naldi, Grazia Giulia Cocina, Liv Bodil Eide, Laura Iannuzzi  and Deirdre Daly, The Impact of the Physical Environment on Intrapartum Maternity Care: Identification of Eight Crucial Building Spaces in the Health Environments Research & Design Journal. 2019, pdf.

WG4 Ongoing studies

“Midconbirth Study”
Variability in intrapartum care raises concerns about how this may impact on the health of some mothers and newborn babies.

This study is looking at how many normal births are attended by midwives in public health settings (for example, hospitals) and at home and recording what happens during the birth and shortly afterwards.

“Midwive’s strategies to promote normal birth in conventional obstetric units”
This study will explore the strategies and methods used by midwives to promote minimal interventions and support normal delivery expectations for women in high-tech settings. This study forms part of the research  CUI2Salut – MidconBirth and contributes to Group 4 in  ISCH COST Action IS1405 (BIRTH).

Participation in  “MAMI. Impacto de la microbiota materna en el desarrollo del niño. Partos domiciliarios en Cataluña”.
WG4 contributes to this study with homebirths attended to in the north-east region of Spain (Catalonia).

WG4 Scientific production
The concerns and insights that are evident in this volume are therefore strongly in line with both the quantitative and qualitative evidence we have to date on what the risks are of risk-averse maternity care, and, in contrast, on what works for optimal maternity service. This paper critically reviews published tools and indicators currently used to measure maternity care performance within Europe. Maternity care in different countries research pdf download link. Link: Assessing the performance of maternity care in Europe: a critical exploration of tools and indicators.

WG4 Impact on Health policy
Catalonia’s Ministry of Health has presented the new Health Plan for 2016-2020. The Health Plan establishes the health policy priorities for the next four years and promotes a model of care that is based and centred on people’s needs. This new Health Plan includes for the first time a policy objective aimed to review and improve the model of care for normal birth in the public health system. Link to story on this website here.

WG4 profiles

deirdre daly 2bw crop

Deirdre Daly
Trinity College Dublin
Disciplinary background: Midwifery

Deirdre is an Assistant Professor in Midwifery (0.5 WTE) and Project Manager for the OptiBIRTH project (0.5 WTE).

Her research interests include maternal health and morbidity postpartum, urinary incontinence, interventions and birth outcomes. More information on the MAMMI study.

laura bw

Laura Iannuzzi
Careggi University Hospital, University of Florence & School of Health Sciences, The University of Nottingham
Disciplinary background: Midwifery

Laura registered as a midwife in 2001 and has practised in different maternity settings (independently, community, hospitals). Since 2004, she has been employed at the Careggi University Hospital in Florence. In the few last years, she has worked mainly as a senior midwife at the birth centre alongside the hospital (Centro Nascita Margherita), one of the few midwife-led units in Italy.

She is currently also an honorary lecturer in Midwifery at the University of Florence, and a PhD student in Health Studies at the School of Health Sciences, the University of Nottingham. Her PhD research – supervised by Prof Helen Spiby and Dr Denis Walsh – is on midwives’ approaches to slow progress of labour in Italian and English birth centres.

Working Group 4 members

Katrien Scheerlinck (Belgium) katrien.scheerlinck@ucll.be University Colleges Leuven Limburg

Annick Bogaerts (Belgium) annick.bogaerts@belgacom.net Leuven-Limburg &University of Antwerp

Joris Vermeulen (Belgium) joris.vermeulen@ehb.be Sec European Midwives Association

Katrien Beeckman (Belgium) katrien.beeckman@uzbrussel.be Vrije Universiteit Brussel, UZ Brussel

Yoana Stancheva (Bulgaria) yoanitta@gmail.com

Gonzalo Leiva (Chile) gonzalo.leiva@usach.cl University of Santiago & Ministry of Health

Michelle Sadler (Chile) msadler@culturasalud.cl University of Chile & Ministry of Health

Lorena Binfa (Chile) lbinfa@med.uchile.cl School of MW Univeristy of Chile

Milos Veleminsky (Czech Republic) veleminsky@volny.cz

Jetta Aaroe Clausen (Denmark) jecl@phmetropol.dk Metropolitan University College

Katerina Nicolopoulou (Greece) knicolopoulou@hotmail.com Strathclyde Business School

Antonella Nespoli (Italy) antonella.nespoli@unimib.it University of Milano-Bicocca

Mariarosaria Di Tommaso (Italy) mariarosaria.ditommaso@unifi.it University of Florence, Ob Gyn Dpt

Sandra Morano (Italy) 53367@unige.it

Simona Fumagali (Italy) simona.fumagalli@unimib.it University of Milano-Bicocca, Monza

Laura Iannuzzi (Italy) ntxli@nottingham.ac.uk University Florence & Nottingham

Nicoletta Setola (Italy) nicoletta.setola@unifi.it University of Florence

Sara Borrelli (Italy) sara.borrelli@nottingham.ac.uk University of Nottingham

Bianca Guarino (Italy) biancadoris.guarino@gmail.com University of Genoa

Grazia Cocina (Italy) grazia.cocina@polito.it Phd student University of Turin

Ank de Jonge (Netherlands) j.dejonge1@vumc.nl VU University Medical Center, Amsterdam

Anne Britt Vika Nilsen (Norway) abvn@hib.no Bergen University College

Professor Ellen Blix (Norway) ellen.blix@hioa.no Oslo and Akershus University

Mario Santos (Portugal) mariojdssantos@gmail.com CIES-IUL

Paul Corcoran (Republic of Ireland) pcorcoran@ucc.ie UCC

Deirdre Daly (Republic of Ireland) dalyd8@tcd.ie TCD

Ona Pop (Romania) pop.oanamaria@gmail.com

Antoinette Du Preez (South Africa) Antoinette.DuPreez@nwu.ac.za NW Uni Potchefstroom

Christa van der Walt (South Africa) christa.vanderwalt2@gmail.com NW Uni Potchefstroom

Karin Minnie (South Africa) Karin.Minnie@nwu.ac.za

Ramon Escuriet Peiro (Spain) rescuriet@gencat.cat Catalonia Dept of Health

Lola Ruiz Berdún (Spain) lola.ruizberdun@uah.es University of Alcalá, Madrid

Anna Dencker (Sweden) anna.dencker@gu.se University of Gothenburg

Marie Berg (Sweden) marie.berg@fhs.gu.se University of Gothenburg

Barbara Kaiser (Switzerland) barbara.kaiser@hesge.ch Uniof Applied Sciences , Western Switzerland

Claudia Meier Magistretti (Switzerland) claudia.meiermagistretti@hslu.ch

Justin Waring (UK) justin.waring@nottingham.ac.uk

Sue Brailey (UK) S. Brailey@mdx.ac.uk Middlesex University

Patricia Gillen (UK) patricia.gillen@southerntrust.hscni.net

Elena Skoko (Italy) elena.skoko@gmail.com Human Rights in Childbirth

Elena Ateva (US) elena.ateva@gmail.com White Ribbon Alliance

Martina König-Bachmann (Aut) martina.koenig-bachmann@fhg-tirol.ac.at

Jessica Pehlke-Milde (Switzerland) pehl@zhaw.ch Zurich University of Applied Sciences

Anna Seijmonsbergen-Schermers (Netherlands) Department of Midwifery Science, AVAG and APH research institute, Amsterdam