Perinatal health services: an immodest proposal

The sociology of childbirth: an autobiographical journey through four decades of research

The sociology of childbirth emerged in the 1970s largely as a result of influences from outside sociology. These included feminism, maternity care activism, the increasing medicalisation of childbirth, and evidence-based health care. This paper uses the author's own sociological 'career' to map a journey through four decades of childbirth research. It demonstrates the importance of social networks and interdisciplinary work, particularly across the medical-social science divide and including cross-cultural perspectives, argues that the study of reproduction has facilitated methodological development within the social sciences, and suggests that childbirth remains on the periphery of mainstream sociological concerns.

Anthropology in research on the quality of health services

Current crisis in the health sector has increased research directed towards quality of health services. Public health research on quality of services commonly assessed adherence to predefined criteria for building structure, equipment and technical procedures. The paper explores the contribution anthropology can make to health services research by including a lay perspective in quality evaluation. Rapid approaches to the lay perspective assume that conflict between the providers and users of health services result only from the different explanatory models and are thus resolvable through training and education. The holistic approach of anthropology demonstrates that service quality must be located in the wider contexts of health service structure, and the socio-economic circumstances of user's lives as well as differences between medical and lay models of health.

The work of the National Perinatal Epidemiology Unit. One example of technology assessment in perinatal care

This article describes one approach to assessing the effects of perinatal care--that adopted by the National Perinatal Epidemiology Unit in Oxford, England. The unit's research has been based primarily on a combination of simple, descriptive analyses of observational data and statistically robust analyses of evidence derived from randomized controlled trials.

Antenatal and perinatal care in southern Italy. I. The mothers' reports

A population-based cross-sectional study of antenatal and perinatal care was performed in Campania, a region of southern Italy. One thousand three hundred women who had given birth in 1982 were interviewed. The number of antenatal visits was very low, less than 1% of the mothers having attended more than three times during pregnancy. The women at high obstetric risk did not attend more than those at low risk and certain aspects of their antenatal care were unsatisfactory. The place of birth was similar for high risk and low risk mothers, with 40% delivering in small private facilities (with few neonatal resuscitation facilities and often with inadequate infant transport services). The labour was induced or accelerated in 60% of the mothers. The organisation of perinatal care did not take into account many of the needs of the mothers such as presence of a relative at delivery, ambulation during labour, early relationship with the newborn, rooming-in, or encouragement to breastfeed.

Antenatal care in general practice, Trondheim, Norway

In this study from the city of Trondheim during 1979-81 nulliparae were found to be younger, higher educated, and more actively working outside the home than parous women. Most women were examined by their GP during the first trimester, and were seen about 10 times on average during the pregnancy. Women who smoked tended to consult later in pregnancy than the non-smokers. Drugs were prescribed for 33% of the women during their pregnancy, 10% during the first trimester. Medication was most frequently prescribed for genitourinary disorders. Sick leave was often the result of low-back-pain and lasted on average 5 weeks longer in parous women. Hospitalization was most often due to hypertension and threatened premature labour and lasted on average longer among nulliparae. Controlled trials are needed to evaluate future antenatal care provision in the light of pregnancy outcome.

Increased obstetric activity: a new meaning to "induced labour"?

This study examines the possible reasons for increased obstetric activity in Denmark over the past 25 years. Since 1960 there has been a substantial increase in the average number of hospital admissions (from 10 to 32 per 100 deliveries), in deliveries diagnosed as complicated (from 15 to 49%), and above all in major interventions at delivery (from 4 to 22%). In spite of this increase in activity there is no evidence that the postwar trend of decreasing perinatal mortality has been further improved during the period of study. It seems possible that the rising level of activity is the result of increasing availability of new technology, decreasing numbers of deliveries and unchanged obstetric staffing levels, with an increased tendency to diagnose and intervene in "at risk" pregnancies. There is a need to determine how the current level of obstetric activity has arisen. Since there is evidence for an increased expectation of intervention by pregnant women, the theory of supplier induced demand may be among the leading contenders to be tested.

Women's acceptance of a preterm birth prevention program

A major modification in French national perinatal policy was proposed in 1970. Its primary aim was to reduce preterm births, and a specific program has been progressively applied to all pregnant women in France since 1971. Because the policy was introduced at a national level, it was possible to use a district hospital in Haguenau (northeastern France) as an observation site for measuring the effects of the change. A longitudinal study was begun in 1971 and continued for 12 years, during which time a total of 16,004 singleton pregnancies were followed. This article focuses on acceptance by the pregnant women in Haguenau in response to the new prenatal care proposals. A major reduction in preterm births is demonstrated, and the relationship between acceptance and observed changes in preterm birth is discussed. Certain time-related patterns were observed: it took time for the policy modification to be measurable; while the outcomes showed general improvement, results were closely related to the patient's social status; there were significant time-lag differences between social class groups with regard to acceptance of specific interventions.

Maternity services: the consumer's view

Findings are reported from a study designed to compare consumer perception of a range of maternity provision. Detailed exploratory work was followed by a pilot study and a postal survey to which 562 mothers responded. An analysis of the data indicated a strong preference for the antenatal and postnatal services provided by general practitioners or neighbourhood hospitals. Although the ratings given to all hospitals for care during labour and delivery were broadly similar, the majority of mothers would prefer a delivery under general practitioner care where considerations of safety permit. Important characteristics of the preferred services are accessibility, continuity, personalized and small-scale care, and recognition of childbirth as a life event. The desirability of retaining a range of services is discussed.

Some characteristics of antenatal care in 13 European countries

This study compares the organization of antenatal care in 13 European countries having a fetal and infant mortality rate below 20 per 1000. The countries differ in the number of prenatal visits, the role performed by midwives and the use of home care. It shows that there is no single model of antenatal care among countries having similar fetal and infant mortality.

Obstetric retrospect

A series of 818 consecutive obstetric patients in a general practice between 1946 and 1970 is analysed in detail. The findings are discussed in relation to other studies from general practice and to current obstetric hospital practice.