This paper critically reviews published tools and indicators
currently used to measure maternity care performance within Europe, focusing
particularly on whether and how current approaches enable systematic appraisal
of processes of minimal (or non-) intervention in support of physiological or
“normal birth”. The work formed part of COST Actions IS0907: “Childbirth
Cultures, Concerns, and Consequences: Creating a dynamic EU framework for optimal
maternity care” (2011-2014) and IS1405: Building Intrapartum Research Through
Health - an interdisciplinary whole system approach to understanding and
contextualising physiological labour and birth (BIRTH) (2014-). The Actions
included the sharing of country experiences with the aim of promoting
salutogenic approaches to maternity care.
A structured literature search was conducted of material
published between 2005 and 2013, incorporating research databases, published
documents in english in peer-reviewed international journals and indicator
databases which measured aspects of health care at a national and pan-national
level. Given its emergence from two COST Actions the work, inevitably, focused
on Europe, but findings may be relevant to other countries and regions.
A total of 388 indicators were identified, as well as seven
tools specifically designed for capturing aspects of maternity care.
Intrapartum care was the most frequently measured feature, through the
application of process and outcome indicators. Postnatal and neonatal care of
mother and baby were the least appraised areas. An over-riding focus on the
quantification of technical intervention and adverse or undesirable outcomes
was identified. Vaginal birth (no instruments) was occasionally cited as an
indicator; besides this measurement few of the 388 indicators were found to be
assessing non-intervention or “good” or positive outcomes more generally.
The tools and indicators identified largely enable
measurement of technical interventions and undesirable health (or pathological
medical) outcomes. A physiological birth generally necessitates few, or no,
interventions, yet most of the indicators presently applied fail to capture (a)
this phenomenon, and (b) the relationship between different forms and processes
of care, mode of birth and good or positive outcomes. A need was identified for
indicators which capture non-intervention, reflecting the reality that most
births are low-risk, requiring few, if any, technical medical procedures.
Full article at: http://goo.gl/Jtno43
By: 
# Joanna White,# Katrien Beeckman, Lucy Frith, Fatima Leon-Larios, Christine Loytved, Ans Luyben,Marlene Sinclair, Edwin van Teijlingen, and and EU COST Action IS0907. ‘Childbirth Cultures, Concerns, and Consequences’
# Joanna White,# Katrien Beeckman, Lucy Frith, Fatima Leon-Larios, Christine Loytved, Ans Luyben,Marlene Sinclair, Edwin van Teijlingen, and and EU COST Action IS0907. ‘Childbirth Cultures, Concerns, and Consequences’
Directorate-General
for Health Planning and Research, Ministry of Health of the Government of
Catalonia, Barcelona, Spain
Department of
Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
Centre for
Research in Anthropology/Centro em Rede de Investigação em Antropologia
(CRIA-IUL, Lisbon, Portugal
Department of
Health and Social Sciences, University of the West of England, Bristol, UK
Nursing and
Midwifery research unit, University hospital Brussels, Vrije universiteit
Brussel, Brussel, Belgium
Department of
Health Services Research, The University of Liverpool, Liverpool, UK
Departamento de
Enfermería. Facultad de Enfermería, Fisioterapia y Podología, Universidad de
Sevilla, Sevilla, Spain
Zurich University
of Applied Sciences, School of Health Professions, Institute of Midwifery,
Zurich, Switzerland
Women’s Clinic,
Spital STS AG, Thun, Switzerland
Maternal Fetal
and Infant Research Centre, University of Ulster, Coleraine, UK
Centre for
Midwifery, Maternal & Perinatal Health Bournemouth University, Bournemouth,
UK
Ramón Escuriet, Email: tac.tulastac@teirucser.
Corresponding
author.
#Contributed equally.
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