Enacting Homebirth Bodies: Midwifery Techniques in Germany

Skills and knowledge of midwives at free-standing birth centres and home birth: A meta-ethnography

PROBLEM

When midwives offer birth assistance at home birth and free-standing birth centres, they must adapt their skill set. Currently, there are no comprehensive insights on the skills and knowledge that midwives need to work in those settings.

BACKGROUND

Midwifery care at home birth and in free-standing birth centres requires context specific skills, including the ability to offer low-intervention care for women who choose physiological birth in these settings.

AIM

To synthesise existing qualitative research that describes the skills and knowledge of certified midwives at home births and free-standing birth centres.

STUDY DESIGN

We conducted a systematic review that included searches on 5 databases, author runs, citation tracking, journal searches, and reference checking. Meta-ethnographic techniques of reciprocal translation were used to interpret the data set, and a line of argument synthesis was developed.

RESULTS

The search identified 13 papers, twelve papers from seven countries, and one paper that included five Nordic countries. Three overarching themes and seven sub-themes were developed: 'Building trustworthy connections,' 'Midwife as instrument,' and 'Creating an environment conducive to birth.'

CONCLUSION

The findings highlight that midwives integrated their sensorial experiences with their clinical knowledge of anatomy and physiology to care for women at home birth and in free-standing birth centres. The interactive relationship between midwives and women is at the core of creating an environment that supports physiological birth while integrating the lived experience of labouring women. Further research is needed to elicit how midwives develop these proficiencies.

Comparison of Frequency of Home Births in the Member States of the EU Between 2015 and 2019

Introduction. The disagreement of the general public’s views on home births is practically identical for the professional public and specialists also. The core of the problem lies in the disunity between individual countries of the European Union—complete prohibition under the risk of committing a crime on one side and standard procedure perceived as something completely common on the other side. Methods. The authors focused on the prevalence of home births in individual EU countries, together with the proportion of neonatological mortality compared to the number of live births, which are data that, unlike home births, are mandatory in each EU Member State. Data on home births were obtained from available official and verified sources such as the Ministry of Health, reviews published by the WHO, or published peer-reviewed scientific and professional works. Secondary data were procured via Web of Science, Scopus, or PubMed. Results. The aim of the study was to trace the documented numbers of home births in the individual states of the European Union in the years 2015 to 2019, to analyze them with data on live births together and with data on infant mortality. A comparative analysis of the compiled data can be used to conclude which countries have the highest domestic birth rates and how the birth rate is manifested in these countries. Based on the analysis of available data, it can be determined that the Netherlands, Denmark, and Germany have the highest share of domestic births. The link between home births and increased neonatal mortality has not been established. Eastern Europe countries have the highest neonatal mortality, namely Romania (1.19%) and Malta (0.63%). Conclusion. The Netherlands has the highest domestic birth rate per 100 000 inhabitants with a 5-year average of 161 922 (overall average of all live births 993.40), but is also in 11th place in neonatal mortality, together with Denmark and Belgium, which have 0.35% neonatal neonatal mortality. The country with the lowest neonatal mortality of 0.19% is Slovenia. The total average of all children born in 5 years (915 live births) is 1.422. When monitoring the number of domestic births in other countries in the years 2015 to 2019, an increasing tendency of this trend is observed.

Thinking with attachments: Appreciating a generative analytic

Much current work in Science and Technology Studies inflects knowing with care. Analyses of the ethos of objectivity, and of the practices by which objectivity is crafted, have shown that knowing and caring cannot be thought apart from each other. Using case studies from our own work we analyse how, in the sociotechnical relationships that we study, knowing and caring are entangled through 'attachments'. We appreciate - both in the sense of valuing or respecting and in the sense of evaluating or assessing - how the notion of 'attachment' invites re-imagining relations between the social and the technical, between knowers and objects known, and between sociotechnical work and the affective sensibilities that enable, and are brought to life by, such work. Our respective ethnographic engagements with dog-human relations, obesity surgery and dementia care demonstrate that it is agents' diverse and shifting attachments to technologies and techniques that shape the ways in which bodies, knowledge and practices form. The affects that arise in this process, or so we claim in neo-pragmatist fashion, are not preconditions to, but rather the result of such practices of attachment; rather than a prerequisite, they are an effect of the work of attaching itself. Thinking with attachments recognizes how techno-scientific work builds and shapes passions, aesthetics and sensory experience, allowing us to trace how varied sensibilities to what constitutes 'the good' come to be and come to matter in practices of relating between humans, animals and things.

Triage as an infrastructure of care: The intimate work of redistributing medical care in nursing homes

This article explores how professionals in older persons care work on a triage system in the daily care setting. We follow how triage is introduced in older persons care organizations in The Netherlands, to deal with a scarcity of physicians and distribute care among health workers in the region. We offer a sociological analysis in which we use the notion of infrastructure and infrastructural work to study how professionals work with triage in the daily care setting. This study is based on a formative evaluation in which we as researchers both studied and contributed to the construction of the triage system by sharing and participating in reflexive infrastructural work practices. We show how this method enabled to gradually adjust the triage system to the daily practices of care delivery, taking the spatial-temporal setting of care into account. We argue that triage not only structures and simplifies but also opens up new ways of re-placing medical and care work, both professionally and geographically. As our results reveal, re-placing physicians has complex effects above and beyond the efficient deployment of medical staff. Triage as infrastructure not only changes the location, but also reconfigures the relationships physicians have with residents and nurse aids.

Experiences as Actors: Labor Pains in Childbirth Care in Germany

Taking labor pains in childbirth care in Germany as a case study, I develop a practice-based notion of experience. Labor pains are sociomaterial experiences and effected actors that are shared and "worked with." Drawing on fieldwork, I show an extensive repertoire of possible interventions used to deal with, and to co-enact, continuously shifting actorships of labor pains in childbirth care. These actorships include helpful tools, unproductive sensations, effective work, fruitless investments, products of bodily tension, and pure labor pains. Experiences such as labor pains are not only passively known, felt and done but also take active part in shaping (childbirth care) practices.