Background: Despite evidence supporting the safety of vaginal birth after caesarean section (VBAC), rates are low in many countries. Methods: OptiBIRTH investigated the effects of a woman-centred intervention designed to increase VBAC rates through an unblinded cluster randomised trial in 15 maternity units with VBAC rates < 35% in Germany, Ireland and Italy. Sites were matched in pairs or triplets based on annual birth numbers and VBAC rate, and randomised, 1:1 or 2:1, intervention versus control, following trial registration. The intervention involved evidence-based education of clinicians and women with one previous caesarean section (CS), appointment of opinion leaders, audit/peer review, and joint discussions by women and clinicians. Control sites provided usual care. Primary outcome was annual hospital-level VBAC rates before the trial (2012) versus final year of the trial (2016). Between April 2014 and October 2015, 2002 women were recruited (intervention 1195, control 807), with mode-of-birth data available for 1940 women. Results: The OptiBIRTH intervention was feasible and safe across hospital settings in three countries. There was no statistically significant difference in the change in the proportion of women having a VBAC between intervention sites (25.6% in 2012 to 25.1% in 2016) and control sites (18.3 to 22.3%) (odds ratio adjusted for differences between intervention and control groups (2012) and for homogeneity in VBAC rates at sites in the countries: 0.87, 95% CI: 0.67, 1.14, p = 0.32 based on 5674 women (2012) and 5284 (2016) with outcome data. Among recruited women with birth data, 4/1147 perinatal deaths > 24 weeks gestation occurred in the intervention group (0.34%) and 4/782 in the control group (0.51%), and two uterine ruptures (one per group), a rate of 1:1000. Conclusions: Changing clinical practice takes time. As elective repeat CS is the most common reason for CS in multiparous women, interventions that are feasible and safe and that have been shown to lead to decreasing repeat CS, should be promoted. Continued research to refine the best way of promoting VBAC is essential. This may best be done using an implementation science approach that can modify evidence-based interventions in response to changing clinical circumstances.
Abstract and poster (poster title differs).
MULTIFILE
This study theorizes on the sociomateriality of food in authority-building processes of partial organizations by exploring alternative food networks (AFNs). Through the construction of arenas for food provisioning, AFNs represent grassroots collectives that deliberately differentiate their practices from mainstream forms of food provisioning. Based on a sequential mixed-methods analysis of 24 AFNs, where an inductive chronological analysis is followed by a qualitative comparative analysis (QCA), we found that the entanglements between participants’ food provisioning practices and food itself shape how authority emerges in AFNs. Food generates biological, physiological and social struggles for AFN participants who, in turn, respond by embracing or avoiding them. As an outcome, most AFNs tend to bureaucratize over time according to four identified patterns while a few idiosyncratically build a more shared basis of authority. We conclude that the sociomateriality of food plays an important yet indirect role in understanding why and how food provisioning arenas re-organize and forge their forms of authority over time. Pascucci, S., Dentoni, D., Clements, J., Poldner, K., & Gartner, W. B. (2021). Forging Forms of Authority through the Sociomateriality of Food in Partial Organizations. Organization Studies, 42(2), 301-326. https://doi.org/10.1177/0170840620980232
