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The importance of evaluating primary midwifery care for improving the health of women and infants

In most countries, maternal and newborn care is fragmented and focused on identification and treatment of pathology that affects only the minority of women and babies. Recently, a framework for quality maternal and newborn care was developed, which encourages a system-level shift to provide skilled care for all.This care includes preventive and supportive care that works to strengthen women’s capabilities and focuses on promotion of normal reproductive processes while ensuring access to emergency treatment when needed. Midwifery care is pivotal in this framework, which contains several elements that resonate with the main dimensions of primary care. Primary health care is the first level of contact with the health system where most of the population’s curative and preventive health needs can be fulfilled as close as possible to where people live and work. In this paper, we argue that midwifery as described in the framework requires the application of a primary care philosophy for all childbearing women and infants. Evaluation of the implementation of the framework should therefore include tools to monitor the performance of primary midwifery care.

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The importance of evaluating primary midwifery care for improving the health of women and infants

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Hechting, therapeutische relatie en behandeluitkomsten binnen de ambulante verslavingszorg

Onderzoeken laten zien dat hechtingsstijlen veranderbaar zijn als gevolg van psychologische behandeling. Doel was om na te gaan of hechting ook binnen een psychologische behandeling van verslaving kan veranderen. Daartoe is bij 49 cliënten in de ambulante verslavingszorg gekeken of de therapeutische relatie invloed had op de hechting van een cliënt. Op groepsniveau werd gevonden dat de hechtingsstijl niet veranderde, maar op individueel niveau werd verband gevonden tussen de therapeutische relatie en de vermijdende component van hechting na de behandeling. Ook werd, in overeenstemming met ander onderzoek, verband gevonden tussen veranderingen in de angstige component maar niet de vermijdende component van hechting met veranderingen in sociaal steunende interacties en klachten. Binnen de groep mensen met een verslaving werden geen significante veranderingen van hechting (vermijding en angst) gevonden, terwijl dit in andere populaties wel werd gevonden. Wel werd, zoals verwacht, een relatie gevonden tussen een hechtingscomponent en uitkomstmaten.

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Hechting, therapeutische relatie en behandeluitkomsten binnen de ambulante verslavingszorg

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Art in social work practice

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Prosocial preferences can escalate intergroup conflicts by countering selfish motivations to leave

When defending against hostile enemies, individual group members can benefit from others staying in the group and fighting. However, individuals themselves may be better off by leaving the group and avoiding the personal risks associated with fighting. While fleeing is indeed commonly observed, when and why defenders fight or flee remains poorly understood and is addressed here with three incentivized and preregistered experiments (total n = 602). In stylized attacker-defender contest games in which defenders could stay and fight or leave, we show that the less costly leaving is, the more likely individuals are to abandon their group. In addition, more risk-averse individuals are more likely to leave. Conversely, individuals more likely stay and fight when they have pro-social preferences and when fellow group members cannot leave. However, those who stay not always contribute fully to group defense, to some degree free-riding on the efforts of other group members. Nonetheless, staying increased intergroup conflict and its associated costs.

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Prosocial preferences can escalate intergroup conflicts by countering selfish motivations to leave

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Need for answers: conspiracy theories and other religions

Polarizing may be a logical consequence, but it’s certainly not helpful. Of course I understand that everyone wants to regain control of the situation. However, sacrificing transmissions towers, or even human scapegoats to satisfy our need to understand, crosses every line. But it is easy to understand that in their conspiracy theories people try to regain control of a reality that is beyond any understanding. It’s actually also quite cheap to dismiss everything as superstition and fake news, it doesn’t meet our scientific standards.

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Need for answers: conspiracy theories and other religions

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Neuroscience can contribute to change management: STREAP-Be model

In our world of VUCA (volatile, uncertain, complex and ambiguous), a capacity for change and adaption is vital. However, changing successfully has been a challenging task for both individuals and organizations. Taking into account the insights of neuroscience, this chapter introduces a framework of change management called STREAP-Be. The acronym represents 7 factors that could significantly influence the effect of change: safety; trigger; reward; emotion; alignment; people; and behavior.

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Neuroscience can contribute to change management: STREAP-Be model

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Beta talent forward (2)

This colomn is the sequel of the colomn Beta talent forward. In this colomn the central question is how our autistiform beta talent candidates can use their powers as part of the "tribe", so that they reinforce the team 's intelligence.

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Regional variations in childbirth interventions and their correlations with adverse outcomes, birthplace and care provider

Background Variations in childbirth interventions may indicate inappropriate use. Most variation studies are limited by the lack of adjustments for maternal characteristics and do not investigate variations in adverse outcomes. This study aims to explore regional variations in the Netherlands and their correlations with referral rates, birthplace, interventions, and adverse outcomes, adjusted for maternal characteristics. Methods In this nationwide retrospective cohort study, using a national data register, intervention rates were analysed between twelve regions among single childbirths after 37 weeks’ gestation in 2010–2013 (n = 614,730). These were adjusted for maternal characteristics using multivariable logistic regression. Primary outcomes were intrapartum referral, birthplace, and interventions used in midwife- and obstetrician-led care. Correlations both between primary outcomes and between adverse outcomes were calculated with Spearman’s rank correlations. Findings Intrapartum referral rates varied between 55–68% (nulliparous) and 20–32% (multiparous women), with a negative correlation with receiving midwife-led care at the onset of labour in two-thirds of the regions. Regions with higher referral rates had higher rates of severe postpartum haemorrhages. Rates of home birth varied between 6–16% (nulliparous) and 16–31% (multiparous), and was negatively correlated with episiotomy and postpartum oxytocin rates. Among midwife-led births, episiotomy rates varied between 14–42% (nulliparous) and 3–13% (multiparous) and in obstetrician-led births from 46–67% and 14–28% respectively. Rates of postpartum oxytocin varied between 59–88% (nulliparous) and 50–85% (multiparous) and artificial rupture of membranes between 43–52% and 54–61% respectively. A north-south gradient was visible with regard to birthplace, episiotomy, and oxytocin. Conclusions Our study suggests that attitudes towards interventions vary, independent of maternal characteristics. Care providers and policy makers need to be aware of reducing unwarranted variation in birthplace, episiotomy and the postpartum use of oxytocin. Further research is needed to identify explanations and explore ways to reduce unwarranted intervention rates.

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Regional variations in childbirth interventions and their correlations with adverse outcomes, birthplace and care provider

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Birth as a neuro-psycho-social event

Background Psychological aspects of labor and birth have received little attention within maternity care service planning or clinical practice. The aim of this paper is to propose a model demonstrating how neurohormonal processes, in particular oxytocinergic mechanisms, not only control the physiological aspects of labor and birth, but also contribute to the subjective psychological experiences of birth. In addition, sensory information from the uterus as well as the external environment might influence these neurohormonal processes thereby influencing the progress of labor and the experience of birth. Methodology In this new model of childbirth, we integrated the findings from two previous systematic reviews, one on maternal plasma levels of oxytocin during physiological childbirth and one meta-synthesis of women´s subjective experiences of physiological childbirth. Findings The neurobiological processes induced by the release of endogenous oxytocin during birth influence maternal behaviour and feelings in connection with birth in order to facilitate birth. The psychological experiences during birth may promote an optimal transition to motherhood. The spontaneous altered state of consciousness, that some women experience, may well be a hallmark of physiological childbirth in humans. The data also highlights the crucial role of one-to-one support during labor and birth. The physiological importance of social support to reduce labor stress and pain necessitates a reconsideration of many aspects of modern maternity care. Conclusion By listening to women’s experiences and by observing women during childbirth, factors that contribute to an optimized process of labor, such as the mothers’ wellbeing and feelings of safety, may be identified. These observations support the integrative role of endogenous oxytocin in coordinating the neuroendocrine, psychological and physiological aspects of labor and birth, including oxytocin mediated. decrease of pain, fear and stress, support the need for midwifery one-to-one support in labour as well as the need for maternity care that optimizes the function of these neuroendocrine processes even when birth interventions are used. Women and their partners would benefit from understanding the crucial role that endogenous oxytocin plays in the psychological and neuroendocrinological process of labor.

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The importance of evaluating primary midwifery care for improving the health of women and infants