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.
Hoofdstuk in The history of youth work in Europe and its relevance for youth policy today. Youth work in the Netherlands goes back a long way and since the 1970s has taken on a rather strong professional image. During the last decades, it went through some hard times, but recently it has undergone a revival and revaluation. (Griensven & Smeets, 2003). The first section of this paper is about how the characteristics of the Dutch affect social work and youth work concepts. The second part discusses the Dutch framework for youth work: definition, fields of activities, core tasks and the ambiguous relationship between youth work and social work. The third section deals with the history of youth work. The paper concludes with a reflection on the future directions that youth work could take. The article is based on Dutch historical research, some by the author, and the author’s involvement in youth work, both as a youth worker and editor- in- chief of the semi-scientific journal Jeugd en samenleving.
The World Hunt: An Environmental History of the Commodification of Animals is written by John F. Richards, a ‘pioneer in environmental history’ as J. R. McNeill calls him in his introduction to the volume. This introduction explains how this unique yet not always easily accessible text exploring the environmental and socio-economic dimensions of commercial exploitation of non-humans came into being, and how it can be seen in the contexts of the history of human relationships to the environment and of contemporary ethics. The World Hunt is an unusual volume in that it blends environmental history, the dispassionate narrative of facts, with a voice that is at times full of hurt, as it expresses genuine concern for the voiceless victims of hunters’ increasingly global pursuits. The volume is essentially an extract from the meticulously researched and finely detailed history of hunting, fishing and whaling presented in Richards’ exhaustive The Unending Frontier. https://doi.org/10.1016/j.biocon.2014.09.025 https://www.linkedin.com/in/helenkopnina/
MULTIFILE
