Alternative versus conventional institutional settings for birth

Background: Alternative institutional settings have been established for the care of pregnant women who prefer and require little or no medical intervention. The settings may offer care throughout pregnancy and birth, or only during labour; they may be part of hospitals or freestanding entities. Specially designed labour rooms include bedroom-like rooms, ambient rooms, and Snoezelen rooms. Objectives: Primary: to assess the effects of care in an alternative institutional birth environment compared to care in a conventional institutional setting. Secondary: to determine if the effects of birth settings are influenced by staffing, architectural features, organizational models or geographical location. Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2010). Selection criteria: All randomized or quasi-randomized controlled trials which compared the effects of an alternative institutional maternity care setting to conventional hospital care. Data collection and analysis: We used standard methods of the Cochrane Collaboration Pregnancy and Childbirth Group. Two review authors evaluated methodological quality. We performed double data entry and have presented results using risk ratios (RR) and 95% confidence intervals (CI). Main results: Nine trials involving 10684 women met the inclusion criteria. We found no trials of freestanding birth centres or Snoezelen rooms. Allocation to an alternative setting increased the likelihood of: no intrapartum analgesia/anaesthesia (five trials, n = 7842; RR 1.17, 95% CI 1.01 to 1.35); spontaneous vaginal birth (eight trials; n = 10,218; RR 1.04, 95% CI 1.02 to 1.06); breastfeeding at six to eight weeks (one trial, n = 1147; RR 1.04, 95% CI 1.02 to 1.06); and very positive views of care (two trials, n = 1207; RR 1.96, 95% CI 1.78 to 2.15). Allocation to an alternative setting decreased the likelihood of epidural analgesia (seven trials, n = 9820; RR 0.82, 95% CI 0.75 to 0.89); oxytocin augmentation of labour (seven trials, n = 10,020; RR 0.78, 95% CI 0.66 to 0.91); and episiotomy (seven trials, n = 9944; RR 0.83, 95% CI 0.77 to 0.90). There was no apparent effect on serious perinatal or maternal morbidity/mortality, other adverse neonatal outcomes, or postpartum hemorrhage. No firm conclusions could be drawn regarding the effects of variations in staffing, organizational models, or architectural characteristics of the alternative settings. Authors' conclusions: When compared to conventional settings, hospital-based alternative birth settings are associated with increased likelihood of spontaneous vaginal birth, reduced medical interventions and increased maternal satisfactio

Insider Action research as an approach and a method – Exploring institutional encounters from within a birthing context

The aim of this paper was to describe the first person perspective of being a peer midwife and a novice researcher initiating collaborative AR in her own organization to develop knowledge about the first encounters between the labouring woman and her care-givers in a hospital birthing context. It was motivated by the author’s longstanding professional clinical experience of observing and hearing parents’ stories of vulnerability and fear of childbirth, and how staff’s attitudes affected the childbirth experience negatively. Data were collected between 2010 and 2013 and included the researcher’s log with reflections from clinical work, as well as interviews, participant observation, and research group communications. A reflective interpretative lifeworld research approach was used to analyze the data. The experience of being a novice insider action researcher (IARr) consisted of three thematic meanings: ‘‘the struggle to initiate a clinical insider action research project,’’ ‘‘standing alone at the messy front line,’’ and ‘‘being a catalytic counterbalance to the prevailing medico technical focus.’’ The comprehensive understanding was ‘‘learning how to clinically reflect on and to voice the tacit components of care.’’ The strategy used in undertaking this study was influenced by the philosophies of both midwifery care and AR

THE REFORM OF FRENCH CONTRACT LAW: A CRITICAL OVERVIEW

Since the Napoleonic Code of 1804 we have seen republics, monarchies and empires coming and going; local and world wars; revolutions, from the industrial to the informational; and our society has moved from an economy based on agriculture to one open to the world, based on tertiary services. In all this time, French contract law has been able to stay up and keep up to date with the many changes in society, thanks to the judicial interpretation of the various articles of the French civil code and the generality of its articles. There have been many previous attempts to reform French contract law but its principles, forged in 1804, have escaped unscathed, except for certain transpositions of European directives. This article focuses on an academic point of view with regards the reforms to the French civil code that will bring private contract law into line with modern international standards. This is the first step in a series of broader changes the government is making to the French law of obligations. This reform is said to have both adapted and revolutionised French contract law and merits scholarly attention.Since the Napoleonic Code of 1804 we have seen republics, monarchies and empires coming and going; local and world wars; revolutions, from the industrial to the informational; and our society has moved from an economy based on agriculture to one open to the world, based on tertiary services. In all this time, French contract law has been able to stay up and keep up to date with the many changes in society, thanks to the judicial interpretation of the various articles of the French civil code and the generality of its articles. There have been many previous attempts to reform French contract law but its principles, forged in 1804, have escaped unscathed, except for certain transpositions of European directives. This article focuses on an academic point of view with regards the reforms to the French civil code that will bring private contract law into line with modern international standards. This is the first step in a series of broader changes the government is making to the French law of obligations. This reform is said to have both adapted and revolutionised French contract law and merits scholarly attention

Selling Sex, Studying Sexuality: Voices of Costa Rican Prostitutes and Visions of Feminists

This paper explores the images of disembodiment and disengagement put forth in feminist representations of prostitution and prostitutes and contrasts them to the embodied and engaged experiences of fifty-three street prostitutes in San Jose, Costa Rica. The importance of focusing on the global as well as local context is emphasized.Cet exposé explore les images de désincamement et de désengagement présentées dans les représentations féministes de la prostitution et des prostituées et les compare aux expériences incarnées et engagées des prostituées de la cinquante-troisième rue à San José à Costa Rica. On souligne l’importance de se concentrer au contexte mondial anisi qu'au contexte local

"Force Fields" of Motherhood and Maternal Empowerment: An Indigenous Mother in Canada Engages the Narratives of African Caribbean Mothers in Barbados

Isabel is a grandmother from a northern Cree community in Saskatchewan. As she copes with temporarily losing custody of her young grandson, she engages with the stories of two mothers from the eastern Caribbean, one who lives a similar life to hers and one from over two hundred years ago. This article presents that narrative engagement and argues that it constitutes a force field of maternal affinity that allows Isabel to recollect her own grandmother’s strength and perseverance. This kind of maternal affinity—extending across geographical distance, cultural divides, and historical periods—can be a source for maternal empowerment in three ways. First, it establishes a motherline that is significant in times of distress. Second, it gives rise to redemptive narratives that help mothers living with HIV and addiction navigate and mitigate the intruding forces of marginalization and disruption. Third, it creates a sense of longevity and safety that can be a much needed reprieve from the oppressive surveillance and scrutiny that Indigenous mothers in Canada face

THE DETERMINANTS OF VOTER TURNOUT IN ENGLISH LOCAL GOVERNMENT ELECTIONS

SIGLEAvailable from British Library Document Supply Centre-DSC:DXN017348 / BLDSC - British Library Document Supply CentreGBUnited Kingdo