Invariant envelopes of holomorphy in the complexification of a Hermitian symmetric space

In this paper we investigate invariant domains in $\, \Xi^+$, a distinguished $\,G$-invariant, Stein domain in the complexification of an irreducible Hermitian symmetric space $\,G/K$. The domain $\,\Xi^+$, recently introduced by Kr\"otz and Opdam, contains the crown domain $\,\Xi\,$ and it is maximal with respect to properness of the $\,G$-action. In the tube case, it also contains $\,S^+$, an invariant Stein domain arising from the compactly causal structure of a symmetric orbit in the boundary of $\,\Xi$. We prove that the envelope of holomorphy of an invariant domain in $\,\Xi^+$, which is contained neither in $\,\Xi\,$ nor in $\,S^+$, is univalent and coincides with $\,\Xi^+$. This fact, together with known results concerning $\,\Xi\,$ and $\,S^+$, proves the univalence of the envelope of holomorphy of an arbitrary invariant domain in $\,\Xi^+\,$ and completes the classification of invariant Stein domains therein.Comment: 24 page

Geometry of Hermitian symmetric spaces under the action of a maximal unipotent group

Let G/K be a non-compact irreducible Hermitian symmetric space of rank r and let NAK be an Iwasawa decomposition of G. By the polydisc theorem, AK/K can be regarded as the base of an r-dimensional tube domain holomorphically embedded in G/K. As every N-orbit in G/K intersects AK/K in a single point, there is a one-to-one correspondence be- tween N-invariant domains in G/K and tube domains in the product of r copies of the upper half-plane in C. In this setting we prove a generalization of Bochner’s tube theorem. Namely, an N-invariant domain D in G/K is Stein if and only if the base Ω of the associated tube domain is convex and “cone invariant”. We also obtain a precise description of the envelope of holomorphy of an arbitrary holomorphically separable N-invariant domain over G/K. An important ingredient for the above results is the characterization of several classes of N-invariant plurisubharmonic funtions on D in terms of the corresponding classes of convex functions on Ω. This also leads to an explicit Lie group theoretical description of all N-invariant potentials of the Killing metric on G/K

An exploration of midwives’ approaches to slow progress of labour in birth centres, using case study methodology

Background: Slow progress of labour (SPL) occurs in 3-37% of all labours. It constitutes the main cause of primary caesarean section (CS) and is associated with operative births, maternal and foetal morbidity, and a negative birthing experience. SPL is also the principal reason for the transfers of women from midwife-led units (MLUs) or their home, to hospitals. The current standard medical management of SPL, including intravenous administration of synthetic oxytocin and artificial rupture of membranes (ARM), has been increasingly questioned and the need for alternatives recommended. A midwifery approach to SPL represents a possible important alternative. However, contemporary literature shows a surprising dearth of research concerning midwives’ approaches to SPL. Birth centres appear ideal settings for exploring a midwifery approach to SPL, given the strong midwifery philosophy and the relevance of SPL reported in these contexts. Aim: To explore midwives’ approaches to SPL in birth centres, focusing in particular on midwives’ understanding of the phenomenon, diagnostic process, clinical management and decision-making. Methods: A qualitative multiple case study, underpinned by a critical realist perspective. Midwives’ approaches to SPL represented the ‘case’ of interest; an Italian alongside- (AMU) and an English freestanding- (FMU) midwifery units were purposively selected as case-sites. Data was collected between November 2012 and July 2013, after obtaining all necessary ethical approvals. An inductive reasoning, and triangulation logic characterised data collection. Multiple methods were adopted including individual semi-structured interviews, focus groups, observations and document reviews. Practising midwives, midwife managers and two lead obstetricians were included as participants after obtaining written informed consent. Data was analysed at two levels, within-case and cross-case, using a thematic analysis. Findings from the cross-case analysis supported the development of assertions and final conceptualisation regarding midwives’ approaches to SPL in birth centres. Findings: At the Italian site, midwives identified SPL as the problem of their care in the AMU. They perceived the process of recognition of this phenomenon as an engaging challenge and attempted to untangle the main cause amongst the many intertwined ones, in order to tailor their approach. Dealing with SPL represented a struggle; midwives adopted several different interventions and their decisions appeared enabled or constrained by numerous factors, especially the problematic relationship with the hospital staff. At the English site, SPL was not considered an issue, midwives were keen in looking at diagnostic and causal factors of SPL within a bigger picture. Midwives’ interventions aimed at giving women the best chance to overcome SPL and give birth in the FMU. The several influential factors were managed by many midwives through experience. Across cases, midwives’ understanding of SPL varied. SPL was acknowledged to result from a complex interaction of causes. Early labour was considered a critical stage for the development of SPL. The process of recognition of SPL appeared a dynamic one and aimed at reaching an objective diagnosis. Distinguishing whether SPL represented a physiological rest or arrest of labour progress represented an emerging dilemma. Midwives tailored interventions to single situations. Some interventions appeared to be fundamental to midwifery care, whilst others depended on various factors. Midwives’ relationships with all factors in the context appeared to be pivotal for both performing interventions and decision-making. Conclusion: This is the first case study exploring midwives’ approaches to SPL in birth centres, in both an English and an Italian context. This research outlines midwives’ approaches to SPL as a result of a complex and dynamic system. Midwives’ understanding, identification, clinical management of SPL and decision-making represents a multifaceted and stratified reality. The individual characteristics of the women, the birth attendants, the midwife, and colleagues, as well as the relationships occurring in this context, represent the main factors whose variable interactions may result in variable manifestations of the midwifery approach. On the basis of the findings of this research, recommendations are made for midwifery practice, education and research

An exploration of midwives’ approaches to slow progress of labour in birth centres, using case study methodology

Background: Slow progress of labour (SPL) occurs in 3-37% of all labours. It constitutes the main cause of primary caesarean section (CS) and is associated with operative births, maternal and foetal morbidity, and a negative birthing experience. SPL is also the principal reason for the transfers of women from midwife-led units (MLUs) or their home, to hospitals. The current standard medical management of SPL, including intravenous administration of synthetic oxytocin and artificial rupture of membranes (ARM), has been increasingly questioned and the need for alternatives recommended. A midwifery approach to SPL represents a possible important alternative. However, contemporary literature shows a surprising dearth of research concerning midwives’ approaches to SPL. Birth centres appear ideal settings for exploring a midwifery approach to SPL, given the strong midwifery philosophy and the relevance of SPL reported in these contexts. Aim: To explore midwives’ approaches to SPL in birth centres, focusing in particular on midwives’ understanding of the phenomenon, diagnostic process, clinical management and decision-making. Methods: A qualitative multiple case study, underpinned by a critical realist perspective. Midwives’ approaches to SPL represented the ‘case’ of interest; an Italian alongside- (AMU) and an English freestanding- (FMU) midwifery units were purposively selected as case-sites. Data was collected between November 2012 and July 2013, after obtaining all necessary ethical approvals. An inductive reasoning, and triangulation logic characterised data collection. Multiple methods were adopted including individual semi-structured interviews, focus groups, observations and document reviews. Practising midwives, midwife managers and two lead obstetricians were included as participants after obtaining written informed consent. Data was analysed at two levels, within-case and cross-case, using a thematic analysis. Findings from the cross-case analysis supported the development of assertions and final conceptualisation regarding midwives’ approaches to SPL in birth centres. Findings: At the Italian site, midwives identified SPL as the problem of their care in the AMU. They perceived the process of recognition of this phenomenon as an engaging challenge and attempted to untangle the main cause amongst the many intertwined ones, in order to tailor their approach. Dealing with SPL represented a struggle; midwives adopted several different interventions and their decisions appeared enabled or constrained by numerous factors, especially the problematic relationship with the hospital staff. At the English site, SPL was not considered an issue, midwives were keen in looking at diagnostic and causal factors of SPL within a bigger picture. Midwives’ interventions aimed at giving women the best chance to overcome SPL and give birth in the FMU. The several influential factors were managed by many midwives through experience. Across cases, midwives’ understanding of SPL varied. SPL was acknowledged to result from a complex interaction of causes. Early labour was considered a critical stage for the development of SPL. The process of recognition of SPL appeared a dynamic one and aimed at reaching an objective diagnosis. Distinguishing whether SPL represented a physiological rest or arrest of labour progress represented an emerging dilemma. Midwives tailored interventions to single situations. Some interventions appeared to be fundamental to midwifery care, whilst others depended on various factors. Midwives’ relationships with all factors in the context appeared to be pivotal for both performing interventions and decision-making. Conclusion: This is the first case study exploring midwives’ approaches to SPL in birth centres, in both an English and an Italian context. This research outlines midwives’ approaches to SPL as a result of a complex and dynamic system. Midwives’ understanding, identification, clinical management of SPL and decision-making represents a multifaceted and stratified reality. The individual characteristics of the women, the birth attendants, the midwife, and colleagues, as well as the relationships occurring in this context, represent the main factors whose variable interactions may result in variable manifestations of the midwifery approach. On the basis of the findings of this research, recommendations are made for midwifery practice, education and research

Early labour midwifery care in Italy: local and cross-cultural challenges

INTRODUCTION. The definition of early labour and its management are debatable issues at a local, national and international level. In Italy, this issue is also of concern. APPROACH. This is a descriptive discussion paper designed to portray the cross-cultural issues and the comparisons between Italian and international early labour care. KEY ISSUES. Many of the issues regarding early labour care in Italy resonate with what emerged from the international literature. These include the dilemmas of diagnosis and management of early labour, appropriate timing for women’s admission to hospitals in the latent phase and the type of maternity service available to women in early labour. The lack of a mapping of the geographically variable services offered to women in the Italian peninsula makes the task of offering national data to international research on early labour care challenging as little is known about the availability, efficiency and effectiveness of triage systems for women in the latent phase of labour. THE WAY FORWARD. The organisation of maternity services within the Italian national health system requires a review to consider how best to meet women’s needs during early labour. Research in this field needs to be carried out in Italian birthing settings in order to be able to understand what would work best for women within the specific socio-cultural context and what is required to enhance midwifery knowledge and skill