"It can't be like last time" - Choices made in early pregnancy by women who have previously experienced a traumatic birth

Background: A significant number of women experience childbirth as traumatic. These experiences are often characterized by a loss of control coupled with a perceived lack of support and inadequate communication with health care providers. Little is known about the choices women make in subsequent pregnancy(s) and birth(s), or why they make these choices. This study aimed to understand these choices and explore the reasons behind them.Methods: A longitudinal grounded theory methods study involving nine women was conducted. Over half of the participants had a formal diagnosis of post-traumatic stress disorder (PTSD) and/or PND related to the previous birth. Interviews were carried out at three timepoints perinatally. These findings are from the first interviews at 12–20 weeks.Results: From the first days of pregnancy, this cohort of women were focused on concerns that this birth would be a repeated traumatic experience. The women were deliberately searching out and analyzing information about their choices in this pregnancy and birth, and making plans which had two aims; firstly to avoid a repeat of their previous birth experience and secondly to avoid a loss of control to other people during the birth. The women considered a range of birth choices, from elective cesareans to freebirth. Some women felt well supported by those around them, including care providers, partners, friends, and family. Others did not feel supported and were anticipating conflict in trying to assert their birth choices. Many early relationships with healthcare professionals were characterized by fear and mistrust.Discussion: If women who have previously experienced a traumatic birth become pregnant again, they have a strong desire to avoid a repeat experience and to feel in control of their birth choices. Access to robust information appears to help reduce uncertainty and arm women in their discussions with professionals. Similarly making plans and seeking to have them agreed with care providers at an early stage is used a way to reduce the risk of having a further traumatic experience. Implications for practice include supporting women in formulating and confirming pregnancy and birth plans at an early stage to reduce uncertainty and foster a sense of control

How important were formalized charity and social spending before the rise of the welfare state? A long-run analysis of selected Western European cases, 1400-1850

Poor relief in the pre-industrial period is a much-investigated topic, but we still lack an idea of its quantitative importance and development, especially in a comparative perspective. This article estimates the magnitude of the various kinds of formalized relief for three present-day countries (Italy, England, and the Netherlands) in the very long run (1400–1850). The results show that in this period a substantial share of GDP, up to 3 per cent, could be spent on formal relief, offering subsistence to up to 8–9 per cent of the population, with a gradual rise over time and the highest figures being reached in the Netherlands in the eighteenth century. The three cases show a steep decline around 1800, a pattern found more generally in Europe. Next, these results are placed in a broader geographical perspective. This highlights the sharp differences within countries—which could be even larger than those between countries—and the high levels reached in the regions bordering the southern shores of the North Sea. In the last section, the results are used to discuss the possible causes underlying these long-run patterns and geographical differences, including urbanization, wealth, religion, and social-organizational features