Childbirth Cultures, Concerns and Consequences: iResearch4Childbirth
Scientific report: Meeting, March 21st- 24th 2011 Athens Greece
Programme for the event
Monday March 21st
9:00-11:00: Action core group meeting
11.00-11:30 Introductions to groups and STSM recipients
11:30-12:30 ESR Think Tank
13.00-16.00 Workshop Fetal and infant psychology (1)
16.00-18.00 Discussion Web requirements and solutions
Tuesday March 22nd
9:00-12:00 Workshop Fetal and infant psychology (2)
13:00 -15.00 Workshop Systematic reviews: quality assessment and analytic strategies
15.00-16.30 Discussion Setting up Communities of Practice
16.30-18.00 Working Groups
Wednesday March 23rd
9:00-12:00 Working Groups/STSM activities, continued
12:00-12:30 Presentation: What outcomes matter for maternity care research?
13:00-16:00 Working Groups/STSM activities, continued
16.00-18.00 Working Group/STSM feedback and discussion
Thursday March 24th
7:30-10:00 Management Committee meeting
Attendees: see Appendix One
SUMMARY OF ACTIVITIES
The meeting was attended by 49 individuals. 27 were MC members or other COST staff, 7 were invited experts, and 15 were interested observers/collaborators. Since the meeting in the UK in September 2011 three non-COST applications to join the Action had been approved (from China, South Africa and Australia), and representatives from two of these countries (China and South Africa) attended the meeting in Athens. The event continued the networking and collaborations that had started at the first meeting in the UK in September 2010, and which had been building by virtual means since then. A presentation and three workshops were run, covering aspects of prenatal psychology (two workshops), the quality assessment and analysis of systematic reviews, and ways of determining and assessing optimum outcomes for maternity care.
The time set aside for WG activity provided the opportunity to build on the work on question setting and search strategy development that commenced in the UK in September 2010. WG’s had been working on these questions over the intervening months, and, in one case (WG3) had reached the point of having two outline papers already prepared, as well as significant progress on their core systematic review. Other WG’s were at various stages in the process. By the end of the working time in Athens, at least one group (WG4) had created two distinct sub-groups, one working on salutogenesis and one on complexity. These new sub-divisions allowed for the incorporation of new members into the Action since September 2010. All WG’s made significant progress, and all have plans to complete their reviews by September 2011, as planned.
New ESR’s had joined the Action since September 2010. They met, and undertook blue skies thinking to determine what they would like to gain from the Action over the next three years. This generated a list of requests and activities. It was agreed by the MC on the final day of the meeting that a new WG would be set up (WG6) that was focused on ESR activity. Three individuals, Fen Cheung (China), Claudia Meier Magistretti (Switzerland) and Kristin Akerjordet (Norway) agreed to co-chair this WG on a rotational basis, with two of them taking the lead at any one time.
The possibility of making a bid against the July FP7 call was discussed in all the WG’s, and in the MC. It was felt there might be scope for two separate bids, one focused on organisational aspects of maternity care (coordinated by Dr Lucy Frith, UK) and the other on service user engagement (led by Professor Cecily Begley, Ireland). Activity on both of these bids has continued since the meeting, using virtual media.
Matters relating to the organisation of the Action
The short title of the Action was agreed by the MC (iResearch4Birth). All those present were asked to contribute designs for a logo, and 8 potential designs were submitted. Following voting by the whole group, one of these was selected to be taken forward to the webdesigners to tidy up for the website.
As noted above, building on the activity of the pre-existing and new ESR’s in the Action, the MC agreed to support the set up of WG6, with a focus on the development of ESR’s. The MC also noted that work was not currently taking place in one specific aspect of the MoU, namely prenatal diagnosis and antenatal care. It was proposed that a new WG should also be set up to address this topic, and members of the MC present at the meeting indicated that they would be willing to become active members of this WG. The MC agreed in principle to set up WG7. The practicalities of this will be discussed at the next Core Group Skype meeting in June 2011.
It was agreed that the Core group will organise the set up of a peer review subgroup of 3 people from the MC, to work on a rolling basis, with a fixed time over which they will undertake the work before they hand it to the next three members. This group will review all publications, papers, grants proposals, presentations and posters that are outputs of the Action, based on an agreed checklist of relevant criteria. The checklist will be produced by the core group.
Discussion on the Work Plan for the second year of the Action included recognition that it would be helpful to be able to offer more STSM’s next year. More discussion also took place on how the proposed Community of Practice should be set up.
Discussions on the look and functionality of the website continued, led by Hugh Wiseman, who will be providing the technical expertise to build the Action website.
A number of individuals have undertaken presentations relating to the Action, for internal audiences. One article has been published in an internal Swiss university journal, and a poster has been accepted for a Swiss Midwifery Conference, Schweizer Hebammenkongress, Fribourg, 12./13.. Mai 2010
(see Appendix Two).
Workshop 1 and 2
Action expert: Olga Gourni, Greece
Invited expert: Professor Marti Glenn, USA
These two workshops were synergistic. In the first one, Olga Gourni presented a novel, stimulating and challenging view of the nature and effect of prenatal psychology in the mother and the infant, and the inter and cross-generational effects of this that have been postulated over recent years. This workshop presented the information from the point of view of a practitioner in the field. The second workshop, presented by Professor Glenn, focused on theoretical perspectives, and on current research evidence. It also included examples of how this knowledge has influenced and been integrated into practice, and how practice has, in turn, influenced research questions. The general philosophical and evidential underpinning for both workshops can be summed up in the following précis of a paper published by Professor Glenn and Dr Wendy Anne McCarthy.
There is an alarming rise in prematurity, low-birth weight, surgical births, autism, ADHD, childhood aggression and depression, asthma, overweight and obese children, attachment disorders, learning disabilities, and use of psychiatric drugs to manage children’s conditions, as well as a rise in the number children in foster care, adolescent homicide, child abuse and teen pregnancy. There is a risk of a range of poor outcomes and social ills for these children, as they become adults. Interestingly, insights from the field of economics—human capital theory and monetary payoffs—have contributed to a shift in early childhood policies. Prize–winning economists, and other business and economic leaders have led the call to increase public “investments” in early childhood. This call is driven by research findings that increasingly emphasize the importance of laying a strong foundation in early childhood and that show that a range of early interventions can successfully put children on the path toward positive development, preventing poor outcomes in adulthood. The key to re-visioning of a healthy economy, healthy communities, families and children, is one that is built upon decades of research and wisdom across many fields of inquiry and practice and begins at the conception of human life. During the primary period of human development, from preconception through the first year of postnatal life, the core foundations of physical and mental health, emotional intelligence, and the ability to develop one’s capacities and talents are established. Brain structures, capacity for resiliency and productivity are all built upon this primary foundation.
Emerging research on brain development, as well as clinical findings, now demonstrate that kindergarten and pre-school are far too late for interventions to have the optimum effect. Developmental neuroscience, and studies of attachment and childhood trauma have together transformed our view of infancy and childhood. It is clear that very early experiences establish the core wiring and architecture of the brain as well as key foundations for future health, emotional stability and resiliency. Early experience, early relationships, and the interplay between gene expression and environmental conditions are essential to establishing healthy foundations for life.
The newest developments in science and psychology suggest that the most critical formative period goes back even earlier than birth. Findings from an array of disciplines point to the period between pre-conception through baby’s first postnatal year as the most “sensitive and critical period” in the establishment of life patterns in all domains: physical, mental, emotional, relational, and spiritual. Prenatal and perinatal psychology has been studying our earliest development from the baby’s point of view, from pre-conception through birth and bonding, for over 30 years. The field’s research and clinical experience have established the fact that our earliest experiences form the foundation of our sense of self, our capacity to relate to others and our resiliency in life. This work has also effectively mapped out key nodal points of development that need to be met in order to promote healthy life patterns. This has relevance for maternity care, as well as for the field of prenatal psychology.
Systematic review techniques (2)
Invited expert: Dr Beverley French, University of Central Lancashire, UK
This workshop continued on from the introductory session that was run by Dr French in the UK in September 2010. On this occasion, the workshop presented a range of different techniques and perspectives on quality assessment of papers included in systematic reviews, and on ways of analysing the data in included papers. The workshop paid particular attention to reviews of data that are complex and varied, where standard meta-analytic or meta-synthesis techniques would not be applicable. Examples included policy documents, opinion pieces, and mixed methods research. The session combined teaching with interactive and iterative debate and work-throughs. Beverley then worked iteratively with each WG as they progressed their systematic reviews later in the meeting.
What outcomes are important in maternity care, and how should they be measured?
Invited expert: Professor Jo Green, University of York, UK
Professor Green is a leading expert in the field of maternity care outcomes. She presented an overview of the current thinking and research in this field, along with the range of outcome measures that are currently used. The presentation raised the issue of whether the perspective from which current maternity care outcomes are designed is the one that will ultimately deliver high quality maternity services. Clinical or organisational outcomes designed for populations might serve professionals, policy makers and managers, but they might not be measuring what actually matters to service users. New tools, such as the Mother Generated Index, offer the possibility of more nuanced data collection that can inform a range of service, organisational, professionals, policy makers, and service user agendas. Professor Green suggested that the Action has the opportunity to influence this matter across Europe.
Green JM 1999 Great expectations. J R Soc Med 92(4):216
Green JM, Baston HA.2003 Feeling in control during labor: concepts, correlates, and consequences.Birth 30(4):235-47.
Rijnders M, Baston H, Schönbeck Y, van der Pal K, Prins M, Green J, Buitendijk S 2008 Perinatal factors related to negative or positive recall of birth experience in women 3 years postpartum in the Netherlands. Birth. 35(2):107-16.
Symon A, McGreavey J, Picken C. 2003 Postnatal quality of life assessment: validation of the Mother-Generated Index. BJOG. 110(9):865-8.
Symon AG, Dobb BR 2008 An exploratory study to assess the acceptability of an antenatal quality-of-life instrument (the Mother-generated Index). Midwifery. 24(4):442-50. Epub 2007 Sep 11.
APPENDIX ONE: Attendance list
Eva Schoening firstname.lastname@example.org
Anne Lyberg email@example.com
Anne M Fredriksen firstname.lastname@example.org
Ans Lyben email@example.com
Antoinette du Preez
Marie-Clare Balaam firstname.lastname@example.org
Beverly French BFrench1@uclan.ac.uk
Marie Berg Marie.email@example.com
Mercedes Botella Perez firstname.lastname@example.org
Cecily Begley email@example.com
Carine Bresser firstname.lastname@example.org
Claudia Magistretti Meier email@example.com
Christine Loytved firstname.lastname@example.org
Declan Devane email@example.com
Krisitn Engnes Kristin.firstname.lastname@example.org
Eva Sommerseth email@example.com
Lucy Frith firstname.lastname@example.org
Helga Gottfreðsdóttir email@example.com
Mechthild Gross firstname.lastname@example.org
Marti Glenn email@example.com
Leo Guilfoyle Leo.firstname.lastname@example.org
Huge Wiseman email@example.com
Olga Gouni firstname.lastname@example.org
Ingela Lundgren email@example.com
Jo Green firstname.lastname@example.org
Karin Minnie Karin.Minnie@nwu.ac.za
Katri Vehvilainen-Julkunen email@example.com
Kleopatra Alamantariotou firstname.lastname@example.org
Kristin Akerjordet email@example.com
Kristin Enges Kristinfirstname.lastname@example.org
Marianne Nieuwenhuijze email@example.com
Marlene Sinclair firstname.lastname@example.org
Marlies Rijnders email@example.com
Mercedes Perez-Botella firstname.lastname@example.org
Maria Fountoulaki email@example.com
Ngai Fen Cheung firstname.lastname@example.org
Piedade Vaz Rebelo email@example.com
Maria Johanna Schouten firstname.lastname@example.org
Soo Downe email@example.com
Solveig O Sandvik Solveig.firstname.lastname@example.org
Tine Schauer Eri
Slobodan Sekulic turija@EUnet.rs
Berit Viken Berit.email@example.com
Ylva Rancken-Lutz firstname.lastname@example.org
Zora Raboteg-Saric email@example.com