I Reseach 4 Birth Portal

Complexity Theory Sub Group

Much research in the area of childbirth is based on the notion of simplicity. The assumption is that there is a straightforward cause–effect relationship in the physiology of birth. Additionally, it also assumes that clinical parameters are of overriding importance, in isolation from other parameters that impinge on birth, such as social interactions and environmental impact.

More and more it becomes clear that the progress and experience of birth is influenced by many factors inside and outside women. And that these may act independently, or may interact in complex ways. The notion of cause and effect is no longer efficient to grasp the complexity of the system. The model where A, influenced by B, leads to C begins to break down unless it can cope with the kind of ‘noise’, such as the individual practitioner’s skills and attitudes, the culture of an organization, the efficiency of administration systems or other factors that actually influence the quality of care delivery.

The power of complexity theory lies in the observation that events are profoundly interconnected. The concept of a simple linear process is replaced with the metaphor of a web or network of interconnections. It therefore challenges the assumption that there is a one ‘right’ way of doing things for everyone. Interactions are non-linear, meaning that small ‘causes’ may have large effect (Downe, 2010; Martin, 2010; Topolski, 2009; Sturmberg, 2009).

• Downe, S. Beyond evidence-based medicine: complexity and stories of maternity care. Journal of Evaluation in Clinical Practice, 16, 232–237.
• Martin, C. M. & Kasperski J. Developing interdisciplinary maternity services policy in Canada. Evaluation of a consensus workshop. Journal of Evaluation in Clinical Practice, 16, 238–245.
• Topolski, S. (2009) Understanding health from a complex systems perspective. Journal of Evaluation in Clinical Practice, 15, 749–754.
• Sturmberg, J. P. & Martin, C. M. (2009) Complexity and health – yesterday’s traditions, tomorrow’s future. Journal of Evaluation in Clinical Practice, 15, 543–548.

The work of the subgroup ‘Complexity Theory’ is focused on the complexity theory and its meaning for analysing maternity care. The aim is to explore what models of maternity care are based on or are evaluated within the framework of complexity theory. And how the complexity framework is used to initiate changes in maternity care. These findings will be brought together in systematic review.
Next, together with the work of the subgroup salotogenic theory, this will be input to a review that looks at tools and techniques based on these theories that are used in any area of health or social care. These reviews will be completed in year two, and papers will be prepared for publication. The findings will be synthesized into an organizational assessment tool as part of the EU survey.