In the first year, collaborating groups in this working group will systematically locate, review, and synthesise research studies reporting on outcome measures for the clinical, psychological, and socio-cultural outcomes of varying systems of FTPD and routine intrapartum care in low risk women, and for migrant women.
This will be synthesised in three parts;
FTPD outcomes; routine intrapartum care outcomes; and care for migrant women.
A subgroup will search in detail for outcome measures that are salutogenic, and/or focused on resilience, and wellbeing, and outcomes that map and measure complex individualised outcomes that are of importance to service users, strategists, policy makers, and clinicians.
These findings will be published as a series of formal systematic reviews (qualitative and quantitative). They will be combined with the outputs of other European groups working on outcome measures in maternity care.
A salutogenic outcomes model that takes account of the complexity of childbirth issues will be formulated. This model will form part of the Framework and the Toolkit.
During the second year, the outcomes model will be tested for appropriateness, efficacy and utility with a range of service users (including migrant women), clinicians, strategists, and policy makers from the European countries that are signatories to the Action. This will include a European wide e-Delphi study to test these salutogenically focussed outcomes. In year three, a longitudinal database will be set up to continue to collect data from the women who respond to the outcomes studies, and from their infants, across the full taxonomy of maternity care systems, to track medium and long-term outcomes for these groups.
This data base will be maintained beyond the end of the Action, so that the impact on children, families and societies can be assessed. This will link with the EU Birth/Mother child cohort database, and Peristat.
Years three and four will see the final outcomes model being used in a range of maternity care settings, chosen to illustrate the full taxonomy of maternity care cultures and systems of provision that will have been identified by the organisational Design working group, identifying the outcomes related to different systems of maternity care provision. The outcomes model development and testing will be written up for publication and dissemation. The results of the prospective longitudinal study will be regularly updated. New researchers wanting to conduct retrospective analysis on the data will be permitted access, with the appropriate ethical and regulatory approvals.
From the second year onwards, grant applications will be prepared to follow up the emerging questions that arise from the work of this working group. These will include bids for biochemical studies into the neurophysiological effects of pregnancy and childbirth processes on women and their neonates, and the long-term impact of these neuro-physiological effects, and bids for sociological studies of questions such as, is there a connection between the socialisation of pregnant women via FTPD, the application of FTPD in routine antenatal care, and the rise of the CS rate?. What is the impact of the discourse about risks on women’s thinking about giving birth using their own resources? What is the effect of different modes of birth on neonatal neuro-hormonal adjustment postnatally?