Katja Schrøder

The contestations in birth care are often framed as interprofessional conflicts, particularly between obstetricians and midwives. However, some of the disputes arise within the midwifery profession itself, and this chapter explores these internal tensions. Historically, the midwifery profession has positioned itself in opposition to the medicalisation of childbirth, with the promotion of ‘normal birth’ serving as a cornerstone of midwifery identity. The chapter examines how this professional identity may constitute some of the internal conflicts and introduces a conceptual framework which identifies three distinct midwifery roles that midwives adopt to varying degrees, depending on the context. Using a debate within the profession of midwifery in the UK as a case study, it is argued that historical interprofessional dynamics have constrained the ingroup development within the midwifery profession. To conclude, the chapter proposes that midwives can transcend the limiting dichotomy that seems to have led to a dead end in maternity care by embracing internal disagreement and fostering second-order reflection within the ingroup.

Anchored in a theoretical understanding of birth as a space constituted of different expectations and ideals of care, this chapter seeks to explore normal birth as a discursive construct when defining birth and birth care. The definition of birth is highly relevant to explore, as it shapes professional expertise, women's expectations, and societal understandings of childbirth. By questioning the necessity and implications of negotiating normalcy, this chapter examines how normal birth is constructed, who determines it to be normal, and what the construct excludes, highlighting the importance of policies in the contested space of birth and birth care. The chapter investigates birth policies in the UK and Denmark in recent decades with a specific focus on how birth care policy has unfolded differently in the two countries, despite a shared aim of promoting more births without medical interventions.

Childbirth is a site of ongoing struggle over meaning, authority, regulation and control. This edited collection offers critical perspectives on current challenges in birth care by exploring how birth is shaped by competing epistemologies: medical, cultural, experiential and political. The book addresses analytically and theoretically some of the many negotiations, tensions, contestations and dilemmas with regard to care practices as well as birthing experiences. Moreover, the book reflects on how these challenges can be grasped as dilemmas moving beyond the often-declared dichotomy between medical and midwifery models of care or natural versus medical birth. The chapters are authored by researchers within the fields of social and human sciences, located geographical in different countries within different historical, organisational and political birth care settings. The book is oriented to not only scholars and students with interest into birth care but also practitioners and stakeholders politically and professionally engaged in the development of maternity care practices and settings.

The idea for this international edited collection on childbirth and the tensions, contestations, and dilemmas surrounding the provision of good birth care emerged from years of shared engagement with research on birth care policies and practices. We, the editors, bring together disciplinary perspectives from sociology of health (NT) and midwifery and health sciences (KS) and have worked in close collaboration over many years. Our collaboration is sustained by an ongoing conversation between us – one that pauses and resumes, loops back and evolves – grounded in a mutual interest in the social, political, and embodied dimensions of birth, maternity care, and reproductive health.

Background The second victim (SV) experience limits the performance of health and care workers and places patients at risk. Peer support is recognised as the most effective, feasible and acceptable intervention to mitigate its impact. Objective To define a set of success factors when designing interventions to support SVs in health and care facilities based on expertise in different European countries. Setting International collaboration involving countries with diverse cultures, structures and legal frameworks. Design Qualitative research. Method Focus groups involving a total of 43 participants were conducted in five countries. Prominent professionals in European peer support interventions were engaged. Analysis of common elements considered key to the success of these programmes was underscored. Results Critical success factors for designing effective SV support interventions included the need for an occupational health approach, the establishment of a strong organisational safety culture, immediate psychological first aid, long-term resilience building, the engagement and training of peer supporters, the provision of adequate resources and ongoing support, the importance of leadership commitment and the necessity of tailoring interventions to the specific context and needs of each institution and country considering their diverse sociocultural and legal framework. The expected benefits included ensuring optimal patient care and reducing associated costs such as staff turnover and litigation. Conclusion Effective SV support interventions are essential for enhancing the resilience and performance of health and care workers, ultimately improving patient safety. By implementing tailored and well-resourced interventions, healthcare institutions can mitigate the negative impact of the SV phenomenon, promoting optimal care.

Dårligt mentalt helbred er en stigende sundhedstrussel både globalt og i Danmark. Dette gælder ikke mindst for unge mennesker – den gruppe i befolkningen som i de kommende år vil få børn og blive forældre. I relation til fødsel og forældreskab har den eksisterende forskning ofte fokus på, hvordan vi kan forbedre den mentale sundhed ved at undgå mentale sygdomme, som for eksempel angst og depression. Men fødsel og forældreskab indebærer både erfaringer af sårbarhed, afmagt, glæde og styrke. I denne artikel diskuterer vi derfor, hvordan en salutogenetisk tilgang til mental sundhed i forbindelse med fødsel og forældreskab kan bidrage til en bedre forståelse for denne livsomvæltende overgang. Med udgangspunkt i Aron Antonovskys begreb Sense of Coherence (på dansk Oplevelse af Sammenhæng), fokuserer vi særligt på det element, han selv benævner motivationskomponenten, nemlig meningsfuldhed. Vi diskuterer imidlertid meningsfuldhed i nyere salutogenetiske forståelser, som inkluderer tanker fra eksistenspsykologi og eksistensfilosofi. Vi eksemplificerer ved at vise, hvordan det at spørge udforskende ind til livsdilemmaer og livsvilkår kan afstedkomme nye perspektiver på livet hos mødre og fædre, og være hjælpsomt i forhold til at begribe egne forestillinger om meningsfuldhed. Helt overordnet argumenterer vi endvidere for, at det at udforske og stille forskningsspørgsmål, som peger frem mod stærkere salutogenetiske tilgange, specifikt med fokus på begrebet meningsfuldhed og de indlejrede eksistentielle aspekter af livet, vil kunne føre til ny viden om, hvordan man kan fremme god mental sundhed i svangreomsorgen i Danmark.

The aim of this study was to identify (i) emotions experienced by healthcare professionals (HCPs) after adverse or traumatic events and (ii) needs for support after adverse or traumatic events. Data for this qualitative, descriptive study were collected at 27 seminars for 198 HCPs introducing a peer-support programme after adverse or traumatic events (The Buddy Study). Through interactive exercises, participants shared their experiences, and this study reports on the responses of an exercise identifying emotions and needs after an adverse or traumatic event. The top five emotions were anger, guilt, impotence, grief, and frustration and anxiety, and the top five needs were to be met with understanding, recognition, listening, care, and respect. Ten categories of emotions experienced by HCPs after adverse or traumatic events were constructed, and the five categories with the highest number of mentions were anger and impotence, fear and insecurity, negative self-evaluation, guilt and shame, and alone and overloaded. Nine categories relating to needs for support after adverse or traumatic events were constructed, and the five categories with the highest number of mentions were: being seen and understood, compassion, being respected, time to recover, and organisational support. The emotional disclosure promoted at the peer seminars of the Buddy Study revealed that all participants share the same emotional distress, being either second victims or potential second victims. Moreover, the support needed was of a human-to-human nature that all participants felt capable of providing as a “buddy” for a colleague. Both the identified emotions and needs for support identified in this study may contribute to qualifying the development of the content of support programmes for HCPs after traumatic or adverse events.

Background: Healthcare professionals involved in adverse events may suffer severe physical and emotional distress in the aftermath. Adequate support is critical to an overall culture of safety for any healthcare institution. This study evaluates a formalised peer support program, ‘the Buddy Study’, in two Danish university hospital departments. The program consists of a 2-h seminar about second victims and self-selected buddies to provide peer support after adverse events. Methods: The study design involved a cross-sectional survey comprised of two close-ended questionnaires evaluating the Buddy Study seminar (Q1) and the Buddy Study program (Q2), along with two open-ended questions and three individual interviews for more elaborate answers. Results: Out of the 250 HCPs employed in both departments, 191 midwives, physicians, and nursing assistants completed Q1 and 156 completed Q2. The seminars were evaluated positively; 91.6% were satisfied with the overall content of the seminar, and 69.1% agreed that insight into how other people may react to adverse events has helped them contain their own reactions or emotions. Assessments of having the Buddy Study program in the department or using or being used as a buddy were more diverse, yet overall positive. Three benefits of the program were identified: the program i) has encouraged an open and compassionate culture; ii) has caused attentiveness to the wellbeing of colleagues; and iii) the self-selected buddy relationship has created a safe space for sharing. Additionally, three challenges or shortcomings were identified: i) although peer support is valuable, it should not stand alone; ii) informal peer support is already in place, hence making a formalised system redundant; and iii) the buddy system requires continuous maintenance and visibility. Conclusions: The overall evaluation of the Buddy Study program was positive, suggesting that this type of formalised peer support may contribute to a rapid and accessible second-victim support program in healthcare institutions. A key principle for the Buddy Study program is that relationships are crucial, and all buddy relationships are based on self-selection. This seems to offer a safe space for health care professionals to share emotional vulnerability and professional insecurity after an adverse event.