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Understanding childbirth as a complex salutogenic phenomenon: the EU COST BIRTH Action Special Collection

Authored by Lucy Frith, Marie-Clare Balaam, Soo Downe

July 2020 sees the launch of the PLOS Special Collection Understanding childbirth as a complex salutogenic phenomenon: the EU COST BIRTH Action. The Collection is a product of many years’ effort. It showcases the work produced by a team funded by the EU COST programme. This programme funds networks (called ‘Actions’) of academics, businesses, practitioners and others who are interested in exploring new fields and changing practice. Between 2014 and 2018 it supported our Action, Building Intrapartum Research Through Health – an interdisciplinary whole system approach to understanding and contextualising physiological labour and birth (BIRTH). Our Action was made up of over 120 scientists, practitioners, activists and policy makers from 34 countries. We wanted to advance the state of research and practice about normal (‘physiological’) labour and birth. In particular, we wanted to learn from places across Europe that provide a high standard of maternity care. 

We were motivated by the growing recognition that the normal (physiological) process of childbirth can be a trigger for long-term wellbeing. Because of the gap in knowledge in this area, we deliberately brought together people who would not usually talk to each other. This included artists and engineers, policy makers and birth activists, obstetricians, midwives and historians, architects, bioethicists, physiologists and psychologists. Together, we set out to re-imagine the kinds of questions that could be asked. We worked to unsettle current scientific and normative ways of understanding and investigating birth. We know that most research in maternity care is focused on when things go wrong, so we drew on complexity theory and the concept of salutogenesis (wellbeing) to investigate how things go well in complex situations.

The papers in this Special Collection show the inter and trans-disciplinary insights that emerged as a consequence. They also illustrate the new kinds of questions that can be asked once those from different disciplines and perspectives spend time listening to each other. They include an exploration of neurophysiology (both the psychology of neurophysiological events, and oxytocin levels related to breastfeeding and birth interventions); thermal imaging as a basis for understanding how physiological labour works; an examination of how midwives work to help women to give birth normally; cross-European mapping of variations in use of oxytocin regimes; and of the economic consequences of different caesarean section rates.

This Collection illustrates the knowledge that can be generated when a diverse group of people come together with similar goals and perspectives. The networks formed by the scientists, academics, clinicians, service users, activists and policy makers have generated unexpected, emergent insights, that have led to new areas of enquiry that are ongoing. What the papers don’t capture is the excitement, creative energy, and sheer joy generated by the process of meeting together, walking together, eating together, and challenging each other. Many of us are still meeting and working on the projects generated by the network, and we are sure we will continue to do so well into the future.

Check out all the articles in the BIRTH Special Collection here: https://collections.plos.org/birth

And the COST Action website: https://www.cost.eu/actions/IS1405/#tabs|Name:overview

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