![]() The aim of this paper is to provide a critical review of existing published literature on the tools and indicators currently being used to measure the performance of maternity care within Europe, identify the dominant focus of existing measurements, and highlight any areas which are not being systematically examined. At the same time, indicators of any form often play a valuable role in prompting useful questions and stimulating informed debate. The ways in which maternity and other forms of health care provision are measured using indicators and tools are inevitably conditioned by whoever is designing and conducting this appraisal, what the aims of this activity are, and what types of decisions will be taken as a consequence. Moreover, the monitoring of indicators can lead to better understanding of how maternity health care services function, identify areas requiring improvement and can point to the need for necessary research. ![]() Validated, reliable indicators, and methodological tools for collecting such indicators, are essential for measuring maternal health care provision, performance and quality, enabling comparison at various levels and evaluating progress against defined targets. A need was identified for indicators which capture non-intervention, reflecting the reality that most births are low-risk, requiring few, if any, technical medical procedures. A physiological birth generally necessitates few, or no, interventions, yet most of the indicators presently applied fail to capture (a) this phenomenon, and (b) the relationship between different forms and processes of care, mode of birth and good or positive outcomes. The tools and indicators identified largely enable measurement of technical interventions and undesirable health (or pathological medical) outcomes. Vaginal birth (no instruments) was occasionally cited as an indicator besides this measurement few of the 388 indicators were found to be assessing non-intervention or “good” or positive outcomes more generally. An over-riding focus on the quantification of technical intervention and adverse or undesirable outcomes was identified. Postnatal and neonatal care of mother and baby were the least appraised areas. Intrapartum care was the most frequently measured feature, through the application of process and outcome indicators. ResultsĪ total of 388 indicators were identified, as well as seven tools specifically designed for capturing aspects of maternity care. Given its emergence from two COST Actions the work, inevitably, focused on Europe, but findings may be relevant to other countries and regions. MethodsĪ structured literature search was conducted of material published between 20, incorporating research databases, published documents in english in peer-reviewed international journals and indicator databases which measured aspects of health care at a national and pan-national level. The Actions included the sharing of country experiences with the aim of promoting salutogenic approaches to maternity care. The work formed part of COST Actions IS0907: “Childbirth Cultures, Concerns, and Consequences: Creating a dynamic EU framework for optimal maternity care” (2011-2014) and IS1405: Building Intrapartum Research Through Health - an interdisciplinary whole system approach to understanding and contextualising physiological labour and birth (BIRTH) (2014-). This paper critically reviews published tools and indicators currently used to measure maternity care performance within Europe, focusing particularly on whether and how current approaches enable systematic appraisal of processes of minimal (or non-) intervention in support of physiological or “normal birth”.
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