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(1) Background: "To change the world, we must first change the way the babies are being born", said Michel Odent, the famous French obstetrician and pioneer of the "natural birth" movement. This quotable phrase has been widespread in activism campaigns, and it refers to a project for social change that goes beyond birth. Conceiving childbirth in the broader social context, it is not surprising that this emblematic quote inspires emancipatory struggles around birth. This paper results from a study of childbirth activism in different European contexts, where the author explores the emergence and modes of action of social movements advocating for the humanization of childbirth and women's rights in pregnancy and childbirth. (2) Methods: Starting from the analysis of the main characteristics of childbirth activism, in this paper the author briefly analyzes the cases of organizations from Portugal, Spain and the Netherlands, as well as a campaign promoted by the European Network of Childbirth Associations (ENCA). The author mobilizes empirical data resulting from a triangulation approach, essentially based on documentary analysis, complemented by conversations and participant observation in different settings. (3) Results: Preliminary results show how childbirth activism is contributing to the construction of alternative conceptions of birth, challenging established paradigms. (4) Conclusion: In its differences and similarities, childbirth activism assumes distinct features, but it also has the ability to adapt and promote changes, depending on the specificities of the contexts where it operates. [ABSTRACT FROM AUTHOR]

Peripartum cardiomyopathy is an idiopathic cardiomyopathy presenting with heart failure secondary to left ventricular systolic dysfunction towards the end of pregnancy or in the months following delivery, where no other cause for heart failure is identified. Outcome varies from full recovery to residual left ventricular systolic dysfunction and even death. Many women return to their physician to acquire information on their long-term prognosis, to seek medical advice regarding contraception, or when planning a subsequent pregnancy. This position paper summarizes current evidence for long-term outcome, risk stratification of further pregnancies and overall management. Based on the best available evidence, as well as the clinical experience of the European Society of Cardiology Study Group on Peripartum Cardiomyopathy members, a consensus on pre- and postpartum management algorithms for women undergoing a subsequent pregnancy is presented. [ABSTRACT FROM AUTHOR]

This paper analyses the postponement of first births of the 1990s compared to the 1980s, using panel data from four countries, namely, Germany (GSOEP), Great Britain (BHPS), the Netherlands (OSA) and Sweden (HUS). We find substantial postponement o f maternity in all four countries for all educational groups with the most pronounced postponement among highly educated women. However the mean age of the mother at giving birth to the first child was the lowest in Great Britain both in the 1980s and 19 90s. Theoretically we can distinguish two motives for postponing maternity namely, the consumption-smoothing motive and the career planning motive. In this paper we concentrate on an important determinant of the maternal time costs: the time spent out of market work. [ABSTRACT FROM AUTHOR]

Since the 1990s, the correlation between divorce and total fertility has turned positive on the country level in Europe. This paper investigates whether this positive association also holds on the individual level. To this end, it uses micro-level data from the third round of the European Social Survey about 23 countries. We introduce location-scale models to analyze both the average number of children and the dispersion around this number. Particular attention goes to the role played by repartnering. We find that a past divorce experience is generally negatively associated with the number of children ever born for both men and women, even for people who are in a new post-divorce union. So, contrary to what is suggested by aggregate level correlations, divorce has not become a pro-natal force in Europe. The only exception may be remarried men, who are somewhat more likely to have three or more children in our sample. Whereas the difference in average number of children born between divorced and never divorced people is small, divorce is associated with much greater heterogeneity in childbearing. [ABSTRACT FROM AUTHOR]

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Users show a growing interest in expanding the implementation of digital tools as a support of technical and management issues in healthcare. This medical care has focused on telemedicine but does not include the recognition of needs as an important part of patient-centred healthcare. Nurses interact with patients at critical times in their life journeys, including birth and death, which are historical events linked with religious beliefs. Furthermore, large migration flows have led to multicultural societies in which religion and spirituality are experienced in distinct ways by different people. Finally, most healthcare professionals lack the proper skills to handle the spiritual needs of their patients, especially for core and digital competences. This article shows the results of qualitative research applying as a research tool an open-ended questionnaire, which allows detecting the educational needs for nurses' interventions aimed at providing spiritual support to their patients using digital tools. The results obtained reveal that nurses need education and training on fundamental spiritual concepts and digital competencies to meet the multiple demands of their patients' spiritual needs. Finally, we present an open digital educational proposal for the development of competencies for nurses and other health professionals to provide spiritual care with the support of digital tools. [ABSTRACT FROM AUTHOR]

The paper intends to check if there is a long-term equilibrium relationship between family and childcare support public expenditure and the total fertility rate, using a sample of 30 European countries, and to evaluate its magnitude. The results obtained using recent techniques for panel data analysis confirm the theoretical predictions that family and childcare public spending has a positive long-term effect on total fertility rate. [ABSTRACT FROM AUTHOR]

Background: Across Europe there are increasing numbers of migrant women who are of childbearing age. Migrant women are at risk of poorer pregnancy outcomes. Models of maternity care need to be designed to meet the needs of all women in society to ensure equitable access to services and to address health inequalities. Objective: To provide up-to-date systematic evidence on migrant women's experiences of pregnancy, childbirth and maternity care in their destination European country. Search strategy: CINAHL, MEDLINE, PubMed, PsycINFO and Scopus were searched for peer-reviewed articles published between 2007 and 2017. Selection criteria: Qualitative and mixed-methods studies with a relevant qualitative component were considered for inclusion if they explored any aspect of migrant women's experiences of maternity care in Europe. Data collection and analysis: Qualitative data were extracted and analysed using thematic synthesis. Results: The search identified 7472 articles, of which 51 were eligible and included. Studies were conducted in 14 European countries and focused on women described as migrants, refugees or asylum seekers. Four overarching themes emerged: 'Finding the way—the experience of navigating the system in a new place', 'We don't understand each other', 'The way you treat me matters', and 'My needs go beyond being pregnant'. Conclusions: Migrant women need culturally-competent healthcare providers who provide equitable, high quality and trauma-informed maternity care, undergirded by interdisciplinary and cross-agency team-working and continuity of care. New models of maternity care are needed which go beyond clinical care and address migrant women's unique socioeconomic and psychosocial needs. [ABSTRACT FROM AUTHOR]

Aims: The purpose of this study is to describe disease presentation, co-morbidities, diagnosis and initial therapeutic management of patients with peripartum cardiomyopathy (PPCM) living in countries belonging to the European Society of Cardiology (ESC) vs. non-ESC countries.Methods and Results: Out of 500 patients with PPCM entered by 31 March 2016, we report on data of the first 411 patients with completed case record forms (from 43 countries) entered into this ongoing registry. There were marked differences in socio-demographic parameters such as Human Development Index, GINI index on inequality, and Health Expenditure in PPCM patients from ESC vs. non-ESC countries (P < 0.001 each). Ethnicity was Caucasian (34%), Black African (25.8%), Asian (21.8%), and Middle Eastern backgrounds (16.4%). Despite the huge disparities in socio-demographic factors and ethnic backgrounds, baseline characteristics are remarkably similar. Drug therapy initiated post-partum included ACE inhibitors/ARBs and mineralocorticoid receptor antagonists with identical frequencies in ESC vs. non-ESC countries. However, in non-ESC countries, there was significantly less use of beta-blockers (70.3% vs. 91.9%) and ivabradine (1.4% vs. 17.1%), but more use of diuretics (91.3% vs. 68.8%), digoxin (37.0% vs. 18.0%), and bromocriptine (32.6% vs. 7.1%) (P < 0.001). More patients in non-ESC vs. ESC countries continued to have symptomatic heart failure after 1 month (92.3% vs. 81.3%, P < 0.001). Venous thrombo-embolic events, arterial embolizations, and cerebrovascular accidents were documented in 28 of 411 patients (6.8%). Neonatal death rate was 3.1%.Conclusion: PPCM occurs in women from different ethnic backgrounds globally. Despite marked differences in socio-economic background, mode of presentation was largely similar. Embolic events and persistent heart failure were common within 1 month post-diagnosis and required intensive, multidisciplinary management. [ABSTRACT FROM AUTHOR]

Aim: To monitor the trends in prevalence of cerebral palsy (CP) by birthweight in Europe, 1980 to 2003.Method: Data were collated from 20 population-based registers contributing to the Surveillance of Cerebral Palsy in Europe database. Trend analyses were conducted in four birthweight groups: <1000g (extremely low birthweight [ELBW]); 1000 to 1499g (very low birthweight [VLBW]); 1500 to 2499g (moderately low birthweight [MLBW]); and >2499g (normal birthweight [NBW]).Results: The overall prevalence of CP decreased from 1.90 to 1.77 per 1000 live births, p<0.001, with a mean annual fall of 0.7% (95% confidence interval [CI] -0.3% to -1.0%). Prevalence in NBW children showed a non-significant trend from 1.17 to 0.89 per 1000 live births (p=0.22). Prevalence in MLBW children decreased from 8.5 to 6.2 per 1000 live births (p<0.001), but not linearly. Prevalence in VLBW children also declined from 70.9 to 35.9 per 1000 live births (p<0.001) with a mean annual fall of 3.4% (95% CI -2.4% to -4.3%). Prevalence in ELBW children remained stable, at a mean rate of 42.4 per 1000 live births.Interpretation: The decline in prevalence of CP in children of VLBW continues, and confirms that previously reported. For the first time, there is also a significant decline among those of MLBW, resulting in a significant overall decrease in the prevalence of CP. [ABSTRACT FROM AUTHOR]

We examine the effect of delaying motherhood on the transition to the second childbirth across European countries. There exist two opposite forces of delaying the first birth: biological and socio-cultural factors producing a postponement effect and career-related factors leading to a catch-up effect. Estimating a multistate duration model that addresses the endogeneity of age at first birth, we find a catch-up effect in countries where the career effect is large and a postponement effect in countries where the opportunity cost of childbearing is relatively high due to the lack of family friendly institutions and cultural influences, which may discourage late childbearing. [ABSTRACT FROM AUTHOR]

Background: In Europe, different studies forecast an increase in maternal mortality in the coming years, associated with advanced maternal age and delay in maternity. This study aims to analyse the age-related trend in the maternal mortality ratio among mothers in Spain for the decade 1996-2005, and to describe the causes of death and associated sociodemographic factors for the years with highest mortality. Methods: An ecological study on trends, for the age-related trend in the maternal mortality ratio; an indirect standardisation and Poisson regression model was used. For the description of the causes of death, a cross-sectional study was used. Results: Prevalence of live births among mothers aged 35 years and over was 15% higher in Spain than in Europe. The maternal mortality rate increased by 20% (standardised mortality ratio of 1.2, 95% CI 0.9 to 1.4) in 2005 with respect to 1996. The age-related risk of maternal mortality was three times higher (relative risk of 2.90, 95% CI 2.01 to 4.06) among mothers aged 35-44 years versus those aged under 35 years. The highest mortality was detected during 2003-2004. The risk of maternal mortality was higher in foreign mothers. Conclusion: This study confirms that there was a change in the maternal mortality trend characterised by an increase in deaths, associated with advanced maternal age, as well as an increase in the prevalence of live births among mothers aged 35 years and over. This change in pattern identifies the need to intensify maternal mortality surveillance by collecting the necessary set of variables that allows investigation of the causes and determinant factors underlying deaths. [ABSTRACT FROM AUTHOR]

This contribution looks at the influence of immigration on childbearing trends in the countries of Western, Northern and Southern Europe, which have received relatively large numbers of immigrants during the last decades. It analyses the contribution of migrants to the total number of births and compares fertility rates of migrant women with the fertility rates of native women, pointing out huge diversity between migrant groups. It also discusses the evidence regarding the progressive 'assimilation' in migrants' fertility to the local fertility patterns and analyses the net impact of migrants on period fertility rates. This review reveals that migrant women typically retain substantially higher levels of period fertility than the 'native' populations, but this difference typically diminishes over time and with the duration of their stay in a country. Immigrants contribute substantially to the total number of births and their share of total births has increased in the last decade, exceeding in some countries one fifth of the recorded live births. However, the 'net effect' of the higher fertility of migrants on the period total fertility of particular countries remains relatively small, typically between 0.05 and 0.10 in absolute terms. [ABSTRACT FROM AUTHOR]

Early in the 21st century, three-quarters of Europe's population lived in countries with fertility considerably below replacement. This general conclusion is arrived at irrespective of whether period or cohort fertility measures are used. In Western and Northern Europe, fertility quantum was slightly below replacement. In Southern, Central and Eastern Europe, fertility quantum as measured by the period total fertility rate (TFR) and its tempo-adjusted version was markedly below replacement; in many countries it was around 1.5, and in some populations it was as low as 1.3 to 1.4 births per woman. Throughout Europe, a historic transformation of childbearing patterns characterised by a pronounced delay of entry into parenthood has been taking place. This secular trend towards later childbearing has greatly contributed to the decline and fluctuations in period fertility rates. Delayed births were being recuperated, especially among childless women, but the extent of recuperation differs by country and region. All in all, despite a recent upward trend in the period TFR, European fertility early in the 21st century was at its lowest point since the Second World War. [ABSTRACT FROM AUTHOR]

Objectives: To assess at a population-based level the frequency with which severe structural congenital malformations are detected prenatally in Europe and the gestational age at detection, and to describe regional variation in these indicators. Methods: In the period 1995-1999, data were obtained from 17 European population-based registries of congenital malformations (EUROCAT). Included were all live births, fetal deaths and terminations of pregnancy diagnosed with one or more of the following malformations: anencephalus, encephalocele, spina bifida, hydrocephalus, transposition of great arteries, hypoplastic left heart, limb reduction defect, bilateral renal agenesis, diaphragmatic hernia, omphalocele and gastroschisis. Results: The 17 registries reported 4366 cases diagnosed with the 11 severe structural malformations and of these 2300 were live births (53%), 181 were fetal deaths (4%) and 1863 were terminations of pregnancy (43%); in 22 cases pregnancy outcome was unknown. The overall prenatal detection rate was 64% (range, 25-88% across regions). The proportion of terminations of pregnancy varied between regions from 15% to 59% of all cases. Gestational age at discovery for prenatally diagnosed cases was less than 24 weeks for 68% (range, 36-88%) of cases. There was a significant relationship between high prenatal detection rate and early diagnosis (P < 0.0001). For individual malformations, the prenatal detection rate was highest for anencephalus (469/498, 94%) and lowest for transposition of the great arteries (89/324, 27%). Termination of pregnancy was performed in more than half of the prenatally diagnosed cases, except for those with transposition of the great arteries, diaphragmatic hernia and gastroschisis, in which 30-40% of the pregnancies with a prenatal diagnosis were terminated. Conclusion: European countries currently vary widely in the provision and uptake of prenatal screening and its quality, as well as the "culture" in terms of decision to continue the pregnancy. This inevitably contributes to variation between countries in perinatal and infant mortality and in childhood prevalence and cost to health services of congenital anomalies. [ABSTRACT FROM AUTHOR]

When the period total fertility rate fell below the replacement level in the majority of European countries in the 1970s and 1980s, appropriate demographic terminology was readily available. "Low fertility," "below-replacement fertility," and "sub-replacement fertility" soon became the keywords describing European fertility trends. The unexpected decline of total fertility rates to levels close to 1.0, experienced by an increasing number of European societies over the 1990s, has revealed the need to discriminate between different levels of below-replacement fertility. That the shifts in the timing (tempo) of childbearing may cause considerable fluctuations in period fertility rates has been known at least since John Hajnal's analysis of changes in period fertility in a number of European countries following the baby bust of the 1930s. High fertility of the baby boom era between the mid-1950s and the mid-1960s was in many countries of Western and Northern Europe partly driven by the advancement of childbearing to younger ages of women.

It is widely known that modern economic development has been accompanied by the initiation and spread of effective limitation of fertility, and that generally the populations which experienced development at a late date also had a belated reduction in childbearing. Here a surprising relation is found between (and within) broad regions: the areas in which traditional age of entry into marriage was late were the areas in which marital fertility was reduced first. [ABSTRACT FROM AUTHOR]