Optimal maternal and infant health is critical to societal well-being. Reducing childbirth mortality and severe morbidity is a primary concern for most governments. However, this focus on pathology has been associated with an over-extension of clinical interventions to low risk women, with unexpected adverse clinical consequences, and rising health care costs. Part of the problem has been a scientific focus on understanding pathologies of pregnancy and childbirth from simple, clinical, linear perspectives, with a consequent lack of understanding of the range and limits of normal childbirth physiology in different populations, individuals, and contexts. The proposed Action will advance scientific knowledge in this area from a whole-systems perspective, using the realist research framework of what works, for whom, in what circumstances. It will include five domains:
1. Biomedicine (epigenetics and the hygiene hypothesis); 2. Biomechanics (maternal and fetal movement); 3. Socio-cultural perspectives (social expectations and experiences, including marginalised and migrant populations); 4. Organizational perspectives (the effect of organizational contexts and cultures on variation in rates of childbirth interventions) 5. Neuro-psycho-social perspectives (how inter-personal actions and behaviours affect physiological processes).
