During recent decades, a growing and preoccupying excess of medical interventions during childbirth, even in physiological and uncomplicated births, together with a concerning spread of abusive and disrespectful practices towards women during childbirth across the world, have been reported. Despite research and policy-making to address these problems, changing childbirth practices has proved to be difficult. We argue that the excessive rates of medical interventions and disrespect towards women during childbirth should be analysed as a consequence of structural violence, and that the concept of obstetric violence, as it is being used in Latin American childbirth activism and legal documents, might prove to be a useful tool for addressing structural violence in maternity care such as high intervention rates, non-consented care, disrespect and other abusive practices.

Introduction Uterine fundal pressure, or the Kristeller maneuver (KM), is a non–evidence‐based procedure used in the second stage of labor to physically force the fetus to delivery. Even though officially banned, the KM is practiced in 25% of vaginal deliveries in Spain. Methods Using semi‐structured interviews (N = 10 women, N = 15 midwives, N = 3 obstetricians), we sought to understand how providers justify using the KM, and to describe the current circumstances in which the KM is practiced. Women described their preexisting knowledge of and experiences with the KM; providers described how they learned and practiced the KM. We used framework analysis to analyze the transcripts, and we consensus‐coded across three independent investigators. Results Providers reported practicing a new, gentler Kristeller to which official policy did not apply. Providers knew the KM posed risks, but they assumed the risks resulted from poor technical training. Providers did not learn the KM through standard means, and they practiced it in secret. Women knew about the KM before delivery, and many had planned to refuse the procedure. Providers made women's refusal more difficult by offering the KM in coded terms as “just a little help.” Women did not experience the KM as gentle, and the force of the procedure made their refusal nearly impossible. Conclusions The normal birth policy has failed to achieve its objectives due to maternity care providers’ unique logic surrounding a new KM technique. Women’s ability to refuse the Kristeller is limited.

Background: Public patient involvement (PPI) generates knowledge about the health-illness process through the incorporation of people's experiences and priorities. The Babies Born Better (BBB) survey is a pan-European online questionnaire that can be used as a PPI tool for preliminary and consultative forms of citizens' involvement. The purpose of this research was to identify which practices support positive birth experiences and which ones women want changed. Methods: The BBB survey was distributed in virtual communities of practice and through social networks. The version launched in Spain was used to collect data in 2014 and 2015 from women who had given birth in the previous 5 years. A descriptive, quantitative analysis was applied to the sociodemographic data. Two openended questions were analyzed by qualitative content analysis using a deductive and inductive codification process. Results: A total of 2841 women participated. 41.1% of the responses concerned the category "Care received and experienced," followed by "Specific interventions and procedures" (26.6%), "Involved members of care team" (14.2%), and "Environmental conditions" (9%). Best practices were related to how care is provided and received, and the main areas for improvement referred to specific interventions and procedures. Conclusions: This survey proved a useful tool to map the best and poorest practices reported. The results suggest a need for improvement in some areas of childbirth care. Women's reports on negative experiences included a wide range of routine clinical interventions, avoidable procedures, and the influence exerted by professionals on their decision-making.

BACKGROUND: The publication of the World Health Organization (WHO) recommendations on antenatal care in 2016 introduced the perspective of women as a necessary component of clinical guidelines in maternity care. WHO highlights the crucial role played by evidence-based recommendations in promoting and supporting normal birth processes and a positive experience of pregnancy. This paper aims to explore and critically appraise recommendations of national antenatal care guidelines across European countries in comparison with the WHO guideline. METHODS: We collected guidelines from country partners of the EU COST Action IS1405. Components of the documents structure and main recommendations within and between them were compared and contrasted with the WHO guideline on antenatal care with a particular interest in exploring whether and how women's experience were included in the recommendations. RESULTS: Eight out of eleven countries had a single national guideline on antenatal care while three countries did not. National guidelines mostly focused on care of healthy women with a straightforward pregnancy. The level of concordance between the national and the WHO recommendations varied along a continuum from almost total concordance to almost total dissonance. Women's views and experiences were accounted for in some guidelines, but mostly not placed at the same level of importance as clinical items. CONCLUSIONS: Findings outline convergences and divergences with the WHO recommendations. They highlight the need for considering women's views more in the development of evidence-based recommendations and in practice for positive impacts on perinatal health at a global level, and on the experiences of each family.

SUMARIO: 1.-Introducción. 2.-La implicación de varios Ministerios en la depuración de las matronas de Madrid. 3.-Depuración y sanción de las trabajadoras en la Universidad Central. 4.-Depuración y sanción de las matronas que actuaron como funcionarias de prisiones. 5.-La depuración de las matronas por el Colegio de Médicos de Madrid. 6.-Matronas sancionadas por el Colegio de Médicos de Madrid. 7.-Conclusiones.

ABSTRACT:The objective of this work is to examine the serious consequences the Spanish Civil War of 1936 had on the professional midwifery collective, exclusively made up of women in these historic times. In spite of the difficulties faced upon identifying and quantifying the mortal victims of this conflict, various midwives were murdered during the battle by both sides due to their political believes. On the other hand, given the professional independence and the social relevance that these healthcare professionals had acquired during the Spanish Second Republic, a clearly different repression can be seen when we compare it to the suffering experienced by other female collectives in Franco's postwar Spain. For this, part of the abundant documentation found in different archives has been condensed. A table reflecting the changes of which they were accused, the sentences which were imposed and the data obtained from their time spent in francoistic prisons until they were set free was created. KEYWORDS:History of Midwifery; Spanish Civil War; Repression; Francoism.Cómo citar este artículo/Citation: Ruiz-Berdún, Dolores y Gomis, Alberto (2016), "Matronas víctimas de la Guerra Civil Española", Asclepio, 68 (2): p159. doi: http://dx.doi.org/10.3989/asclepio.2016.31 RESUMEN: El objetivo de este trabajo es analizar las consecuencias más graves que tuvo la Guerra Civil española de 1936 sobre el colectivo profesional de las matronas, exclusivamente femenino en esos momentos. A pesar de las dificultades que supone filiar y cuantificar las víctimas mortales de este conflicto bélico, se han identificado a varias matronas que fueron asesinadas durante la contienda por ambos bandos, debido a su afiliación política. Por otro lado, dada la independencia profesional y la relevancia social que estas profesionales sanitarias habían adquirido durante la Segunda República, se puede observar una represión claramente diferenciada, comparándola con la sufrida por otros colectivos femeninos, en la España franquista de la postguerra. Para ello se ha condensado parte de la abundante documentación localizada en diferentes archivos. Se recogen los cargos de los que fueron acusadas, las condenas que les fueron impuestas y los datos obtenidos de su paso por las cárceles franquistas y hasta su puesta en libertad.

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IntroductionThirty-two years after Spain first allowed women to join the armed forces, 12% of active troops are women, although there are no data on how many of them are mothers. There is a lack of research related to the impact of motherhood on their careers and the challenges they face as well. Previous quantitative research, within North Atlantic Treaty Organization (NATO) forces, has focused on the increased vulnerability and reduced performance of women returning to service after childbirth. However, no study to date has examined the narratives of these women.MethodsA qualitative, cross-sectional study was carried out by means of individual interviews which were subsequently analysed employing the interpretative approach of hermeneutic phenomenology. All the interviews were conducted by videoconference, being recorded for subsequent transcription and analysis with MAXQDA v.2018.ResultsServicewoman reported experiencing fear of informing their command chain of their pregnancy. Many women described feelings of constantly having to prove their worth, and thus perceived the physical restrictions associated with pregnancy and/or postpartum as a threat to their previous achievements. This sometimes led to behaviours that posed a risk to the health of mothers and babies, or eventually resulted in both acute and chronic conditions.ConclusionsSome restrictions put in place to protect them during their pregnancies become a source of additional anxiety. Returning to active service, we found that women’s desire to fulfil their duties can cause long-term damage to their physical and psychological health. The attitudes servicewomen perceive towards pregnant women and mothers seems to exert a strong influence on the risks they are willing to assume. Understanding and addressing the needs of servicewomen after childbirth, either now, as active members of the Armed Forces, or in the foreseeable future, as veterans, is crucial to both military and civilian healthcare providers.