Background: The fulfilment of expectations, labour pain, personal control and self-efficacy determine the postpartum evaluation of birth. However, researchers have seldom considered the multiple determinants in one analysis. To explore to what extent the results can be generalised between countries, we analyse data of Belgian and Dutch women. Although Belgium and the Netherlands share the same language, geography and political system and have a common history, their health care systems diverge. The Belgian maternity care system corresponds to the ideal type of the medical model, whereas the Dutch system approaches the midwifery model. In this paper we examine multiple determinants, the fulfilment of expectations, labour pain, personal control and self-efficacy, for their association with satisfaction with childbirth in a cross-national perspective.

Despite several suggestions that peer support is empowering for persons with mental health problems because of its mutual nature, few studies have empirically studied the role of its reciprocity and the effects on subjective well-being of clients from mainstream mental health care settings. Using data of 628 users of vocational and psychiatric rehabilitation centers (N = 51) in Flanders, the effects of the reciprocity of peer support on self-esteem and self-efficacy are explored by testing hypotheses derived from the theories of exchange, social capital, equity, and self-esteem enhancement. Results show that providing peer support is more beneficial than receiving it. One conclusion is that the net beneficial effects of receiving support from peers are overestimated.

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Supporting and caring for each other are crucial parts of the social tissue that binds people together. In these networks, men and women hold different positions: Women more often care more for others, listen more to the problems of others, and, as kin keepers, hold families together. Is this true for all life stages? And are social conditions, among other things bound to the organization of work and family, an essential explanation of these differences? Data from the sixth wave (1997) of the Panel Study of Belgian Households allow us to answer these questions. The results show that women are the glue holding social relations together. They play a central role as friends, daughters, sisters, mothers, and grandmothers throughout all stages of the life course. Similar life commitments do not reduce these gender differences but instead emphasize them even further.

BackgroundThere is an international trend to shorten the postpartum length of stay in hospitals, driven by cost containment, hospital bed availability and a movement toward the ‘demedicalization’ of birth. The aim of this systematic literature review is to determine how early postnatal discharge policies from hospitals could affect health outcomes after vaginal delivery for healthy mothers and term newborns.MethodsA search for systematic reviews, meta-analyses, and primary studies was carried out in OVID MEDLINE, Embase, CINAHL, Econlit and the Cochrane Library (Cochrane Database of Systematic Reviews, DARE and HTA databases). The AMSTAR checklist was used for the quality appraisal of systematic reviews. The quality of the retrieved studies was assessed by the Cochrane Collaboration’s tools. The level of evidence was appraised using the GRADE system.ResultsSeven RCTs and two additional observational studies were found but no comprehensive economic evaluation. Despite variation in the definition of early discharge, the authors of the included studies, concerning early discharge and conventional length of stay, reported no statistical difference in maternal and neonatal morbidity, maternal and neonatal readmission rates, infant mortality, newborn weight gain, neonatal hyperbilirubinemia, or breastfeeding rates. The authors reported conflicting results regarding postpartum depression and competence of mothering, ranging from no difference according to length of stay to better results for early discharge. The level of evidence of the vast majority of outcomes was rated as low to very low.ConclusionsBecause of the lack of robust clinical evidence and full economic evaluations, the current data neither support nor discourage the widespread use of early postpartum discharge. Before implementing an early discharge policy, Western countries with longer length of hospital stay may benefit from testing shorter length of stay in studies with an appropriate design. The issue of cost containment in implementing early discharge and the potential impact on the current and future health of the population exemplifies the need for publicly funded clinical trials in such public health area. Finally, trials testing the range of out-patient interventions supporting early discharge are needed in Western countries which implemented early discharge policies in the past.

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Background: The Belgian and Dutch societies present many similarities but differ with regard to the organisation of maternity care. The Dutch way of giving birth is well known for its high percentage of home births and its low medical intervention rate. In contrast, home births in Belgium are uncommon and the medical model is taken for granted. Dutch and Belgian maternity care systems are compared with regard to the influence of being referred to specialist care during pregnancy or intrapartum while planning for a home birth. We expect that a referral will result in lower satisfaction with childbirth, especially in Belgium.

Fear of childbirth has gained importance in the context of increasing medicalization of childbirth.Belgian and the Dutch societies are very similar but differ with regard to the organization of maternity care. The Dutch have a high percentage of home births and low medical intervention rates.In contrast, home births in Belgium are rarer, and the medical model is more widely used. By comparing the Belgian and the Dutch maternity care models we explored the association between fear of childbirth and medicalization.An antenatal questionnaire was completed by 833 women at 30 weeks of pregnancy. Fear of childbirth was measured by a shortened Dutch version of the Childbirth AttitudesQuestionnaire. A four-dimensional model with baby-related, pain and injuries-related, general and personal control-related, and medical interventions and hospital care-related fear, fitted well in both countries. Multiple regression analysis showed no country differences, except that Belgian women in midwife-led care were more fearful of medical interventions and hospital care than the Dutch. For the other dimensions, both Belgian and Dutch women receiving midwifery care reported less fear compared to those in obstetric antenatal care. Hence, irrespective of the maternity care model, antenatal care providers are crucial in preventing fear of childbirth.