'Nobody in a Maternity Hospital Really Talks to You': Socialist Legacies and Consumerism in Czech Women's Childbirth Narratives

Hřešanová, Ema

doi:10.13060/00380288.2014.50.6.150

Cited by 23 publications

(17 citation statements)

References 22 publications

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“…It is also possible that the organisational changes in birth care in the Czech Republic have broader health consequences for mothers. Recent surveys among postpartum women revealed that they often suffer from the lack of communication by the care providers and experience unwanted or unexplained birth interventions . Future research should focus more attention on how organisational changes in birth care influence its recipients.…”

Section: Discussionmentioning

confidence: 99%

Shortening gestational age at term and organisation of birth care in the Czech Republic

Štípková

2017

Health Planning & Management

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A trend of the shortening duration of pregnancies carried to term has been observed in several countries and represents a growing public health concern. This paper describes the trend in the Czech Republic and shows its relation to the changing demographic structure of mothers and the organisation of maternity care. Data from the birth register are used and supplemented with information about the capacity of maternity care (number of beds at maternity clinics, number of obstetricians and midwives). Logistic regression is used to estimate the odds of 37 to 39 vs 40+ completed weeks of gestation. The results show that the average gestational age at term decreased by 2.1 days between 2000 and 2013. The odds of 37 to 39 weeks of gestational duration increased, mainly due to the reduction in the number of beds at maternity clinics (adjusted odds ratio of 1.51). The effects of the number of health care staff members were weaker. The number of midwives positively influenced gestational duration, while the number of obstetricians had a negative effect. Maternal demographic structure cannot explain the trend. A likely explanation is the increased use of planned early term caesarean sections.

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Section: Discussionmentioning

confidence: 99%

Shortening gestational age at term and organisation of birth care in the Czech Republic

Štípková

2017

Health Planning & Management

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“…In the Czech Republic, the paternalistic approach of healthcare professionals is firmly rooted [11,12]. The dominant position of healthcare professionals in relation to the patient allows the medical staff to decide what will be disclosed to parents and how to support them.…”

Section: Discussionmentioning

confidence: 99%

Decision-making of Czech mothers about contact with their baby after perinatal loss

Ratislavová¹,

Beran²,

Lorenzová³

2016

Kontakt

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The objective is to describe the experience of Czech mothers in terms of decision-making about visual and physical contact with a baby after perinatal loss, and also to explore the effect of this experience on the intensity of the mothers' grief after perinatal loss. Methods: A mixed method design using qualitative data from 18 in-depth interviews was used in the Czech Republic, as well as mixed qualitative and quantitative data from an internet based questionnaire. A total of 100 questionnaires were analyzed using "Interventions after Perinatal Loss" and the Czech version of "the Perinatal Grief Scale". Results: The decision making of women after perinatal loss over contact with their deceased baby is influenced by internal factors (the need of a woman to get to know her child, concerns and fear of contact) and external factors (emotional support for the woman, professional information and interventions of the midwife or doctor). Internal factors are often conflicting and the social environment has the decisive say. The research has proven that a mother's independent decision about contact with a baby after perinatal loss has significant impact on the intensity of her grief. The grief of mothers who decided independently and who were sure about their decision was statistically significantly less intense than in mothers for whom the decision had been made by medical staff. Conclusion: The results of our research reflect the professional uncertainty of Czech midwives taking care of mothers after perinatal loss. This is demonstrated in a majority of cases by a paternalistic approach to communication.

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“…So too has been the issue of shifting patients’ rights and responsibilities, both in terms of the focus on building patients’ capacities to take greater control over their health care (Čada ), and the need for more respectful (‘caring’) attitudes towards patients on the part of healthcare providers (Hrešanová , Read ). Both developments are facets of the move towards a more consumer‐focused healthcare system that not only enables, but requires patients to make their own choices about their care, for example, no longer being assigned a primary‐care physician based on their area of residence, but being able to choose one themselves.…”

Section: Cam and Spa Care As Facets Of Contemporary Czech Health Carementioning

confidence: 99%

“…Both medical traditions are currently at the crux of debates over how to assess efficiency, effectiveness and equality in a post‐socialist society that has spent the last 28 years moving away from a healthcare system ostensibly focused on providing equal care for all, towards an increasingly stratified model with the introduction of “nadstandards” or “above‐standard” care paid for by patients in ever‐increasing areas of medical care. The post‐socialist promotion of patients as self‐responsible healthcare consumers has also shifted more decision‐making onto patients (Čada , Hrešanová , Trnka 2017a), requiring a new understanding of what we might mean by equality of care. Both CAM and spa care are, moreover, marked by debates over how to demonstrate and rationalise efficiency and effectiveness.…”

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confidence: 99%

Equality, efficiency and effectiveness: going beyond RCTs in A. L. Cochrane's vision of health care

Trnka

Stöckelová

2018

Sociology Health & Illness

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A. L. Cochrane's Effectiveness and Efficiency frequently appears as a key reference in debates over, and a justification for, contemporary evidence-based medicine. Cochrane's concern in this text with the equality of care as the ultimate rationale for why effectiveness and efficiency of cure are needed has, however, largely disappeared from debate. In this article, we reconsider Cochrane's approach through the use of case studies of plural forms of medicine in the Czech Republic, namely traditional Chinese medicine, homeopathy and spa care. In addition to bringing equality back into the picture, we also identify four expansions to Cochrane's original vision arising from the difficulties of separating cure from care; the overlap between prevention and cure; the complex actions of some multifaceted therapies; and recent reconceptualisations of the placebo effect. In conclusion, we suggest that instead of the widely used strictly vertical "evidence pyramid", a descriptor of the horizontal and additive ordering of evidence might be more appropriate. We also argue that in healthcare systems characterised by a multiplicity of approaches, if we want to truly benefit from this heterogeneity, we must take seriously each medical tradition's approaches to prevention, cure, care, as well as efficiency, efficacy and equality.Keywords: complementary and alternative medicine, Central and Eastern Europe, evidencebased medicine, equity, fairness, health policy, ethnography It is difficult to overestimate the wide-scale impact of A. L. Cochrane's 1971 assessment of the British National Health Service, Effectiveness and efficiency: random reflections on health services. Indeed, Cochrane's strong support of Random Clinical Trials (RCTs) as the most reliable method of data generation in assessing the effectiveness of treatment has become part of a revolution in international healthcare standards. Cochrane's legacy is exemplified by the Cochrane Collaboration, an international forum for medical advice, which focuses on "transform[ing] the way health decisions are made" (Cochrane, n.d.). However, as Askheim et al.(2017) note, contemporary advocates of improving healthcare efficiency tend to pick and choose aspects of Cochrane's position that suit the agendas of RCT-driven treatments. In this article, we take up Askheim and co-authors' call for considering more broadly Cochrane's approach to medical care as a tripartite structure, involving not only effectiveness and efficiency but also equality. We revisit these issues, however, by means of not only conceptual analysis, akin to Askheim et al. (2017), but through the use of empirical case studies of plural forms of medical care in the Czech Republic. Our intention is not only to recover Cochrane's

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'Nobody in a Maternity Hospital Really Talks to You': Socialist Legacies and Consumerism in Czech Women's Childbirth Narratives

Cited by 23 publications

References 22 publications

Shortening gestational age at term and organisation of birth care in the Czech Republic

Shortening gestational age at term and organisation of birth care in the Czech Republic

Decision-making of Czech mothers about contact with their baby after perinatal loss

Equality, efficiency and effectiveness: going beyond RCTs in A. L. Cochrane's vision of health care

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