Two international maternity meetings: 'birth, culture and society' and 'BICOG 2007': multidisciplinary meetings focusing on different aspects of maternal health were held in London, UK, in June and July 2007.

Biomedical knowledge, culture, safety and maternal health policy: international perspectives

Midwives, doctors and others gathered for this symposium at King's College London, UK, on June 18, 2007. Jane Sandall, co-chair of the ICM Research Standing Committee, and Edwin van Teijlingen of Aberdeen University, on behalf of the Birth, Culture and Society International Study Group, were organisers. They aimed to illuminate cross-national comparisons of the social shaping of biomedical knowledge production and the relationship with maternal health policy.

Gene Declercq of Boston University, USA, opened with a talk on 'The caesarean imperative in industrialized countries and its relationship to maternal attitudes'. He explored the often repeated statement that women's own choices are the cause of rising Caesarean (CS) rates, but found little evidence for this, showing that the pressure comes from obstetricians onto women, not vice versa. He noted that clinical indications for carrying out a CS have not changed over several decades, but attitudes have. He felt that there was a common' one-percent-doctrine' among obstetricians, i.e. if there is a 1% risk then the solution is to behave as though it is a certainty.

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Ray de Vries, of the University of Michigan, USA, spoke on a similar theme in 'Professions and the use of evidence: The US National Institutes of Health State of the Science conference on Maternal Request Cesarean Delivery'. His talk touched on the ethics of the C S/vaginal birth decision, and the effect of the varying 'desires' of doctors and women.

Jane Sandall, Professor of Midwifery at King's College, presented on 'Safety and maternal health policy in the UK--professions, policies and people'. She queried some statements made in recent UK policy documents, such as 'Increasing choice will increase the safety, quality and friendliness of services', but agreed that the evidence should not be based on a mortality endpoint but have a woman-centred focus.

Susan Murray of King's College London reported on her work in Chile where she tracked the effects of an increasingly privatised health system, finding that the highest CS rates were among women who had private health care but only at the cheapest level. In labour they often suffered from the midwives having to either speed up or slow down the contractions in order to time the delivery for the doctor's arrival, as medical presence was required.

Many other speakers...