Background: Evidenced-based practice is a key component of quality care. However, studies in the Philippines have identified gaps between evidence and actual maternity practices. This study aims to describe the practice of evidence-based intrapartum care and its associated factors, as well as exploring the perceptions of healthcare providers in a tertiary hospital in the Philippines. Methods: A mixed-methods study was conducted, which consisted of direct observation of intrapartum practices during the second and third stages, as well as semi-structured interviews and focus group discussions with care providers to determine their perceptions and reasoning behind decisions to perform episiotomy or fundal pressure. Univariate and multivariate logistic regression were used to analyse the relationship between observed practices and maternal, neonatal, and environmental factors. Qualitative data were parsed and categorised to identify themes related to the decision-making process. Results: A total of 170 deliveries were included. Recommended care, such as prophylactic use of oxytocin and controlled cord traction in the third stage, were applied in almost all the cases. However, harmful practices were also observed, such as intramuscular or intravenous oxytocin use in the second stage (14%) and lack of foetal heart rate monitoring (57%). Of primiparae, 92% received episiotomy and 31% of all deliveries received fundal pressure. Factors associated with the implementation of episiotomy included primipara (adjusted Odds Ratio [aOR] 62.3), duration of the second stage of more than 30 min (aOR 4.6), and assisted vaginal delivery (aOR 15.0). Factors associated with fundal pressure were primipara (aOR 3.0), augmentation with oxytocin (aOR 3.3), and assisted delivery (aOR 4.8). Healthcare providers believe that these practices can prevent laceration. The rate of obstetric anal sphincter injuries (OASIS) was 17%. Associated with OASIS were assisted delivery (aOR 6.0), baby weights of more than 3.5 kg (aOR 7.8), episiotomy (aOR 26.4), and fundal pressure (aOR 6.2). Conclusions: Our study found that potentially harmful practices are still conducted that contribute to the occurrence of OASIS. The perception of these practices is divergent with current evidence, and empirical knowledge has more influence. To improve practices the scientific evidence and its underlying basis should be understood among providers.

Background Evidenced-based practice is one of the key components of quality care. However, previous studies have identified gaps between evidence and actual maternity practices in the Philippines. This study aims to describe practice of evidence-based intrapartum care and its associated factors, as well as exploring the perception of healthcare providers in a tertiary hospital in the Philippines. Methods A mix-methods study was conducted, which consisted of direct observation of intrapartum practices during the second and third stages; semi-structured interviews and focus group discussions with care providers to confirm the reasons to perform episiotomy or fundal pressure and their perception. Univariate and multivariate logistic regression were used to analyse the relationship between observed practices and maternal, neonatal and environmental factors. Qualitative data were extracted and categorised to identify themes related to the decision-making process of practices. Results A total of 170 deliveries were included. Recommended care, such as prophylactic use of oxytocin and controlled cord traction in the third stage, were applied in almost all the cases. However, harmful practices, such as intramuscular or intravenous oxytocin use in the second stage (14.1%) and lack of foetal heart rate monitoring (57.1%) were also observed. 92.0% of primiparas received episiotomy and 31.2% of all deliveries received fundal pressure. The following factors were associated with implementation of episiotomy; primipara (adjusted Odds Ratio [aOR] 62.3), duration of the second stage more than 30 minutes (aOR 4.6) and assisted vaginal delivery (aOR 15.0). Factors associated with fundal pressure were primipara (aOR 3.0), augmentation with oxytocin (aOR 3.3) and assisted vaginal delivery (aOR 4.8). Healthcare providers believe these practices can prevent laceration. Women who got obstetric anal sphincter injuries (OASIS) was 17.1% in this study. Assisted vaginal delivery (aOR 6.0), baby’s weight more than 3500g (aOR 7.8), episiotomy (aOR 26.4) and fundal pressure (aOR 6.2) were associated with OASIS. Conclusions Our study found potentially harmful practices were still conducted, contributing to the occurrence of OASIS. The perception of these practices was divergent with the current evidence, with empirical knowledge having more influence. Scientific evidence and its underlying basis should be understood among providers to improve practices.

Guns as Socially Constructed ThingsGuns are not only material and industrial products, but they are also symbols of violence and triggers of memories, and sometimes they even form a historical index that reflects the political history of a particular location. While I was living among the Banna, I sometimes tried to touch or take a picture of a person's gun, but I was rarely successful because of the political and social attributes of guns.The political attributes of guns are constructed in particular settings. One such setting is the Ethiopian centre/periphery situation, which stratifies the relationship between the centre of government and peripheral society, culturally, politically and economically.No one denies that anthropological studies in Ethiopia have been influenced by the socalled 'centre/periphery model', where, as Donham says, 'what was "peripheral" was always relative to a particular level of the hierarchy of centres' (Donham 1986: 24). On the issue of guns, the Muguji (Koegu) society was defined as relatively peripheral, as they bought out-of-date guns from the Banna, who are also peripheral to the centre of Ethiopia (Matsuda 1997). In addition, Ethiopia is peripheral to the centre in the modern world system.The fact that all the guns described in this chapter were produced in Europe, the USA, China and North Korea reflects Ethiopian foreign policy and the history of the global political situation. However, the people who used those guns at each level of the world system are not necessarily conscious of their position in the whole. For example, the Banna collaborated with the British army and with Ethiopian soldier-settlers in an anti-

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Background Evidenced-based practice is a key component of quality care. However, studies in the