European Journal of Midwifery of low risk women in spontaneous labour 4 . It has been demonstrated that many common obstetric practices such as rupture of membranes for induction of labour, routine intrapartum amniotomy, continuous electronic foetal heart-rate monitoring or routine continuous infusion of intravenous fluids and oxytocin augmentation, are of limited benefit [5][6] . The range of and variation in the use of interventions in healthy low-risk women who are cared for in highly-technological birth environments have implications both in economic and health terms [7][8][9][10][11][12] . ABSTRACTThis paper presents the Protocol for a multicentre study that seeks to analyse the relationship between midwife care during childbirth and spontaneous vaginal birth. Each participating hospital collects outcome data from a sample of all women birthing, determined according to the number of annual births attended by midwives, in each hospital.Data collected are sociodemographic variables (age, nationality, level of education). Clinical variables collected are onset of labour, augmentation of labour, professional (midwife or obstetrician) providing care in the first and second stage of labour, transfer of care between professionals, mobility during labour, pharmacological and non-pharmacological pain-management methods used, if any, position for birth, mode of birth outcomes, Apgar score at 1 and 5 minutes, birth weight, timing of breastfeeding initiation and breastfeeding rates. The Bologna Score scale items, are evaluated also.The midwife's contribution in the care of normal birth, and the relationship with spontaneous birth (i.e. vaginal birth without the use of instruments) will serve as a basis for further improving the quality of care provided to pregnant women and their families. Phase I of the study ended in January 2017.

Objective: To appraise the relationship between the length of exposure to epidural analgesia and the risk of non-spontaneous birth, and to identify additional risk factors. This study is framed within the MidconBirth project. Study design: A multicentre prospective study was conducted between July 2016 and November 2017 in three maternity hospitals in different Spanish regions. The independent variable of the study was the length of exposure to epidural analgesia, and the dependent variable was the type of birth in women with uncomplicated pregnancies. The data was analyzed separately by parity. A multivariate logistic regression was performed. The odds ratios (OR), using 95% confidence intervals (CI) were constructed. Main outcome measures: During the study period, 807 eligible women gave birth. Non-spontaneous births occurred in 29.37% of the sample, and 75.59% received oxytocin for augmentation of labour. The mean exposure length to epidural analgesia when non-spontaneous birth happened was 8.05 for primiparous and 6.32 for multiparous women (5.98 and 3.37 in spontaneous birth, respectively). A logistic regression showed the length of exposure to epidural during labour was the major predictor for non-spontaneous births in primiparous and multiparous women followed by use of oxytocin (multiparous group). Conclusions: The length of exposure to epidural analgesia during labour is associated with non-spontaneous births in our study. It highlights the need for practice change through the development of clinical guidelines, training programs for professionals and the continuity of midwifery care in order to support women to cope with labour pain using less invasive forms of analgesia. Women also need to be provided with evidence-based information.

Objective: Our objectives were to study the association between epidural analgesia and risk of severe perineal laceration (SPL) , and identify additional risk factors for SPL. This multicentre study consisted of an analysis of data from the MidconBirth Phase I Dadabase, on the use of EA and perineal results during childbirth. (World Health Organization, International Clinical Trials Registry Platform,2016:http://apps.who.int/trialsearch/Trial2.aspx?TrialID=ISRCTN17833269). Methods: We conducted a prospective study of pregnant women at term between July 2016 till July 2017 in 30 public maternity hospitals in Catalonia, Spain. Inclusion criteria were an uncomplicated singleton pregnancy, in cephalic presentation and vaginal birth. Data was analysed separately for instrumental births and spontaneous vaginal births, as the former is more frequently associated with episiotomy and more perineal lacerations. Risk factors as well as protective factors in each cohort of women (instrumental and spontaneous vaginal birth), were identified. Multivariate logistic regression model was performed to study the association between epidural analgesia and SPL to identify potential confounders. Odds ratios (OR), using 95% confidence intervals (CI) were constructed. Findings: During the study period, 5,497 eligible women gave birth, 77.46% of them received epidural analgesia. SPL occurred in 1.63% of births. The univariate analysis showed births with epidural analgesia had significantly higher rates of inductions, augmentation of labour, lithotomy position for birth and episiotomy. However, this association disappeared when the variable "type of vaginal birth" was introduced. In multivariate logistic regression, nulliparity