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The Netherlands are well-known for their high percentage of home deliveries and low medical intervention rates. In Flanders home deliveries are rare and maternity care is dominated by the biomedical discourse. By combining insights from the cross-national analysis of welfare states with medical sociology and the sociology of professions, we explore the diverging social forces causing these Flemish-Dutch differences in the organisation of formal and informal care. The cross-national differences are the result of the diverging professionalisation trajectories of the Flemish and Dutch midwives, and the family policies of the Belgian and Dutch welfare states. In Flanders defamilialising family policies complement the medicalisation of maternity care through the formalisation of care. In addition, the professionalisation of the medical profession, but not midwives, has been supported. The Netherlands are characterised by the ambivalent co-presence of familialising and defamilialising structures in parental care, and the social and medical model regarding maternity care. The social model is supported by the semi-professionalisation of Dutch midwives.

In this article, the way young children give meaning to hyperactive behaviour is examined. An altemative to the dominating medical model that conceptualises ADHD (Attention Deficit Hyperactivity Disorder) as individual pathology is proposed: a sociological explanatory model based on the self-categorisation theory. By means of life world research methodes, the interaction between child and environment receives a central place. Observations and interviews with hyperactive children resulted in a few hypotheses. With children receiving medical treatment, hyperactivity plays a greater role in their life world and (therefore) identity, compared to children who don't thake any medication. In the same scope medically treated children consider hyperactive behaviour more as a problem, compared to non-treated children.

Abstract 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. Methods Two questionnaires were filled out by 605 women, one at 30 weeks of pregnancy and one within the first 2 weeks after childbirth either at home or in a hospital. Of these, 560 questionnaires were usable for analysis. Women were invited to participate in the study by independent midwives and obstetricians during antenatal visits in 2004–2005. Satisfaction with childbirth was measured by the Mackey Satisfaction with Childbirth Rating Scale, which takes into account the multidimensional nature of the concept. Labour pain was rated retrospectively using Visual Analogue Scales. Personal control was assessed with the Wijma Delivery Expectancy/Experience Questionnaire and Pearlin and Schooler's mastery scale. A hierarchical linear analysis was performed. Results Satisfaction with childbirth benefited most consistently from the fulfilment of expectations. In addition, the experience of personal control buffered the lowering impact of labour pain. Women with high self-efficacy showed more satisfaction with self-, midwife- and physician-related aspects of the birth experience. Conclusion Our findings focus the attention toward personal control, self-efficacy and expectations about childbirth. This study confirms the multidimensionality of childbirth satisfaction and demonstrates that different factors predict the various dimensions of satisfaction. The model applies to both Belgian and Dutch women. Cross-national comparative research should further assess the dependence of the determinants of childbirth satisfaction on the organisation of maternity care.

- Medicalisation is a commonly used and 'easily' understood concept among health care providers and researchers as well as in popular culture, but it is contested within medical sociology. This paper distinguishes between four meanings bestowed on medicalisation to enhance its conceptual clarity, using the example of childbirth as an illustration. Within the first generation of medicalisation theory, largely covering the ideas of Freidson, Conrad and Illich, we distinguish between three layers of meaning: (a) the origin of the medical model; (b) medical imperialism; and (c) iatrogenesis. The first meaning refers to the origin of the medical knowledge. In the second meaning daily life becomes increasingly defined in terms of health and illness, hence incorporating a growing number of life domains and social problems. The power of the medical discourse and the associated social control are central issues. The third meaning is represented by the critical or conflict sociological approach, in which medicalisation is interpreted as an exaggeration of medical control, hence emphasising its iatrogenic ('sick-making') effects. The second generation medicalisation theory addresses a changed and more complex organisation of health care. New medicalisation tendencies surpass the old ones, adding a new layer of meanings to the concept: the optimalisation of normal characteristics or processes. Hence, normal phenomena become problematic and a new consuming market is created. A key message from our paper is that poor conceptualisation of medicalisation as an analytical tool endangers the quality and comparability of social scientific research and interdisciplinary collaboration.Keywords: medicalization, birth, iatrogenesis, medical imperialism, sociology of health, health care.Parole chiave: medicalizzazione, parto, iatrogenesi, imperialismo medico, sociologia della salute, assistenza sanitaria.

- Medicalisation is a commonly used and 'easily' understood concept among health care providers and researchers as well as in popular culture, but it is contested within medical sociology. This paper distinguishes between four meanings bestowed on medicalisation to enhance its conceptual clarity, using the example of childbirth as an illustration. Within the first generation of medicalisation theory, largely covering the ideas of Freidson, Conrad and Illich, we distinguish between three layers of meaning: (a) the origin of the medical model; (b) medical imperialism; and (c) iatrogenesis. The first meaning refers to the origin of the medical knowledge. In the second meaning daily life becomes increasingly defined in terms of health and illness, hence incorporating a growing number of life domains and social problems. The power of the medical discourse and the associated social control are central issues. The third meaning is represented by the critical or conflict sociological approach, in which medicalisation is interpreted as an exaggeration of medical control, hence emphasising its iatrogenic ('sick-making') effects. The second generation medicalisation theory addresses a changed and more complex organisation of health care. New medicalisation tendencies surpass the old ones, adding a new layer of meanings to the concept: the optimalisation of normal characteristics or processes. Hence, normal phenomena become problematic and a new consuming market is created. A key message from our paper is that poor conceptualisation of medicalisation as an analytical tool endangers the quality and comparability of social scientific research and interdisciplinary collaboration.Keywords: medicalization, birth, iatrogenesis, medical imperialism, sociology of health, health care.Parole chiave: medicalizzazione, parto, iatrogenesi, imperialismo medico, sociologia della salute, assistenza sanitaria.

Abstract Background A cross-national comparison of Belgian and Dutch childbearing women allows us to gain insight into the relative importance of pain acceptance and personal control in pain relief in 2 maternity care models. Although Belgium and the Netherlands are neighbouring countries sharing the same language, political system and geography, they are characterised by a different organisation of health care, particularly in maternity care. In Belgium the medical risks of childbirth are emphasised but neutralised by a strong belief in the merits of the medical model. Labour pain is perceived as a needless inconvenience easily resolved by means of pain medication. In the Netherlands the midwifery model of care defines childbirth as a normal physiological process and family event. Labour pain is perceived as an ally in the birth process. Methods Women were invited to participate in the study by independent midwives and obstetricians during antenatal visits in 2004-2005. Two questionnaires were filled out by 611 women, one at 30 weeks of pregnancy and one within the first 2 weeks after childbirth either at home or in a hospital. However, only women having a hospital birth without obstetric intervention (N = 327) were included in this analysis. A logistic regression analysis has been performed. Results Labour pain acceptance and personal control in pain relief render pain medication use during labour less likely, especially if they occur together. Apart from this general result, we also find large country differences. Dutch women with a normal hospital birth are six times less likely to use pain medication during labour, compared to their Belgian counterparts. This country difference cannot be explained by labour pain acceptance, since - in contrast to our working hypothesis - Dutch and Belgian women giving birth in a hospital setting are characterised by a similar labour pain acceptance. Our findings suggest that personal control in pain relief can partially explain the country differences in coping with labour pain. For Dutch women we find that the use of pain medication is lowest if women experience control over the reception of pain medication and have a positive attitude towards labour pain. In Belgium however, not personal control over the use of pain relief predicts the use of pain medication, but negative attitudes towards labour. Conclusions Apart from individual level determinants, such as length of labour or pain acceptance, our findings suggest that the maternity care context is of major importance in the study of the management of labour pain. The pain medication use in Belgian hospital maternity care is high and is very sensitive to negative attitudes towards labour pain. In the Netherlands, on the contrary, pain medication use is already low. This can partially be explained by a low degree of personal control in pain relief, especially when co-occurring with positive pain attitudes.

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.