SALUTOPHYSIOLOGY

WHAT IS SALUTOPHYSIOLOGY

Salutophysiology is a model of maternity care theorised by Verena Schmid that shifts the paradigm from the current “RISK-ORIENTED CARE” to a new “HEALTH-ORIENTED CARE”. To do so, it develops the paradigms of Salutogenesis and merge them with the new branch of medicine known as Psychoneuroendocrinephysiology (PNEP).

In medicine, with the term “Pathophysiology” we study the functional and biochemical changes that are associated with – or a result of – disease or injury (patho= latin root for “pathology”).

In “Salutophysiology” we study the functional and biochemical changes that are associated with – or a result of – a good healthy pregnancy, birth and post-partum (salus= latin root for “health”).

THE 10 LEADING PARADIGMS OF SALUTOPHYSIOLOGY

Health-oriented care has better outcomes than risk-oriented care.
Mothers/parents and babies have instinctive competences.
Pregnancy, birth and postpartum are health processes.
Supporting inner resources counteracts the effects of risk factors and pathologies.
The autonomous nervous system is the key.
Most symptoms/high risk scenario are downsized when health resources are investigated in a personalised care.
Health resources can be enhanced for good.
Listening is crucial: people’s stories, insights and experiences count.
Salutophysiology is revolutionary because it teaches new clinical skills
The empathic relationship and alliance with families is the foundation of maternity/reproductive care.

1. HEALTH-ORIENTED CARE

When we focus solely on a risk-oriented view, everything becomes a risk, everything is scary and potentially harmful, so that the only care valued is that based on risk avoidance, which makes people feel fragile and insecure. This model is manifested in the excess of medicalisation and has not benefited maternal and child health globally. Health orientation, on the other hand, provides better outcomes.

2. MOTHERS/PARENTS AND BABIES HAVE INSTINCTIVE COMPETENCES

When we focus on a health-oriented care instead, fear ceases, mothers/parents and babies are viewed as competent and full of potential.

3. PREGNANCY, BIRTH AND POST-PARTUM ARE HEALTH PROCESSES

Maternity, paternity, biological parenthood are not pathologies; they are constituted by many opportunities for health and personal expression that, if valued, produce long-term health on many levels: physical, relational and social.

4. SUPPORTING INNER RESOURCES COUNTERACTS THE EFFECTS OF RISK FACTORS AND PATHOLOGIES

In pregnancy as well as in childbirth and post-partum, health factors are recognised and enhanced even in the presence of risk factors (whether physical or social) or pathologies. This model reduces medical interventions and their side effects and puts mothers/parents and babies in the best possible condition to express their health potential. Rossetti theorises the concept of ‘residual physiology’, which identifies the physiology that is always present in the body even when complex pathologies are present. Residual physiology is always to be enhanced.

5. THE AUTONOMOUS NERVOUS SYSTEM IS THE KEY

The key to understand Salutophysiology is the Autonomous Nervous System (ANS): parasympathetic (rest and digest) and sympathetic (fight or flight) fibers are the red thread between uterus, breast, environment, hormones, fascia, and emotions.

6. MOST SYMPTOMS/HIGH RISK SCENARIOS ARE DOWNSIZED WHEN HEALTH RESOURCES ARE INVESTIGATED IN A PERSONALISED CARE.

By studying Salutophysiology, you can learn to understand the body’s signals: how hormones in the placenta express their health, how the nervous system communicates and how their interactions change over the three trimesters of pregnancy and the three stages of childbirth. In this model, a symptom – or a risk factor – is scaled down when compared with the person’s health resources. This approach reduces the use of medicalisation, improving outcomes, perceived health and family satisfaction.

7. HEALTH RESOURCES CAN BE ENHANCED FOR GOOD

By knowing the interaction pathways of Salutophysiology, one can learn how to support them towards health, counteracting stress and risk factors. Salutophysiology teaches how to recognise and strengthen the resources to prevent diseases or reduce their impact on health.

8. LISTENING IS CRUCIAL: PEOPLE’S STORIES, INSIGHTS AND EXPERIENCES COUN

Salutophysiology also means listening: through narrative medicine women’s and parents’ voices are heard and valued, their stories, perception and intuition are connected with their/their babies physical health.

9. SALUTOPHYSIOLOGY IS REVOLUTIONARY BECAUSE IT TEACHES NEW CLINICAL SKILLS

The Salutophysiology model is the new revolution in midwifery care globally because it teaches professionals new clinical skills. That is, it teaches them how to integrate communication techniques, clinical manual skills, clinical findings, laboratory tests, parents’ experiences and neuroscience into their work.

10. THE EMPATHIC RELATIONSHIP AND ALLIANCE WITH FAMILIES IS THE FOUNDATION OF MATERNITY/REPRODUCTIVE CARE

In opposition to the directive medical model, biased by fear and gender stereotypes and polluted by the abuse of medicalisation, Salutophysiology aims to work by enhancing physiology (the channels of bonding), with appropriate use of technology when necessary, and personalised care that makes generations healthier. In this model, both care providers and families feel capable and competent. A healthy, deep alliance and empathic relationship with families and their needs enriches both professionals and society and becomes a factor of personal growth.

PUBLICATIONS SUPPORTING THE MODEL OF SALUTOPHYSIOLOGY

ARCHIMETRA. The international journal of salutophysiology in midwifery. Edited SEAO, director Anna Maria Rossetti (English eBooks available)

VERENA SCHMID’S BOOKS

About Physiology in Pregnancy and Childbirth – 2024- (English eBook) https://seaoflorence.it/prodotto/about-physiology-in-pregnancy-and-childbirth/
The Essence of Childbirth – Life Journeys and Resources – 2024- (English eBook) https://seaoflorence.it/prodotto/the-essence-of-childbirth-pregnancy-women-midwifes/
Mamma da grande. Vivere al meglio la maternità dopo i 35 anni – 2023, TERRANUOVA Edizioni (Italian paper Book)
Salute e Nascita. Le basi della Salutofisiologia. La Salutogenesi in gravidanza – 2021- SEAO Edizioni (Italian paper Book)
Il parto in casa e in casa maternità. Criteri di qualità e sicurezza. I vantaggi di un parto fisiologico e consapevole – 2019 – TERRANUOVA Edizioni (Italian paper book)
Voglia di parto. Metodi e tecniche per gestire le doglie e ridurre il dolore – 2017 TERRANUOVA Edizioni (Italian paper Book)
Partorire dopo un cesareo. Esperienze e strumenti per una scelta informata – 2017 – TERRANUOVA Edizioni (Italian paper book)

ARTICLES, BOOKS AND STUDIES

Downe S, Calleja Agius J, Balaam M-C, Frith L (2020) Understanding childbirth as a complex salutogenic phenomenon: The EU COST BIRTH Action Special Collection. PLoS ONE 15(8): e0236722. https://doi.org/10.1371/journal.pone.0236722 Editor: Dario Ummarino, PLOS, UNITED KINGDOM August 5, 2020
Downe S, Finlayson K, Oladapo O, Bonet M, Gu¨lmezoglu A. What matters to women during childbirth: A systematic qualitative review. PLoS One 2018; 13(4):e0194906. https://doi.org/10.1371/journal.pone. 0194906 PMID: 29664907
Downe S. Beyond evidence-based medicine: Complexity and stories of maternity care. Journal of Evaluation in Clinical Practice. 2010; 16: 232–237.
Downe S., Byrom S, Topalidou A. Squaring the Circle: Normal birth research, theory and practice in a technological age (2019) Publisher: Pinter & Martin Ltd
Ferguson S, Brown J, Taylor J, Davis D, Sense of coherence and women׳s birthing outcomes: A longitudinal survey, Midwifery, Volume 34, 2016, Pages 158-165, ISSN 0266-6138, https://doi.org/10.1016/j.midw.2015.11.017
Fernandez Turienzo C, Silverio SA, Coxon K, Brigante L, Seed PT, Shennan AH, Sandall J; POPPIE Collaborative Group. Experiences of maternity care among women at increased risk of preterm birth receiving midwifery continuity of care compared to women receiving standard care: Results from the POPPIE pilot trial. PLoS One. 2021 Apr 21;16(4):e0248588. doi: 10.1371/journal.pone.0248588. PMID: 33882059; PMCID: PMC8059847
Hildingsson I, Cederlöf L, Widén S. Fathers’ birth experience in relation to midwifery care. Women Birth. 2011 Sep;24(3):129-36. doi: 10.1016/j.wombi.2010.12.003. Epub 2011 Jan 8. PMID: 21216684.
Kerstin Uvnäs-Moberg, MD, PhD (2023) The physiology and pharmacology of oxytocin in labor and in the peripartum period. EXPERT REVIEW| VOLUME 230, ISSUE 3, SUPPLEMENT , S740-S758, MARCH 2024Download Full Issue Open AccessPublished:July 13, DOI:https://doi.org/10.1016/j.ajog.2023.04.011
Li, B., Zhao, M., Zhu, Z., Zhao, H., Zhang, X., Wang, J., Zeng, T., & Yuan, M. (2024). The Childbearing sense of coherence scale (CSOC-scale): development and validation. BMC public health, 24(1), 1613.https://doi.org/10.1186/s12889-024-19109-1
Maaløe, N., Kujabi, M. L., Nathan, N. O., Skovdal, M., Dmello, B. S., Wray, S., van den Akker, T., & Housseine, N. (2023). Inconsistent definitions of labour progress and over-medicalisation cause unnecessary harm during birth. BMJ (Clinical research ed.), 383, e076515. https://doi.org/10.1136/bmj-2023-076515
Malvasi A, Baldini GM, Cicinelli E, Di Naro E, Baldini D, Favilli A, Quellari PT, Sabbatini P, Fioretti B, Malgieri LE, et al. (2024). Localization of Catecholaminergic Neurofibers in Pregnant Cervix as a Possible Myometrial Pacemaker.International Journal of Molecular Sciences.; 25(11):5630. https://doi.org/10.3390/ijms25115630
Malvasi, A., Vimercati, A., Ricci, I., Picardi, N., Cicinelli, E., Kosmas, I., Baldini, G. M., & Tinelli, A. (2022). Dystocic Labor and Adrenergic and Noradrenergic Neurotransmitters: A Morphological Experimental Study.International journal of molecular sciences, 23(19), 11379. https://doi.org/10.3390/ijms231911379
Meier Magistretti C, Downe S, Lindstrøm B, Berg M, Schwarz KT. Setting the stage for health: Salutogenesis in midwifery professional knowledge in three European countries. Int J Qual Stud Health Well-being. 2016 Dec 13;11. doi: 10.3402/qhw.v11.33155. PMCID: PMC5156852.
Mercedes Perez-Botella, Soo Downe, Claudia Meier Magistretti, Bengt Lindstrom, Marie Berg, The use of salutogenesis theory in empirical studies of maternity care for healthy mothers and babies. Sexual & Reproductive Healthcare, Volume 6, Issue 1, 2015, Pages 33-39, ISSN 1877-5756, https://doi.org/10.1016/j.srhc.2014.09.001.
Midwifery, Volume 29, Issue 4, 2013, Pages 407-415, ISSN 0266-6138, https://doi.org/10.1016/j.midw.2012.09.006.
Molly R. Altman PhD, CNM, MPH, Patience A. Afulani PhD, MPH, MBChB, Daphina Melbourne MPP, Miriam Kuppermann PhD, MPH Factors associated with person-centered care during pregnancy and birth for Black women and birthing people in California First published: 25 August 2022. https://doi.org/10.1111/birt.12675
Pinsard, M., Mouchet, N., Dion, L., Bessede, T., Bertrand, M., Darai, E., Bellaud, P., Loget, P., Mazaud-Guittot, S., Morandi, X., Leveque, J., Lavoué, V., Duraes, M., & Nyangoh Timoh, K. (2022). Anatomic and functional mapping of human uterine innervation.Fertility and sterility, 117(6), 1279–1288. https://doi.org/10.1016/j.fertnstert.2022.02.013
Sally Ferguson, Jenny Browne, Jan Taylor, Deborah Davis, (2016)Sense of coherence and women׳s birthing outcomes: A longitudinal survey, Midwifery, Volume 34, Pages 158-165, ISSN 0266-6138,https://doi.org/10.1016/j.midw.2015.11.017. https://www.sciencedirect.com/science/article/pii/S0266613815003344)
Shefaly S, Esperanza DNg, Application of the salutogenic theory in the perinatal period: A systematic mixed studies review, International Journal of Nursing Studies, Volume 101, 2020, 103398, ISSN 0020-7489, https://doi.org/10.1016/j.ijnurstu.2019.103398.
Shefaly Shorey, Esperanza Debby Ng, Application of the salutogenic theory in the perinatal period: A systematic mixed studies review, International Journal of Nursing Studies, Volume 101, 2020, 103398, ISSN 0020-7489, https://doi.org/10.1016/j.ijnurstu.2019.103398
Shirazi, M., Torkzaban, M., Ghaemi, M., Moshfeghi, M., Shirazi, M., Emadzadeh, M., Ahmadi, L., Khazaeipoor, Z., & Mirzaeian, S. (2023). Anxiety and Uterine Artery Doppler Flow in A Population of Pregnant Women of High Risk Down Syndrome Fetus: A Prospective Cohort Study.International journal of fertility & sterility, 17(1), 52–56. https://doi.org/10.22074/ijfs.2022.534209.1159
Shona Dove, Eimear Muir-Cochrane, Being safe practitioners and safe mothers: A critical ethnography of continuity of care midwifery in Australia, Midwifery, Volume 30, Issue 10, 2014, Pages 1063-1072, ISSN 0266-6138, https://doi.org/10.1016/j.midw.2013.12.016.
Unn Dahlberg, Ingvild Aune, The woman’s birth experience—The effect of interpersonal relationships and continuity of care,
Viken, Berit, Balaam, Marie-Clare and Lyberg, Anne (2017) A salutogenic perspective on maternity care for migrant women.In: New thinking on improving maternity care: International perspectives. Pinter & Martin. ISBN 978-1-78066-240-4