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1
Davies, Jacqueline. "Blurring the boundaries between midwifery and obstetrics : an exploration of the role of midwife practitioner in a maternity unit in Wales." Thesis, University of South Wales, 2008. https://pure.southwales.ac.uk/en/studentthesis/blurring-the-boundaries-between-midwifery-and-obstetrics(40182058-a1b5-4628-961a-5a5d7ab92fc6).html.
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This thesis explores the newly established role of midwife practitioner (MP) and its impact on midwives and obstetricians in a maternity unit in Wales. MPs manage the care of women at high obstetric risk and carry out aspects of care, such as assessment, diagnosis and the development of management plans, which in the past were predominantly performed by obstetricians. This qualitative study employs a focused ethnographic approach and uses a purposive sample. Phase one consisted of seven focus groups, which were held between May and August 2004, with midwives (n=48) from maternity units in Mid and South Wales. In Phase two, participant observation was undertaken with MPs (n=3) over a two-week period encompassing eight 12-hour night shifts, during November and December 2004. For Phase three, semi-structured interviews were conducted with midwives (n=10), clients (n=10) and obstetricians (n=7), between July and December 2005. Phases two and three were carried out in a maternity unit in South Wales. The key findings of this study demonstrate that the lack of planning for the MP role inadvertently resulted in the creation of a distinct health care role, which encompasses positive aspects of both midwives' and obstetricians' work to provide safe and acceptable care for clients. The MPs in this study are committed to providing holistic care that takes into consideration the emotional and social needs of women and their families. In addition, these MPs are developing confidence and analytical skills, normally demonstrated by medical staff. However, further initiatives such as allowing MPs to prescribe, or to refer to other specialties, have not yet been adapted to support these new roles. It is too early to see the full impact of this role, but it is argued that it will have no significant effect on the work of the other midwives. MPs, however, do have the potential to impact upon the work of the obstetricians. This study contributes to the current body of knowledge concerning policy and practice for maternity care by examining a new role early in its genesis. This study makes a number of recommendations, including extending the number of MPs employed in Wales, the need for careful planning of future extensions to the midwives' role and further research into the safety and effectiveness of the MP role.
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Badger, Frances Jane. "Delivering maternity care : midwives and midwifery in Birmingham and its environs, 1794-1881." Thesis, University of Birmingham, 2014. http://etheses.bham.ac.uk//id/eprint/5318/.
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This thesis examines the working milieu of midwives in the urban west midlands, primarily Birmingham and Coventry, between 1794 and 1881. Adopting a microhistorical approach, and by integrating sources including a midwife’s register, lying-in charity and poor law records, the thesis argues that developments in midwifery provision over the period mainly arose from local factors and circumstances, however some metropolitan influences can also be discerned. Reasons for the relatively late introduction of midwifery training in the locality, and the minimal interest by local midwives are considered, alongside evidence of midwives’ awareness of the varying reputation of their occupation. This research indicates that midwives worked for a range of clients including charities, the poor law and private clients, and midwifery could be combined with other strands of caring work, or even work unrelated to caring. The analysis illustrates the existence of full-time, sustained midwifery careers and of midwives who achieved a middle-class lifestyle, and a degree of status within their localities. Combined with the evidence of entrepreneurial approaches to midwifery, the thesis argues that these provincial midwives should be integrated into the historiography of businesswomen.
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Kabamba, Beatrice Mubanga. "An inquiry into the feasibility of integration of the advanced midwifery and neonatology clinical nurse specialist in the district health system: the Zambian experience." Thesis, University of the Western Cape, 2004. http://etd.uwc.ac.za/index.php?module=etd&.
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Research has shown that there is a problem in the delivery of quality care in maternal and child health services in Zambia. The 1996 Zambia demographic and health survey estimated maternal mortality rate as high as 649 per 100,000 live birth, with this reason among others, human resource constraints and low number of supervised antenatal clinics, deliveries and postnatal clinics by skilled personnel as some of the reasons for the high maternal mortality. Selected studies identify the role of a clinical nurse specialist in advanced midwifery and neonatology who has acquired the knowledge and practical skills to bring about the desired impact of quality care in safe mother hood in order to bring down the high maternal mortality rates. In order to achieve this, the government needs to integrate the advanced midwifery and neonatology clinical nurse specialist in the health system. It was the purpose of the study to inquire into the feasibility of integration of the advanced midwifery and neonatology clinical nurse specialist in the Ndola District Health system .
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O'Connell, Rhona. "The size paradox : the mega-maternity unit as a vector for authentic midwifery to emerge." Thesis, University of Central Lancashire, 2011. http://clok.uclan.ac.uk/2916/.
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Midwifery practice in Ireland has emerged from a system of care dominated by the biomedical model of childbirth. The aim of this study was to explore the experiences of labour ward midwives who are potentially complicit with this approach. This study reveals how midwives’ environment impacts on their construction of childbirth. The opening of a large new maternity hospital afforded the opportunity to see if the move to this setting would influence midwifery practice. A hermeneutic phenomenological approach was used based on the work of Heidegger and Gadamer. The study was undertaken in two phases, the first involved interviewing six labour ward midwives working in a busy obstetric led labour ward which was due to close. The findings revealed that midwives complied with the norms for the unit and did not take responsibility for the biomedical approach to care. The second phase was undertaken twelve months after the opening of the hospital which was an amalgamation of three maternity units. Seventeen midwives were interviewed for this phase of the study. The move to the larger unit revealed a paradox for midwifery autonomy and enabled midwives to practice in new ways. The maternity service was delivered through a system that values detachment and an attempt at equal (not individualised) care under conditions of limited resources and constraints. This had resonance with Lipsky’s and Foucault’s work. A contrasting situation occurred within the individual labour rooms as the midwives worked in relative isolation, away from the general activity of the unit. This phase of data was framed in terms of Merleau-Ponty’s four existentials. Midwives had opportunities to enact ‘real midwifery’ and normalise birth for women using a range of strategies rather than resorting to interventionist therapies. Midwives shared in the joy of achievement when positive births occurred. The paradox of this mega maternity unit enabled authentic midwifery to emerge. The study provides an insight into the experience of labour ward midwives and how midwifery identities are revealed by the narratives they relate. It also highlights the complexity of contemporary maternity care in large centralised maternity units.
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Abel, Sally. "Midwifery and maternity services in transition: An Examination of change following The Nurses Amendment Act 1990." Thesis, University of Auckland, 1997. http://hdl.handle.net/2292/1968.
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The Nurses Amendment Act 1990 enabled midwives in New Zealand/Aotearoa to care for women throughout normal childbirth on their own responsibility, without the supervision of a medical practitioner, as had previously been the case. The Act brought about significant changes to midwives' scope of practice, pay and status which had important implications for women's care, midwifery, the relationship between midwifery and medicine and the structure of maternity services. Three years after the passage of the Act, in July 1993, major restructuring of the health system along market principles began. From this time, consultation began for new maternity services arrangements, which fitted within the philosophy and structure of the new health system and which aimed to rectify some of the perceived problems resulting from the initial implementation of the 1990 Act. The consultation process was to take three years. This thesis describes and critically analyses changes to midwifery and maternity services, particularly in the greater Auckland region, in the six years from the passage of the Nurses Amendment Act in August 1990 until the official introduction of the new maternity structure in July 1996. This was a period in which midwifery was establishing itself in a medically-dominated domain while, simultaneously, a significant ideological shift was occurring in the philosophy and structure of the health system. Using an ethnographic approach, which included extensive key informant interviews and participant observation at a range of meetings over a period of three years I investigated in depth both the process of change and the relations of power between interest groups (consumer representatives, midwifery, medicine, hospital managers and regional health authorities) within local and national maternity services arenas. These findings were analysed using Foucault's later work on power and his concept of governmentality. A range of factors, including some of the trends occurring within the public sector, weakened the medical profession's control of normal childbirth and facilitated midwifery's entry as a competing provider of maternity care. Strategies used by midwifery representatives to maintain and develop the occupation's autonomous status were often effective, albeit constantly challenged. Despite ongoing conflict and some polarisation between medicine and midwifery, in general, relations of power between the various interest groups in both local and national settings were found to be complex and contestable with unstable alliances forming around particular issues. However, the fluidity of these power relations and the gains made by midwifery operated within constraints imposed by the influence of neo-liberal policies on the development of the new maternity structure. This gave the government's agents, the regional health authorities, the controlling influence on maternity services policy. Although the professed aim of the new structure was a more women-centred service, there were limits to consumer influence on maternity services policy and fiscal imperatives took precedence over some consumer interests. KEYWORDS: Midwifery; Maternity Services; Nurses Amendment Act 1990; Health Reforms; Power; Foucault; Professions; New Zealand; Aotearoa.
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Thompson, Faye E. "The ethical nature of the mother-midwife relationship: a feminist perspective." University of Southern Queensland, Faculty of Sciences, 2001. http://eprints.usq.edu.au/archive/00001517/.
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This research explored the ethical nature of the mother-midwife relationship in order to refine our understanding of the place of ethics in the context of everyday midwifery practice – the practice of ‘being with woman’ in childbirth. The ethics explicitly available to midwives are derived from practices such as moral philosophy and bioethics, whose ethical frameworks are reductionist in their exclusion of context and relationship. Given that the midwifery profession is currently promoting a model of practice built on partnership and relationship, existing codes and frameworks are examined for their adequacy. An assumption of the study was that a distinctive midwifery ethic was implicitly available in the lived realities and shared engagement of mothers and midwives, embedded in practice. Conceptual theoretical research methodology facilitated exploration of the taken-for-granted assumptions of established theory, official policies such as Codes, and the profession’s literature. Feminist-constructivist theory formed the epistemological basis for gaining insight into the implicit ethics of midwifery. Personal narratives of mothers and midwives were analysed and interpreted for meaning, and transcripts returned to participants for validation. These constructed meanings were then compared and contrasted with those explicit in Codes and current literature. The central theme to emerge from the narratives was the use and abuse of power in relationships. Other major themes were institutional dominance consistently used to describe the status quo, values conflict especially linked to workplace/service provider versus personal/professional midwifery ethics, and the ethical adequacy of a ‘being with woman’ relationship. Findings indicate that midwifery does need a different ethic to that of bioethics and problem-solving principlism, and that such a new ethic would look like those promoted by feminist-virtue ethics. The latter not only redress the politics of the existing hegemonic maternity services system, but they also place women’s concerns central to practice and deliberation. The aspirations, values and lived reality of mothers and midwives, and the commitment of the professional-friend midwife to the particularity of the birthing woman, are the focus of a reconstructed ethic for midwifery practice, an ethic which reunites morality and personal interest. Implications and recommendations are discussed.
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Thopola, Magdeline Kefilwe. "An evidence-based model for enhancing optimal midwifery practice environment in maternity units of public hospitals, Limpopo Province." Thesis, University of Limpopo, 2016. http://hdl.handle.net/10386/1541.
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Thesis ( Ph.D. ( Nursing)) -- University of Limpopo, 2016The purpose of this study was to develop an evidence-based model for enhancing optimal midwifery practice environment in maternity units of public hospitals, Limpopo Province. A mixed method sequential explanatory design was adopted. The study was conducted in four phases, namely: quantitative, qualitative, model development and validation of the model. Self-developed 4-point Likert scale questionnaires consisting of 81 item questions for learner midwives and 89 item questions for midwifery practitioners were administered. The questionnaires were pre-tested prior to being administered to the respondents of the main study. The sample size of midwifery practioners was 174 and that of the learner midwives was 163. Data collected from respondents were analyzed quantitatively using descriptive and inferential statistics. Tables, pie and bar graphs were drawn to present the results. The results from the quantitative phase were utilized to formulate the interview guides that were used to explore the experiences of midwifery practitioners, experiences of learner midwives and perceptions of puerperal mothers. Phenomenological semi-structured individual interviews were conducted for midwifery practitioners (n=20), 3 Focus group discussions of learner midwives (n=18) and 3 focus group discussions of puerperal mothers (n=18) were held until data reached saturation. Data were analyzed qualitatively using Tesch’s open-coding method. Themes and sub-themes were coded manually. Results that emerged from the corroboration, comparison and integration of quantitative and qualitative results revealed the existence a sub-optimal midwifery practice environment, sub-optimal midwifery experiential learning environment and provision of sub-optimal midwifery interventions in the public hospitals of Limpopo province. Development of an evidence-based model emanated from the findings of numeric quantitative data and qualitative narratives. The evidence-based information from the existing situation as seen from the world of participants brought about a gap of optimal midwifery practice environment. The ideal situation was designed in a way of addressing the gaps identified. Experts were given the validation tool to assess whether the model was clear, simple, understood and that it can be utilized by any discipline in future.
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Boon, Leen Ooi, University of Western Sydney, College of Social and Health Sciences, and of Nursing Family and Community Health School. "Exploring childbearing women's perception of the role of a midwife." THESIS_CSHS_NFC_Boon_L.xml, 2002. http://handle.uws.edu.au:8081/1959.7/762.
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In this study, the childbearing women's perception of the role of a midwife in Australia was explored using a descriptive study. Data was gathered using a semi structured questionnaire.The findings revealed that childbearing women in Australia overwhelmingly believed a midwife is specifically trained and qualified to deliver babies normally and to care for a woman in labour.In addition, the belief was that a midwife is trained to provide a comprehensive range of maternity related tasks.The overriding themes which emerged identified the midwife as a source of advice, information, support, education, guidance, specific midwifery knowledge and being a liason person between the doctor and the pregnant woman.Limitation of the role of a midwife was believed to be due to the nursing based training of a midwife.The findings from this study revealed that childbearing women in Australia, United Kingdom and Singapore have similar perceptions of a midwife's role.Recommendations were made for further studies to investigate the reasons for a persistent lack of information regarding the role of a midwife and the type of information required by pregnant women.Master of Nursing (Hons.)
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Maimbolwa, Margaret C. "Maternity care in Zambia : with special reference to social support /." Stockholm, 2004. http://diss.kib.ki.se/2004/91-7349-612-X/.
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Kerrigan, Angela Mary. "Care of obese women during labour : the development of a midwifery intervention to promote normal birth." Thesis, University of Stirling, 2017. http://hdl.handle.net/1893/27479.
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Normal birth, defined as birth without induction of labour, anaesthetic, instruments or caesarean section conveys significant maternal and neonatal benefits. Currently one-fifth of women in the United Kingdom are obese. There is increasing evidence of the detrimental effects obesity has on intrapartum outcomes. There is a lack of research on how to minimise the associated risks of obesity through non-medicalised interventions and how to support obese women to maximise their opportunity for normal birth. This thesis aims to provide evidence to address this gap and develop an evidence-based intervention to promote normal birth. Using a methodological approach aligned with pragmatism, this research was conducted in four parts and underpinned by the Medical Research Council framework for the development of complex interventions. Part one was a national survey involving 24 maternity units. Part two was a qualitative study of the experiences of 24 health professionals and part three involved 8 obese women. The final part was a multi-disciplinary workshop that used consensus decision-making to design the intervention. Collectively, the findings suggest that intrapartum care of obese women is medicalised. Health professionals face challenges when caring for obese women but many strive to optimise the potential for normal birth by challenging practice and utilising ‘interventions’ to promote normality. The findings also demonstrate that obese women have an intrinsic fear of pregnancy and birth, have a desire for normal birth and ‘obese pregnancy’ presents a window of opportunity for change. The intervention consists of three component parts; an educational aspect (e-learning package), a clinical aspect (intrapartum care pathway) and a leadership aspect (ward champions). Whilst acknowledging the importance of safety, increasing intervention during labour for obese women may further increase the risk of complications, with detrimental effects. Addressing intrapartum management of obese women through non-medicalised interventions is of paramount importance in order to promote normality, maximise the opportunity for normal birth and reduce the associated morbidities.
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Coyle, Karen. "Women's perceptions of birth centre care: A qualitative approach." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 1998. https://ro.ecu.edu.au/theses/1004.
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The purpose of this exploratory study was to describe women's perceptions of the care they received in a birth centre, compared to their previous experiences in a hospital. Australian statistics indicate that five percent of childbearing women now choose to receive care in a birth centre setting. Clinical outcomes of birth centre care are now well documented, but there is limited empirical data about women's experiences of this model of care. Seventeen women, who had recently given birth in a birth centre, and had previously experienced care in a hospital setting, were interviewed about their care experiences. Using content analysis, the primary patterns in the data were coded and categorised into the four key themes of : Beliefs about Pregnancy and Birth, Nature of the Care Relationship, Care Interactions and Care Structures. The underlying clinical issues were those relating to philosophies of care, control over childbirth, and continuity of carer. Women wanted carers who viewed birth as a natural process rather than as an illness, and who engaged in a sharing, rather than a controlling, relationship. Finally women preferred to know, and be known by their carers. These findings are important for midwives, in terms of their education and practice. They also have implications for hospital administrators, health planning agencies, and the medical profession.
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Tucker, Christina. "An exploratory study into the perceptions of maternity service managers and midwives of succession planning and the midwifery leadership role in England." Thesis, University of Bristol, 2004. http://hdl.handle.net/1983/35470fd8-f589-4f71-9a83-c9637dc4e797.
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Patterson, Jean Ann. "A time of travelling hopefully : a mixed methods study of decision making by women and midwives about maternity transfers in rural Aotearoa, New Zealand : a thesis submitted to the Victoria University of Wellington in fulfilment of the requirements for the degree of Doctor of Philosophy in Midwifery /." ResearchArchive@Victoria e-thesis, 2009. http://hdl.handle.net/10063/1028.
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Vedam, Saraswathi. "Moving from Interprofessional Disarticulation to Transformative Dialogue and Action: Examining a Transdisciplinary Process to Address Equitable Access to High Quality Maternity Care in North America." Thesis, The University of Sydney, 2019. https://hdl.handle.net/2123/21692.
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Maternity providers in North America are in conflict about birth place, debating issues related to safety, autonomy, and quality of care. Very little is known about how birth place interacts with experience and outcomes of maternity care, or about how to resolve these differences among provider disciplines within established health care systems. A multi-stakeholder group of leaders convened at a series of Home Birth Summits in the United States to delineate a Common Ground Agenda, including nine priority areas for action and research. The aim of this doctoral study was to examine how and why this transdisciplinary process generated new evidence and tools that can improve maternity services. Methods I synthesized the results of four original research studies using a range of methodologies as appropriate to the study topic. In the Canadian Birth Place Study, I examine mixed methods data on provider attitudes to place of birth. In the Changing Childbirth in British Colombia (BC) and Giving Voice to Mothers studies, psychometric analysis cross-sectional survey data led to development of four new person-centered measures of experience of maternity care. In the Access and Integration Maternity Care Mapping Study, a Delphi study created a scoring system (MISS) to assess midwifery integration. Correlation and regression analyses elicit linkages between integration and key maternal-newborn outcomes. Finally, I triangulated results of these studies within the Taming Wicked Problems Framework, to elicit an underlying and contributory factor for effective transdisciplinary action. Results Among maternity care providers (n=825), 84% of variance in attitudes to home birth was attributable to provider type alone. Women from diverse backgrounds (n=2051, 3586 pregnancies) reported reduced autonomy and respect when cared for by physicians and when 9 giving birth in institutional settings. Among women in the United States (US) (n=2700), disparities in experiences of care, including mistreatment, links to race, socioeconomic status, place of birth and type of provider. U.S. states with higher midwifery integration and greater access to home birth reported significantly fewer adverse maternal-newborn outcomes and significantly higher rates of physiologic birth. Discussion The participatory approach and synthesis of outcomes of these studies was essential to understand and address inequities in experience and access to quality maternity health services in the US. Person-centered care emerged as a hidden common value that informed a transdisciplinary research process, and community-responsive knowledge translation outputs. Conclusion Increasing knowledge among all types of providers about quality and safety of birth place, and person-centered care, could improve outcomes across birth settings. The Summit process of transdisciplinary engagement reduced interprofessional conflict and facilitated cocreation of evidence and tools that improve quality, safety, and accountability in North American maternity care.
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Njikija, Vuyelwa Francina. "The role of assessments in enhancing midwifery programme outcomes at a public nursing education institution in the Eastern Cape Province." Thesis, Nelson Mandela Metropolitan University, 2016. http://hdl.handle.net/10948/11597.
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The substandard care noted and reported on in midwifery practice at level one midwifery care institutions in South Africa raises a concern about the effectiveness of the assessment strategies used at nursing institutions in enhancing midwifery programme outcomes. The concern is mainly directed particularly at the performance of the newly qualified professional nurses as they are the ones that practise at level one institutions, had just gone through training and been found to be competent practitioners. The success of any training programme and specifically midwifery practice as in the content of this study is dependent on the effectiveness of the assessment techniques or strategies used; hence assessment is considered integral to monitoring the quality of the midwifery care programme. The current study used a quantitative research design to explore and describe the role of assessments in enhancing midwifery programme outcomes at a public nursing education institution in the Eastern Cape Province. Recommendations to enhance the role of assessments for the benefit of midwifery programme outcomes at a public nursing education institution that were made were guided by the findings of the study. Participants were non-randomly selected and were personally provided with a self-developed questionnaire to complete. 134 participants returned fully completed questionnaires while approximately 25% of the selected sample did not return theirs. Data was captured on an excel spread sheet and analysed using Cronbach’s alpha programme under the guidance of the statistician and supervisor. Findings of the study were that: • the participants perceived the role of assessments as positively enhancing the midwifery programme outcomes, • though they also agreed and strongly agreed that there were major factors that prevented enhancement of midwifery programme outcomes. Ethical considerations were autonomy, beneficence, justice and non-maleficence. The validity and reliability of the data- collection instrument was ensured. Furthermore, recommendations were made for nursing education, clinical practice and future research. The study was conducted during the period of July 2014 to January 2016.
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Scamell, Mandie. "An investigation into how midwives make sense of the concept of risk : how do midwifery perceptions of risk impinge upon maternity care services." Thesis, University of Kent, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.580372.
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This thesis is the product of an ethnographic discourse analysis of midwifery talk and practice, and the data used to inform-this work was collected in the south-east of England. The analytical focus of the thesis is on how risk is understood within the context of midwifery knowledge and expertise and how this is expressed within contemporary childbirth performance. The proposition being made is that the meaning of risk should not be taken as a given and that, although much of routine midwifery activity circulates around sensitivity to risk, the precise meaning of risk is rarely articulated or questioned by practitioners. By using a combination of both qualitative methodological and analytical devices, it has been possible to explore the social and political operations of the interpretative work midwives do when translating risk into meaningful action and the impact this has upon the way birth can be both imagined and performed.
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Mustafa, Alrasheed. "Information practices in midwifery: a case study of an antenatal and intrapartum care environment in the Western Cape, South Africa." Thesis, Cape Peninsula University of Technology, 2015. http://hdl.handle.net/20.500.11838/1394.
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Thesis submitted in fulfilment of the requirements for the degree Master of Technology in Information Technology in the Faculty of Informatics & Design at the Cape Peninsula University of TechnologyResearch on health informatics has seen a steady increase during this decade as the role of information technology in the health sector becomes pertinent. Findings of previous research in this domain have uncovered vast information needs of health workers, particularly in developing countries. However, there is a need to continue with multidisciplinary research in priority areas such as midwifery practice and in the environment of marginalised settings. This study explores the significance of the information needs and information-seeking behaviour or practice of midwives during the antenatal and intrapartum care within the environment of a midwifery unit. Additionally, the researcher obtained permission from Faculty of Informatics and Design – CPUT and Health department authority – Western Cape Government in South Africa, to conduct research in the Elsies River Midwifery Obstetric Unit (ERMOU). The research was carried out as case study in a Midwifery Obstetric Unit in the Western Cape, South Africa. The investigator conducted semi-structured interviews and observations to collect qualitative data of the antenatal and intrapartum care environment. The data was transcribed and analysed using thematic analysis and essomenic modelling. The findings comprehensively point to the importance of this research context. The study found that midwives acquired patients’ information from a handwritten Maternity Case Record (MCR) book and midwives’ colleagues, and often during handovers. In addition, midwives also communicate with each other during care activities in the ERMOU. It was apparent that the use of such communication practices is inadequate, and midwives did not always have sufficient information to make appropriate decisions in the ERMOU. All patient information, referral notes, and reporting is paper-based. In addition, essomenic models were used to depict the midwives’ work activities in the antenatal and intrapartum care environment in the Unit. Furthermore, essomenic models defined all the systematic processes that occur in the ERMOU which is described by midwives’ activities and work environment. To improve communication, future research is recommended to consider the importance of the continuity of the education of midwives. Further research will be on the implementation of nursing informatics and the electronic health record system in the Elsies River Midwifery Obstetric Unit.
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Cooper, Melanie. "Meeting the health and social needs of pregnant asylum seekers : midwifery students' perspectives : a critical discourse analysis of language use by midwifery students in their social constructions of the health and social needs of asylum seekers accessing maternity services." Thesis, University of Bradford, 2011. http://hdl.handle.net/10454/5364.
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Current literature has indicated a concern about standards of maternity care experienced by pregnant asylum seeking women. As the next generation of midwives, it would appear essential that students are educated in a way that prepares them to effectively care for pregnant asylum seekers. Consequently, this study examined the way in which midwifery students constructed a pregnant asylum seeker's health and social needs, the discourses that influenced their constructions and the implications of these findings for midwifery education. For the duration of year two of a pre-registration midwifery programme, eleven midwifery students participated in the study. Two focus group interviews using a problem based learning (PBL) scenario were conducted. In addition, three students were individually interviewed and two students' written reflections on practice were used to construct data. Following a critical discourse analysis, dominant discourses were identified which appeared to influence the way that pregnant asylum seekers were perceived. The findings suggested an underpinning discourse around the asylum seeker as different and of a criminal persuasion. In addition, managerial and medico-scientific discourses were identified, which appeared to influence how midwifery students approach their care of women in general, at the expense of a woman centred, midwifery perspective. The findings from this study were used to develop 'the pregnant woman within the global context' model for midwifery education and it is recommended that this be used in midwifery education, to facilitate the holistic assessment of pregnant asylum seekers' and other newly arrived migrants' health and social needs.
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Haith-Cooper, Melanie. "Meeting the health and social needs of pregnant asylum seekers - midwifery students' perspectives. A critical discourse analysis of language use by midwifery students in their social constructions of the health and social needs of asylum seekers accessing maternity services." Thesis, University of Bradford, 2011. http://hdl.handle.net/10454/5364.
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Current literature has indicated a concern about standards of maternity care experienced by pregnant asylum seeking women. As the next generation of midwives, it would appear essential that students are educated in a way that prepares them to effectively care for pregnant asylum seekers. Consequently, this study examined the way in which midwifery students constructed a pregnant asylum seeker's health and social needs, the discourses that influenced their constructions and the implications of these findings for midwifery education.
For the duration of year two of a pre-registration midwifery programme, eleven midwifery students participated in the study. Two focus group interviews using a problem based learning (PBL) scenario were conducted. In addition, three students were individually interviewed and two students' written reflections on practice were used to construct data. Following a critical discourse analysis, dominant discourses were identified which appeared to influence the way that pregnant asylum seekers were perceived. The findings suggested an underpinning discourse around the asylum seeker as different and of a criminal persuasion. In addition, managerial and medico-scientific discourses were identified, which appeared to influence how midwifery students approach their care of women in general, at the expense of a woman centred, midwifery perspective. The findings from this study were used to develop 'the pregnant woman within the global context' model for midwifery education and it is recommended that this be used in midwifery education, to facilitate the holistic assessment of pregnant asylum seekers' and other newly arrived migrants' health and social needs.Became: Haith-Cooper, Melanie. Please search under Haith-Cooper for later articles.
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Dokter, Anija (Rachel). "Listening to birth : metallurgy, maternity, and vocality in the reproduction of the patriarchal state." Thesis, University of Cambridge, 2018. https://www.repository.cam.ac.uk/handle/1810/278616.
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Listening to Birth asserts that structures of power reproduce themselves by instituting particular modes of listening and sound production. Situating my research within feminist sound studies, I argue that meanings conjured around the audible, material bodies of women were carefully crafted by elites in antiquity, in order to construct gendered ideologies of kingship, civilisation, and nature. I examine these power dynamics as expressed in mythic and magical texts and iconographies, dating from the Bronze Age to later Roman antiquity. Throughout the thesis, I examine the development of symbolic systems and narrative tropes that linked mining and metallurgy with reproduction and vocality. My analysis emphasises how the invention of nature was accomplished, in part, through a metallurgical reclassification of the voices and sexualities of women as indiscrete phenomena: womb, mouth, and voice were elided with mining and smelting to form a unified semantic realm. I argue that this invention of ‘vulvar vocality’ reclassified female sounds as illicit, providing a plaform for the removal of women from the public sphere. I attempt to connect the gendered discourse found in myths and magical rituals to the political and economic domain of state-craft, to demonstrate the importance of hegemonic mythopoeic control of audible female reproduction for establishing ideologies of colonisation and extraction. I link analyses of texts and iconographies from the Bronze Age Mesopotamians, Hittites, Canaanites, Minoans, and Egyptians to later materials from the Iron Age Greeks, Israelites, and Romans—my goal is to demonstrate both the ubiquity and the continual reproduction of metallurgical ideology across the ancient world. I also present my preliminary research into the lasting impact that antique notions of vulvar vocality had on later state-craft. I begin to trace the preservation and elaboration of antique metallurgical literature by Byzantine and Islamic scholars, who in turn exerted strong influence on the Ottomans and late medieval and early modern Europeans. I outline future work to investigate the exponential rise of entrepreneurial metallurgy in late medieval and early modern Europe, arguing that this metallurgical discourse provided symbolic re-enforcement for the rapidly-accelerating mining and metal trade that formed the core of European colonial expansion. I suggest that vulvar vocality was central to early modern metallurgical, demonological, and colonial discourse, and that specific female vocalities and silences were purposefully crafted into the colonial project in order to forcibly redefine women, along with the lands and children stolen from them, as mere natural resources.
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Boon, Leen Ooi. "Exploring childbearing women's perception of the role of a midwife." Thesis, View thesis View thesis, 2002. http://handle.uws.edu.au:8081/1959.7/762.
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In this study, the childbearing women's perception of the role of a midwife in Australia was explored using a descriptive study. Data was gathered using a semi structured questionnaire.The findings revealed that childbearing women in Australia overwhelmingly believed a midwife is specifically trained and qualified to deliver babies normally and to care for a woman in labour.In addition, the belief was that a midwife is trained to provide a comprehensive range of maternity related tasks.The overriding themes which emerged identified the midwife as a source of advice, information, support, education, guidance, specific midwifery knowledge and being a liason person between the doctor and the pregnant woman.Limitation of the role of a midwife was believed to be due to the nursing based training of a midwife.The findings from this study revealed that childbearing women in Australia, United Kingdom and Singapore have similar perceptions of a midwife's role.Recommendations were made for further studies to investigate the reasons for a persistent lack of information regarding the role of a midwife and the type of information required by pregnant women.
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Lenaway, Dennis David. "Evaluation of a public-private certified nurse-midwife maternity program for indigent women /." Thesis, Connect to this title online; UW restricted, 1995. http://hdl.handle.net/1773/10872.
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Thomas, Catherine. "Accoucher en France aujourd'hui. Les enjeux de la profession de sage-femme et la position des femmes face à la naissance médicalisée." Thesis, La Réunion, 2016. http://www.theses.fr/2016LARE0022/document.
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À l'heure actuelle, les résultats périnataux en France demeurent parmi les moins satisfaisants en Europe malgré une très forte médicalisation. Les autorités de santé affirment reconnaître l'influence de la prise en charge et de l'accompagnement pendant la grossesse, l'accouchement et la période néonatale sur l'état de santé de la mère et de l'enfant mais l'offre de soins peine à s'élargir. Contrairement à ce que prévoient les lois concernant le libre choix du praticien en France, les parturientes ne sont pas à même de choisir le professionnel de santé qui les accompagnera lors de leur accouchement. De même, les sages-femmes, contrairement à ce qu'impose leur code de déontologie, ne sont pas en mesure de garantir à leurs patientes ni les conditions, ni le lieu de leur accouchement. De surcroît, peu d'entre elles exercent leur profession de façon autonome tout en pratiquant le plein exercice de leur fonction. En centrant cette recherche anthropologique sur l'expérience des femmes et des sages-femmes dans leurs relations autour de la naissance et de l'accouchement, l'objectif de cette étude qualitative est de faire la lumière sur les tenants et les aboutissants de l'uniformisation de l'offre de soins. Dans un premier temps sont abordés les différents types d'accompagnement proposés aux femmes aujourd'hui ainsi que la place qu'y occupent les sages-femmes. Dans un second temps, l'étude de l'accompagnement global permet l'examen de la prise en charge des patientes et de ses liens de causalité avec les relations interprofessionnelles. Ainsi sont révélés les impacts de cette pratique sur le soutien à la parentalité et la nécessité d'une diversification de l'offre de soinsCurrently, the perinatal results in France remain among the least satisfactory in Europe in spite of a very strong medicalization. However, health authorities acknowledge the influence of maternity care during pregnancy, childbirth and neonatal period on the state of health of the mother and the child but health services hardly increase. Contrary to what French law says on free choice of practitioner, parturient women cannot choose the health professional who will assist them during labor. Likewise, midwives cannot guarantee their patients the place and conditions of childbirth, contrary to their code of ethics. In addition, few of them have the opportunity to work in an independent way and at the same time fully practice their profession. By focusing this anthropological research on women's and midwives' experience in their relationships around childbirth, the aims of this qualitative study are to clarify the ins and outs of the standardization of health services. Initially, the various types of care provided to women today and the place granted to midwives are discussed. Secondly, possible causal links between interprofessional relations and maternity care are searched for through the study of comprehensive care. So are revealed the impacts of a close and trusting relationship in supporting parenthood and of a diversification of health services
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Melin, Wenström Lisa. "Maternity Home and Education Center in Mozambique." Thesis, KTH, Arkitektur, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-122577.
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There is a large indigence for more maternity homes in Mozambique. Pregnant women often have to walk long distances to get assistance giving birth. The conditions are hard to improve because of the shortage of educated staff. The maternity home and education center is a combined program for women in Maputo, Mozambique. The purpose for this is – apart from improving opportunities and help for pregnant women – to create a connection between education and practice so that the pupils can do their practice at the maternity home before working out in the country. The two instances are therefore closely integrated with each other. We want to develop a program that is also long-term giving, a kind of pay-forward-effect. The supposed consequence of the pay-forward effect is for graduated women to spread the knowledge to less educated midwifes in the countryside and at a long term improve health care for women.Det finns ett stort behov av fler mödravårdscentraler i Mocambique. Gravida kvinnor går oftast långa sträckor för att få hjälp att föda. Förhållandena är svåra att förbättra i avsaknad av utbildad personal. Mödravårdscentralen och barnmorskeutbildningen är ett kombinerat program för kvinnor i Maputo, Mocambique. Målet med vårt projekt är att hjälpa gravida kvinnor och att skapa ett utbyte mellan utbildning och praktik. Därför är programmen tätt integrerade med varandra. Programmet ska skapa insikt om graviditet, födsel, sexualitet, en slags ”pay-forward effect”. Verkningarna av ”pay-forward” är att utbildade kvinnor ska sprida kunskap till mindre utbildade barnmorskor på landsbygden och på lång sikt bidra till en bättre sjukvård för kvinnor.
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Holm, Camilla. "Maternity home and education center in Mozambique." Thesis, KTH, Arkitektur, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-122563.
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There is a large indigence for more maternity homes in Mozambique. Pregnant women often have to walk long distances to get assistance giving birth. The conditions are hard to improve because of the shortage of educated staff. The maternity home and education center is a combined program for women in Maputo, Mozambique. The purpose for this is – apart from improving opportunities and help for pregnant women – to create a connection between education and practice so that the pupils can do their practice at the maternity home before working out in the country. The two instances are therefore closely integrated with each other. We want to develop a program that is also long-term giving, a kind of pay-forward effect. The supposed consequence of the pay-forward effect is for graduated women to spread the knowledge to less educated midwifes in the countryside and at a long term improve health care for women.Det finns ett stort behov av fler mödravårdscentraler i Mocambique. Gravida kvinnor går oftast långa sträckor för att få hjälp att föda. Förhållandena är svåra att förbättra i avsaknad av utbildad personal. Mödravårdscentralen och barnmorskeutbildningen är ett kombinerat program för kvinnor i Maputo, Mocambique. Målet med vårt projekt är att hjälpa gravida kvinnor och att skapa ett utbyte mellan utbildning och praktik. Därför är programmen tätt integrerade med varandra. Programmet ska skapa insikt om graviditet, födsel, sexualitet, en slags ”pay-forward effect”. Verkningarna av ”pay-forward” är att utbildade kvinnor ska sprida kunskap till mindre utbildade barnmorskor på landsbygden och på lång sikt bidra till en bättre sjukvård för kvinnor.
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Halderot, Karin, and Maria Sjöstrand. "EDA - På gott och ont : Förstföderskors kunskaper och behov av information om EDA." Thesis, Högskolan i Skövde, Institutionen för hälsa och lärande, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:his:diva-12955.
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Bakgrund: Antalet förstföderskor som använder sig av EDA har ökat och idag använder dryga hälften EDA under förlossning. Det är den mest effektiva smärtlindringsmetoden som förlossningsvården har att tillgå. EDA vid förlossning är dock förknippat med biverkningar och risker. Barnmorskor har en viktig roll att ge information och undervisning om smärtlindring till gravida kvinnor. Syfte: Syftet med studien var att undersöka förstföderskors kunskaper och behov av information om EDA inför förlossning. Metod: Studien genomfördes och analyserades med metoden kvalitativ innehållsanalys med induktiv ansats. Semistrukturerade intervjuer genomfördes med åtta förstföderskor. Resultat: De analyserade intervjuerna utmynnade i två huvudkategorier; EDA är en metod med fördelar och nackdelar och Förstföderskor har behov av olika information på olika sätt, med tre, respektive två, tillhörande underkategorier. Konklusion: Kvinnornas kunskaper varierade, och många var osäkra. De hade behov av olika information om EDA på flera olika sätt. De upplevde att det varken fanns tid eller möjlighet för diskussion om EDA med barnmorskor, vilket kunde bidra till en känsla av att inte ha fått tillräckligt med information. Barnmorskor behöver därför blir bättre på att erbjuda förstföderskor information om EDA, men även annan smärtlindring som används under förlossning, förslagsvis genom uttökad tid på MHV.Background: The number of primparas who use EDA has increased, and today more than half of them use EDA during childbirth. It is the most effective method of pain relief that is available in maternity care. EDA during childbirth is, however, associated with side effects and risks. Midwives have an important role to provide information and education about pain relief to pregnant women. Purpose: The purpose of this study was to investigate primiparas knowledge and need of information about EDA during childbirth. Method: The study was conducted and analyzed by qualitative content analysis method with inductive approach. Semi-structured interviews were conducted with eight primiparas. Results: The analyzed interviews resulted in two main categories; EDA is a method with advantages and disadvantages and Primiparas need different information in different ways, with three and two associated subcategories. Conclusion: The women's knowledges varied, and many were unsure. They needed different information about EDA in several different ways. They felt that there was neither time nor opportunity for discussion about EDA with midwives, which could contribute to a feeling of not having received sufficient information. Midwives must therefore improve in offering primiparas information about EDA, but also other forms pain relief used during childbirth, suggested by extended time at maternal health care.
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Williamson, Melissa Grace. "Exploring midwives' experiences of managing patients' perinatal loss at a maternity hospital in the Western Cape, South Africa." University of the Western Cape, 2016. http://hdl.handle.net/11394/5645.
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Magister Curationis - MCurPerinatal deaths are emotion-laden events not only for the mothers, but also for physicians and midwives. Hence, mothers experiencing the phenomenon need support to overcome the experience. If the loss occurs in a health institution, the responsibility of supporting the woman is borne by healthcare providers, particularly midwives. However, limited information exists on how midwives manage patients who experience perinatal loss in health institutions. Consequently, this study on midwives' experiences of managing patients' perinatal loss at a maternity hospital in the Western Cape, South Africa was conducted. The aim of the study was to explore midwives' management of patients with perinatal loss. The study utilised a qualitative research design and employs a phenomenological approach. Purposive sampling was used to select eight registered midwives to participate in the study. Data was collected by means of in-depth unstructured interviews, which were audio-recorded. It was then analysed by utilising Colaizzi's (1978) steps of phenomenological data analysis. Four themes emerged from the data, namely, knowledge of perinatal loss, challenges when managing patients, managing perinatal loss, and getting emotionally involved. Themes were informed by several subthemes. In addition, implication on practice indicates that improving support to mothers with pregnancy loss requires a multi-disciplinary approach or teamwork from various professionals in order to enhance mutual collaboration between families and healthcare workers. The study concludes that nursing education programmes should be reviewed to ensure that they include midwives' needs in the area of managing clients experiencing a perinatal loss. Hence, student midwives should be given more clinical experience of caring for bereaved couples under supervision, as well as compassionate support, which would assist them to develop these skills before they graduate.
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Davison, Clare Louise. "The relationship is everything : women’s reasons for, and experience of maternity care with a privately practising midwife in Western Australia." Thesis, Curtin University, 2014. http://hdl.handle.net/20.500.11937/2085.
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The aim of this descriptive qualitative study was to investigate women’s reasons for, and experiences of maternity care with a privately practising midwife. Data analysis from the fourteen women interviewed revealed three major categories characterising reasons for choosing private midwifery care: I knew what I wanted from my care provider; I knew what I wanted from my pregnancy and birth experience and I was willing to do the research to get what I wanted.
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Denham, Sara Helen. "A case study exploration of approaches to the delivery of safe, effective and person centred care at two rural community maternity units." Thesis, Robert Gordon University, 2015. http://hdl.handle.net/10059/1372.
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Background: This research explores whether rural Community Maternity Units (CMUs) contribute to NHS Scotland’s Quality Ambitions of safe, effective and person centred care. Currently there is no available recent evidence regarding the quality of this particular model of care in a rural setting. This research makes an important contribution given that most women are encouraged to access local maternity services. Design: An exploratory case study was used with a hermeneutic phenomenological approach to the qualitative data collection and analysis. Quantitiative data were collected and analysed to provide descriptive statistics. Methods: The study was conducted in three phases. In phase one a retrospective medical records review was undertaken to provide quantitative data on the care provided. Phase two was an observation of team meetings, interviews with staff and focus groups with stakeholders in roles aligned to the provision of care at the CMUs. In phase three observations of clinical encounters and interviews with women informed by aide memoire diaries were used. Findings: Maternity services provided by the CMU teams achieved a consistently high standard of safety and effectiveness when measured against national guidelines, standards and other evidence. The stakeholders appreciated the ability within these small teams to provide local, accessible services to women with effective support when required from tertiary services. The women valued person centred and relationship based continuity of antenatal carer, provided by compassionate named midwives, but were disappointed by the discontinuity when complications occurred. Conclusions: The CMUs’ physical position within the community, smallness of scale and the midwifery team’s ethos of normality within a socially based but medically inclusive service facilitated local access for most women to maternity care. This service provision addressed NHS Scotland’s Healthcare Quality Strategy of improving health and reducing inequalities for the people of Scotland. The role of the named midwife was key to providing high quality care by maintaining connections across contextual boundaries for women experiencing normal and complicated pregnancies. This research provides an original contribution to the study of rural maternity service provision in Scotland to help inform future sustainability and service development of rural CMUs.
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Mfundisi, Zama. "The role of professional nurses in promoting a healthy self-esteem in hospitalised, pregnant women with HIV/AIDS in a maternity unit in a public hospital in Cape Town." Thesis, Cape Peninsula University of Technology, 2019. http://hdl.handle.net/20.500.11838/3017.
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Thesis (Master of Nursing)--Cape Peninsula University of Technology, 2019In the fight against the human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), one of the aspects to be taken into consideration is the self-esteem of pregnant women. Professional nurses in maternity settings need to support pregnant women, with a focus on providing balanced care to meet all of the women’s needs and build their self-esteem. Self-esteem reflects one’s subjective emotional evaluation of one’s worth. A decrease in the self-esteem of the individual with HIV/AIDS infections is common and professional nurses should advise patients on the appropriate ways to deal with HIV/AIDS. A supportive environment for HIV/AIDS women could enhance their self-esteem. The researcher overheard HIV/AIDS positive patients in a maternity unit express their feelings of worthlessness and wondered how he could support them to have self-worth. The purpose of the study was to explore and describe the role of professional nurses in promoting a healthy self-esteem in hospitalised, pregnant women with HIV/AIDS in a maternity unit in a public hospital in Cape Town. The study was qualitative in nature, departing from assumptions of the theoretical framework of Eric Erikson. An exploratory, descriptive, contextual, qualitative design was followed when the semi-structured interviews were conducted. The accessible population comprised of 15 professional nurses working at the maternity unit. Purposive sampling was used to obtain a sample of 11 professional nurses (participants) working in a maternity unit who met the eligibility criteria. Individual interviews were conducted with eight participants as a starting point until data saturation was reached. After obtaining permission from the necessary authorities, the researcher visited the manager of the unit. Two pilot individual interviews were conducted to determine whether the research questions were understood. The researcher explained the purpose and information on the information sheet and obtained informed consent. Interviews lasted 45 minutes were conducted in a private room and recorded. The researcher used an interview schedule and made field notes while conducting the interviews. Data triangulation of the interviews and field notes ware done. Thematic analysis coding was applied to analyse data. Trustworthiness was ensured through credibility, transferability, dependability and conformability. The following ethical principles of privacy, the right to withdraw and anonymity were followed. The findings indicated HIV/AIDS-related stigma as the main cause of a poor self-esteem among pregnant women with HIV/AIDS. Participants furthermore felt that there is a need for training and skills development of professional nurses to enable them to understand how to support HIV/AIDS pregnant women and enhance their self-esteem. It was concluded that professional nurses should support pregnant women with HIV/AIDS places a socio-economic burden on societies and has set the world into spending millions on healthcare settings in an attempt to curb the disease.
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Avanzo, Sylvie. "Accompagnement à l'élaboration psychologique de la maternité. : problématiques et enjeux." Thesis, Lyon, 2016. http://www.theses.fr/2016LYSE2165.
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L’accompagnement à l’élaboration psychologique de la maternité est l’un des axes de progrès ayant contribué à améliorer et à sécuriser le champ de la périnatalité. L’entretien prénatal précoce du quatrième mois est ainsi proposé à toutes les femmes enceintes, aux futurs parents, afin d’ouvrir le dialogue et de recueillir les facteurs de vulnérabilité.Or, psychologue en exercice libéral, je constate que plusieurs jeunes mères me demandant un accompagnement peu après l’accouchement, font état d’un mal-être et d’un besoin de suivi psychologiques déjà présent durant leur grossesse, auquel la sage-femme ou le médecin traitant n’a pas donné suite. La prise en compte de la dimension psychologique lors de l’entretien prénatal précoce ou s’il n’a pas eu lieu, lors des visites de contrôle avec le professionnel de santé, se limite-t-il aux femmes enceintes dont la fragilité est apparente ? Les états de mal-être psychologique ressenti par les femmes enceintes, non évidents, mais justifiant d’un accompagnement psychologique, sont-ils difficilement identifiables par la sage-femme ou le médecin lors de l’EPP ou lors des visites de contrôle de la grossesse ?Les réponses à ces questions s’appuient sur trois études traitant : de la perception de l’utilité de cet entretien par les futures mères qui y ont participé ; de la manière dont les sages-femmes conduisent cette rencontre ; de la nature et des causes d’états émotionnels douloureux vécus durant leur grossesse par certaines mères, qui auraient nécessité alors un suivi n’ayant pas eu lieu. Plusieurs pistes sont proposées pour améliorer la réponse au besoin d’accompagnement psychologique de la femme enceinte, les unes davantage adaptées au milieu hospitalier et d’autres aux praticiens exerçant en mode libéralThe psychological accompaniment of motherhood is one area of development that has contributed to improve the quality and safety of perinatal care. The early prenatal interview of the fourth month (the EPP of the 4th month) is offered to all pregnant women and expectant parents, in order to initiate a dialogue and surface vulnerabilities. In my private practice as a psychologist, I have observed that several young mothers asking for accompaniment after delivery, suffer from a psychological pain and express a need for support, which were already present during their pregnancy, but which were not attended to by the midwife or doctor.Is the psychological dimension in the EPP, or during prenatal visits to the doctor, only taken into account in the case of pregnant women, whose fragility is obvious? Are the states of psychological discomfort felt by pregnant women, which are not obvious, but deserve a psychologist support, easily identified by the midwife or doctor during the EPP or prenatal visits? The answers to these questions are based on three following studies assessing: (a) the perceived usefulness of the EPP by expectant mothers who availed of it; (b) the way midwives lead the EPP; (c) the nature and causes of painful emotional states felt during pregnancy by some expectant mothers, who would have needed a support that did not materialize.Several recommendations are made to improve the response to the need for psychological support in pregnant women, some more suited to the hospital environment and others geared toward midwives and doctors operating in private practices
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Byrskog, Ulrika. "’Moving On’ and Transitional Bridges : Studies on migration, violence and wellbeing in encounters with Somali-born women and the maternity health care in Sweden." Doctoral thesis, Uppsala universitet, Institutionen för kvinnors och barns hälsa, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-259881.
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During the latest decade Somali-born women with experiences of long-lasting war followed by migration have increasingly encountered Swedish maternity care, where antenatal care midwives are assigned to ask questions about exposure to violence. The overall aim in this thesis was to gain deeper understanding of Somali-born women’s wellbeing and needs during the parallel transitions of migration to Sweden and childbearing, focusing on maternity healthcare encounters and violence. Data were obtained from medical records (paper I), qualitative interviews with Somali-born women (II, III) and Swedish antenatal care midwives (IV). Descriptive statistics and thematic analysis were used. Compared to pregnancies of Swedish-born women, Somali-born women’s pregnancies demonstrated later booking and less visits to antenatal care, more maternal morbidity but less psychiatric treatment, less medical pain relief during delivery and more emergency caesarean sections and small-for-gestational-age infants (I). Political violence with broken societal structures before migration contributed to up-rootedness, limited healthcare and absent state-based support to women subjected to violence, which reinforced reliance on social networks, own endurance and faith in Somalia (II). After migration, sources of wellbeing were a pragmatic “moving-on” approach including faith and motherhood, combined with social coherence. Lawful rights for women were appreciated but could concurrently risk creating power tensions in partner relationships. Generally, the Somali-born women associated the midwife more with providing medical care than with overall wellbeing or concerns about violence, but new societal resources were parallel incorporated with known resources (III). Midwives strived for woman-centered approaches beyond ethnicity and culture in care encounters, with language, social gaps and divergent views on violence as potential barriers in violence inquiry. Somali-born women’s strength and contentment were highlighted, and ongoing violence seldom encountered according to the midwives experiences (IV). Pragmatism including “moving on” combined with support from family and social networks, indicate capability to cope with violence and migration-related stress. However, this must be balanced against potential unspoken needs at individual level in care encounters.With trustful relationships, optimized interaction and networking with local Somali communities and across professions, the antenatal midwife can have a “bridging-function” in balancing between dual societies and contribute to healthy transitions in the new society.
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Cappelen, Ane, and Veronica Stridh. "Förlossningsställningens betydelse för perineala bristningar under utdrivningsskedet : Ett barnmorskeperspektiv." Thesis, Högskolan i Skövde, Institutionen för hälsa och lärande, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:his:diva-12958.
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Bakgrund: Perineala bristningar är vanligt förekommande vid vaginal förlossning. Bristningar kan leda till bland annat smärta i underlivet som i sin tur kan påverka den sexuella hälsan negativt. Befintlig forskning visar att en förlossningsställning kan påverka både uppkomsten samt graden av bristning, dock framkommer inte förklaring om varför. Syfte: Undersöka barnmorskors uppfattning av förlossningsställningens betydelse för perineala bristningar under utdrivningsskedet. Metod: Studien baseras på en fenomenografisk forskningsmetod där tio intervjuer har genomförts med barnmorskor från sex olika förlossningsavdelningar i södra och mellersta Sverige. Resultat: Förlossningsställningen uppfattas av barnmorskor kunna avlasta trycket mot perineum, undvika ett utdraget utdrivningsskede, vara avgörande för kvinnors kroppskontroll samt bidra till ett långsamt framfödande, vilket uppfattas minska risken för uppkomst av perineala bristningar. Förlossningsställningen uppfattas även kunna öka belastningen mot perineum, minska kvinnors möjlighet att själv kontrollera sin kropp samt bidra till spänd muskulatur i bäckenbotten, vilket uppfattas öka risken för perineala bristningar. I denna studie belyser även barnmorskor värdet av kommunikation med de födande kvinnorna under utdrivningsskedet. Detta uppfattas vara en av de viktigaste faktorerna för att förebygga perineala bristningar. Konklusion: Barnmorskor uppfattar att förlossningsställningen har olika betydelser för perineala bristningar. De för också ett resonemang kring varför och hur bristningar kan uppkomma samt förebyggas relaterat till olika förlossningsställningar.Background: Perineal tears are common in vaginal delivery. The injury can lead to vaginal pain, which in turn can affect the sexual health negatively. Existing research shows that a birth position can influence both the onset and the degree of rupture, but does not reveal the explanation of why. Aim: Investigate midwives perception of the birth positions significans to perineal tearing during the second stage of labor. Method: The study is based on a phenomenographical research where ten interviews were conducted with midwives from six maternity hospitals in southern and central Sweden. Result: Birth positions is perceived by midwives to relieve pressure on the perineum, avoid prolonged second stage of labor, be crucial to women's body control and contribute to a slow birth, which is perceived to reduce the risk of perineal tearing. The birth position perceived also to be able to increase the pressure against the perineum, reduce women's ability to control their body and contribute to tense muscles in the pelvic floor, which is perceived to increase the risk of perineal tearing. This study also highlights the value of midwives communication with women giving birth during the second stage of labor. This is perceived to be one of the most important factors for the prevention of perineal tearing. Conclusion: Midwives perceive that birth position has different meanings for perineal tearing. Midwives also reason why and how perineal tearing can occur and be prevented related to different birth positions.
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Kolář, Vojtěch. "Porodnice." Master's thesis, Vysoké učení technické v Brně. Fakulta architektury, 2017. http://www.nusl.cz/ntk/nusl-316353.
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A new concept of maternity hospital creates a place, where future mother is not stressed and where she feels free. A place, where birth is perceived as a common part of everyday life. It searches a compromise between birth at classical hospital environment on one side and birth at home on the other. Both aforementioned possibilities bring certain risks that are intended to be minimized using this concept. The idea is based on practice from birth facilities from Germany and creates new concept of so called „birth houses“ that is consistent with law in the Czech Republic. Design of maternity hospital should not be based solely on meeting technical requirements of a bulding, but first of all comfort of mothers should be taken into account to make them feel home.
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Blomqvist, Sara, and Johanna Thor. "Barnmorskans arbete kring kostråd till gravida kvinnor : En deskriptiv tvärsnittsstudie." Thesis, Uppsala University, Uppsala University, Department of Public Health and Caring Sciences, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-105101.
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Syftet med denna undersökning var att undersöka barnmorskans syn på kostrådgivning till gravida kvinnor, om och hur de ger information om kost och i så fall vad de informerar om. Vidare undersöktes till vilken grad barnmorskorna på mödravårdscentralerna följer de rekommendationer om kost till gravida kvinnor som Svenska Livsmedelsverket tagit fram. En deskriptiv tvärsnittsstudie genomfördes bland samtliga barnmorskor på mödravårdscentraler i Uppsala län. Det var 36 barnmorskor som deltog i studien (53 % svarsfrekvens) och som besvarade ett webbaserat frågeformulär. Resultatet från undersökningen visar att barnmorskorna ofta ger kostråd till den gravida kvinnan i samarbete med dietisten. Informationen ges då för det mesta både muntligt och skriftligt. Vidare visar resultatet att barnmorskorna anser att det är viktigt att ge kostråd till gravida kvinnor och att de allra flesta kvinnor får kostrådgivning på mödravårdscentralen. Barnmorskorna anser att de och den gravida kvinnan har ett gemensamt ansvar när det gäller information angående kost. Barnmorskorna grundar kostrådgivningen främst på Svenska Livsmedelsverkets rekommendationer och undersökningen visar att de informerar om det mesta som det Svenska Livsmedelsverket tar upp angående kost under graviditeten. Slutsatsen av denna undersökning är att barnmorskorna ger en individuellt anpassad kostrådgivning som följer det Svenska Livsmedelsverkets rekommendationer.
The aim of this study was to examine what view the midwives have on nutritional guidance towards pregnant women, if they give information regarding diets, and if so, how they inform pregnant women, and also what the information consists of. Furthermore, the aim of this study was to determine how the midwives comply with the recommendations given by the Swedish National Food Administration. A descriptive cross-sectional study was carried out among all midwives at the maternity clinics in the county of Uppsala. There were 36 midwives that participated in the study (53 %) which consisted of a web based questionnaire. The result of this study indicated that the midwives frequently give nutritional guidance to the pregnant woman in collaboration with the dietician. The pregnant woman often receives both verbal and written information. The results also indicate that the midwives believe that it is important to give nutritional guidance to pregnant women and that most of them get this guidance at the maternity clinic. The attitude of the midwives is that they, together with the pregnant woman, have a mutual responsibility when it comes to information about nutrition during pregnancy. The midwives nutritional guidance is based on the given recommendations of the Swedish National Food Administration, and the study also shows that the information given by the midwife corresponds with the information that the Swedish National Food Administration emphasise. Therefore the conclusion of this study is that the midwives give an individually adjusted nutritional guidance which corresponds to the recommendations given by the Swedish National Food Administration.
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Domeij, Anna, and Charlotte Lennström. "Barnmorskans erfarenhet av handläggning vid uppkommen grad II-bristning : Kvalitativ intervjustudie med barnmorskor verksamma vid förlossningsavdelning." Thesis, Högskolan Dalarna, Sexuell, reproduktiv och perinatal hälsa, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:du-27197.
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Bakgrund: Det är vanligt att kvinnor under en vaginal förlossning drabbas av grad II-bristning. I barnmorskans ansvarsområde ingår att handlägga dessa bristningar. Forskning visar att det finns begränsat med rutiner kring dessa bristningar och att fokus ofta ligger på grad III- och grad IV-bristningar trots att även grad II-bristningar kan ge långtidskomplikationer. Syfte: Syftet var att beskriva barnmorskans erfarenhet av handläggning vid uppkommen grad II-bristning. Metod: Semistrukturerade individuella intervjuer genomfördes med åtta barnmorskor verksamma vid en mellanstor förlossningsavdelning i Mellansverige. Kvalitativ innehållsanalys användes för att analysera materialet. Resultat: Fyra kategorier och två underkategorier identifierades. Kategorierna var Information, Kollegialt stöd, Behov av uppföljning och Undersökning och underkategorierna Strategier för återkoppling och Dokumentation. Slutsats: Det framkom en osäkerhet hos barnmorskorna gällande diagnostisering och suturering av grad II-bristning. Detta gällde främst de barnmorskor med minst yrkeserfarenhet. Barnmorskorna uttryckte också en önskan om bättre återkoppling på de bristningar de suturerat samt en bättre uppföljning för de kvinnor som fått en grad II-bristning. Resultatet visade även att barnmorskorna informerar kvinnorna på olika sätt gällande deras bristning. Inga tydliga rutiner finns gällande vilken information som ska ges eller på vilket sätt. Klinisk tillämpbarhet: Studiens resultat syftar till att skapa ökad kunskap och riktlinjer kring grad II-bristningar. Ytterligare forskning skulle kunna beröra information i samband med bristningen och när den är bäst att ge.Background: Many women sustain a second-degree tear when giving birth vaginally. The work field of a midwife includes managing these injuries. There is limited research regarding this field and the focus tend to be on third- and fourth-degree tears, even though second-degree tears may also result in long-term complications. Aim: The aim was to investigate the midwife’s experience of managing second-degree tears. Method: Eight semi-structured individual interviews were conducted with midwives working at a medium large maternity ward located in the middle of Sweden. Qualitative content analysis was used to analyze the material. Results: Four categories and two subcategories were identified. The categories were: Information, The support of colleagues, The need for follow-ups and Physical examination and the subcategories were: Feedback strategies and Documentation. Conclusion: The result show that midwives feel insecure when managing second-degree tears, especially the midwives with less experience. The midwives also requested more feedback from the women they sutured regarding their second-degree tears and the midwives also wished for a better follow-up for the women with second-degree tears. The result also showed that the midwives give different information to women regarding their tears. No pronounced routines were found regarding what information to give and in what way. Clinical application: The results of the study aim to increase the knowledge and to develop routines regarding second-degree tears. More knowledge is needed about information given about the tear and when it is the best time to give information.
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Nilsson, Karin, and Anna Südow. "Barnmorskors tankar om hinder och möjligheter för kontinuerlig hud-mot-hud på BB." Thesis, Högskolan i Borås, Akademin för vård, arbetsliv och välfärd, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-12029.
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Studier har visat att hud-mot-hud har flera positiva effekter för modern och det nyfödda barnet. Trots detta upplever barnmorskor hinder för kontinuerlig hud-mot-hud under föräldraparens BB-vistelse. Syftet med arbetet var att beskriva barnmorskors tankar kring hinder och möjligheter för kontinuerlig hud-mot-hud på barnbördshus (BB). Forskning finns om hud-mot-hud men inga specifika studier om barnmorskors tankar kring vilka hinder och möjligheter som finns för kontinuerlig hud-mot-hud under BB-vistelsen. En intervjustudie utfördes och materialet bearbetades med kvalitativ innehållsanalys för att lyfta fram de viktigaste aspekterna. Resultatet som framkom belyser barnmorskors tankar om hinder och möjligheter vid implementering av kontinuerlig hud-mot-hud under barnets första dygn på BB. Resultatet av studien visade att barnmorskorna största hinder var brist på riktlinjer, förekomsten av barnsängar, bristande föräldrainformation, platsbrist, samt föräldrarnas kulturella bakgrund och personalens attityder. De möjligheter som lyftes fram var enkelrum, bärhjälpmedel såsom tubtopp eller bärsjal, samt att utbilda föräldrarna under graviditeten. Vårdhandlingen införlivas lättast om de blivande föräldrar deltar i förberedande föräldrakurser under graviditeten, samt att personalen är välutbildade och uppmuntrar till hud-mot-hud.Studies have shown that skin-to-skin care has several positive effects for both the mother and the newborn. Despite this, midwifes experience that it can be difficult to get parents to implement the skin-to-skin care continuously during its stay the maternity ward. The aim of the thesis is to describe midwives’ thoughts on the obstacles and opportunities for continuous skin-to-skin care at the maternity ward. There are studies on skin-to-skin care but no specific studies regarding midwives’ thoughts on the obstacles and opportunities for continuous skin-to-skin care during maternity stay. An interview study was conducted, and the material was processed using qualitative content analysis to highlight the main points. The result highlighted midwives’ thoughts on the obstacles and opportunities in the implementation of continuous skin-to-skin contact during the child's first days in the maternity ward. The results of the study showed that midwives biggest obstacles are the hospital baby beds, as well as lack of guidelines, parental information, private rooms, and the parents' cultural background and the staff attitudes. The opportunities that arouse were private rooms, aids such as tube tops or slings, and prenatal parental training during pregnancy. Skin-to-skin care can most easily be implemented when parents participate in preparatory parenting training, and when the staff is well trained and encourage implementing skin-to-skin care.
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Cederqvist, Melissa. "Reliability of the COntext Assessment for Community Health (COACH) tool when administered on mobile phones versus pen-paper: A comparative study among healthcare staff in Nairobi, Kenya." Thesis, Uppsala universitet, Internationell mödra- och barnhälsovård (IMCH), 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-262512.
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Aim: To investigate the reliability of the COntext Assessment for Community Health (COACH) tool on mobile phone versus pen-paper in Nairobi, Kenya. Background: One of the barriers to the progress of the MDGs has been the failure of health systems in many LMICs to effectively implement evidence-based interventions As a result of the “know-do” gap, patients do not benefit from advances in healthcare and are exposed to unnecessary risks. Better mapping of context improves implementation by allowing tailoring of strategies and interpretation of knowledge translation. COACH investigates healthcare contexts for LMICs and has only been used on pen-paper. With 5 billion mobile phone users globally, mobile technologies is being recognized as able to play a formal role in health services. Methods: Comparative study with 140 nurses/midwives and doctors in four hospitals in Nairobi. 70 were randomly assigned to mobile phone and pen-paper each. The tool was administered twice with a two week interval and test-retest reliability, internal consistency and interrater reliability were assessed. Findings: Excellent test-retest reliability for both pen-paper and mobile phone (ICC >0.81). 45% (pen-paper) and 34% (mobile phone) moderate agreement between individual questions in round 1 and 2. Acceptable average Cronbach’s alpha (>0.70). Conclusion: Both mobile phone and pen-paper were reliable and feasible for data collection. The findings are a good first step towards using COACH in Kenya. Additional research is needed for individual settings. Using mobile phones could increase healthcare facilities’ accessibility in implementation research, helping to close the “know-do” gap and reach the SDGs.
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"Counting maternity : the measure of midwifery in Australia, 2002." Thesis, University of Technology, Sydney. Faculty of Nursing, Midwifery & Health, 2002. http://hdl.handle.net/10453/20062.
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University of Technology, Sydney. Faculty of Nursing, Midwifery & Health.The aim of this Professional Doctorate in Midwifery is to challenge the status quo in maternity services through scholarly reflection and research. Through the studies reported here I aim to provide women with information on which to make informed choices about the services available to them, and to ensure politicians become more responsive to the lack of options currently available in Australia. My aim is also to provide measures that would allow maternity service managers to deploy resources more efficiently to achieve the best care. The majority of the papers in the portfolio are derived from population data that is routinely collected in Australia. One of the cornerstones of healthcare improvement is creating meaningful information and measurement from these collections. True comparisons from accurate data can be used to better understand the nature of the system, and to gauge whether changes have been effective. Thus, the information derived from various collections of routinely collected data is used to measure and evaluate the maternity services. This measures only part of the experience of childbirth, however. The Doctorate is a collection of nine major works undertaken in the years 1999 to 2002, during my appointment as a research midwife with the Australian Midwifery Action Project (AMAP). The first paper is an essay that tells of the juxtaposition of two different worldviews and the paradigmatic issues that shape the professional differences between obstetrics and midwifery. The second consists of a brief overview of the Australian maternity system described within the terms of reference for a Senate Inquiry into Childbirth Procedures. The third and fourth papers explore the levels of obstetric intervention for low risk women and the cost of these interventions using a new costing model derived from population data. The fifth paper reviews the contemporary issues in the workforce and education of midwives. The sixth paper outlines a proposal for funding reform and a new model of midwifery care. The seventh paper compares midwifery in Australia and New Zealand, in terms of a public health strategy. The eighth paper explores the concept of a new research method called Graffiti; and the final paper continues the theme of measurement in an essay titled 'Evidence based Everything. The portfolio explores a number of issues around public funding and the call for reform of the maternity services in Australia. In particular it argues for reforms to fund a more responsive service, based on values outlined by women who experience maternity care in Australia, as opposed to those guided by obstetrics and technology who currently set the agenda and determine the way maternity services will be offered and funded. Although I have articulated and measured some of the characteristics of midwifery and obstetric care in Australia, this disentangling or quantification merely underlies and emphasises the many more continuations and complexities that coexist beyond that, which is 'measured'.
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"Counting Maternity: The Measure of Midwifery in Australia, 2002." University of Technology, Sydney. Faculty of Nursing, Midwifery & Health, 2002. http://hdl.handle.net/2100/292.
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The aim of this Professional Doctorate in Midwifery is to challenge the status quo in maternity services through scholarly reflection and research. Through the studies reported here I aim to provide women with information on which to make informed choices about the services available to them, and to ensure politicians become more responsive to the lack of options currently available in Australia. My aim is also to provide measures that would allow maternity service managers to deploy resources more efficiently to achieve the best care. The majority of the papers in the portfolio are derived from population data that is routinely collected in Australia. One of the cornerstones of healthcare improvement is creating meaningful information and measurement from these collections. True comparisons from accurate data can be used to better understand the nature of the system, and to gauge whether changes have been effective. Thus, the information derived from various collections of routinely collected data is used to measure and evaluate the maternity services. This measures only part of the experience of childbirth, however. The Doctorate is a collection of nine major works undertaken in the years 1999 to 2002, during my appointment as a research midwife with the Australian Midwifery Action Project (AMAP). The first paper is an essay that tells of the juxtaposition of two different worldviews and the paradigmatic issues that shape the professional differences between obstetrics and midwifery. The second consists of a brief overview of the Australian maternity system described within the terms of reference for a Senate Inquiry into Childbirth Procedures. The third and fourth papers explore the levels of obstetric intervention for low risk women and the cost of these interventions using a new costing model derived from population data. The fifth paper reviews the contemporary issues in the workforce and education of midwives. The sixth paper outlines a proposal for funding reform and a new model of midwifery care. The seventh paper compares midwifery in Australia and New Zealand, in terms of a public health strategy. The eighth paper explores the concept of a new research method called Graffiti; and the final paper continues the theme of measurement in an essay titled 'Evidence based Everything. The portfolio explores a number of issues around public funding and the call for reform of the maternity services in Australia. In particular it argues for reforms to fund a more responsive service, based on values outlined by women who experience maternity care in Australia, as opposed to those guided by obstetrics and technology who currently set the agenda and determine the way maternity services will be offered and funded. Although I have articulated and measured some of the characteristics of midwifery and obstetric care in Australia, this disentangling or quantification merely underlies and emphasises the many more continuations and complexities that coexist beyond that, which is 'measured'.
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Hittinger, Jennifer Furst. "A Decade of nurse-midwifery research 1984-1994 : a report submitted in partial fulfillment ... for the degree of Master of Science (Parent-Child Nursing) ... /." 1998. http://catalog.hathitrust.org/api/volumes/oclc/68901183.html.
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Ezekwem, Ogechukwu Christiana. "Missions and the rise of the western maternity among the Igbo of South-eastern Nigeria." Thesis, 2014. http://hdl.handle.net/2152/26260.
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This project examines midwifery in the precolonial setting, the nature of Christian missionary activities in Southeastern Nigeria, the colonial process of erecting the maternity, and the collaborations between traditional and Western midwives. The colonial history of Nigeria can be traced to 1885 when British claims to a West African sphere of influence received international recognition. However it was not until 1900, following the British government's acquisition of the Royal Niger Company's territories, that Nigeria was officially considered a British colony. Nonetheless, the groundwork of colonial rule in Southeastern Nigeria predated these eras and is attributed to the establishment of the London-based Church Missionary Society (CMS) at Onitsha in 1857, followed by the Roman Catholic Missions (RCM) in 1885. The rivalry that ensued between them led to the development of a medical mission and the launching of the Western maternity in Southeastern Nigeria, undermining traditional childbirth practices, and providing new forms of training and facilities for a new class of midwives.text
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Mashazi, Maboikanyo Imogen. "The utilization of a midwifery obstetrical unit in a metropolitan area." Thesis, 2012. http://hdl.handle.net/10210/6516.
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M.Cur.In this study a qualitative design which is explorative, descriptive and contextual in nature is followed. The objective of the study is three-fold: firstly, to explore and describe the opinions of members of the community about the reasons for the under-utilization of the Midwifery Obstetrical Unit ; secondly, to explore and describe the suggestions of the community for improving the utilization of the Midwifery Obstetrical Unit and, thirdly, to formulate intervention strategies for community nurses to improve the utilization of the MOU. Data was collected by means of focus group interviews, and was analysed using Tesch's method of data analysis. Trustworthiness was ensured by using the method of Guba and Lincoln. The participants in research were mothers who delivered their babies at the hospital, mothers who delivered their babies at the MOU, members of the Community Health Committee and MOU nurses.
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Nolan, Sheila, Jane Morgan, Jacky Pickles, Melanie Haith-Cooper, and Phipps Fiona E. MacVane. "Delivery suite assessment unit: auditing innovation in maternity triage." 2007. http://hdl.handle.net/10454/6690.
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yesA Delivery Suite Assessment Unit (DSAU) has been established at a large Northern teaching hospital. This was as a recommendation of ASQUAM (achieving sustainable quality in maternity) to reduce antenatal admissions to delivery suite and provide a more appropriate environment for women attending for antenatal or labour assessment. The DSAU has also provided an effective teaching environment where skills such as effective telephone triage, diagnosis of labour and care of women with pre-labour spontaneous rupture of membranes (SROM) have been developed by junior staff. The first twelve months' audit results indicate that the establishment of the DSAU has been successful in reducing antenatal admissions to delivery suite by increasing the transfers of clients home, rather than to the antenatal wards. This may reflect the confidence of the highly skilled midwives working in this environment and the confidence women feel about their ability to obtain prompt and accurate advice over the telephone.
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McIntosh, Bryan. "The future of midwifery practice and roles." 2012. http://hdl.handle.net/10454/6506.
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noThe NHS needs to make real term cost savings whilst maintaining and, where possible, enhancing the quality of essential services. The performance of maternity services is seen as a touchstone of whether the NHS is delivering quality health services in general. Recent events in relation to increased infant and maternal mortalities demonstrate the necessity of the benefits of continued improved patient safety. The pressing issues which maternity services face are financial, quality and safety.
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Passant, L. "Exploring the key elements required for midwives to develop a new model of postnatal care within an acute care setting." Thesis, 2012. http://hdl.handle.net/10453/20419.
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University of Technology, Sydney. Faculty of Nursing, Midwifery and Health.Aim This research aimed to explore the key elements to improve the quality of postnatal care provided to women in a public hospital postnatal ward in Sydney and to attempt to implement a new model of postnatal care. Background Reports, internationally and nationally, indicate that women are least satisfied with hospital-based postnatal care when compared with antenatal, labour and birth care. Many researchers have identified the components of postnatal care that women find most helpful however, there continues to be barriers to develop and test innovative approaches or models of postnatal care within hospital settings. The focus of this project was to try to move the postnatal ward to a culture that is woman and baby centred rather than illness or institution-centred. The development process drew on Practice Development approaches that would enable midwives to facilitate change in the environment and culture of the postnatal ward with a view to improving postnatal care for women and their families. Method A qualitative descriptive study, using a three phased approach, was adopted for this research. Phase one was to identify the issues and concerns by conducting focus groups with staff. Phase two challenged usual practices and explored new ways of providing care in the postnatal ward. This phase incorporated working with the staff utilising Practice Development approaches. The third phase explored with key stakeholders the outcomes and issues of phase two including the barriers and limitations to enable midwives to implement a new model of postnatal care. Findings There were a number of barriers for change to occur including the current system of maternity care provided to women. This has also been reported by others over the past few decades. Within an acute care hospital environment, the midwives struggled to provide quality midwifery care with a philosophy of care counter to that which had been imbedded over many years. Midwives were caught up managing the day to day issues and most were unable to reflect on the care women received or to have the time to contemplate changes. Challenging the usual rituals and routines with the midwives generated some attainable changes that included providing women with more information about what to expect following birth and updated policies for healthy women and babies. The policies reflect the latest evidence and a more woman and baby centred approach to a daily assessment. This research also explored ways for midwives to be able to spend more time with women, and included challenging the everyday non-midwifery tasks undertaken by midwives working within the hospital system. These non-midwifery tasks included managing administration, security, catering and domestic duties. Barriers towards providing a more woman and baby centred way of providing postnatal care included the need for further professional development of the midwives and more professional support. There was also a need for role modelling of womancentred approaches to care and the development of a different way of providing care that included midwifery continuity of care. Conclusion Maternity services in hospitals have been subsumed into the general wards often governed by sickness priorities and it is acknowledged changing to a more womancentred approach was challenging. Without support from leaders, the change towards a woman-centred approach may not happen within the constraints of the medicalised model. Implications for Practice My research found a number of implications for others planning improved postnatal care for women in an acute care setting. Key elements included the need for midwives to have a clear articulation of their vision for the ward. Change may not happen if midwives do not believe the benefits of providing individualised care that meets the needs of the women. For this to be realistic and achievable, strong visionary leadership is key to moving the ward vision forward and implementing a new model of care. The timing for change in this setting is critical. It is unreasonable to implement change with midwives during a period of restructure. This can have a negative impact on successful change by threatening the midwives personal sense of control. In summary, this research found that effective leadership, adopting a shared vision, providing high support and high challenge were all important elements to support moving towards a more woman-centred care approach. Threatening the midwives sense of control over their professional world was also found to be an important factor when attempting to bring about change and will be discussed in this thesis.
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Taylor, Ann. "Childbirth practice and feminist theory:re-imagining birth in an Australian public hospital." Thesis, 2003. http://hdl.handle.net/1959.13/41751.
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Research Doctorate - Doctor of Philosophy (PhD)The thesis involves a re-examination of feminist views of the childbearing body from a post-structuralist perspective and applies these theoretical ideas to an empirical investigation into contemporary childbirth and midwifery. Critiques of medicalised childbirth developed in Australia, Britain and the USA in the 1970s are related to debates within feminism about appropriate ways to theorise motherhood and the female body as well as to understand the role played by midwives and doctors in childbirth. It is argued these critiques were the product of three strands of feminism that differed in their analysis of gender politics, their philosophy of knowledge and their understanding of power. The three critiques are also related to differences between the USA, Britain and Australia in respect of their medical system, ways in which the history of childbirth practices are viewed and differences between the professional roles of midwives. It is argued that these critiques need to be modified by more recent post-structuralist feminist approaches, particularly the way in which bodies are shaped by language and power is related to the distribution of knowledge The empirical study concentrates on a maternity unit in a regional town in New South Wales. The unit was studied through repeat interviews with mothers attending the hospital for the birth of their second or a later child, interviews with the midwives and doctors working in the unit and observations over several months. Childbirth is re-imagined as a drama and found to be an intense embodied experience shaped in turn by the practices of the hospital and the changing boundaries between medicine and midwifery, relationships of the women with the staff and the women’s own diversity. This approach to the analysis of the interview data demonstrates the limitations of the liberal feminist critique that there is insufficient rational and ‘scientific’ evaluation of childbirth practices, the radical feminist critique that the key issue is men’s domination of women’s bodies and the materialist feminist critique of the lack of fairness and support given to childbearing women, while showing how these discourses continue to circulate in debates over the management of childbirth.
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Taylor, Ann. "Childbirth practice and feminist theory:re-imagining birth in an Australian public hospital." 2003. http://hdl.handle.net/1959.13/41751.
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Research Doctorate - Doctor of Philosophy (PhD)The thesis involves a re-examination of feminist views of the childbearing body from a post-structuralist perspective and applies these theoretical ideas to an empirical investigation into contemporary childbirth and midwifery. Critiques of medicalised childbirth developed in Australia, Britain and the USA in the 1970s are related to debates within feminism about appropriate ways to theorise motherhood and the female body as well as to understand the role played by midwives and doctors in childbirth. It is argued these critiques were the product of three strands of feminism that differed in their analysis of gender politics, their philosophy of knowledge and their understanding of power. The three critiques are also related to differences between the USA, Britain and Australia in respect of their medical system, ways in which the history of childbirth practices are viewed and differences between the professional roles of midwives. It is argued that these critiques need to be modified by more recent post-structuralist feminist approaches, particularly the way in which bodies are shaped by language and power is related to the distribution of knowledge The empirical study concentrates on a maternity unit in a regional town in New South Wales. The unit was studied through repeat interviews with mothers attending the hospital for the birth of their second or a later child, interviews with the midwives and doctors working in the unit and observations over several months. Childbirth is re-imagined as a drama and found to be an intense embodied experience shaped in turn by the practices of the hospital and the changing boundaries between medicine and midwifery, relationships of the women with the staff and the women’s own diversity. This approach to the analysis of the interview data demonstrates the limitations of the liberal feminist critique that there is insufficient rational and ‘scientific’ evaluation of childbirth practices, the radical feminist critique that the key issue is men’s domination of women’s bodies and the materialist feminist critique of the lack of fairness and support given to childbearing women, while showing how these discourses continue to circulate in debates over the management of childbirth.
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(12552852), Sharon Haste. "The perceived barriers to implementing a midwifery model of care in a tertiary hospital." Thesis, 2005. https://figshare.com/articles/thesis/The_perceived_barriers_to_implementing_a_midwifery_model_of_care_in_a_tertiary_hospital/19776244.
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This report aims to identify the barriers to implementing a midwifery model of care in the Royal Darwin Hospital. A Government directive was the catalyst to implement the model, however this precedes along history of consumer complaint and government review (Northern Territory Government Media Release, October 2002).
The official project spans over a period of fourteen months with an immediate preceding history of nineteen months relating to other government directives. The directives affecting the project were to develop and implement a caseload midwifery model of care and to plan a birth centre (Northern Territory Government Media Release October, 2002).
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Haith-Cooper, Melanie, and Gwendolen Bradshaw. "Meeting the health and social needs of pregnant asylum seekers; midwifery students perspectives. Part 1; Dominant discourses and midwifery students." 2013. http://hdl.handle.net/10454/6695.
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noCurrent literature has indicated a concern about standards of maternity care experienced by pregnant women who are seeking asylum. As the next generation of midwives, it is important that students are educated in a way that prepares them to effectively care for these women. To understand how this can be achieved, it is important to explore what asylum seeking means to midwifery students. This article is the first of three parts and reports on one objective from a wider doctorate study. It identifies dominant discourses that influenced the perceptions of a group of midwifery students' about the pregnant asylum seeking woman. The study was designed from a social constructivist perspective, with contextual knowledge being constructed by groups of people, influenced by underpinning dominant discourses, depending on their social, cultural and historical positions in the world. In a United Kingdom University setting, during year two of a pre-registration midwifery programme, eleven midwifery students participated in the study. Two focus group interviews using a problem based learning scenario as a trigger for discussion were conducted. In addition, three students were individually interviewed to explore issues in more depth and two students' written reflections on practice were used to generate data. Following a critical discourse analysis, dominant discourses were identified which appeared to influence the way in which asylum seekers were perceived. The findings suggested an underpinning ideology around the asylum seeker being different and of a criminal persuasion. Although the pregnant woman seeking asylum was considered as deserving of care, the same discourses appeared to influence the way in which she was constructed. However, as the study progressed, through reading alternative sources of literature, some students appeared to question these discourses. These findings have implications for midwifery education in encouraging students to challenge negative discourses and construct positive perceptions of asylum seeking.