Dissertations / Theses on the topic 'Maternity care'
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Briscoe, Lesley. "Vulnerability within maternity care." Thesis, Edge Hill University, 2018. http://repository.edgehill.ac.uk/10083/.
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Background: Vulnerability is universally present but experienced biopsychosocially on an individual level. Stigma develops when populations are labelled vulnerable. Individual vulnerability can be lessened by resources accessed to assist in developing resilience. A deeper analysis of vulnerability and resilience is required to inform policy, ethics, law and social life. Design: Qualitative, quantitative and mixed method approaches were used. Sample: Five papers represented the perspectives of 102 women, 21 clinicians and 13 student midwives. A further paper presented a concept analysis which included the perspectives of 10,067 women and 325 clinicians (total sample size women n=10,169; clinicians n=346; student midwives n=13). Methods: Gadamer’s ontological perspective of time, place and culture and was seen through Engel’s biopsychosocial lens. Epistemologically, truth originated from multiple realities. Methodologically, women’s experiences were captured via mixed methods. 7 Analysis: Thematic analysis and descriptive statistics were synthesised via framework analysis. Findings: A coherent theme of vulnerability in maternity care was apparent. Women’s concerns were trivialised. The professional’s style of communication determined the women’s experience of maternity care. Clinician control of care provision undermined women’s ability to choose. Women developed resilience in adverse circumstances via: accessing other supportive members of society, identifying their need for information, talking to others and developing accommodative coping strategies. Conclusion: The new conceptual model, in this thesis, should be evaluated via mixed methods. A biopsychosocial approach should underpin informed choice. Clinicians need raised awareness about how interaction can lower women’s self-esteem and build resilience in others. Higher education needs to challenge preconceived biases in safe environments via reflective processes. Research should explore women’s influential circle in decision making during maternity care. Women should be involved in the design of research to inform how best to capture their complex lived experience. Funders of research and ethics committees should request information about how implementation of evidence may be influenced by the current clinical environment. Impact should be measured post implementation. Social policy should be informed by a deeper, conceptual analysis of vulnerability and resilience.
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Edwards, Sian Elizabeth. "Sepsis in maternity care." Thesis, University of Bristol, 2016. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.707715.
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Brundell, Kathryn Felicity. "Maternity care in rural Victoria: Midwives' perspectives." Thesis, Australian Catholic University, 2015. https://acuresearchbank.acu.edu.au/download/86d0d9b9b67fb204d15a134d98ff32193e99938b46baebfb665a6e6f4947d1b5/2369167/Brundell_2015_Maternity_care_in_rural_Victoria.pdf.
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This modified Grounded Theory study explored the experiences of midwives working in a rural Victorian setting during a period of maternity service redesign. Changes to the local maternity service under study were block funded by the Rural Maternity Initiative, Victoria, Australia (Edwards & Gale, 2007). The Rural Maternity Initiative, along with the release of the maternity service review report (Commonwealth of Australia, 2009), incorporated women’s requests for continuity of care provision, demedicalised care, choice in care, and accessibility of services across the pregnancy, birth and postnatal period. Midwifery workforce shortages and maternity unit closures in rural Australia have been identified by the government, maternity service users and other stakeholders as factors reducing options, and increasing travel requirements, and social and emotional costs for women (Hoang, Le, & Ogden, 2014). Australian state and territory governments encouraged the redesign of maternity services with continuity models of care, more often caseload care or team midwifery, in an effort to combat workforce deficits and rural inequities (Commonwealth of Australia, 2009). A review of literature was undertaken to frame key points associated with Australian health and maternity provision, recent policy developments, health workforce strategies, models of continuity care and rural maternity care accessibility. Significant gaps were noted, relating to the experience of the maternity service restructure in the rural setting, and the relationship between the health services undergoing maternity redesign and local communities. A modified Grounded Theory methodological approach was undertaken, using symbolic interactionalism as the theoretical perspective to frame the study. The work of seminal theorists Glaser and Strauss (1967) informed the design methods employed, particularly that of constant comparative analysis, coding and memoing. A modified approach was taken, however, influenced by constructivist concepts. Charmaz asserts that rather than ‘discovering’ theory, data is socially constructed by study participants with reference to their individual circumstances (Charmaz, 2006). Developmental work by Blumer (1986) significantly influenced the theoretical perspective of this study, as an inquiry based on the lived experiences of a small group of midwives who were affected by maternity service redesign in one locality. In line with symbolic interactionism, this study seeks to understand the meaning these midwives placed on changes and the social interactions they attributed to their work environment. The research setting was a small, rural maternity service, with a select sample population of fifteen. Participants were theoretically sampled and semi-structured interviews were the primary method of data collection. Constant comparative analysis was employed throughout the study, during which time the researcher became increasingly and thoroughly immersed in the data. Coding and categorisation was completed using OneNote Microsoft software to demonstrate thematic saturation and emerging theoretical concepts. It was during this rigorous analysis of data that a deep appreciation and understanding of Grounded Theory methodology was achieved. Constant comparative analysis enabled repeated interaction with data, comparative assessment of literature in conjunction with further data collection, and self-examination by the researcher. Themes that emerged from the midwives’ experiences of maternity service redesign in the rural Victorian context reflected known elements such as midwifery retention rates and burnout (Mollart, Skinner, Newing, & Foureur, 2013), and change planning, change leadership and interprofessional relationships associated with sustaining continuity models of maternity care (Monk, Tracy, Foureur, & Barclay, 2013). Two key themes related specifically to the rural context were communication of maternity service change, and change preparedness inclusive of women, families and interwoven rural communities.
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Wahl, Grendi Heidi. "Measuring Patient Experience in Hospital Maternity Care." Thesis, KTH, Skolan för elektroteknik och datavetenskap (EECS), 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-281290.
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This thesis concerns Patient Experience (PX), in hospital maternity care in Sweden. The focus lies in the development of a measure to describe the current state of PX. The thesis uses a semi-sequential mixed-methods study design; exploration of the patient journey, through qualitative methods, informs the adaptation of an existing maternity care experience survey instrument. The resulting survey instrument is tried in a pilot study and renders a composite measure of PX. Part of the analysis is dedicated to understanding the e!ect of information and communication in PX; Exploratory Factor Analysis is used to test the model and attempt an answer. The results show that it is possible to describe PX using the proposed survey instrument. The composite measure preserves di!erences in perceptions better than an arithmetic average of two discrete VAS-1 type measurements, and is more appropriate when measuring attitudes, and opinions using Likert-type measures. A three component solution describes 65.44% of the total sample variance. Determining to what degree PX is influenced by information and communication remains di"cult to quantify, but these initial results indicate that the manner of the attending sta! during aftercare and the respondent’s mastery of information during discharge are important dimensions of patients’ total PX (ANOVA R .695, R Square .483). The model’s three components are almost entirely built from items that address interpersonal skills and information assimilation. These correspond to two of the three Service Quality Dimensions, namely Interaction Quality and Outcome Quality. Most important of the three is the component “Chemistry in aftercare”. The predictive strength of the model shows merit under the context of the study and could advise further e!orts to develop measurements for PX in maternity care in a Swedish hospital setting. Lastly, this study contextualises Service Design in hospital maternity healthcare; the study therefore o!ers ample opportunity for innovation.Arbetet handlar om Patientupplevelse (PU), i förlossningsvården i Sverige. Fokus ligger på utvecklingen av ett mätvärde att beskriva den nuvarande patientupplevelsen. Arbetet använder kvalitativa och kvantitativa metoder (mixed-methods), i en semi-sekventiell design; utforskning av patientresan ligger till grund för anpassningen av ett existerande mätinstrument. Det nya mätinstrumentet testas i en pilotstudie och ger ett kompositmätvärde av PU. En del av analysen ägnas åt att förstå vilken e!ekt information och kommunikation har på PU; Explorativ faktoranalys används för ändamålet. Resultaten visar att det är möjligt att beskriva PU genom det föreslagna mätinstrumentet. Det resulterande kompositvärdet är bättre på att beskriva skillnader i uppfattning än ett medelvärde av två diskreta variabler av VAS-1 typen, och är också lämpligare när attityder och åsikter mäts med hjälp av Likert-skalor. En trekomponentslösning beskriver 65.44% av den totala stickprovsvariansen. Att avgöra hur mycket PU påverkas av information och kommunikation förblir svårt att kvantifiera, men dessa inledande resultat visar att patientbemötande under eftervårdstiden och patientens förmåga att bemästra information under utskrivningen är viktiga dimensioner av patienters totala PU (ANOVA R .695, R Square .483). Modellens tre komponenter är nästan uteslutande uppbyggda av variabler som fångar upp personliga relationer och assimilering av information. Dessa motsvarar två av de tre dimensionerna i Servicekvalitetsmodellen, nämligen Interaktionskvalitet och Utfallskvalitet. Viktigaste komponenten är Personlig kemi under eftervården. Modellens förutsägningsstyrka visar förtjänst under studiens kontext och kunde informera framtida ansträngningar att utveckla mätvärden för förlossningsvården inom svensk sjukhusmiljö. Till sist kan nämnas att studien kontextualiserar Service Design inom förlossningsvården; studien erbjuder därför omfattande möjligheter för innovation.
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Westin, Martin. "No Care for Distance : The (Market) Logic of Regionalizing Maternity Care." Thesis, Uppsala universitet, Kulturgeografiska institutionen, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-326420.
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A wave of maternity unit closure is sweeping through the North Atlantic zone, leaving rural communities without the care they crucially need. In its wake resistance grows, mobilizing against closures in the face of a discourse of economic efficiency and neoliberal austerity. To understand the issue, research on maternity care and geography offer useful insights on the particular costs and consequences of losing access to care but is less useful for engaging the causes behind them. Not suffering from a lack of critical engagement, Marxist theory enables the wave to be understood in terms of changing political incentives and the ways these have come about. The present essay brings the two fields together in an effort to aid local resistance in rural communities, concluding that regionalization does not operate on a logic of its own as is otherwise stated but on the logic of markets, imposed on governments by the neoliberalization of the Western world and beyond. The essay aims to provide the political-economic framework needed to confrontt he logic of markets, neoliberalism, and the capitalist political-economic system that underline the closures.
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Hundley, Vanora. "Determining success in the provision of maternity care." Thesis, University of Aberdeen, 2001. http://digitool.abdn.ac.uk/R?func=search-advanced-go&find_code1=WSN&request1=AAIU137217.
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This thesis explores the benefits and limitations of traditional evaluations of maternity care, looking specifically at one innovation in service provision, a midwife managed delivery unit. The research undertaken in this thesis can be described in terms of three developmental phases. In phase one, care in a midwife-managed delivery unit is compared with care in a consultant-led labour ward within the framework of a randomised controlled trial. 'Success' is measured in terms of both the clinical aspects of care and as viewed by the women who received this care. Care of women at low obstetric risk in a midwife-managed delivery unit is shown to result in less intervention, greater continuity of carer, more involvement in decision making and greater women's satisfaction with how care was managed. There were no differences in overall satisfaction and the limitations of satisfaction as an outcome measure are discussed. Phases two and three build on the work of the randomised controlled trial. In phase two, perinatal mortality and morbidity data are reviewed through an independent case review of the perinatal deaths and further analysis of the morbidity data. In phase three, the thesis utilises techniques from the discipline of health economics to go beyond the traditional measure of women's views, satisfaction. Willingness to pay and conjoint analysis are used to determine women's preferences, and the strength of these preferences, for different models of maternity service provision.
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Siassakos, Dimitrios. "The active ingredients of effective teamwork in maternity care." Thesis, University of Bristol, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.571277.
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The body of work described in this thesis aimed to identify the characteristics of effective teams to inform the development of better team training. Whereas previous studies from the same research group showed that practical team rehearsals (clinical drills) are beneficial, subsequent work suggested that further improvement might be possible. The commentary links the studies that comprise this thesis with the background: a sustained need for better teamwork, a previous preponderance of opinion over evidence as to what constitutes effective teamwork in healthcare, and a widespread use of teamwork training programmes based on aviation despite lack of evidence for impact of aviation-derived training alone on outcome. The commentary summarises the peer-reviewed papers, starting with a critical review of training programmes at the time this body of work was developed and planned. Two studies followed that aimed to clarify the successes and the challenges, from a team perspective, of a unit with published improvements in outcome after the introduction of a clinical training programme. Mixed-methods multicentre research was used in subsequent studies in an iterative process, to identify what makes teams effective in simulation, and what makes them effective in actual emergencies as described by frontline staff. A critical analysis evaluates their contribution to testing the hypothesis and to informing further research. The commentary concludes by summarising the academic, clinical, and educational impact of this thesis and by outlining possible future work to ensure team training programmes remain relevant, evidence-based, effective, and responsive to patient and staff needs.
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Kongnyuy, Eugene Justine. "An innovative approach to improving maternity care in Malawi." Thesis, Staffordshire University, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.522122.
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Taylor, A. "Consumer perceptions of maternity care in one health district." Thesis, University of Bath, 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.383618.
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Ertok, Merve. "Essays on the economics of maternity care in England." Thesis, University of Bristol, 2015. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.683702.
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This PhD examines the impact of policies introduced to improve outcomes in health care in England in the first decade of the 21st century, focusing on their impact on outcomes in maternity care. It uses data from the primary hospital discharge data set for English National Health Service hospitals, known as Hospital Episode Statistics (HES). Chapter 1 examines the impact of a "payment by results" policy aimed at improving care outcomes in hospitals. This scheme was known as the Commissioning Quality and Innovation (CQUIN) payment framework. I examine the impact of this policy on csection rates in England. My focus is on the scheme as used in the financial year 2010/11. I investigate whether there are any reductions attributable to the CQUIN scheme in c-sections. [ find that the scheme does not have any statistically significant impact on c-section rates. Chapter 2 investigates the effect of being born on a weekend on the probability of dying among babies born at English NHS acute hospitals. The "weekend effect" has been documented in a range of hospital settings. We examine whether this is still present in maternity care after large increases in hospital staffing during the mid-2000s. We use 2009/10 Hospital Episode Statistics maternity data and control for a wide range of baby's and mother's characteristics. We find that being born on a weekend is not associated with any statistically significant increase in the odds of dying. Chapter 3 examines the use of the hospital (as distinct from the individual) as the unit of analysis in a difference-in-difference analysis. We provide evidence for our theoretical framework with an empirical application of the evaluation of Payment by Results (PbR) scheme, started in 2005/2006 in maternity care. We find that there is no statistically significant association of this scheme on the outcomes. However, we find modest evidence for the fact that NHS acute trusts game the scheme by increasing the amount of antenatal admissions not related to a delivery event. Chapter 4 examines the impact of Maternity Matters Agenda (2009) on maternal outcomes. The policy introduced choice of place of birth among women. This followed the introduction of competition across English NHS acute trusts. I investigate the impact of competition on the quality of maternity services. I find that although the market competition has increased over the 7 year period, this is not associated with any improvements in the level of quality of maternity services.
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Ransjö, Arvidson Anna-Berit. "Childbirth care in affluence and poverty : maternity care routines in Sweden and Zambia /." Stockholm, 1998. http://diss.kib.ki.se/1998/91-628-2858-4.
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Rhodes, Maxine. "Municipal maternity services : policy and provision 1900-1939 with particular reference to Kingston upon Hull and its Municipal Maternity Home." Thesis, University of Hull, 1996. http://hydra.hull.ac.uk/resources/hull:4620.
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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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Frame, Jean Caitlin. "Outcomes of primary maternity care in Fort Smith, Northwest Territories." Thesis, University of British Columbia, 2014. http://hdl.handle.net/2429/46568.
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Introduction:
In northern Canada women residing in rural communities without local access to maternity care must evacuate at 36-37 weeks gestation to await labour in a city with a regional hospital. Midwifery services are expanding to rural areas of Canada, yet there are few studies that evaluate the safety of rural and remote midwifery compared to routine evacuation for birth. The purpose of this study is to assess the safety of the Fort Smith Midwifery Program in the Northwest Territories, and to understand the experiences of, and the meaning of, community birth with midwives among the women of Fort Smith.
Methods:
A retrospective cohort study was conducted to compare birth outcomes from the Fort Smith Midwifery Program (n=281) to: 1) the Inuulitsivik Midwifery Program in northern Quebec (n=1388), and 2) the community of Hay River where women evacuate at 37 weeks to receive intrapartum care elsewhere (n=143). Maternal and newborn outcomes were compared among the three comparison groups using univariate and multivariate logistic regression. Focus groups were held with women from Fort Smith who had used the midwifery program to understand their experiences of using the midwifery service and what it means to have access to community birth. Purposive sampling was used to invite Aboriginal and non-Aboriginal participants who gave birth in the community and elsewhere.
Results:
There were no statistically significant differences in the odds of 5-minute APGAR scores less than 7. The odds of 1-minute APGAR scores below 7 in Fort Smith were increased compared to the Hudson coast communities, however the rate was similar to those of newborns of women who reside in Hay River and delivered in Yellowknife.
Two themes emerged from the focus groups: 1) the midwifery model of care in the community leads to positive experiences of maternity care, and 2) the benefits of and reasons for giving birth in the community. Women spoke positively about their experiences of using the midwifery service whether or not they delivered in the community.
Discussion:
The findings of this thesis support the development and evaluation of midwife-led models of maternity care in rural and remote communities.
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Simms, Rebecca Ann. "Monitoring the quality of maternity care : methods, experiences and opinions." Thesis, University of Bristol, 2015. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.685355.
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Reducing substandard care and improving healthcare quality is an NHS priority. Maternity care is a key area where improvements can be made. Through risk management strategies multiple quality-monitoring tools exist, including the clinical dashboard. Maternity dashboards were nationally recommended for use by all UK maternity units in 2008. However, it is unclear to what extent units have implemented dashboards or any associated issues with their use and quality monitoring as a whole.
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Van, Teijlingen Edwin R. "A social or medical model of childbirth? : comparing the arguments in Grampian (Scotland) and the Netherlands." Thesis, University of Aberdeen, 1994. http://digitool.abdn.ac.uk/R?func=search-advanced-go&find_code1=WSN&request1=AAIU059195.
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This study explored the differences between the organisation of maternity care in Britain and the Netherlands. The debates within each national system between proponents of high-technology obstetric hospitals and those of low-technology maternity care were analysed. This specific comparison was approached through a qualitative analysis and a quantitative content analysis. In the Netherlands I analysed the debate between home and hospital-birth supporters in a medical journal in 1986-1987 and in Scotland I analysed the replies to Grampian Health Board's proposals to close peripheral maternity units in 1987-1988. At a theoretical level the distinction is made between 'medical' and 'social' model of childbirth. Three levels of approaching the differences between these two models were unravelled in order to come to a better understanding of reality. One of the central points is question of risk in childbirth, which is the dividing factor between models of childbirth. The concepts of 'patriarchy' and 'medicalisation' are rejected as possible explanations for the differences between the Dutch and British organisation of maternity care. I explore the possibility of Jamous and Peloille's I/T ratio as an explanatory tool, and suggest a minor adaptation to this theory. Furthermore, in order to incorporate the state intervention in the interprofessional competition between midwives and doctors I suggest that Abbott's theory of 'systems of professions' could bring some light on the question. Finally, I suggest as a policy conclusion that a risk selection list similarly to the one in existence in the Netherlands should be drawn up in Britain. However, such a list should not be drawn up by obstetricans only or even a committee wherein obstetricians form a majority. I argue that a committee for the drawing up of national selection criteria should include representatives from midwives, health visitors and consumers.
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Sutherns, Rebecca Lee. "Women's experiences of maternity care in rural Ontario, do doctors matter?" Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2002. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp05/NQ65835.pdf.
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Tyler, Suzanne. "User influence on maternity care policy and service development in Europe." Thesis, University of Birmingham, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.343879.
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De, Labrusse Claire. "Patient-centred care in maternity services : a multiple case study approach." Thesis, University of Aberdeen, 2016. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=233533.
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Schroeder, Elizabeth-Ann. "The cost-effectiveness and efficiency of intrapartum maternity care in England." Thesis, University of Oxford, 2013. http://ora.ox.ac.uk/objects/uuid:f9cf3e25-34ae-49a3-ab50-5721e81a7458.
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Background: High quality evidence on the cost-effectiveness of planned birth in alternative settings (at home, in a midwifery unit or an obstetric unit) has been lacking, and is a priority area for maternity policy. Aim: To provide evidence about the efficiency of the configuration of maternity care in England and to estimate the cost-effectiveness of alternative settings for intrapartum care for ‘low risk’ women, thereby providing guidance for commissioners, clinicians and for pregnant women and their families. Methods: A literature review of existing evidence was followed by four stand-alone empirical studies using different methods to determine the efficiency and cost-effectiveness of alternative settings for intrapartum care. Data from the Birthplace in England Programme of Research were analysed to explore whether there are differences in the efficiency of maternity units when they are stratified according to the type and scale of unit. Incremental cost-effectiveness ratios were used to estimate the short-term cost-effectiveness of different planned settings for birth for ‘low risk’ women and to develop a template for the design of decision-analytic models to estimate life-long cost-effectiveness for the mother and baby dyad. Findings: The larger obstetric units (OUs) tended to be more efficient than the smaller OUs. Less than half of free-standing midwifery units (FMUs) were operating at full efficiency. The cost of intrapartum and after birth care, and associated related complications, was less for births planned at home, in a free standing midwifery unit (FMU), or in an alongside midwifery unit (AMU) compared with planned births in an obstetric unit (OU). Planned birth in a FMU or in an AMU compared with an OU will generate incremental cost savings but with uncertainty surrounding the outcomes for the baby. Planned birth in all non-OU settings generated incremental cost savings and improved outcomes for mothers. For ‘low risk’ women having a second or subsequent birth, planned birth at home was found to be the most cost-effective option.
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Daniele, M. "Involving men in maternity care in Burkina Faso : an intervention study." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2017. http://researchonline.lshtm.ac.uk/4645532/.
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Background: The Sustainable Development Goals draw attention to the need for further improvements in reproductive health in low-resource settings. In Burkina Faso, the uptake of postpartum contraception, postnatal care attendance and the practice of exclusive breastfeeding are low. Men take many decisions that affect women and newborns’ health, despite having little exposure to health information. We hypothesised that a strategy to involve men in facility-based maternity care, in an urban area with high antenatal care attendance, would improve adherence to recommended healthy practices after birth. Methods: This was a mixed-methods study. Focus group discussions and consultations informed the development of an intervention with three components: A) a group discussion with male partners of pregnant women, B) a couple counselling session during pregnancy, and C) partner participation in the pre-discharge postpartum consultation. This was tested through a randomised controlled trial. 1144 pregnant women were enrolled in 5 primary health centres in Bobo-Dioulasso, and randomised 1:1 to intervention or control (routine care only). Participants were followed up at 3 and 8 months postpartum. For process evaluation, 40 semi-structured interviews were conducted with women, men and health workers. Results: Three quarters of male partners in the intervention arm attended at least 2 of 3 components. The intervention increased attendance at outpatient postnatal care (at least 2 consultations), exclusive breastfeeding at 3 months postpartum, effective modern contraception use at 8 months postpartum, especially long-acting methods, and improved an unvalidated measure of relationship adjustment. Several factors influencing adherence to the intervention emerged from the qualitative process data. The intervention appears to have worked mainly by increasing male knowledge on key topics and promoting couple communication and shared decision-making. Providers reported specific implementation challenges. Conclusion: Gender-transformative interventions to involve men as supportive partners in maternity care can improve adherence to recommended healthy practices among postpartum women.
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Lee, Elaine Carole. "Disclosure in maternity care contexts : the paradigm case of sexual orientation." Thesis, University of Dundee, 2010. https://discovery.dundee.ac.uk/en/studentTheses/f6167a54-09d1-4e3e-a31d-e2108dca9fce.
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This thesis is a hermeneutic phenomenological study of the concept of disclosure in maternity care contexts using the example of sexual orientation. There is a significant body of literature within psychology and sociology relating to the health and social purposes and consequences of disclosure. There is a further body of outcomes-focused evidence relating to disclosure of sexual orientation in health care. There is, however, little research undertaken into the disclosure of sexual orientation in pregnancy as an action with motive and purpose. This study aimed to address this issue. The study employed unstructured interviews with eight lesbian mothers, seven of whom were birth mothers and one was a social mother. The hermeneutic method used an iterative process of analysis integrating researcher pre-understandings, thematic analysis of individual interview transcripts and broader analysis of the individual interview data within the total interview data, exploring the parts within the whole. The aim was to identify the shared meaning of disclosure for the participants Data analysis resulted in five main themes: being invisible/visible; being upfront; being me; being entitled; being safe. An additional finding was the process of managing negativity through strategies such as rationalisation. Three encompassing concepts were identified: protection; power; and identity. Two motivations for disclosure were also identified: pro-action and altruism The thesis concludes that disclosure is a motivated and purposeful act which has real meaning and consequences. It makes extensive recommendations for midwifery practice including acknowledging the disclosure, understanding the legal complexity, and recognising the lesbian family. Recommendations for policy suggest having explicit and detailed policies that include information about how to be inclusive rather than only abstract concepts of inclusion. Recommendations for research include qualitative and quantitative research with midwives about attitudes and knowledge as well as research exploring the role of the social mother in promoting family health outcomes.
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Mennie, Moira E. "Prenatal genetic screening for cystic fibrosis carriers : implications for maternity care." Thesis, University of Edinburgh, 1995. http://hdl.handle.net/1842/20687.
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The psychological response of 64 women identified as CF carriers and their partners who received a negative test result were assessed together with selected controls on 4 further occasions: 10 on receiving the carrier's positive test result; 2) on receiving the partner's negative test result; 3) six weeks later; 4) six weeks after delivery. Knowledge of the genetics of CF and attitude to having been screened were measured by self-administered questionnaire. Compared to control subjects, carriers showed a significant increase in generalised psychological disturbance attributed specifically to symptoms of anxiety and depression during the period awaiting their partner's test result but returned to control levels on receipt of a partner's negative test result. Although there was no significant difference in generalised psychological disturbance between partners and their selected controls, partners did become significantly more anxious and manifested signs of inadequacy while awaiting their own test result. All four groups were well informed about the genetics of CF and the significance of being a gene carrier, although 23% of carriers felt information given at the booking clinic was insufficient. 20% of carriers felt regret or ambivalence about having been screened. There was a consensus that screening should be routinely offered to pregnant women but should also be made available in family planning clinics and GP centres. Results showed that the implications for midwifery practice focus on 3 areas of care: information giving; counselling; and emotional support.
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Rodriguez, Lisette. "The Effect of Maternity Care Practices on the Duration of Breastfeeding." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6371.
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The natural practice of breastfeeding has been strongly noted as one of the most cost-effective, health promoting, disease-prevention strategies of the 21st century. Although primary health organizations recommend exclusive breastfeeding for the first 6 months of life with added complementary foods and continued breastfeeding up to 2 years of age or longer, many mothers do not breastfeed their infants for the recommendation length of time. Applied policies and health practices, such as those described under the 10 Steps to Successful Breastfeeding and The International Code of Marketing of Breast Milk Substitutes, have been noted as contributing factors that can considerably impact the manner which women choose to feed their infants. A cross-sectional methodology assessed associations between maternity health practices and breastfeeding duration among women birthing in the United States. A secondary data analysis of the Infant Feeding Practice Study II and its Year 6 Follow-Up was conducted using IBM SPSS Statistics Version 24. Procedures for data analysis included frequencies, Ï?2 tests, and ordinal logistic regressions. Outcomes revealed that feeding infants any formula during their hospital stay drastically reduces the likelihood for prolonged breastfeeding duration. Study results also concluded that offering a pacifier to infants during their hospital stay reduced the length of breastfeeding duration. This study confirms many of the primary breastfeeding practices that are at the frontline of maternity patient care in the United States. Establishing well-grounded practices that aid in the long-term duration of breastfeeding could help save lives and improve child and maternal health outcomes within the United States.
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Arnold, Rachel E. "Afghan women and the culture of care in a Kabul maternity hospital." Thesis, Bournemouth University, 2015. http://eprints.bournemouth.ac.uk/24519/.
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Female Afghan healthcare providers are vital to reduce the number of women dying in labour. Since 2001 the numbers of female providers have been substantially increased. Ensuring quality care for women in childbirth, however, remains a more elusive goal. The aim of this qualitative ethnographic study was to analyse the culture of care of a Kabul maternity hospital and explore the barriers and facilitators to quality care. My particular focus was the experiences, thoughts, feelings, and values of the doctors, midwives and care assistants. Six weeks of participant observation, 23 semi-structured interviews with hospital staff, 41 background interviews and 2 focus group discussions with women in the community, between 2010 and 2012, were used to gather diverse perspectives on childbirth and care in Kabul maternity hospitals. A thematic approach was used to analyse the data. Five themes were identified: the culture of care; motivation; fear, power and vulnerability; challenges of care; family and social influences. Three themes are explored in depth in this thesis. They are discussed in the following order: the culture of care, challenges of care, and fear, power and vulnerability. The influence of family and social norms on healthcare providers was integral to understanding hospital life; it therefore contributes to each chapter. Women in childbirth laboured alone with minimal monitoring, kindness or support. For staff, the high workload was physically and emotionally demanding, resident doctors struggled to acquire clinical skills, midwives were discouraged from using their skills. Family expectations and social pressures influenced staff priorities. A climate of fear, vulnerability and horizontal violence fractured staff relationships. ‘Powerful’ hospital staff determined the behavioural agenda. This study offers multiple insights into healthcare provider behaviour. It reveals complex interrelated issues that affect care in this Afghan setting but its relevance is far broader. It is one of few international studies that explore care from the perspective of healthcare providers in their cultural and social environment. It reveals that understanding the context of healthcare is pivotal to understanding behaviour and the underlying obstacles to quality care. Furthermore, it challenges conventional assumptions about individual staff agency, motivation, and common strategies to improve the quality of care.
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Strauch, Jessica. "Support of Maternity Care Practices to Increase Breastfeeding Among First-Time Mothers." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/557.
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Breastfeeding offers numerous health benefits to both the mother and infant, yet it is not routinely practiced due to a number of internal and external factors that influence the mother's decision. Guided by the social ecological model, the purpose of this study was to examine the effect of required reporting to The Joint Commission on perinatal measures, a proxy measure for maternity care practices, and those professional effects on breastfeeding initiation and exclusivity for first-time mothers. The hypotheses were that the mandatory reporting, and thus an increase in maternity care practices, would increase the initiation of breastfeeding and exclusive breastfeeding on discharge in first-time mothers. This study was a quantitative retrospective study design that included data collected from the medical records of 1,000 mothers from Southeast Alabama Medical Center who gave birth between 2013 and 2014. The multiple logistic regression analysis indicated that the odds ratio for initiation of breastfeeding was greater among first-time mothers after implementation of mandatory reporting measures (OR = 2.07; p = 0.0007); however, the odds for exclusive breastfeeding on discharge did not show a statistically significant change (OR = 0.94; p = 0.7507). These findings may inform the work of healthcare providers at hospitals, community centers, and public health workers, guiding their maternity care practices to increase the number of first-time mothers who will breastfeed for longer periods of time and improving children's health outcomes.
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Wibbelink, Margreet. "Perceptions of private sector midwives and obstetricians regarding collaborative maternity." Thesis, Nelson Mandela Metropolitan University, 2014. http://hdl.handle.net/10948/d1020979.
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The World Health Organization (WHO) states that no region in the world is justified in having a caesarean section rate greater than 10-15 percent, calculated as the number of caesarean deliveries over the total number of live births. There is however, an international increase in the rate of caesarean section deliveries and this is a concern to midwives. The increase is evident in South Africa as well. Currently the rate of caesarean section deliveries in the private sector can be as high as 70 percent per total number of live births per year. As a result, the public often perceives giving birth surgically in South Africa as ‘normal’ and ‘safer’ than vaginal delivery, even for low-risk pregnancies. The lack of involvement of midwives in the care of pregnant women in the private sector is indicated as one of the reasons related to the high caesarean section delivery rates. This motivated the researcher to undertake a study to explore and describe the perceptions of private sector midwives and obstetricians regarding the feasibility of collaboration in maternity care. A literature review to support the study identified research done previously regarding collaborative maternity care. The study followed a qualitative, exploratory, descriptive, contextual design. The research population included midwives and obstetricians in the private sector in the Eastern Cape. Non-probability, purposive sampling was used. The researcher conducted semi-structured one-to-one interviews to collect information rich data. The researcher ensured that the study was conducted in an ethical manner by adhering to ethical principles such as autonomy, non-maleficence, beneficence and justice. The interviews were transcribed and Creswell’s’ data analysis spiral was used as a guide for the data analysis. Themes and sub-themes were identified and grouped together to form new categories. An independent coder assisted with the coding process. Data analysis results revealed the following results Participants perceived a collaborative working relationship as being beneficial to maternity care. Participants identified that there might be critical impediments that need to be faced in order to realize collaborative maternity care. The researcher ensured the validity of the study by conforming to Lincoln and Guba’s model of trustworthiness, which consists of the following four criteria namely credibility, transferability, dependability and conformability. The information obtained from this study assisted in developing guidelines to facilitate the implementation of collaborative maternity care between midwives and obstetricians in private practice in South Africa. The objective of the study was thus met.
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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.
Full textAbstract:
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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Whelan, Amanda Rebecca. "Measuring quality of health care delivery : maternal satisfaction in the South Wales valleys." Thesis, Cardiff University, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.337715.
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Shaw-Battista, Jenna Cleave. "Optimal outcomes of labor and birth in water compared to standard maternity care." Diss., Search in ProQuest Dissertations & Theses. UC Only, 2009. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3378507.
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Burden, Barbara. "Privacy in maternity care environments : exploring perspectives of mothers, midwives and student midwives." Thesis, Open University, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.441141.
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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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Luphai, Mbulaheni Rhona. "The role of advanced midwives regarding maternity care in tertiary hospitals in Gauteng." Diss., University of Pretoria, 2017. http://hdl.handle.net/2263/63047.
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The researcher explored the role of advanced midwives allocated in maternity
care in tertiary hospitals in Gauteng. Advanced midwives form part of the
multidisciplinary team in Gauteng tertiary hospitals in accordance with the
staffing norms as prescribed by the Maternity Guidelines of South Africa for
advanced practice nurses. Advanced practice nursing (APN) strengthens
nursing and advanced practices to assist and fill in where there is a shortage of
physicians in rural and densely populated areas. The scope of practice in
tertiary hospitals for advanced practice nurses is not explicit; the role of
advanced midwives in these hospitals is not clearly defined and, as a result, the
role of the advanced midwife and physician overlap in tertiary hospitals in
South Africa.
A qualitative, exploratory, descriptive and contextual research design was
followed. Advanced midwives allocated in three selected tertiary hospitals in
Gauteng served as the study population. After conducting a pilot study at the
fourth tertiary hospital in Gauteng, data collection occurred during three focus
group interviews. Field notes were taken. Application letters for obtaining
ethical permission and permission in the setting were sent to the chief
executive officers (CEOs) of the three selected hospitals. All ethical principles
were strictly adhered to. A moderator was used to conduct the focus groups in
a quiet setting of each hospital. Participation was voluntary and informed
consent was signed. The collected data was analysed by using the 8 steps of
the Tesch’s model of data analysis. Trustworthiness was adhered to with
confirmability, credibility, dependability and transferability. The study findings
were discussed and confirmed by literature control. The limitation of this study
was highlighted.
The findings revealed three main themes: positive attributes of advanced
midwives, responsibilities of advanced midwives in tertiary hospitals and
challenges posed by patients who do not adhere to the admission criteria. The recommendations were made for the support and supervision of the
utilisation of advanced midwives in tertiary hospitals by the Gauteng
Department of Health employing body, support by training institutions/universities, support for advanced midwives by nursing
management, and self-empowerment of the advanced midwife.
The conclusion was that advanced midwives are not optimally utilised. Support
recommendations were made to different stakeholders on strengthening
multidisciplinary team decision making on management of patient care. Further
research studies on the placement of advanced midwives within tertiary
hospitals were recommended.Dissertation (Mcur)--University of Pretoria, 2017.
Nursing Science
Mcur
Unrestricted
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Skerman, Jindalae. "Birth on the Fringe: high-risk homebirth and contentious decisions in maternity care." Thesis, The University of Sydney, 2022. https://hdl.handle.net/2123/29649.
Full textAbstract:
Homebirth is a minority choice in Australia (less than 0.4% in 2020). It is available through publicly funded homebirth programs as well as independent midwives, but it is becoming progressively more difficult to access. Despite being a minority option, homebirth is an emotive and polarising issue. Women who choose homebirth when they are assessed as "high-risk" are making an even more contentious choice. High-risk homebirth raises a number of legal and bioethical issues around choice, autonomy and risk. My argument is that it is overly simplistic to frame high-risk homebirth from a position of conflict between women's autonomy and the interests of the fetus. Women and the fetus should not be seen as being in conflict. Rather, there should be a recognition that they are in a relationship. The clinical evidence around risk is contested and I discuss some of the conflicting studies. In any event, women balance and prioritise different kinds of risk. They may choose to accept the increased risk of homebirth in order to obtain a different benefit, such as being able to birth in a familiar environment with a lower risk of obstetric intervention. Strong, trusting relationships between women and their care providers will ensure that risk is discussed appropriately. I also argue in favour of a relational conception of autonomy, where strong relationships with care providers can also increase women’s autonomy. This approach places pregnant women in the best position to make informed, authentic decisions on behalf of the fetus as well as themselves. Rather than focusing on whether women are “right” when they choose high-risk homebirth, I propose that a pragmatic and compassionate approach is to try and accommodate contentious birth choices rather than abandoning these women on the fringe of maternity care. Women can choose to accept the consequences of their choices, even if this means failing to comply with medical advice.
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Wood, Juliet Rebecca Anne. "Discourses of blood loss in normal childbirth." Thesis, London South Bank University, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.342398.
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Laryea, Maureen Gato Gasele. "A cross-cultural study of women's preparation for childbirth : Canada and England." Thesis, University of Ulster, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.390065.
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Ngula, Asser Kondjashili. "Women's perception on the under utilization of intrapartum care services in Okakarara district, Namibia." Thesis, University of the Western Cape, 2005. http://etd.uwc.ac.za/index.php?module=etd&.
Full textAbstract:
Maternal health care services are one of the health interventions to reduce maternal and infant morbidity and mortality. The health of mothers of childbearing age and of the unborn babies is influenced by many factors some of which include the availability and accessibility of health services for pregnant women. Low quality of health services being provided, and limited access to health facilities is correlated with increases maternal morbidity and mortality. This situation is caused by long distances between facilities as well as the people's own beliefs in traditional practices. This study was about the assessment of the women's knowledge on benefits of delivery in a hospital, the barriers to delivery services, and the perception of the delivery services rendered in the maternity ward of Okakarara hospital.
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Soud, Fatma Ali. "Medical pluralism and utilization of maternity health care by Muslim women in Mombasa, Kenya." [Gainesville, Fla.] : University of Florida, 2005. http://purl.fcla.edu/fcla/etd/UFE0010181.
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Rudrum, Sarah Elizabeth Ellen. "The social organization of maternity care and birth in Amuru sub-county, northern Uganda." Thesis, University of British Columbia, 2014. http://hdl.handle.net/2429/51419.
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High maternal mortality rates throughout sub-Saharan Africa attest to the critical importance of comprehending barriers to health care during pregnancy and birth. This study examines how maternity care and birth are socially organized in Amuru sub-county, northern Uganda, a rural setting recovering from two decades of conflict. To conduct this study, I spent seven months undertaking fieldwork in Amuru, northern Uganda. In addition to observations, I interviewed and held focus groups with childbearing women, and in a second study stage spoke with health care providers and health care administrators. My research methods draw from institutional ethnography.
The challenging context for maternity care and childbirth in Amuru was exacerbated by poor infrastructure and ongoing social distress in the aftermath of the protracted conflict between the Lord’s Resistance Army (LRA) and government forces that ended in 2006. Findings drawn from the data illustrated that approaches to care and birth among participants were shaped by everyday challenges associated with poverty and lack of infrastructure, the most prominent of which were accessing transportation, avoiding arduous physical work while pregnant, and ensuring adequate nutrition. Couples’ HIV testing, which was positioned as compulsory and wherein women were responsible for husbands’ participation, also challenged participants access to antenatal and delivery care. Childbearing women’s approaches to maternity care were also shaped by the mama kit project (distribution of a non-profit ‘gift’ of baby-care basics to mothers), and its associated discourses of deservingness, scarcity, and uncertainty. Imbued with power, all these factors affected access to care. This dissertation contributes to scholarship on the social constitution of maternity care and childbirth in northern Uganda.Arts, Faculty of
Gender, Race, Sexuality and Social Justice, Institute for
Graduate
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Bich, Thuy Dinh Thi. "Maternity care in change : the case study of a suburban village in Northern Vietnam." Thesis, University of Essex, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.504881.
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After over two decades of'doi moi', with rapid changes taking place in the economy, it is inevitable that there will also be significant social changes. This research aimed to provide a detailed ethnographic exploration in the area of maternity practices, health care and health services in their socio-economic context, in order to further sociological understanding of maternity care both by women and health professionals. At the heart is the hypothesis that women's' perspectives and their activities in daily life and in maternity care would reflect key aspects of these socio-economic changes. This research shows how women in a period of pregnancy and childbirth are deeply interwoven with their everyday experiences of domestic responsibilities and economic contributions. On the other hand, pregnancy and childbirth are closely linked to women's ideas ofthe 'happy family' and their status in family and society. This research also examines how socio-cultural factors influence the utilization of maternal health. care providers and services. In fact, by exploring the maternity practice and utilisation of health care service and health care provision, the broader aim of the research is to generate relevant socio-cultural information to assist in the development of safe motherhood intervention programs and to fulfil the gap between the actual needs and provision in health care at a grassroots level in the socio-culture context. The focus of my research is the dialectical relation between two reciprocally related orientations: it is to study the social, cultural and economic influences to maternity care practices and how these practices contribute to the socio-cultural ideas concerning maternity care at the grassroots level in a transitional society.
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Hulton, Louise Anne. "Quality of care in maternity services : childbirth among the urban poor of Mumbai, India." Thesis, University of Southampton, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.274650.
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Nordin, Elin. "Power and Patients : An ethnological study of access to maternity care in rural Sweden." Thesis, Umeå universitet, Institutionen för kultur- och medievetenskaper, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-155339.
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In february 2017 the maternity ward in Sollefteå was shut down. The citizens of the surrounding area, Ådalen, thus have more than two hours - with private transportation on narrow roads without phone connection - to the nearest maternity ward. The shutdown is a result of various developments in society, connected to larger structures of power that present these changes as natural and inevitable. This qualitative study explores the relationship between individual and structure by examining the area of Ådalen and its inhabitants’ access to maternity care. The emphasis lay on power dynamics within - and between - different structures and how these come to influence people’s everyday life. With ethnographic material collected through in depth-interviews and observations, the impact of these power structures are exemplified and discussed from the perspectives of a few individuals. The relevant structures are examined through three norms; a male norm, a neoliberal norm and an urban norm. The analysis problematize how the norms, through the conceptions of women, rurality and human values they reproduce, influence access to maternity care and limit the agency of the study’s participants. The analysis is based on power theories of both Foucault and Bourdieu. Foucault’s theories of subject and resistance are used to examine structural exercise of power and the informants’ collective actions and experiences. While Bourdieu’s theories of habitus, capital and field are used to analyze the informants’ individual perceptions of power. The power structures discussed are tied together by an intersectional framework, which enables a broader analysis of how these structures cooperate and strengthen each other. The study shows the complexity of power where the local movements challenge prevailing structures through mobilization and resistance.I februari 2017 stängdes Sollefteå BB. Invånarna i det omgivande området, Ådalen, har därmed över två timmars bilfärd - med privat transport på smala vägar utan telefontäckning - till närmaste förlossningsvård. Nedstängningen av Sollefteå BB kan förstås som en konsekvens av olika samhälleliga förändringar, vilka är kopplade till större maktstrukturer som får denna utveckling att framstå som naturlig och oundviklig. Denna kvalitativa studie utforskar relationen mellan individ och struktur genom att undersöka Ådalen och dess invånares tillgång till förlossningsvård. Fokus ligger på makt-dynamiken inom, liksom mellan, olika strukturer och hur dessa påverkar människors villkor. Maktstrukturerna exemplifieras och diskuteras utifrån ett antal individers perspektiv, med etnografiskt material insamlat genom djupintervjuer och observationer. De för studien relevanta strukturerna undersöks genom tre normer; en manlig norm, en neoliberal norm och en urban norm. Utifrån dessa normer diskuteras hur informanterna relaterar till makt i kontexten av nedstängningen av Sollefteå BB. Analysen problematiserar hur de olika normerna genom den uppfattning om kvinnor, landsbygd och mänskliga värden som reproduceras påverkar tillgången till förlossningsvård, liksom handlingsutrymmet för studiens deltagare. Analysen utgår från teorier om makt av både Foucault och Bourdieu. Foucaults teorier om bl. a. subjekt och motmakt används för att analysera strukturellt maktutövande och informanternas kollektiva handlingar och upplevelser. Medan Bourdieus teorier om habitus, kapital och fält används för att förstå informanternas individuella erfarenheter av och uppfattningar om makt. De maktstrukturer som diskuteras knyts samman genom ett övergripande intersektionellt ramverk, vilket möjliggör en bredare analys av hur dessa strukturer samarbetar och stärker varandra. Studien visar en komplex bild av makt och maktutövning där de lokala rörelserna i Ådalen utmanar rådande maktstrukturer genom mobilisering och motstånd.
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Shi, Hong. "The Maternity Care Needs of, and Service Provision for, Chinese Migrant Women in Brisbane." Thesis, Griffith University, 1999. http://hdl.handle.net/10072/366136.
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In Australia, there are significant differences in the perinatal health of non-English speaking background (NESB) women compared with that of English speaking background and Australia born (except for Aborigines). A recent preliminary study of Chinese migrant communities in Brisbane has shown that health and wellbeing of new mothers during the postnatal period is a growing concern. This suggests the necessity of research into the maternity needs of Chinese migrant women and whether or not these needs are being fulfilled by maternity care services in Australia.
In order to explore in depth the experiences of both the consumers and the providers, this study adopted a need assessment approach and employed a variety of qualitative techniques: focus group discussion, in-depth interviews with twenty Chinese migrant mothers, obstetricians, midwives, nurses and community key informants, and participant observation in antenatal classes and four birth deliveries. The study found unmet needs in four major areas: community and social support; cross-cultural communication; accessibility of information on health and services; and cultural appropriateness of service provision. Apart from general recommendations of service improvement in relation to the above four areas, the study has provided practical strategies such as bilingual cards for communication in emergency birth delivery situations. The findings of this study should have important implications for improving cultural sensitivity and appropriateness for service provision for other NESB migrant groups in Australia.Thesis (Masters)
Master of Philosophy (MPhil)
School of Public Health
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Kuforiji, Oluwatoyosi A. "Qualitative study exploring Maternity Ward Attendants' perceptions of occupational (work related) stress and the coping methods they adopted within maternity care settings (hospital) in Nigeria." Thesis, University of Bradford, 2017. http://hdl.handle.net/10454/15941.
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Background: Occupational stress is a global and complex phenomenon, and workers in developing countries can be affected by it (International Labour Organisation 2001). Staff within maternity settings have been identified as being at risk of suffering from stress, resulting in adverse health outcomes (Evenden and Sharpe, 2002). However, MWAs’ perceptions of stress have not been captured and are not reflected in the literature. Purpose: The aim of this study was to explore MWAs’ perceptions of occupational stress, possible cause(s), the impact and support available and the coping methods they adopted within maternity care settings (hospital) in Nigeria. Methodology: This study adopted a qualitative methodology. Husserl’s (1962) phenomenological approach was chosen as it enabled the researcher to collect rich, in-depth, descriptive accounts of the MWAs’ perceptions of the phenomenon under study through the use of semi-structured interviews. Findings: The major sources of stress for MWAs included work overload, long working hours, staff shortages, work exploitation and intensification and lack of support from senior staff. The stress levels MWAs experienced impacted on their health and well-being and resulted in related behavioural and physical reactions. Conclusion: This study confirmed that MWAs were exposed to similar stress factors experienced by other health workers and reported in the research literature. Additionally, it demonstrated the need for more qualitative studies to explore the perceptions of occupational stress among under-represented groups of healthcare workers. Importantly, this study created an opportunity to explore the experience of dedicated women facing challenging employment practices in hospital settings in Nigeria. Equally, it gave a voice to these unrecognised, almost invisible women, who were the MWAs that played a key role within the maternity services.
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Holmqvist, Marika. "Addressing Alcohol : Alcohol Prevention in Swedish Primary and Maternity Health Care and Occupational Health Services." Doctoral thesis, Linköpings universitet, Socialmedicin och folkhälsovetenskap, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-16815.
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Alcohol consumption in Sweden has reached its highest levels of the past 100 years in the wake of the country’s entry into the European Union in 1995. Increased alcohol prevention efforts in Swedish health care settings have been given high priority by the authorities. The Swedish parliament’s national action plan up to 2010 emphasises that public health must be protected by achieving reductions in alcohol consumption and limiting the negative physical, psychological, and social effects of alcohol. This thesis aims to investigate various aspects related to the current alcoholpreventive activity in 2006 among health care professionals in three important health care settings: primary health care (PHC), occupational health services (OHS), and maternity health care (MHC). The thesis includes four studies based on a total population mail questionnaire survey. Results from the studies show that alcohol issues in both PHC and OHS were addressed less frequently than all other lifestyle issues, i.e. smoking, physical activity, overweight, and stress. Important barriers to alcohol-preventive activity in these settings were perceived lack of time, scepticism regarding the effectiveness of addressing the issue of alcohol, fear of potentially negative patient responses, uncertainty about how to ask, uncertainty about how to give advice regarding alcohol, and uncertainty concerning where to refer the patient. OHS professionals generally considered themselves more skilful than their PHC counterparts in achieving change in patients’ alcohol habits and more knowledgeable about providing advice to patients with risky alcohol consumption. The overall frequency of initiating discussions about alcohol with patients in PHC and OHS was positively associated with self-assessed skills, knowledge, and education for all professional categories. Slightly more than one-third of the MHC midwives used a questionnaire to assess the woman’s alcohol intake before the pregnancy; AUDIT was the most commonly used questionnaire. Their perceived knowledge concerning alcohol and pregnancy matters was generally high, but the midwives considered themselves less proficient at detecting pregnant women with risky alcohol consumption before the pregnancy. MHC midwives had participated in more continuing professional education in handling risky drinking than all other categories investigated. PHC nurses was the category that had the highest proportion of professionals who lacked education in handling risky drinking. Professionals in PHC, OHS, and MHC to a large extent believed that provision of more knowledge about counselling techniques to use when alcohol-related symptoms are evident could facilitate increased alcohol intervention activity.
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Brooks, Fiona M. C. "Alternatives to the medical model of childbirth : a qualitative study of user-centred maternity care." Thesis, University of Sheffield, 1990. http://etheses.whiterose.ac.uk/2970/.
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This thesis sets out to explore some important gaps in the sociological and feminist understanding of the provision of maternity care and of women's health needs. The research was concerned with an exploration of the implementation of proposals for the provision of user-centred maternity care which emerged from the critiques of current medicalised provision. It evaluates the effects of an attempt to provide user-centred maternity care within the Primary Health Care sector (PHC) from both the women's and workers' perspectives and experience. The central questions addressed within the research have been: Firstly, to assess the degree to which such models of service delivery provide a user centred approach. Secondly, to identify the form of the relationship between the women users and providers from the practices and to develop an understanding of the mechanisms of interaction between them. Thirdly, to explore the extent to which the provision of such care is appropriate to match women users' self identified needs. Finally, to assess the potential of female health workers to adopt a form of provider and user relationship where the balance of power is altered in the users' favour. The main body of the research consisted of a qualitative study conducted in two general practices. These were chosen as specific examples of innovative practices attempting to provide a genuinely user-centred maternity service. The fieldwork consisted of three methodological components: Firstly, unstructured interviews were conducted with women users and workers. A sample of 30 women who were pregnant for the first time were interviewed on three occasions during their pregnancy and in the immediate post-natal period. In addition, 10 second time mothers were also interviewed post-natally. In terms of the workers', in depth interviews were conducted with midwives, GPs and practice nurses within the PHC setting. Secondly, observations were undertaken on the interactions between the women and workers and between members of the PHC team during the course of the women's antenatal and post-natal care. Finally, a structured questionnaire was used with a sample of women from one of the practice's well woman clinic. The research findings indicate the existence of a user-centred frame of reference held by female health workers - especially the midwives - for the provision of health care to women, which was opposed to the medical model. It explores the translation into practice of this model of maternity care and identifies the way that it functioned to enable women to exercise greater control over their health care and experience of pregnancy. Within this model the traditional 'with woman' role of the midwife was found to be central. Considerable convergence was found between the models held by the main parties in the interaction - issues concerned with choice, control and the provision of information were all found to be central to the care provided and to women's and workers' models. However, constraints on the effective implementation of the model were found in terms of the influence of professionalism (particularly on the GPs) and the dominance of the hospital system. These resulted in limits to the women workers' ability to meet the needs of women users.
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Birch, Katherine Emma. "Great expectations : a sociological analysis of women's experiences of maternity care in the 'new' NHS." Thesis, University of Liverpool, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.266197.
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Ledward, Alison. "The interface between evidence-based maternity care clinical practice guidelines and the pregnant woman's autonomy." Thesis, University of Leicester, 2017. http://hdl.handle.net/2381/40446.
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The importance of the pregnant woman’s autonomy and the role of increased choice in decision-making relating to her maternity care have gained widespread recognition. This is borne out in the healthcare and bioethics literature, key initiatives in policy documents and clinical guidelines. Although guidelines are a central feature of maternity care, little is known about how their recommendations are experienced by women and the impact on their autonomy. This thesis addresses that gap in knowledge. The methods I used in this research comprised a literature review and an empirical study consisting of semi-structured interviews with 20 participants in an inner-city teaching hospital. Data collection, transcription and analysis were informed by adaptation of the Constructivist Grounded Theory approach (Charmaz: 2006). My analysis generated two main thematic categories. First, women lack the appropriate in-depth pregnancy and birth knowledge to make decisions independently. Second, interactions with trusted professional carers were highly valued. Analysis suggested new insights, namely that the meaning of autonomy to women is more complex than self- government, a range of options and relational responsibilities can account for. Women felt empowered by being a genuine participant in the decision-making process. They expressed their autonomy by being invited to share their previous experiences, current expectations and concerns and request information in a manner consistent and timely with their own agendas. Women’s responses were also shaped by considered reflection of the impact of their decisions on others. My analysis revealed that some level of interdependence may be a precondition for women to exercise their autonomy. It is a paradox that the recommendation professionals should follow guidelines and be non-directive may result in the unintended consequence of women exercising their autonomy by in part reinstating authority to professional carers. Interpretation of findings led to the development of my grounded theory, ’Choosing when to choose’.
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Montgomery, Elsa. "Voicing the silence : the maternity care experiences of women who were sexually abused in childhood." Thesis, University of Southampton, 2012. https://eprints.soton.ac.uk/349089/.
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Childhood sexual abuse is a major, but hidden public health issue estimated to affect approximately 20% of females and 7% of males. As most women do not disclose to healthcare professionals, midwives may unwittingly care for women who have been sexually abused. The purpose of this study was to address the gap in our understanding of women’s maternity care experiences when they have a history of childhood sexual abuse with the aim of informing healthcare practice. This narrative study from a feminist perspective, explored the maternity care experiences of women who were sexually abused in childhood. In-depth interviews with women, review of their maternity care records and individual and group interviews with maternity care professionals were conducted. The Voice-centred Relational Method (VCRM) was employed to analyse data from the in-depth interviews with women. Thematic analysis synthesised findings, translating the women’s narratives into a more readily accessible form. The main themes identified were: narratives of self, narratives of relationship, narratives of context and the childbirth journey. Medical records provided an additional narrative and data source providing an alternative perspective on the women’s stories. Silence emerged as a key concept in the narratives. This thesis contributes to ‘Voicing the silence’. The particular contribution of the study is its focus on the women’s voices and the use and development of VCRM to listen to them. It highlights where those voices are absent and where they are not heard. Women want their distress to be noticed, even if they do not want to voice their silence. The challenge for those providing maternity care is to listen and respond to their unspoken messages and to hear and receive their spoken ones with sensitivity.
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Slavin, Valerie J. "Evaluating Maternity Care: Implementation, Testing and Feasibility of a Standard Set for Pregnancy and Childbirth." Thesis, Griffith University, 2020. http://hdl.handle.net/10072/398874.
Full textAbstract:
Unwarranted variation in clinical practice contributes to inconsistent perinatal outcomes and poor quality maternity care. Value-based healthcare aims to address unwarranted variation and drive quality improvement but requires the systematic and rigorous measurement of outcomes and costs. Traditional maternity measures are insufficient to inform the value of maternity care. The ICHOM (International Consortium for Health Outcomes Measurement) Standard Set for Pregnancy and Childbirth is a core outcome set developed to measure value in maternity care, but the quality of the set has not been tested.
This program of work aimed to evaluate the validity, reliability and feasibility of the ICHOM Standard Set for Pregnancy and Childbirth. The thesis follows a traditional structure with introduction, methods, results and discussion chapters. Thesis findings are presented as a series of five published papers, two submitted papers currently under review, and two unpublished papers.
First, a systematic literature review evaluated the quality of maternal and neonatal core outcome set development. The review is presented in two parts: (I) prospective protocol, and (II) findings. Exponential growth in core outcome set development was identified and no core outcome set met all minimum standards for development. The ICHOM Standard Set for Pregnancy and Childbirth met 75 percent of the minimum standards for development. Although findings highlight a need for more transparency in reporting, results indicate the ICHOM Standard Set was developed using robust methods.
A narrative review evaluated the quality and psychometric performance of the person-reported outcome measures (PROMs) included in the ICHOM Standard Set. Nine PROMs were evaluated against COSMIN (Consensus-Based Standards for the Selection of Health Measurement Instruments) standards for study design methodology and criteria for good measurement properties. The review identified major gaps in the literature regarding the psychometric performance of five included PROMs in relation to childbearing women.
To address some of these gaps, a prospective, longitudinal cohort study was conducted with 309 childbearing women. Participants were asked to complete five online surveys at ICHOM’s prescribed time-points from booking to 26-weeks postpartum and included the ICHOM Standard Set and additional measures chosen to facilitate psychometric analysis. A series of studies then aimed to: (i) assess psychometric performance, (ii) refine PROMs to improve psychometric performance, (iii) offer recommendations, and (iv) offer an alternative if inclusion of the PROM could not be supported.
The first two studies evaluated the psychometric properties of the PROMIS® (Patient-Reported Outcomes Measurement Information System) Global Short Form (health-related quality of life), the International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form (ICIQ-UI SF) and the Wexner Scale (urinary and anal incontinence). The third study developed and evaluated a framework to facilitate standardised reporting of perinatal incontinence. The fourth study compared the screening accuracy of the Patient Health Questionnaire (PHQ-2) using two case-identification methods to detect probable depression. The fifth study evaluated the construct validity of the Single Item Measure of Social Supports (SIMSS) to measure social support. The results of these studies supported the inclusion of all but one of the included PROMs in the ICHOM Standard Set for Pregnancy and Childbirth but under the caveat of some refinements and recommendations.
The final study evaluated the feasibility of the ICHOM Standard Set in practice. High recruitment, response, and completion rates and high retention at 6-months post-birth supported feasibility of the ICHOM Standard Set.
The revised ICHOM Standard Set for Pregnancy and Childbirth is a robust set of outcomes and measures that is acceptable to childbearing women. Universal embedding of the Standard Set into routine clinical practice has the potential to inform value-based healthcare, and drive quality improvement and is recommended. Further research is needed to inform the optimal approach for successful implementation of the Standard Set in the real-world setting.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Nursing & Midwifery
Griffith Health
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