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1
Churchill, Helen. "Caesarean birth : conflict in maternity services." Thesis, Middlesex University, 1994. http://eprints.mdx.ac.uk/6686/.
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This study investigates the history of caesarean section and women's experience of the operation today. There has been no systematic collection of historical data on caesarean section since 1944. This study now constitutes the most comprehensive compilation of the history of the operation to date. It illustrates the development of the medical ethos concerning women as patients and provides the background to the next phase of research: the experience of caesarean section. Previous research on caesarean section has exhaustively analysed the indications for the operation, reasons for the increasing rate and women's perceptions of abdominal delivery. This study differs in eliciting responses from women on a range of issues relating to caesarean birth in order to assess the quality of information given to women in hopital regarding the necessity for caesarean operations and analyse the effects of abdominal birth on women. Women's experiences were examined in a sample of 300 women who had delivered by caesarean section. Significant differences were found in reactions between women who had emergency operations and those whose caesareans were elective. The emergency caesarean women suffered more in all negative measures including increased feelings of pain and depression. Negative sequelae was found to relate to the unexpected nature of emergency operations and the use of general anaesthesia. Subjectively women report that they do not suffer as a result of caesarean birth, yet objectively it is clear that they do. This anomaly is attributed to the unequal relationship between women and doctors. Women feel grateful for the treatment offered by the doctors and therefore do not express dissatisfaction with their care. Recommendations are made suggesting practical ways in which maternity services, in respect of caesarean birth, can be improved.
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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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Putnina, Aivita. "Maternity services and agency in post-Soviet Latvia." Thesis, University of Cambridge, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.624521.
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Spendlove, Zoey. "Revalidation repercussions : contemporary regulatory reform within English maternity services." Thesis, University of Nottingham, 2016. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.716488.
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Revalidation, as a government-led healthcare professional regulatory reform process, marks the largest and potentially the most significant development in the history of healthcare professional regulation within the United Kingdom (UK) National Health Service (NHS). Revalidation, as an emergent regulatory reform, is a professionalisation dilemma for healthcare professionals as it would appear to be diametrically opposed to the notion of professional autonomy and selfregulation; the theorised core characteristics of health professionalism (Dixon-Woods et al., 2011; Freidson, 1970a). At the time of implementation, the impact that this reform would have upon professional groups was unknown. The national rollout of revalidation therefore presented a real time opportunity to witness the operationalisation of such a top-down regulatory reform. Drawing on the concepts of professional 'licence and mandate' (Hughes, 1958) and the 'professional project' (Larson, 1977) as a theoretical framework, I used a focused ethnographic approach to answer the following research questions: Over-arching research question: How are regulatory mechanisms, such as revalidation, interpreted and utilised as part of a 'professional project'? Sub-questions: How is revalidation being implemented within an NHS organisation and how does this compare with national recommendations? How are plans for revalidation being received and implemented within maternity services? How are regulatory mechanisms such as revalidation impacting upon professional roles and responsibilities within maternity services? The overall contribution of my research study lies in providing insight into the intended and unintended consequences of revalidation as contemporary healthcare professional regulatory reform. From a practice perspective this study illustrates how formal regulatory mechanisms were shaped at local level by the informal processes of the research organisation. From a theoretical perspective this study challenges the concept of organisational professionalism (Evetts, 2012; McClelland, 1990), whereby national and organisational objectives, such as revalidation, are theorised to control and regulate professional groups. I argue that professionals engaged with revalidation as part of an ongoing, professional maintenance project of professional status and survival. This was an ultimate acknowledgement that in order to maintain a licence to practise (Hughes, 1958), engagement with revalidation was a statutory requirement.
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Enyeribe, Iwuh Ibezimako Augustus. "Maternal near miss audit in Metro West Maternity services." Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/16525.
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Includes bibliographical referencesBackground: A near miss occurs when a pregnant woman experiences a severe life threatening complication during pregnancy or up to 42 days after the end of the pregnancy and survives. The near miss rate is defined as the number of near misses per 1000 live births. In 2011, World Health Organization (WHO) produced a useful tool for identifying near misses according to composite criteria which include the occurrence of a severe maternal complication together with organ dysfunction and/or specified critical interventions. The ratio of maternal near miss cases to maternal deaths and the mortality index both reflect the quality of care provided in a maternity service Maternal deaths have been audited in the Metro West maternity service for many years but there has been no routine monitoring or evaluation of maternal near misses. Aim of study: The study aim was to perform a near miss audit in Metro West, specifically (a) measuring the near miss rate, the maternal mortality ratio and the mortality index, (b) performing an in-depth investigation of the associated demographic, clinical and health system factors of the near miss cases, and (c) providing input into the development of an on -going system of auditing near misses cases in Metro West. Methods: A retrospective observational study conducted over 6 months between mid- March 2014 to mid -September 2014. This service includes 9 level one maternity facilities which refer all complicated maternal cases to two secondary hospitals, New Somerset (NSH) and Mowbray Maternity (MMH); or to the tertiary hospital, Groote Schuur Maternity Center (GSH). All cases of near miss managed at the three hospitals were identified weekly by the author with the assistance of onsite health providers. These cases included near misses that occurred at level one facilities and were referred on to one or more of the three hospitals. Strict criteria were used to ascertain a case as a near miss according to the WHO near miss definitions. The folders of all the near misses were reviewed and relevant data entered into a data collection form which was adapted from the WHO near miss data form. In addition, these identified folders were reviewed by two senior obstetric specialists to confirm adherence to the WHO inclusion criteria for near miss classification, and also to determine avoidable factors in the management of the near miss cases. Maternal deaths occurring during the same time period of the Near Miss audit were identified from monthly mortality meetings and the ongoing maternal mortality audit system in Metro West. Results: 112 near miss cases and 13 maternal deaths were identified, giving a total of 125 women with severe maternal outcomes. There were a total of 19,222 live births in Metro West facilities. The Maternal mortality ratio (M MR) was 67.6 per 100,000 live births and the maternal near miss rate was 5.83 per 1000 live births. The maternal near miss to death ratio was 8.6:1 and the mortality index was 10.4% Hypertension, obstetric hemorrhage and pregnancy related sepsis were the major causes of the near miss cases accounting for 50(44.6%), 38(33.9%), and 13 (11.6%) of near misses respectively. These three conditions all had low mortality indices; 1.9%, 1.9% and 0 for hypertension, pregnancy related sepsis and hemorrhage respectively. Less common conditions were, medical /surgical conditions, non-pregnancy related infections and acute collapse, accounting for 7 (6.3%), 2 (1.8%), and 2 (1.8%) of near misses respectively. Although these numbers were small, these three conditions accounted for more maternal deaths with mortality indices of 66.7 %, 33.3% and 33.3% for non- pregnancy related infections, medical /surgical conditions, and acute collapse respectively. There were 25 (22.3%) of the near miss cases who were HIV positive. The majority of near misses 99(88.4%) had antenatal care. Analysis of avoidable factors showed that, the most common problems were lack of antenatal clinic attendance (11.6%) and inter-facility transport problems (6.3%). For health provider related avoidable factors, the highest number of avoidable factors were identified at level 2 (38.2%), followed by level one (25.9%) and level 3 (7.1%). The most common factors were problem recognition, monitoring and substandard care Discussion and Conclusions: The near miss rates and maternal mortality ratio in Metro West were lower than for some other developing countries, but higher than rates in high income countries. The mortality index was low for direct obstetric conditions such as hypertensive disorders, obstetric hemorrhage and pregnancy related sepsis, reflecting good quality of care and referral mechanisms for these conditions. The mortality indices for non-pregnancy related infections, medical/surgical conditions and acute collapse were much higher and, suggest that medical problems may need more focused attention. Ongoing near miss audit would be valuable for Metro West but would require identification and monitoring systems to be institutionalized.
6
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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Smith, Helen Jane. "Implementing evidence-based obstetrics in a middle-income setting : a qualitative study of the change process." Thesis, University of Liverpool, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.268901.
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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&.
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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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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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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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Berrow, Diane Claire. "Promoting collaboration between users and health professionals : the experience of Maternity Services Liaison Committees." Thesis, University College London (University of London), 2002. http://discovery.ucl.ac.uk/1317585/.
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The inclusion of user representatives in committees and groups alongside health professionals is one of several ways of involving users in the planning and monitoring of health services. However, there have been reports of barriers to the involvement of users in such groups and very little is understood about the processes that take place and the factors which promote effectiveness. This study addresses this shortfall in relation to a specific type of user involvement forum in maternity services - the Maternity Services Liaison Committee (MSLC). MSLCs are attached to hospital trusts or health authorities and bring together health professionals and local users to plan and monitor local maternity services. The study is a qualitative assessment of a sample of eight MSLCs using a combination of observation and interview methods. It investigates the structure and work of MSLCs, the way members participate, and the meaning and value of MSLCs to members, in order to establish the effectiveness of MSLCs and potential for improvement. The committees were found to have a limited direct impact on maternity services. Arguably their greatest influence was in promoting collaboration between constituent groups and the accountability of health professionals. The impact of MSLCs and the extent to which users were involved were limited by factors to do with the structure and processes of the committees. MSLCs could be improved to some extent through changes to these, but improvement beyond a certain point would be difficult to achieve because the problems reflect fundamental issues to do with the structure of the health service and the way MSLCs were set up, the high degree of professional control over MSLC activity and health care in general, and characteristics of users. These findings have implications for the effectiveness of other forums for user involvement presently being implemented in the health service.
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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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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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Kuronen, Marjo L. A. "The social organisation of motherhood : advice giving in maternity and child health care in Scotland and Finland." Thesis, University of Stirling, 1999. http://hdl.handle.net/1893/2302.
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This study is a qualitative, cross-cultural research on advice giving for mothers in maternity and child health services in Scotland and Finland. It has been accomplished through local case studies using ethnographic methods. The main objective is to analyse how in these service systems motherhood, women's daily life, and their responsibilities for children's welfare and health are defined and organised, and how these definitions vary across social and cultural contexts. Methodologically, referring to the feminist methodology by Dorothy E. Smith, it is emphasised that beginning from the local and particular, from the everyday practices of health professionals, can provide more general understanding of the social relations that organise motherhood in the two societies. Empirical results of the study are presented under six substantial themes: The first theme discusses different professional groups as service providers and the relationships between them. Second theme concentrates on the clinic and the home as the physical settings of service provision and their professional and cultural meanings. Third section discusses the relationship and interaction between health professionals and their clients. Next two themes are related to the standards of motherhood: expectations for proper motherhood, child care, and family relations of the mothers. The last theme analyses possible conflicts between women's everyday experience and professional expertise in motherhood. The general conclusions drawn from the research suggest that motherhood is socially organised at four different but interrelated levels, named in this study as interactional level, institutional level, welfare state level, and socio-cultural leveL. Advice giving for mothers in maternity and child health care is related to family policy measures, social class and gender systems, historical and cultural tradition, customs, and ways of thinking in a certain society. This complexity underlines the relevance of qualitative approach in comparative research.
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Beale, B. L. "Maternity services for urban Aboriginal women : experiences of six women in Western Sydney /." View thesis, 1996. http://library.uws.edu.au/adt-NUWS/public/adt-NUWS20030613.161127/index.html.
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Mendonca, D. M. de M. V. de. "A study of organization and use of maternity services in Viana do Castelo District, Portugal." Thesis, University of Exeter, 1987. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.378238.
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Beale, Barbara L., of Western Sydney Nepean University, and Faculty of Nursing and Health Studies. "Maternity services for urban Aboriginal women : experiences of six women in Western Sydney." THESIS_FNHS_XXX_Beale_B.xml, 1996. http://handle.uws.edu.au:8081/1959.7/316.
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The use of mainstream maternity services by urban Aboriginal women is an important issue for health professionals. Aboriginal mothers are much more likely to die in childbirth than are non-Aboriginal mothers and their excessive risk does not appear to have changed over the last two decades. The infant mortality rate is three times higher than for non-Aboriginal infants. Therefore, this project aimed to discover the cultural needs of urban Aboriginal women who use mainstream maternity services. Six Aboriginal women who were attending the ante-natal clinic at Daruk Aboriginal Medical Service were interviewed. The thesis included the following recommendations and strategies for their implementation: 1/. Establishment of a discrete Aboriginal women's health unit in Western Sydney. 2/. Provision of culturally acceptable education about pregnancy and childbirth. 3/. Promotion of breastfeeding. 4/. Education and encouragement for non- Aboriginal health professionals.Master of Nursing (Hons)
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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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Duong, Dat Van. "Factors that influence the utilization of maternity services and breastfeeding practices in rural Vietnam." Thesis, Curtin University, 2005. http://hdl.handle.net/20.500.11937/1710.
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The overall objective of this thesis is to investigate factors that influence the utilization of maternal services, infant feeding and postpartum contraception practices in rural Vietnam. Field studies were carried out in a rural district of Thanh Hoa, a province located in North Central Vietnam. Willingness-to-pay for maternal preferences was measured in a sample of 200 postpartum and 196 pregnant women, as well as 196 men using the payment card technique. An association was found between satisfaction with the quality of maternal services and willingness-to-pay. There were no significant differences in willingness-to-pay values between prenatal and postpartum groups, and between male and female subjects. The feasibility, reliability and validity of a 20-item scale for measuring perceived quality of maternal services provided at commune health centres, were examined based on a sample of 200 postpartum and 196 pregnant women. The instrument was found to have good inter-rater reliability and internal consistency. Maternal status of clients (prenatal vs. postnatal) was found to influence the perceived quality of maternal services. Determinants of the utilization of maternal services at the primary health care level were investigated in a sample of 200 postpartum women together with sixteen focus group discussions and 16 in-depth interviews. The results showed that client-perceived quality of services and socio-cultural, and economic factors, rather than geographical access, could affect the utilization of maternal services. Factors affecting infant feeding practices were measured in a longitudinal study of 463 women at weeks one, 16 and 24 postpartum. Within the first week after delivery, the initiation and exclusive breastfeeding rates were relatively high at 98.3% and 83.6% respectively, but the premature introduction of complementary food was a great concern.Exclusive breastfeeding dropped from 83.6% at week one to 43.6% at week 16, and by week 24, no infant was exclusively breastfed. Home-cooked solid food was introduced by 4.8%, 40.9% and 74.3% at weeks one, 16 and 24, respectively. Logistic regression analysis showed that, together with socio-cultural determinants, factors related to the mother, such as education level and occupation, and infant related factors could influence the initiation and exclusive breastfeeding within six months postpartum. The practice of contraceptive use within six months postpartum was also examined in a prospective study of 463 postpartum women. The proportion of contraceptive users at weeks 16 and 24 were 17.4% and 43.4% respectively. At week 24, of contraceptive users, 57.3% used IUD, 25.1% used condom, and 13.6% used traditional methods. Logistic regression analysis found age, sufficient knowledge on contraceptives and husband/partner opinion can significantly affect the contraception decision. The results of the study indicated that good physical access does not necessarily increase the utilization of maternal services due to institutional, environment and individual barriers. Client-perceived quality of services, socio-cultural and economic factors are important determinants of the utilization of maternal services. In view of the observed low rates of exclusive breastfeeding and contraception, there is a risk of unwanted pregnancy for women within six months postpartum. To improve maternal and child health status, health workers need to be trained in terms of inter-personal communication and counselling skills, and be appropriately supervised by district health authorities. Mobilizing the participation of the community and family, especially men to share the workload with women, would play a crucial role in the improvement of childbirth, contraception and breastfeeding practice.
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Duong, Dat Van. "Factors that influence the utilization of maternity services and breastfeeding practices in rural Vietnam." Curtin University of Technology, School of Public Health, 2005. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=16762.
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The overall objective of this thesis is to investigate factors that influence the utilization of maternal services, infant feeding and postpartum contraception practices in rural Vietnam. Field studies were carried out in a rural district of Thanh Hoa, a province located in North Central Vietnam. Willingness-to-pay for maternal preferences was measured in a sample of 200 postpartum and 196 pregnant women, as well as 196 men using the payment card technique. An association was found between satisfaction with the quality of maternal services and willingness-to-pay. There were no significant differences in willingness-to-pay values between prenatal and postpartum groups, and between male and female subjects. The feasibility, reliability and validity of a 20-item scale for measuring perceived quality of maternal services provided at commune health centres, were examined based on a sample of 200 postpartum and 196 pregnant women. The instrument was found to have good inter-rater reliability and internal consistency. Maternal status of clients (prenatal vs. postnatal) was found to influence the perceived quality of maternal services. Determinants of the utilization of maternal services at the primary health care level were investigated in a sample of 200 postpartum women together with sixteen focus group discussions and 16 in-depth interviews. The results showed that client-perceived quality of services and socio-cultural, and economic factors, rather than geographical access, could affect the utilization of maternal services. Factors affecting infant feeding practices were measured in a longitudinal study of 463 women at weeks one, 16 and 24 postpartum. Within the first week after delivery, the initiation and exclusive breastfeeding rates were relatively high at 98.3% and 83.6% respectively, but the premature introduction of complementary food was a great concern.Exclusive breastfeeding dropped from 83.6% at week one to 43.6% at week 16, and by week 24, no infant was exclusively breastfed. Home-cooked solid food was introduced by 4.8%, 40.9% and 74.3% at weeks one, 16 and 24, respectively. Logistic regression analysis showed that, together with socio-cultural determinants, factors related to the mother, such as education level and occupation, and infant related factors could influence the initiation and exclusive breastfeeding within six months postpartum. The practice of contraceptive use within six months postpartum was also examined in a prospective study of 463 postpartum women. The proportion of contraceptive users at weeks 16 and 24 were 17.4% and 43.4% respectively. At week 24, of contraceptive users, 57.3% used IUD, 25.1% used condom, and 13.6% used traditional methods. Logistic regression analysis found age, sufficient knowledge on contraceptives and husband/partner opinion can significantly affect the contraception decision. The results of the study indicated that good physical access does not necessarily increase the utilization of maternal services due to institutional, environment and individual barriers. Client-perceived quality of services, socio-cultural and economic factors are important determinants of the utilization of maternal services. In view of the observed low rates of exclusive breastfeeding and contraception, there is a risk of unwanted pregnancy for women within six months postpartum. To improve maternal and child health status, health workers need to be trained in terms of inter-personal communication and counselling skills, and be appropriately supervised by district health authorities. Mobilizing the participation of the community and family, especially men to share the workload with women, would play a crucial role in the improvement of childbirth, contraception and breastfeeding practice.
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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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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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Knight, H. E. "Using routinely collected data to evaluate the performance and quality of English NHS maternity services." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2018. http://researchonline.lshtm.ac.uk/4650762/.
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This 'publication style' thesis comprises a collection of research papers, each of which seeks to address a different element of the overall aim: to determine the extent to which electronic data, captured routinely as part of clinical care and hospital administration, can be used to evaluate the performance and quality of English NHS maternity services. These routine data sources present opportunities for research groups to examine whether current practice and outcomes in NHS maternity services meet guidelines and standards, and to guide research and initiatives to improve the quality of maternity care at a regional and national level. However, the difficulty faced by clinicians, managers and service users in interpreting some of the currently available maternity statistics highlights the need to improve the usefulness of the information being produced to evaluate NHS maternity services. The first part of this thesis comprises a review of the advantages and limitations of existing routinely collected data sources for these purposes. The review identifies three key challenges relating to 1) the handling of missing or inconsistent information, 2) the definition of key exposure, outcome and confounding variables relevant to maternity care and 3) adjustment for confounding variables. In the second part, novel techniques are developed to address current weaknesses in the secondary analysis of these data. The findings show that these new methods can be used to derive accurate information on two key data items: 1) the method of delivery and 2) the parity status of women, although misclassification rates are higher for some subgroups of women. This section demonstrates that overall the quality of administrative data is sufficient to support the evaluation of maternity care but that some organisational-level statistics are sensitive to inconsistencies in the data. Consequently, it is recommended that publications of quality indicators should describe how data were prepared and analysed, in order for results to be replicable. In the third part, a series of retrospective cohort studies are described that illustrate how these new methodological techniques can be used to overcome the three challenges identified in the part 1. The first study calculated rates of attempted and successful vaginal birth after caesarean section, which had not previously been done using administrative data at national and provider-level basis (Chapter 6), and found that among women who attempted a trial of labour for their second birth, almost two-thirds successfully achieved a vaginal delivery. A second study evaluated a clinical intervention (induction of labour) designed to prevent rare outcomes such as perinatal mortality which are impractical to investigate by experimental methods (Chapter 7); it found that bringing forward the routine offer of induction of labour from the current recommendation of 41±42 weeks to 40 weeks of gestation in nulliparous women aged >=35 years might reduce overall rates of perinatal death. A third study examined an important health policy question about when staff should be present on the labour ward (Chapter 8) and involved the linkage of administrative, staffing and clinical datasets. The study found no difference in the rate of maternal and neonatal morbidity according to the presence of consultants on the labour ward. A final study examined whether administrative data provided a cost effective way of monitoring perinatal outcomes using a composite indicator of adverse outcomes. The study found that a measure developed in Australia could be adapted to English data, and had good concurrent and predictive ability (Chapter 9). The thesis concludes that hospital administrative datasets, linked with other sources of clinical data where necessary, are a valuable resource for population-based service evaluations. Taken together, the novel techniques developed, validated and applied as part of this programme of work, advance our understanding of the ways in which routinely collected maternity data can and cannot be used to support the evaluation of maternity services. Whilst these data are not perfect and there is certainly a need to improve their completeness and consistency, this research demonstrates that it is possible to develop techniques to identify and manage data errors, and methods to clearly define key exposure, outcome and confounding variables. Together, these allow answers to be found to many potential questions about maternity care.
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Boyes, Allison Wendy. "Women's Selection and Evaluation of Obstetric Hospitals: A Survey of the Northern Sydney Area." University of Sydney, Public Health and Community Medicine, 1999. http://hdl.handle.net/2123/393.
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A study of women's views of maternity services in the Northern Sydney Area Health Service was conducted as a result of the changing patterns of use of the Area's 7 obstetric hospitals. 340 primiparous women living in the Northern Sydney Area who had given birth in the previous six months were approached in Early Childhood Health Centres and asked to complete a survey exploring the factors influencing their choice of obstetric hospital, postnatal length of stay in hospital, and overall satisfaction with their choice of hospital. Of the 315 eligible women, 312 (99%) consented to participate and 297 (94%) completed the survey. Overall, reputation of the hospital and quality of nursing care were the most frequent reasons given for choice of hospital and there was some evidence that women selected different hospitals for distinct reasons. Women's postnatal length of stay ranged from less than 1 day to 11 days with an average of 5.3 days. Private patients stayed an average of 1 day longer than public patients, after adjusting for delivery type and pregnancy induced hypertension. There was little evidence that women in the Northern Sydney Area Health Service desire a shorter postnatal stay with the majority of women reporting they were satisfied with their length of stay. Overall, women displayed high levels of satisfaction with their choice of hospital; at least 90% of women attending all hospitals except one reported that they would choose the same hospital for the birth of another baby. This study provides valuable information, based on the experiences of the service users, to help guide the Northern Sydney Area Health Service in the provision of its maternity services to ensure they meet the changing needs of women and their families.
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Boyes, Allison Wendy. "Women's Selection and Evaluation of Obstetric Hospitals: A Survey of the Northern Sydney Area." Thesis, The University of Sydney, 1998. http://hdl.handle.net/2123/393.
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A study of women's views of maternity services in the Northern Sydney Area Health Service was conducted as a result of the changing patterns of use of the Area's 7 obstetric hospitals. 340 primiparous women living in the Northern Sydney Area who had given birth in the previous six months were approached in Early Childhood Health Centres and asked to complete a survey exploring the factors influencing their choice of obstetric hospital, postnatal length of stay in hospital, and overall satisfaction with their choice of hospital. Of the 315 eligible women, 312 (99%) consented to participate and 297 (94%) completed the survey. Overall, reputation of the hospital and quality of nursing care were the most frequent reasons given for choice of hospital and there was some evidence that women selected different hospitals for distinct reasons. Women's postnatal length of stay ranged from less than 1 day to 11 days with an average of 5.3 days. Private patients stayed an average of 1 day longer than public patients, after adjusting for delivery type and pregnancy induced hypertension. There was little evidence that women in the Northern Sydney Area Health Service desire a shorter postnatal stay with the majority of women reporting they were satisfied with their length of stay. Overall, women displayed high levels of satisfaction with their choice of hospital; at least 90% of women attending all hospitals except one reported that they would choose the same hospital for the birth of another baby. This study provides valuable information, based on the experiences of the service users, to help guide the Northern Sydney Area Health Service in the provision of its maternity services to ensure they meet the changing needs of women and their families.
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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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Hassan, Shaima M. "A qualitative study exploring British Muslim women's experiences of motherhood while engaging with NHS maternity services." Thesis, Liverpool John Moores University, 2017. http://researchonline.ljmu.ac.uk/7412/.
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Women in the UK have access to NHS maternity services and most will attend hospital to give birth in the NHS. Much effort has been undertaken over several decades to improve childbirth and to enhance the experiences of those using NHS maternity services. However, while most women report positive experiences of maternity care, existing evidence suggests that women from ethnic minority groups in the UK have poorer pregnancy outcomes, experience poorer maternity care, are at higher risk of adverse perinatal outcomes and have significantly higher severe maternal morbidity than the resident white women (Puthussery, 2016; Henderson et al, 2013; Puthussery et al., 2010; Straus et al., 2009). Muslim women of child-bearing age make up a significant part of UK society, yet their health needs and their experiences of health services have not been extensively researched. The term ‘Muslim’ is often combined with ethnic group identity, rather than used to refer to people distinguished by beliefs, practices or affiliations. Muslim women commonly observe certain religious and cultural practices during their maternity journey and the little research there is in this area suggests that more could be done from a service provision perspective to support Muslim women through this, spiritually and culturally significant life event (McFadden et al., 2013; Alshawish et al., 2013). This study explores Muslim women’s perceived needs and the factors that influence their health seeking decisions during their transition to motherhood. Using a generic qualitative approach, seven English-speaking first time pregnant Muslim women and a Muslim mother who is second time pregnant but experiencing motherhood as a Muslim for the first time, were interviewed at different stages of their maternity journey (antenatal, post-labour and postnatal); five focus groups were conducted with Muslim mothers; and 12 semi-structured interviews were conducted with healthcare professionals. Thematic analysis of the transcripts revealed that Muslim women: 1) had a unique perspective on motherhood based on Islamic teaching; 2) sourced information from a number of sources, additional to midwives; 3) experienced difficulty expressing their religious requirements when preparing a birth plan; 4) assumed that healthcare professionals would have a negative view of Islam and Islamic birthing practices. While one-to-one interviews revealed that healthcare professionals: 1) varied in their perceptions of Muslim women; 2) had a general awareness of Muslim women’s Islamic practices but not specific to motherhood; 3) sourced cultural and religious information to enhance their understanding of women’s needs and their specific practices; 4) had some challenges when addressing women’s specific religious practices such as fasting; 5) would benefit from cultural/religious competency training that incorporates lived experience and group discussion. The implications for institutions, midwifery practice and further research are outlined. The study concludes that transcultural knowledge and specifically Muslim women’s worldview incorporated into healthcare professional training would enhance the competency and quality of healthcare services.
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Nguyen, Thi Hoai Thu. "The Governance of human resources in the Vietnamese healthcare system: A critical analysis of maternity services." Thesis, Queensland University of Technology, 2015. https://eprints.qut.edu.au/84093/1/Thi%20Hoai%20Thu_Nguyen_Thesis.pdf.
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This thesis utilised mixed-methods study design to understand the factors that influence the translation and implementation of central human resources in health policy at the district and commune health levels. It provided recommendations for changes to enhance governance approaches to human resources for health policy implementation at local and national levels. This thesis has also contributed to the evolution of the theory on health staff motivation and performance through the description and testing of a new model, using data from a survey on 262 health staff and 43 in-depth interviews conducted in two northern mountainous provinces of Vietnam.
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Nicholl, Katherine Louise. "Is women's legal right of access to informed decision making in maternity care assured in New Brunswick?" [Moncton, N.B.] : New Brunswick Office of the Ombudsman, 2007. http://site.ebrary.com/lib/librarytitles/Doc?id=10222487.
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Dagogo, Lauretta Dataribo. "The traditional birth attendant versus the hospital : a study of factors which contribute to the choices made by pregnant women in obstetric services utilization in Post-Harcourt, Nigeria." Thesis, University of Southampton, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.243633.
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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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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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Huang, Yu-Chu. "A comparative study of the provision of maternity care, cultural influences on the perceived health needs, maternal satisfaction and the prevalence of postnatal depression in the UK and Taiwan." Thesis, University of Sheffield, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.266723.
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Heslehurst, Nicola. "Trends in maternal body mass index, health inequalities, and the impact of maternal obesity on NHS maternity services." Thesis, Teesside University, 2009. http://hdl.handle.net/10149/112673.
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The primary objective of the work presented in this thesis was to identify trends in maternal body mass index (BMI) over time, the demographic predictors of those women most at risk of being obese in pregnancy, health inequalities, and the impact of maternal obesity on maternity services. A mixed methodology utilised quantitative and qualitative research to address these objectives. Data were collated from 34 maternity units across England, including 619,323 deliveries between 1989 and 2007 inclusive. Analysis identified an increasing incidence of maternal obesity over time, regional differences in incidence, and significant inequalities with women residing in the highest levels of deprivation, and Black ethnic group. A systematic review was carried out including 49 studies investigating obesity and pregnancy outcomes with acute maternity resource implications. The meta-analysis found significantly increased odds of a number of outcomes, and concluded that maternal obesity had a considerable impact on maternity resources, and contributed towards a poorer prognosis for the mother and the baby during delivery and in the immediate post-partum period. Qualitative interviews and focus groups with 30 HCPs across eight NHS Trusts in the North East of England were carried out to identify barriers in implementing maternal obesity services, and to gain HCPs perspectives on what they felt was required in order to address maternal obesity effectively. The study identified the themes of ‘Service Development’, ‘Psychosocial Issues and Maternal Obesity Services’, ‘Information, Evidence, and Training’, and ‘Where to go From Here?’. Overall this programme of research has identified that maternal obesity is increasing over time and is significantly associated with health inequalities. The increase in maternal obesity has an impact on acute services, and HCPs feel that a holistic approach is required through partnership work in order to address maternal obesity effectively. This programme of research has primarily contributed to the knowledge of maternal obesity with the provision of the first national level statistics for trends in maternal obesity. The research has also provided a holistic view of the impact of obesity in pregnancy on maternity services, including the impact on resources and the issues relating to addressing the maternal obesity in clinical practice. The research has also identified aspects of service that need to be improved, and knowledge gaps in how to move services forward to effective address maternal obesity. The contribution of this research to the knowledge base is emphasised in the journal pre-publications, dissemination through UK and European, and international conference presentations, being an invited speaker at a number of conferences in the UK, and I received the 2007 Association for the Study of Obesity (ASO) Student Researcher Award for producing exemplary work in the study of obesity.
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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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Tinkler, Angela. "Implementation of health policy and health care reform using a case study of maternity services in England 1994-1997." Thesis, University of Liverpool, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.273986.
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Gerova, Vania Nikolova. "Association between mode of birth, staffing and structural characteristics in NHS trusts with maternity services in England (2010/11)." Thesis, King's College London (University of London), 2014. http://kclpure.kcl.ac.uk/portal/en/theses/association-between-mode-of-birth-staffing-and-structural-characteristics-in-nhs-trusts-with-maternity-services-in-england-201011(05474111-c115-4e7f-9c13-2908d8d7f64c).html.
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Background: Growing international research evidence, mainly from the acute general service sector, suggested that there was a strong link between nurse staffing and patient outcomes. There was a gap in the literature addressing other clinical and non-clinical workforce groups outside acute hospitals. Aim: To investigate the relationship between mode of birth and maternity staffing levels in NHS trusts in England, after accounting for maternal socio-demographic characteristics, individual clinical risk and structural characteristics including type and configuration of trusts. Method: This cross sectional study used Hospital Episode Statistics (HES) 2010/11 and NHS Information Centre 2010/11 maternity workforce datasets. The study population comprised women aged 15-45, who were nulliparous and had a term, singleton, live birth (n=261,481 deliveries in 143 NHS trusts for emergency caesarean section and instrumental deliveries; and n=214,920 deliveries in 127 NHS trusts for normal birth). Multilevel logistic models were fitted separately for each outcome. Risk-adjustment for case mix included maternal age, ethnicity, IMD, gestational age, birth weight and NICE 2007 derived definition of clinical risk. Standardized FTE/birth ratios for obstetricians, midwives, healthcare assistants and other trust characteristics were used as trust level predictors. The percentages of the total variation in outcomes attributable to between trusts variation were calculated. Results: For this sample of women only around 2% of the residual variation in outcomes was due to unobserved trust characteristics. Between trusts and for all women, the standardized consultant FTE/birth ratio was positively related to the probability of instrumental delivery (OR=1.08, 95%CI 1.03-1.13, p < .05), and the standardized midwives FTE/birth ratio was positively related to the probability of normal birth (OR=1.06, 95%CI 1.01-1.11, p < .05). 1 SD increase in FTE doctors increased the odds of emergency CS for high risk women by 5.1% (OR=1.05, 95%CI 1.01-1.10, p < .05); while 1 SD increase in FTE midwives increased the odds of normal birth for low risk women by 7.6% (OR=1.08, 95%CI 1.02-1.14, p < .05). Conclusion: The analyses established significant independent effects of staffing on the three outcomes, although only a small percentage of the total variability in the outcomes was attributable to variations between trusts. The positive association between midwifery staffing and normal birth has policy implications in terms of current and future investment in the profession. More than anything else, women’s outcomes were determined by their characteristics and clinical risk. Other unaccounted for factors such as obesity, smoking, organisational culture and models of care may be able to explain further the variations in outcomes.
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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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Tinson, Julie S. "To what extent do the categorisations of novice and expert contribute to an understanding of the evaluation and communication of service provision in the maternity services." Thesis, Edinburgh Napier University, 1999. http://researchrepository.napier.ac.uk/Output/7311.
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Introduction Measuring consumer expectations and perceptions of service provision is supported by both practitioners and academics. The National Health Service, as a result of policy reforms and structural changes, recognises the role of the patient in health care and is gradually incorporating patient views in policy and practice. This study explores the experience of the patient and its affect on the expectations and perceptions of the service provision. Two hospitals, antenatal and postnatal groups were utilised to ascertain the views and experiences of pregnant and recently delivered women. Methodology Focus groups were held with women who had delivered, since the implementation of the Patient's Charter, to establish the expectations of the women using the service provision. Issues of priority to these women and the perception of their overall service experience were also considered. In-depth interviews were then conducted with pregnant women to identify expectations of their forthcoming delivery and subsequent in-depth interviews were conducted with the same women once they had delivered their children. This was to evaluate their perceptions and compare them with their initial expectations. Finally, key themes and recurrent ideas were tested, using hypotheses developed after the qualitative research. The questionnaire approach was to substantiate or discount the findings of the first two stages of the research. Dissemination Familiar service quality attributes were recognisable from the analysis of the comments. Although there were issues on which women agreed unanimously, many elements of the service provision were viewed differently by women with experience and women from varying categories of residential area. The results also demonstrated that the use and dependence of referent groups varied between the women and that this was imperative for communication. Statistically, the use of referent groups, substantiated through the questionnaire analysis, provided significant results to support the initial findings. Contribution Using the information from the qualitative research, a Maternity User's Matrix was developed identifying key characteristics of users' of this service provision. The significant results from the quantitative research were used to develop an existing consumer behaviour model. Using expectations, levels of satisfaction and perceptions of consumers, this research has implications for service provision, health practice, future research and service itself.
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Mendoza, Jennifer Adams. "Rationality and Reproduction: Health Insurance Coverage and Married Women's Fertility." Diss., CLICK HERE for online access, 2008. http://contentdm.lib.byu.edu/ETD/image/etd2617.pdf.
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Claas, Bianca Muriel. "Self-reported oral health and access to dental care among pregnant women in Wellington : a thesis presented in fulfilment of the requirements for the degree of Master of Public Health at Massey University, Wellington, New Zealand." Massey University, 2009. http://hdl.handle.net/10179/1205.
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Pregnancy can have important effects on oral health and pregnant women are a population group requiring special attention with regard to their oral health and their babies? health. International research shows that oral health care for pregnant women has been inadequate, especially in relation to education and health promotion and there is some evidence of disparities by SES and ethnicity. Improving oral health is one of the health priorities in the New Zealand Health Strategy (Ministry of Health, 2000) and the Ministry of Health (Ministry of Health, 2006a) has recently identified a need for more information on the oral health and behaviour of pre-natal women. The aims of this study were to gain an understanding of pregnant women?s oral health care practices, access to oral health care information and use of dental care services and to identify any difference by ethnicity and socio-economic position. A self-reported questionnaire was completed by 405 pregnant women (55% response rate) who attended antenatal classes in the Wellington region. The questionnaire was broadly divided into four parts: (1) care of the teeth when the woman was not pregnant; (2) care of the teeth and diet during the pregnancy; (3) sources of oral health information during pregnancy and; (4) demographic information . Data were analysed by age, ethnicity, education and income and odds ratios (OR) and 95% confidence intervals (95%CI) were calculated using logistic regression. The majority of women in this survey were pakeha (80.2%), compared to 19.7% „Others? (8.8% Maori, 1.9% Pacific, 8.6% other). Most of the subjects were aged 31-35 years (34.5%), of high SES (household income and education level). Half of the women reported having regular visits to the dentist previous pregnancy while a significant percentage of women saw a dentist basically when they had problems. The usual dental hygiene habits were maintained during pregnancy. However, during pregnancy more than 60% of women reported bleeding gums. Just 32% of women went to see the dentist during pregnancy and less than half had access to oral health information related to pregnancy. „Others? (OR 0.38, 95% CI 0.15-0.91) and low income (OR 0.27, 95% CI 0.10-0.76) groups were significantly less likely to report access to oral health information compared to pakeha and high income groups (respectively). Women who went to see the dentist during pregnancy were more likely to receive information on dental health. However, low income women were more likely to report the need to see a dentist (OR 2.55, CI 1.08-5.99). Information on dental health and access to oral care should be prioritised to low income women, Maori, Pacific and other ethnic groups. Little attention has previously been given to oral health for pregnant women in New Zealand and there is a need to increase awareness of the importance of this area amongst health practitioners particularly Lead Maternity Carers and Plunket and tamariki ora nurses.
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Snyman, J. S. "Effectiveness of the basic antenatal care package in primary health care clinics." Thesis, Nelson Mandela Metropolitan University, 2007. http://hdl.handle.net/10948/728.
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Pregnancy challenges the health care system in a unique way in that it involves at least two individuals – the woman and the fetus. The death rates of both pregnant women (maternal mortality) and newborns (perinatal mortality) are often used to indicate the quality of care the health system is providing. In terms of maternal and perinatal outcomes South Africa scores poorly compared to other upper-middle income countries (Penn-Kekana & Blaauw, 2002:14). The high stillbirth rate compared to the neonatal death rate reflects poor quality of antenatal care. Maternal and perinatal mortality is recognised as a problem and as a priority for action in the Millennium Development Goals (Thieren & Beusenberg, 2005:11). The Saving Mothers (Pattinson, 2002: 37-135) and Saving Babies (Pattinson, 2004:4-35) reports describe the causes and avoidable factors of these deaths with recommendations on how to improve care. The quality of care during the antenatal period may impact on the health of the pregnant woman and the outcome of the pregnancy, in particular on the still birth rate. In primary health care services there are many factors which may impact on and influence the quality of antenatal care. For example with the implementation of the comprehensive primary health care services package (Department of Health, 2001a:21-35) changes at clinic level resulted in a large number of primary health care professional nurses having to provide antenatal care, who previously may only have worked with one aspect of the primary health care package such as minor ailments or childcare. Because skills of midwifery or antenatal care, had not been practiced by some of these professional nurses, perhaps since completion of basic training, their level of competence has declined, and they have not been exposed to new developments in the field of midwifery. The practice of primary health care nurses is also influenced by the impact of diseases not specifically related to pregnancy like HIV/AIDS and tuberculosis. The principles of quality antenatal care are known (Chalmers et al. 2001:203) but despite the knowledge about these principles the maternal and perinatal mortality remains high. The Basic Antenatal Care quality improvement package is designed to assist clinical management and decision making in antenatal care. The implementation of the BANC package may influence the quality of antenatal care positively, which in turn may impact on the outcome of pregnancy for the mother and her baby. The aim of this study was to evaluate the effectiveness of the Basic antenatal care (BANC) package to improve the quality of antenatal care at primary health care clinics.
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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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Sombie, Issiaka. "Amélioration de l'utilisation des services de santé maternelle au Burkina Faso: Quelles stratégies adopter ?" Doctoral thesis, Universite Libre de Bruxelles, 2007. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/210671.
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IntroductionLa mortalité maternelle reste encore élevée dans les pays en développement notamment en Afrique où une femme parmi 16 en âge de reproduction sera touchée par cette mortalité contre 1 femme parmi 2400 dans les pays développés. Au Burkina Faso, ce risque de mortalité est de 1 parmi 12 pour une femme en âge de reproduction.
La littérature internationale montre qu’un meilleur accès aux soins qualifiés à l’accouchement et aux soins obstétricaux d’urgence est la solution majeure pour sauver la vie d’une femme au cours de la grossesse, de l’accouchement et dans le post partum. Elle montre que cet accès est limité en milieu rural par l’existence de barrières liées aux services de santé, de barrières économiques et sociales. Au milieu des années 1990, il a été montré qu’il serait possible d’améliorer l’accès des femmes aux soins qualifiés et aux soins d’urgence par des interventions locales visant à réduire ces barrières. Ces résultats ont entraîné la mise en place de plusieurs interventions en milieu rural burkinabè. L’objectif de cette thèse est d’examiner les activités mises en place au niveau du système de santé dans les districts ruraux de Houndé et d’Orodara au Burkina Faso afin de mieux comprendre ce qui a été à la base de l’évolution des indicateurs de santé maternelle.
Méthodologie
Le travail a combiné des méthodes quantitatives et qualitatives. Des études de cas, plusieurs sources d’informations (revue des documents, interview des populations, prise de notes, observation participante) ont été utilisées pour identifier au niveau du système de santé des districts les activités pouvant influencer l’utilisation des soins obstétricaux d’urgence et analyser la dynamique et la qualité de leur mise en œuvre. Des approches quantitatives (étude écologique, analyse transversale, étude avant et après) ont permis d’étudier l’évolution des indicateurs et de mettre celles-ci en parallèle avec la réalisation de certaines activités. Enfin, les résultats dans les deux districts ont été comparés avec ceux d’autres districts ayant aussi bénéficié d’une intervention en santé maternelle.
Résultats
L’analyse du système de santé a identifié l’existence d’activités d’éducation et de mobilisation des populations, d’amélioration de l’environnement de la prise en charge de la femme enceinte et de renforcement de compétence des agents de santé et des accoucheuses villageoises dans les deux districts. Dans le district de Houndé une intervention bien structurée (le projet SAREDO) avec analyse des besoins a été à la base d’une grande partie des activités de 2000 à 2003. Mais l’analyse de la mise en oeuvre des activités de ce projet a montré des écarts par rapport à ce qui avait été planifié, des retards et un manque de suivi des activités. Ces faiblesses du projet étaient liées à l’approche participative de mise en œuvre, à des faiblesses organisationnelles et à l’arrêt avant terme du financement. Dans le district d’Orodara, la mise en place des activités a démarré avec l’arrivée en 2001 d’un médecin chef en provenance du district de Houndé. Aucune intervention planifiée n’a existé. Les activités ont été mises en place à partir de décisions empiriques s’inspirant de l’expérience du projet SAREDO à Houndé. Dans les deux districts, la collaboration avec des intervenants dans et hors du district, le leadership de l’équipe de district et l’utilisation rationnelle des ressources ont été déterminants dans la mise en œuvre des activités.
L’évolution des indicateurs de soins maternels a montré une amélioration de l’utilisation des soins maternels en général de 1999 à 2006 dans les deux districts. En 2004, si l’utilisation des services de consultation prénatale et de maternité pour l’accouchement était meilleure à Houndé qu’à Orodara, il n’existait aucune différence pour ce qui était du taux des accouchements par césarienne. Pour ce dernier indicateur, on notait une croissance linéaire dans le district de Houndé, tandis qu’à Orodara, le taux était resté stable de 1999 à 2002 et à partir de 2003 on assistait à une amélioration avec un taux atteignant celui de Houndé en 2005. La mise en parallèle de l’évolution du taux d’accouchements par césarienne et du calendrier des activités dans les deux districts montre une amélioration après la mise en place du renforcement de la qualité des soins (formation des agents et équipement) et de la réduction du coût des soins d’urgence surtout dans le district d’Orodara. Ces observations suggèrent l’existence d’une relation entre l’évolution du taux des accouchements par césarienne et, d’une part, le renforcement de la qualité des soins et d’autre part, la mise en place de la réduction du coût des soins d’urgence.
Une évaluation a relevé dans le district de Houndé que l’offre de soins était meilleure après la formation des agents de santé et l’équipement des services. Elle a aussi montré une meilleure utilisation des services de base (consultation prénatale et accouchements institutionnels) et un taux plus élevé d’évacuations obstétricales dans le groupe des centres de santé avec un responsable de la maternité ayant bénéficié de la formation que dans le groupe des centres de santé avec un agent non formé responsable de la maternité. Les proportions d’accouchements par césarienne et d’interventions obstétricales majeures réalisées pour sauver la vie de la mère étaient plus élevées dans le groupe des centres de santé avec un agent formé responsable de la maternité mais les différences n’étaient pas statistiquement significatives. Les résultats de cette évaluation montrent qu’au niveau des centres de santé de base, former les agents et équiper les services permettent d’améliorer la qualité et l’utilisation des services de base mais ne suffisent pas pour améliorer l’utilisation des soins obstétricaux d’urgence.
Au niveau de l’hôpital du district d’Orodara, après la mise en place des kits opératoires, les proportions des évacuations obstétricales à l’admission, des évacuations obstétricales prises en charge et des accouchements par césarienne à l’hôpital du district se sont améliorés significativement tandis que les proportions des complications infectieuses post césarienne et des évacuations obstétricales à l’hôpital de référence, et le coût des soins d’urgence ont été réduits. Ceci montre qu’en réduisant le coût des soins via les kits opératoires et en plus d’une formation des agents de santé, on a pu améliorer l’accès et la qualité des soins obstétricaux d’urgence dans cet hôpital.
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Doctorat en Sciences de la santé publique
info:eu-repo/semantics/nonPublished
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張翠儀 and Chui-yee Cheung. "The process of policy-making: mainland pregnant women in the Hong Kong special administrative region." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B41014200.
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Haque, Hena Wali. "Factors influencing South Asian women's access to maternity related health services : a mixed methods study in an ethnically diverse urban setting in the UK." Thesis, University of East London, 2018. http://roar.uel.ac.uk/7801/.
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Background: Women of South Asian heritage are more likely to experience adverse pregnancy outcomes than White British women. Poor access and engagement with maternity services may be one reason for this. A key measure of access in relation to maternity care is the initiation of antenatal care within the first trimester of pregnancy and late initiation has been linked to adverse pregnancy outcomes. The importance of positive experiences of care is also recognised for improving outcomes. The sociological concept of candidacy was used to understand how women of South Asian heritage access and experience maternity services. Access through a candidacy lens is defined as a dynamic and contingent process, constantly being defined and redefined through interactions between individuals, professionals and the service provision. Aims: This thesis aimed to investigate factors that influence access to and engagement with maternity services for South Asian women living in a deprived, ethnically diverse urban setting. Setting: The setting for this study is an inner-city borough in the UK, one of the poorest boroughs in London. Design and methods: Mixed methods were used in this thesis. There were two components: (i) a quantitative analysis of anonymized maternity data of 11,768 women to examine the predictors of early initiation of antenatal care and (ii) a qualitative study of 30 semi-structured face to face interviews with South Asian women to examine their experiences with maternity services. Data were analysed by means of thematic synthesis of women’s journeys into and through antenatal care, labour, delivery and post-natal care. Findings: Findings from the quantitative analysis of the predictors of late initiation of antenatal care found that late initiation amongst women of South Asian heritage was linked to not being able to speak English (p=0.000 ; 95% CI: 4 0.56-0.82), higher parity (p=0.002; 95% CI: 1.31-3.47), younger maternal age (p=0.005; 95% CI: 0.42-0.86), housing status (living in rented accommodation) (p=0.000; 95% CI:1.51-2.74), being a current smoker (p= 0.010; 95% CI: 1.10- 2.31), experiencing domestic violence (p=0.021; 95% CI: 0.45-0.57), and using alcohol (p=0.047; 95% CI: 0.01-0.97). Findings from the qualitative study identified four key themes these were women’s ethnic and /or migrant identities, permeability of services (the unhelpful features of a service), adjudication (cultural biases of health providers), and the local operating conditions of the services (lack of continuity of care, shortage of resources). Explanatory subthemes related to the cultural distinctness of women where issues with access came to the fore in light of women’s diasporic and compounded identities. For women born and raised in the UK achieving access meant continuous negotiation and renegotiation of their identities in a contextual and contingent way. For recent migrants’ language was an additional barrier. Difficulties in navigating the services were linked to inability to speak English fluently, subjecting them to provider judgements. Women wanted to be taken seriously. They emphasised the importance of continuous care to enable them to develop a relationship with service providers and make informed choices. Conclusion: The candidacy frame provides a balanced platform to detect vulnerabilities associated with access to maternity services for women of South Asian heritage. Findings suggest that women’s needs were not static but are ever changing at each stage of their journey, both groups of women were faced with similar challenges when engaging with the services. This study reiterates the need to embrace the notion of super diversity and promote cultural health capital in health service settings.
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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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Salmon, Chris. "An investigation into the willingness of mothers from lower socioeconomic groups in the Western Cape region of South Africa to pay for private maternity care." Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/95624.
Full textAbstract:
Thesis (MBA)--Stellenbosch University, 2012.An exploratory, cross-sectional, qualitative survey was conducted to describe the market of lower income mothers who had recently given birth to a child in a state hospital in the Western Cape (WC) region of South Africa. These mothers were viewed by the researcher as potential consumers of low cost maternity plans which would provide for maternity care in Active Birthing Units (ABUs) in the private healthcare sector in South Africa. The motivation behind the research stems from various sources. The currently inequitable healthcare system in South Africa, which has been described as a two tier system in the recent Policy Paper on National Health Insurance (Republic of South Africa, 2011: 4-5), is one such source. Reports of poor maternity care in the South African public healthcare system (Vogel, 2011: E1097-E1098), is another source of motivation behind the research report. It was apparent to the researcher that given the low quality of maternity care in state hospitals, a potential market of healthcare consumers – who would be willing to pay a small premium for what they considered to be a more acceptable level of maternity care in the private healthcare sector – could exist. This view was supported by research conducted by Joan Costa and Jaume Garcia (2003: 587-599) in which the “quality gap” was confirmed as a driving force behind the demand for private health care. This focus on the lower socioeconomic groups as a market for private sector goods and services was found to be well described by Prahalad (2005). The researcher conducted interviews amongst mothers who had delivered a child in a public hospital in the previous two years. A convenience sample of 100 mothers was selected in a shopping mall in the Western Cape (WC). The researcher administered a structured questionnaire during a face-to-face interview with each of the 100 respondents. The respondents were rewarded with a shopping voucher to the value of 50 ZAR, which was both a prerequisite specified by the management of the shopping mall and consistent with rewards offered in similar studies (Francis, Battle-Fisher, Liverpool, Hipple, Mosavel, Soogun, & Nokuthula, 2011). Data collected from the questionnaire included both data on willingness to pay (WTP), as well as demographic data, which provided interesting insights into a relatively under-researched market segment. A statistical analysis of the data collected revealed that 31 respondents (31%) reported a positive WTP for private maternity care. A statistically significant relationship was revealed between respondents’ WTP and the birth experience the respondents had had during their most recent pregnancy, whereby mothers who had described their most recent birth experience as “poor” were significantly more likely to exhibit a positive WTP for private maternity care (p=0.00006). Significant relationships between respondents' WTP for private maternity care and their age and household size were also discovered, whereby younger mothers were more likely to be willing to pay than older mothers (p=0.02) and mothers from smaller households were also significantly more likely to be willing to pay than mothers from larger households (p=0.02). Amongst a sub group of 32 respondents deemed to have potential monthly savings, those with a higher monthly household income were more likely to exhibit positive WTP (p=0.02753) than were those with higher levels of monthly expenditure (p=0.04093). The researcher acknowledged that the limitations of the research included the fact that respondents were selected non-randomly, as a small isolated sample, which made the extrapolation of the results to the larger population of South African mothers impossible. The research did, however, serve to describe the demographic characteristics of a new and relatively under researched target market of mothers from the lower socioeconomic segment of the WC. Data gleaned from this survey will serve to inform further research into this target market, so as to complete a more comprehensive feasibility analysis for the establishment of low cost maternity care packages and ABUs in South Africa.
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Mdivasi, Vuyokazi. "The ethical conduct of employees in maternity wards at selected public hospitals in the Western Cape, South Africa." Thesis, Cape Peninsula University of Technology, 2014. http://hdl.handle.net/20.500.11838/1645.
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Mini-thesis submitted in partial fulfilment of the requirements for the degree
Master of Technology: Public Management
in the Faculty of Business
at the Cape Peninsula University of Technology
2014Maternity service in South Africa faces particular problems in the provision of care to birthing mothers. Violence and abuse have been reported and maternity death rates are high, being related to inadequate provision of care (Myburgh, 2007:29). Ethical conduct plays a significant role in service delivery in Midwife Obstetrics Units (MOU) in general. This is of particular importance since every patient, especially pregnant women, should to be handled with the utmost care, respect and dignity. The research problem emanates from nurses’ behaviour towards patients in MOU labour wards, where women continue to be victims of abuse. Ironically, it is regrettable that they are abused by those who are supposed to be their advocates. The objectives of the study were to assess if nurses in MOU labour wards conduct themselves ethically when dealing with patients, to determine the perceptions of patients towards nurses during child birth stages, as well as to examine factors in maternity wards that may influence a nurse’s performance when dealing with patients. The study adopted the quantitative research method to answer the research question and data interpretation was based on statistical analysis. This method was deemed to be the most effective for collection of a large quantity of data and numerical (quantifiable) data is considered objective. A Likert-type questionnaire comprising closed-ended questions was the measurement instrument. This was considered to least inconvenience nurses and postnatal patients to whom these questionnaires were administered. Answer choices were graded from 1 to 4, being strongly agree, agree, disagree and strongly disagree. The population comprised nurses and postnatal patients in MOUs in the Western Cape, South Africa. Consecutive sampling was conducted in two selected MOUs, being Michael Mapongwana (MM) and Gugulethu (GG), with 311 questionnaires being distributed to both nurses and postnatal Patients in these two facilities. The findings indicated that the ethical conduct of nurses in both MM and GG maternity wards was relatively good. However, some survey findings revealed some unsatisfactory gaps that exist in what both hospitals currently offer to patients in the areas of individual patient care, communication and baby security certainty. Furthermore, the findings indicated that a significant number of patients who chose to make use of MM and GG hospitals, are satisfied with the standard of service received during their stay. However, there were some discrepancies in terms of senior management service where excellence in the monitoring role emerged as being lacking. There is a need for improvement in the current levels of ethical conduct of nurses in both the MM and GG labour wards. These needs for improvement relate to working conditions, especially linked to the human resource (HR) function, leadership and management functions, and improved monitoring and control mechanisms.
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Ganle, John Kuumuori. "Free but not accessible to all : free maternity care, access, equity of access, and barriers to accessing and using skilled maternal and newborns healthcare services in Ghana." Thesis, University of Oxford, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.644878.
Full textAbstract:
Limited and inequitable access to skilled maternal and newborn healthcare has been identified as a major contributory factor to poor maternal and newborn health in sub-Saharan African countries, including Ghana. To address the problem of access, the government of Ghana, in 2003, pioneered and is implementing a new maternal healthcare policy that provides free maternity care at the point of delivery in all public and mission health facilities to ensure increased and equitable access and use of skilled maternal and newborn healthcare services. The aim of this doctoral study is to explore how the introduction of the free maternal health policy in Ghana affects access, equity of access, and to investigate barriers to accessibility and utilization of skilled maternal and newborn health services. It does this using data from the Ghana Maternal Health Survey 2007, in combination with qualitative data generated from ethnographic style in-depth interviews and focus group discussions that the author originally conducted with a total of 185 expectant and lactating mothers, and 20 health care providers and policy-makers in six communities in Ghana between November 2011 and June 2012. Survey data suggest that accessibility to, and utilization of skilled antenatal care, delivery in a health facility, delivery with a skilled birth attendant, as well as other post-natal care services have increased by an average of 8% since the introduction of the policy (i.e. between 2003 and 2007).