Dissertations / Theses on the topic 'Midwifery and Health'
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Gleeson, J. A. "Using policy analysis to explore the reciprocal impact of health policy on public health nursing and public health nursing on policy." Thesis, Bournemouth University, 2013. http://eprints.bournemouth.ac.uk/21387/.
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The overall aim of this study was to explore the reciprocal impact of health policy on public health nursing and public health nursing on policy. This study uses a new approach to considering public health nurses’ engagement in policy: one which puts public health nurses, as actors in the policy process, at the centre of the investigation. The overall philosophical lens through which the research was conducted was critical social theory and the methodology was a grounded theory influenced research design. The study adopted a three stage data collection and analysis process: primary data (questionnaires and interviews), detailed policy analyses of two specific White Papers and secondary data (extant documents). The data were collected and analysed through a grounded theory approach in order to answer four research questions: 1. What do public health nurses know about policy, specifically in relation to two English Department of Health White Papers: Creating A Patient-Led NHS (DOH 2005) and Our Health, Our Care, Our Say (DOH 2006)? 2. How do they engage in the policy process? 3. What affects their implementation of policy? 4. Is there a policy-practice gap? A triangulated approach to data collection and analysis was used. Primary data were collected through questionnaires and follow up telephone interviews with public health nurses (health visitors and school nurses) in four PCTs and one social enterprise in five different geographical areas of England. Further data from detailed policy analyses using frameworks by Popple and Leighninger (2008) and Walt and Gilson (1994) were also considered. Finally, secondary data from extant documents including newspapers, websites and organisational documents were reviewed. At the end of the research process, it was possible to answer the four research questions. In addition to this, new knowledge and theory emerged around three main themes: i) A proposal for a new combined framework for policy analysis which leads to a comprehensive and analytical account of policy content and context combined with a detailed consideration of the role of public health nurses as actors in the policy process. ii) Theories as to why and how public health nurses lack influence in the policy process. iii) Analysis of the effect of lack of resources on inhibiting practice innovation in response to policy agendas. Consideration of these theories led to several recommendations for practice. Throughout the research process, there was continued interaction between the three phases of data collection, analysis and theory development.
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Holmes, Elizabeth Ann. "An evaluation of the Midwifery Development Unit service specifications, through the quality assurance model for midwifery." Thesis, University of Glasgow, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.295331.
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Spiteri, Mary Carmen. "Postnatal perineal trauma and general health in Maltese women." Thesis, University of Hull, 2009. http://hydra.hull.ac.uk/resources/hull:2384.
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Over the last twenty years there has been an increasing international research interest in women's experience of postnatal perineal trauma and its impact on their physical, psychological and sexual health. To date, however, no research on perineal morbidity and general health has been undertaken in Malta. Using a longitudinal descriptive correlational design, a homogenous systematic sample of 144 Maltese postnatal mothers was recruited with the aim of exploring the relationship between perineal trauma and general health following normal delivery. Self-administered questionnaires within 48 hour s of delivery and again at 10 days, 6 weeks and 13 weeks sought to assess perineal pain, urinary and faecal continence, resumption of sexual intercourse and dyspareunia. The General Health Questionnaire-12 (Goldberg and Williams, 1998) assessed mothers' psychosocial health. Open-ended questions explored further their experience of perineal trauma and general health. The retention rate at the end of time 4 was 86.1%. Following descriptive and inferential statistical analysis, the key findings revealed a constant decline in perineal trauma and an inconsistent but significant rise in general health over time. Mothers sutured by senior hospital officers reported higher scores of well-being, and resumed sexual intercourse earlier than those sutured by registrars and senior registrars. Significant negative correlations persisted between postnatal total perineal trauma and resumption of sexual intercourse at 13 weeks but not at 6 weeks.Qualitative data generated three main themes: experiencing total perineal trauma, resuming sexual intercourse and maintaining general health. Mothers identified tiredness, exhaustion and emotional pain as other burdens alongside a painful perineum. 'Being not ready yet', 'fear of falling pregnant again' and 'caring for the baby and family' were reasons preventing postpartum sexual intercourse. Tedeschi, Park and Calhoun's (1998) post-traumatic growth theory provided an overarching theoretical framework.
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Mayoh, Joanne. ""It gave me relief ... it gave me confidence" : the online health information seeking experiences of adults with chronic health conditions." Thesis, Bournemouth University, 2010. http://eprints.bournemouth.ac.uk/17519/.
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Background- The recent modernisation of the United Kingdom (UK) National Health Service (NHS) has included a number of sizeable reforms that have emphasised partnership relationships between patients and professionals, and the importance of individuals taking a more active role in their care. Many of these changes have been specifically geared towards patients with chronic health conditions, who are recognised as imposing the largest strain on health services worldwide. This modernisation has occurred in parallel with a huge increase in the number of people within the UK who are turning to the internet for health information in order to become more informed about their health and treatment regimes. Despite this increase in the prevalence of online health information (OHI) seeking, relatively little is known about how people seek OHI and the impact it has on their lives and relationships with others. Overall Study Aim- This study sought to understand the OHI seeking experience of individuals with chronic health conditions by using an innovative mixed-methods approach to collect a breadth and depth of relevant information on the topic. Design – One hundred participants were recruited from local support groups for various chronic health conditions. The participants in the first stage of the study completed one of two questionnaires, depending on whether or not they had sought OHI in the past. The design and focus of stage two of the study was guided by the findings from stage one, and subsequently focused on the experiences of older adults with chronic health conditions seeking OHI. A descriptive phenomenological approach was adopted in order to provide rich descriptions of patients’ experiences. Six participants were purposefully selected from a parallel sample to the stage one respondents. Findings- The results from stage one provided a breadth of information about the OHI seeking experience for people with chronic health conditions. Findings suggested that health professionals were still the most important source of health information for users and non-users of OHI; that patients had an awareness of the inconsistencies in terms of OHI quality; and identified the perceived ease with which useful and relevant OHI was located. A further key finding was that high age, low education levels and low internet usage not only acted as barriers to OHI seeking for participants, but also had a negative impact on participants’ perceptions of the positive outcomes of OHI seeking, such as confidence in decision-making or engaging in discussions with health professionals. Moreover, some non-users demonstrated that they felt they were “too old” to engage in OHI seeking. Stage two findings demonstrated 5 key themes: patients taking responsibility for their health; their expectations of OHI; explicit confidence in their own ability to discern OHI and concern for others to do the same; the selective nature of OHI sharing between patients, and patients and health professionals; and the reinforcement of social sharing networks where positive and useful OHI is shared freely. Conclusion- Although older adults within this sample were less likely to engage in, and perceive the positive outcomes of OHI seeking than their younger counterparts, some older adults were successfully engaging in the OHI seeking experience, and perceiving the constructive effects of this experience such as empowerment. Furthermore both stages of the research demonstrated the valuable role health professionals play in supporting patients seeking OHI. Implication- This study demonstrates a need for health professionals to actively support patients in seeking OHI. In doing so, this could reinforce OHI seeking behaviour, and assist patients in effectively searching for and appraising OHI.
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Pitt, Susan. "Midwifery and medicine : discourses in childbirth, c. 1945-1974." Thesis, University of Wales Trinity Saint David, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.683128.
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Short, Nigel P. "An evocative autoethnography : a mental health professional's development." Thesis, University of Brighton, 2010. https://research.brighton.ac.uk/en/studentTheses/3c4c3868-9bbd-4fbc-8c86-0cba6dedc47f.
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This work grew out of a need to try to understand my often experienced sense of being misunderstood, misrepresented and marginalised. A prerequisite to helping others in mental health nursing is arguably some requirement to understand one’s self. But who is the self? In this thesis I use an autoethnographic approach to examine how the self, multiple selves and identity formation is socially constructed. Social constructionism contends that categories of knowledge and reality are actively created by social relationships and interactions. As an autobiographical genre of writing, this evocative autoethnography has been written in the first person displaying my multiple layers, connecting my selves to the cultures I inhabit. As a reflexive methodology it offers the researcher a means of critically exploring the social forces and discursive practices that have shaped his own cultures. In addition I discuss the contrast between traditional guidelines and protocol driven ethics with more progressive relational ethics. Central to relational ethics is the question ‘What should I do now?’ rather than the statement ‘This is what you should do now.’ I continue by arguing that we use stories as ‘equipment for living’, as tools to understand, negotiate and make sense of the many different situations we encounter. In recent years, as part of the ‘narrative turn’ in the social sciences, a growing number of scholars have suggested that we live in a world shaped by these stories. I discuss connections between the cultures people occupy and how an individual’s reflexivity can keep them stuck or liberated and emancipated with regard to their personal narratives. Whilst the text is not intentionally instructional, storytelling can be instructive. By showing my vulnerabilities the work is a prism for the reader to reflect on their narratives and the cultures they inhabit.
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BOWNE, SHELL L. "MIDWIVES IN A PRECARIOUS BALANCE OF POWER WITHIN THE HEALTH CARE SYSTEM OF THE UNITED STATES." University of Cincinnati / OhioLINK, 2002. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1016569336.
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Hargan, Janine M. "Mental ill health in nursing and midwifery education : a critical discourse analysis." Thesis, University of Bradford, 2017. http://hdl.handle.net/10454/15925.
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Students diagnosed with long-term mental health conditions have been the focus of policy development for over a decade. Student mental health is on the increase and universities are legally obliged to make reasonable adjustments for disabled students. Therefore it is crucial that nursing and midwifery education provides an inclusive learning environment, while maintaining fitness to practice standards. The focus of this study was to explore how discourses of mental health, reasonable adjustments and fitness standards influence nursing and midwifery education for students with a mental health condition. Principles of Wodak’s (2001) critical discourse analysis approach, which gives prominence to dominant discourses, their justifications and persuasive nature was utilised. Ten key written texts and 23 semi-structured interviews with students, lecturers and clinical mentors were conducted to acquire the constructions of mental health, reasonable adjustments and fitness requirements. The findings show that the dominant discourses attributed to students experiencing mental ill health were around medicine, difference and blame, all of which reinforced mental health stigma. In addition, mental health discourses within both verbal and written texts were not underpinned by disability discourses, allowing the exclusion of students who disclose mental ill health from accessing reasonable adjustments. In conclusion, students considered to have a mental health label faced discriminatory barriers and legislative and regulatory requirements of equality were not implemented.
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Chamberlain, Marie. "Factors affecting the acquisition of skills in midwifery students." Thesis, King's College London (University of London), 1993. https://kclpure.kcl.ac.uk/portal/en/theses/factors-affecting-the-acquisition-of-skills-in-midwifery-students(3f4b4340-20b2-4c1d-b355-ef594c83e7b5).html.
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Kathryn, Erica Lillian. "Theory of profound knowing: A study of nurse-midwifery knowledge." Case Western Reserve University School of Graduate Studies / OhioLINK, 1996. http://rave.ohiolink.edu/etdc/view?acc_num=case1057677768.
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Sandall, Jane. "Midwifery work, family life and wellbeing : a study of occupational change." Thesis, University of Surrey, 1998. http://epubs.surrey.ac.uk/848/.
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Maclean, Gaynor D. "An examination of the characteristics of short term international midwifery consultants." Thesis, University of Surrey, 1998. http://epubs.surrey.ac.uk/844464/.
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As humanity hurtles towards the twenty first century, it is apparent that the world is becoming a smaller place. Moreover, the colonization of previous centuries has largely shown deference to a differing approach in international interaction. It would seem that consultancy offers nations the possibility of importing expertise in order to aid development without overtly incurring the domination of foreign powers. This thesis debates the veracity of such an assumption and proceeds to examine international consultancy as practised by a single professional group, namely midwives. The study is confined to consideration of those who provide a short term consultancy service. It debates whether international consultancy can rightly be considered an approach which offers the client an equal partnership or whether it remains contaminated by the spirit of western domination. The thesis explores current thinking on modernization and development and asserts that these issues are of considerable import, demanding an understanding by every midwife practising as an international consultant. This debate sets the scene for the main research question which, using a qualitative research approach, examines the characteristics of midwives who cross international boundaries in order to provide consultancy services, considering how such characteristics may impact on their effectiveness. Across the developing world, the needs within the maternity and child health services and the responsibilities of the midwife have been brought into sharper focus with the advent of the Safe Motherhood Initiative [WHO:1987]. Currently, a significant number of professionals from the industrialized West travel to Third World countries in response to requests to assist or advise on health and related issues. This thesis dissects differing perspectives of need which may occur between the Orient and the Occident and asks who responds to the expressed need for expertise, how they are selected, whether they are prepared and how they are received. Ultimately, a theory is born. This proffers that effectiveness in international consultancy is dependent on the fulfilment of certain "laws". The "laws" are derived from the discoveries made during data analysis relating to the main research question. They are also influenced by the consideration of numerous subsidiary research questions which arise during the study. The "laws" are nurtured in an extensive examination of literature scanning several professional disciplines and spanning several decades up to the present day.
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Cowan, Joyce. "Women's experience of severe early onset preeclampsia a hermeneutic analysis : this thesis is submitted to Auckland University of Technology in partial fulfillment of the degree of Master of Health Science (Midwifery), 2005." Full thesis. Abstract, 2005.
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Beighton, Carole. "What is the relationship between parents who identify positive aspects of parenting their son or daughter who has intellectual disabilities and parental health and mental wellbeing?" Thesis, Kingston University, 2017. http://eprints.kingston.ac.uk/41905/.
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Parenting a son or daughter who has an intellectual disability is typically framed as being very stressful and has been reported to lead to poorer physical health, mental wellbeing and earlier mortality than for parents of typically developing children. While the stress that comes with parenting a child who has intellectual disabilities is undeniable, some parents also report that their child has brought about a positive change in their lives. The aim of this study therefore, was to explore whether there was a relationship between parents who identify positive aspects of parenting their child with itellectual disabilities and their slef-reported health and mental wellbeing. A two-phase sequential mixed methods study was undertaken between September 2013 and September 2015 and a reflexive approach was used by the researcher throughout. The study was underpinned by the theoretical paradigm of critical realism and the philosophical worldview of pragmatism. In phase I, seventeen face-to-face semi-structured interviews were undertaken to elicit how and in what way parents described a positive aspect of parenting their son or daughter. Seven key themes were identified which served as the basis for locating an existing scale which represented the positive aspects. The scale chosen was the posttraumatic growth inventory underpinned by one of the shattered assumptions theories of posttraumatic growth. Phase II explored the relationship between posttraumatic growth, health and mental wellbeing through an online survey of these parents (N=576). Posttraumatic growth was found to be a significant predictor of mental wellbeing, but not of general health. Potential explanations were explored. A lack of clarity between the theoretical underpinning of the construct and the terms used to describe, measure and report positive aspects, posttraumatic growth and/or benefit finding were identified and require further investigation. The study offers new knowledge in relation to the experience and impact of parenting a son or daughter who has intellectual disabilities and the potential for utility in professional practice is explored.
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Brooks, Jill. "An RCT to determine an effective skin regime aimed at improving skin barrier function and quality of life in those with podoconiosis in Ethiopia." Thesis, University of Hull, 2016. http://hydra.hull.ac.uk/resources/hull:13621.
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Podoconiosis is a neglected tropical skin disease caused by a fault in skin barrier function (SBF) combined with a genetic predisposition. Irritant minerals and pathogens entering breaches in plantar skin cause an inflammatory reaction and lower leg lymphoedema. This has a considerable negative impact on the quality of life and economic status of some of the poorest people in 20 countries. Podoconiosis is preventable and treatable but not curable. No previous pre/post controlled intervention studies on skin treatment for the disease have been published. The aim of this randomised control trial (RCT) was to evaluate the effectiveness of a low-cost evidence-based skin care intervention to improve the SBF in the legs/feet and enhance disease related quality of life. A pilot study (n=10) indicated that adding 2% glycerine to the existing skin management regime used in Ethiopia could have a positive effect on stratum corneum (SC) hydration levels and trans-epidermal water loss (TEWL). The study recruited participants from two Ethiopian clinics (n=193). The control group used the existing treatment regime: washing legs/feet with soap, soaking in 6 litres of water with disinfectant added and applying Vaseline®. The experimental group added a 2% dilution of glycerine to 1/6 of the amount of soaking water and 0.0045% less disinfectant. After 3 months the experimental intervention had a highly significant positive effect on TEWL (p = < 0.001) and SC hydration (p = < 0.002) compared to the control. The reduction in foot circumference was highly significant (p = < 0.001). There was no significant group difference in Dermatology Life Quality Index (p = 0.907). The study indicates the very positive effect on SBF of adding 2% glycerine and less disinfectant to the current treatment. This finding offers a significant contribution to the body of knowledge on the management of the disease. The addition of 2% glycerine to treatment regimens may also have positive effects on other skin diseases with compromised SBF.
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Wadephul, Franziska. "3D ultrasound in pregnancy : discourses, women's experiences and psychological understanding." Thesis, University of Hull, 2013. http://hydra.hull.ac.uk/resources/hull:12289.
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This study explores discourses around private three- and four-dimensional (3/4D) ultrasound scans in pregnancy, the experiences of women who have 3/4D scans and what impact these scans may have on pregnant women. A critical discourse analysis of scanning company websites was undertaken to explore the discourses, identities and genres set up on the websites. Longitudinal interviews exploring women’s experiences of 3/4D scans were analysed using interpretative phenomenological analysis. Case studies, using longitudinal questionnaire and interview data, were used to investigate the psychological impact of 3/4D scans on pregnant women. The critical discourse analysis revealed mixed discourses, identities and genres. While 3/4D scans are not overtly medical, they nevertheless contain medical aspects. They are promoted as enhancing bonding and reassurance. In the interview analysis, two superordinate themes emerged: ‘Getting to know the baby’ and ‘Experiences of pregnancy’. While the women’s physical and emotional experiences of pregnancy varied considerably, there were more convergences in the desire to ‘get to know’ the fetus and how women approached this. While routine and 3/4D scans played an important role, fetal movement also emerged as a significant factor. The case studies showed that the psychological impact was not consistent. Scans had no effect on fetal health locus of control, may have reduced anxiety about specific issues for some women and may have had a positive impact on some components of bonding for some women. It is not possible to state categorically that they reduce anxiety or increase bonding. The psychological impact of 3/4D scans appears to be individually mediated and depends on pregnancy experience and individual psychological differences, highlighting the significance of individual factors in both research and practice. Two opposing discourses portray 3/4D scans as either beneficial, by enhancing reassurance and bonding, or problematic, by undermining women’s embodied knowledge and experience and being potentially risky. This study suggests that neither of these two conflicting discourses are reflected in women’s experiences. The women in this study were not motivated primarily by bonding or reassurance when choosing 3/4D scans, but considered them a nice experience; on the other hand, the scans do not seem to have had a detrimental impact either. The interview analysis suggests that women acquire knowledge about the fetus through scans and fetal movement and combine these to make sense of the fetus. This study also provides evidence that the concept and measurement of bonding during pregnancy is problematic and that professional and academic perspectives are not necessarily reflected in women’s experiences.
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Maria, Speciale Anna. "Midwifery in low resource environments. Challenges and opportunities in maternal and reproductive health service provision." Doctoral thesis, Universitat Autònoma de Barcelona, 2016. http://hdl.handle.net/10803/392672.
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Esta tesis busca responder la siguientes preguntas de investigación: “¿Están las parteras en países de bajos recursos proporcionando los servicios de calidad en salud materna y reproductiva que se necesitan?, ¿Qué brechas existen? ¿Cuáles mejoras en la formación son necesarias para que las parteras presten servicios de mayor calidad en salud materna y reproductiva?
Esta tesis es una compilación de estudios de caso de tres investigaciones. Este trabajo identifica los problemas y brechas existentes en la calidad de la prestación de los servicios de partería y la formación del personal, además realiza una evaluación de proyecto proporcionando información sobre los resultados y mejoras en la calidad y disponibilidad de cuidados en partería.
El primer estudio de caso se lleva a cabo en Afganistán y es una presentación del marco Tanahashi y su uso para identificar las barreras y obstáculos en la provisión de servicios de partería. Los resultados finales fueron bastante inquietantes luego de descontar la disponibilidad, aceptabilidad, accesibilidad y contacto, la cobertura efectiva restante fue del 12% para la población urbana y el 26% de la población rural.
El estudio de caso de Tanzania ofrece una imagen muy completa de la (bajo) nivel de calidad que se puede encontrar sobre todo en entornos de bajos recursos. En la investigación aportada en esta tesis se demuestra que la calidad de los servicios ofrecidos por los recién graduados es muy baja y las pruebas de habilidades revelaron que menos del 25% de ellos eran capaces de realizar las estándares internacionales.
El estudio de caso final tiene lugar en Ghana. Este estudio se basa en una evaluación de proyecto de formación de parteras. El caso de estudio presenta resultados cualitativos que demuestran que tanto los profesores, los preceptores y los alumnos, todos ellos, sintieron que el programa tuvo un impacto positivo. Los casos cuantitativos revisados revelaron que los preceptores ofrecieron servicios de planificación familiar de largo plazo y atención integral del aborto a la comunidad después de este proyecto.
En la agenda posterior a 2015, las parteras han sido identificadas como los principales proveedores de servicios de salud materna y reproductiva. A nivel mundial hay una escasez importante de parteras e incluso los países con un número suficiente, existen graves preocupaciones sobre la distribución del personal de partería en los países de bajos recursos, con una tendencia hacia la concentración en entornos urbanos, mientras que la mayor necesidad se encuentra en las áreas rurales. Sin embargo, un aumento en el número de parteras sin un aumento de la calidad probablemente sería infructuosa. La partería es diversa en todos los países y existen grandes diferencias en la salud materna y reproductiva dentro de los países. Antes de diseñar nuevas intervenciones, evaluaciones como las que se contemplaron en esta tesis deben completarse.
Este es un momento emocionante para la partería a nivel mundial, y en particular en países de bajos recursos. Se espera que esta tesis contribuya a la creciente literatura acerca de la partería y que esta ofrezca algunos ejemplos claros de estudio y la mejora (particularmente con respecto a la calidad y disponibilidad) de los servicios de partería en los países de bajos recursos. Mientras que los retos actuales son grandes, también lo son las oportunidades.This thesis sought to answer the question: “Are midwives in low resource countries providing the quality maternal and reproductive health services that are needed? What gaps exist?” What training improvements will better prepare midwives to provide quality maternal and reproductive health services?” This thesis is a compilation of case studies: two investigative studies for problem identification and gaps in quality in midwifery service provision and midwifery education and one project evaluation providing information about outcomes and improvements in the quality and availability of midwifery care. The first case study takes place in Afghanistan and is a presentation of the Tanahashi framework and its use to identify barriers and bottlenecks in midwifery service provision. Final results were quite disturbing, as after discounting for availability, acceptability, accessibility, contact the effective coverage remaining was 12% for urban populations and 26% for the rural population. The Tanzanian case study offers a very complete picture of the level of quality of service that can be found particularly in low-resource settings. The research provided in this thesis demonstrated that quality of services being offered by recent graduates is very low, with less than 25% passing skills testing of crucial life-saving skills. Additionally it showed that the current curriculum and training system do not meet international standards. The final case study took place in Ghana. This case study was based on a project evaluation for a training intervention. This case study presents qualitative findings that demonstrate that the teachers, the preceptors and the students all felt that the program had a positive impact. Quantitative caseload reviews revealed that the preceptors offered more long term family planning and comprehensive abortion care services in the community after this project. In the post-2015 agenda midwives have been identified as the leading providers for maternal and reproductive health services. Globally, there is an important shortage in midwives and even countries with sufficient numbers, there are grave concerns about the distribution of the midwifery workforce in low resource countries with a tendency toward a concentration in urban environments while the greatest need is in the rural areas. However an increase in the number of midwives without an increase in quality will likely be fruitless. Midwifery is diverse in every country and great differences in maternal and reproductive health exist within countries. Prior to designing interventions, assessments such as those viewed in this thesis should be completed. This is an exciting time for midwifery globally, and particularly in low resource countries. It is hoped that this thesis contributes to the growing literature regarding midwifery and that it provides some clear examples of the study of and improvement (particularly with regard to quality and availability) of midwifery services in low resource countries. While the current challenges are great, so are the opportunities.
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Kildea, Sue. "Birthing business in the bush : it's time to listen /." Electronic version, 2005. http://adt.lib.uts.edu.au/public/adt-NTSM20051006.180714/index.html.
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Evans, Kristy. "Independent Midwifery practices in Cape Town: birth outcomes and predictors for medical interventions from 2003-2009." Master's thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/9408.
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Includes bibliographical references.The midwifery model of care is a safe, effective, inexpensive, holistic, woman and baby centered-approach to maternal and infant health. It is widely used in developing and developed world contexts and has proven to have birth outcomes that are comparable to hospital-based, obstetric models. In many settings however, application of the independent midwifery model of care has become increasingly difficult to maintain. Tensions surrounding perceived skills and competencies of midwives, the increasing acceptance of hospital-based, obstetric models of childbirth, controversy over necessity and use of medical interventions, rising insurance premiums, and competition over clients in private sector scenarios are all factors contributing to both low availability and utilization in many countries, including South Africa. In order to consider the role of this model in maternity services in South Africa and to potentially make this model available on a wider scale, it is necessary to understand the demographics of current utilization of existing independent midwifery services, as well their as birth outcomes. This retrospective cohort study documents the total number of deliveries attended by independent midwives, the socio-demographic and reproductive characteristics of women using independent midwives and the birth outcomes and delivery types in the greater Cape Town region among the 16 independent midwives who have practiced during the six and a half year period of January 2003 - end of June 2009. It identifies factors associated with normal vaginal deliveries, instrumental deliveries and caesarean sections, as well as documents the socio-demographic and professional characteristics of the 16 independent midwives. Ethical approval for this research was granted by the University of Cape Town. Anonymous client data was collected from midwifery practices' Maternity Registers and transferred onto a data abstraction sheet. Midwife data was collected via an interviewer-administered questionnaire. All data was entered into Microsoft Excel and analyzed using Stata. The findings of this study will be used to inform maternal and infant health care policy, as well as provide statistics for independent midwives' quality assurance and auditing of services.
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Fergusson, Lindsay. "Working as a coordinator midwife in a tertiary hospital delivery suite a phenomenological study : a thesis submitted to Auckland University of Technology in partial fulfilment of the requirement for the degree of Master of Health Science (Midwifery), 2009 /." Click here to access this resource online, 2009. http://hdl.handle.net/10292/725.
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This phenomenological study has been conducted to reveal midwives’ experiences working as coordinator/charge midwives in tertiary hospital delivery suite settings. The methodology is informed by Heidegger’s interpretive phenomenological, hermeneutic philosophy (1927/1962). Data analysis is based on van Manen’s (1990) research methodology. Five coordinator/charge midwives who work at three tertiary hospitals were interviewed. These interviews were tape recorded, transcribed and analyzed to uncover commonality of themes which revealed what it felt like ‘being’ a coordinator/charge midwife. The three themes which emerged and are discussed in the data analysis chapters are: “The performing art of leadership”, “Time as lived” and “In the face of the ‘known’ and the ‘unknown’”. The findings of this study reveal coordinators are the ‘hub’ or the ‘pivot’ at their workplace with their art and soul of midwifery at the very core of their ‘being’. They ‘know’ the unpredictability of childbirth and are regularly challenged by ‘lived time’ as they ‘leap in’ to situations and ‘leap ahead’. Their ability to facilitate teamwork and their resilience in the face, at times, of seemingly insurmountable obstacles shines through.
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Millar, Kathryn Rae. "Prevalence and Associated Factors of Antenatal Depression in Post-conflict Rwanda| Implications for Nurse Midwifery Policy and Practice." Thesis, University of California, San Francisco, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10936184.
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Background: In low- and lower-middle-income countries (LLMICs), 16% of pregnant and 20% of postpartum women experience common maternal mental health disorders, far surpassing global rates of 10% and 13%, respectively. Maternal depression is associated with poor perinatal outcomes, including maternal, newborn, and early childhood outcomes. The Edinburgh Postnatal Depression Scale (EPDS) was recently validated in Rwanda, yet maternal depression prevalence and associated factors are unknown.
Objectives: The primary objectives of the study are to describe antenatal depression prevalence and its associated factors.
Methods: This is a secondary analysis of the Preterm Birth Initiative-Rwanda randomized controlled trial of group antenatal care (ANC) data obtained between June 2017 – June 2018. Thirty-four health centers in five districts were selected. At each health center, convenience sampling was used to ascertain EPDS scores from the first five women to present for initial ANC each calendar month. A cut-off EPDS score of ≥13 was used to define maternal depression. Multi-level simple and multiple logistic regressions were used to explore associated factors of antenatal depression. The study obtained informed consent and was approved by the Rwanda National Ethics Committee and the University of California, San Francisco institutional review board.
Results: Twenty-percent of women in the antenatal period screened positive for depression. In the adjusted multi-level multiple logistic regression model, family social support, age, ability to communicate with partner, and perceived stress were significantly associated with antenatal depression.
Conclusions: Antenatal and postpartum depression prevalence in Rwanda exceeds LLMIC averages. The authors recommend universal depression screening and treatment for pregnant and postpartum women.
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Lawn-Day, Gayle A. "Using institutionalized social movements to explain policy implementation failure : the case of midwifery /." Full-text version available from OU Domain via ProQuest Digital Dissertations, 1994.
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Emmons, Elaine. "A divided profession : an analysis of the two cultures in midwifery education and practice." Thesis, University of Surrey, 1993. http://epubs.surrey.ac.uk/794563/.
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Salsbury, Gail. "Transparency in mental health nursing : a critical focus." Thesis, University of Brighton, 2010. https://research.brighton.ac.uk/en/studentTheses/80fadf49-42ae-4b18-95d9-9fe156325d54.
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This study explored the ways experienced mental health nurses working within a local acute mental health NHS Foundation and Teaching Hospital Trust felt about being unobtrusively observed in their everyday clinical practice. Participants were recruited from eight local units: four Community Mental Health Teams (CMHT), one Crisis Resolution Home Treatment Team (CRHT), one inpatient ward, one in-patient rehabilitation unit and an Assertive Outreach Team (AOT).
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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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Ross-Davie, Mary C. "Measuring the quantity and quality of midwifery support of women during labour and childbirth : the development and testing of the 'Supportive Midwifery in Labour Instrument'." Thesis, University of Stirling, 2012. http://hdl.handle.net/1893/9796.
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The thesis describes the development and testing of a new computer based systematic observation instrument designed to facilitate the recording and measurement of the quantity and quality of midwifery intrapartum support. The content of the systematic observation instrument, the ‘SMILI’ (Supportive Midwifery in Labour Instrument), was based on a comprehensive review of the literature. The instrument was found to be valid and reliable in a series of studies. The feasibility and usability of the SMILI was extensively tested in the clinical setting in four maternity units in Scotland, UK. One hundred and five hours of direct observation of forty nine labour episodes were undertaken by four trained midwife observers. The clinical study demonstrated that the study and the instrument were feasible, usable and successful in measuring the quantity and quality of midwifery intrapartum support. The data collected has provided significant new information about the support given by midwives in the National Health Service of Scotland, UK. Continuous one to one support was the norm, with 92% of the observed midwives in the room for more than 80% of the observation period. Emotional support, including rapport building, encouragement and praise, was the most frequently recorded category of support.
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Grindle, Norma. "The role of the arts in teaching caring : an evaluation." Thesis, University of Ulster, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.365919.
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Hassall, Jenny Louise. "Women's decisions to exercise in pregnancy : negotiating conflicting identities." Thesis, University of Brighton, 2016. https://research.brighton.ac.uk/en/studentTheses/3b6eccaf-bb60-4736-935e-f7d962fe0fa6.
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Substantial benefits can be gained by participating in regular physical exercise, however only a minority of women meet current pregnancy exercise recommendations and there is limited understanding of women’s decision-making regarding exercise in pregnancy. The purpose of this constructivist grounded theory study was to develop a theoretical insight into the factors that influence women’s decisions regarding exercise in pregnancy and how they process the influences and multiple alternatives they encounter. The constructivist approach drew on the subjective researcher/participant interrelationship to co-construct meaning from the data and ultimately render the women’s experiences into theoretical interpretations. The theory presented was built inductively from the experiences of 10 pregnant women who exercised regularly, supplemented by insights from theoretical sampling of fitness experts, internet forums and extant literature. Longitudinal, audio-recorded semi-structured interviews occurred twice during each pregnancy and 6-8 weeks postnatal. Data generation and data analysis ran concurrently and iteratively using the constant comparative method of analysis. Theoretical constructs generated by the data were progressively amplified and clarified through a series of inductive-deductive cycles and theoretical sampling that drove the evolving interview schedules. Theorising ideas in the form of detailed memos was a fundamental part of the analysis and enabled a detailed audit trail to be established. The resultant substantive theory of ‘Accommodating the pregnant self’ conceptualises pregnancy as a transitional period during which women’s self-identity is modified. ‘The exercising self’ was a salient and valued facet of the women’s self-identity and continuing to exercise enabled women to maintain a degree of continuity and control that was integral to their sense of maintaining and to a degree regaining their past valued self. Decisions regarding exercise were influenced by a complex interplay of contextual factors that simultaneously encouraged exercise and rest. This consequently triggered a degree of identity conflict between two domains of their self-identity, ‘the exercising self’ and ‘the pregnant self’. The women reacted to the challenges to their identity through the process of self-identity regulation. Through this process they gradually re-constructed their self-identity to accommodate their pregnant self while contemplating possible future selves against various self and social normative standards. Negotiating conflicting identities was an integral component of the decision-making process, and ultimately resulted in many of the women modifying their activities to accommodate the pressures they faced to conform to social ideologies of ‘the pregnant self’. The theory explores a range of strategies that the women used to deal with identity conflict, particularly drawing on selective perception and self-justification to resolve cognitive dissonance. It also highlights a duality in the factors that influenced their decisions which suggests women’s identity characteristics resulted in a propensity for behaviour to be steered by either internal (personal) or external (relational and environmental) influences. The substantive theory underscores the significance of self-identity in steering the decisionmaking process. The findings provide insight into how women might be better supported to make informed and assured decisions regarding lifestyle choices. The theoretical potential to inform interventions to enhance activity levels in a wider population is highlighted.
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Roque, Lynn S. "In the womb of inadequacy: a look at maternal health and the role of midwifery in inner cities." Thesis, Boston University, 1995. https://hdl.handle.net/2144/27754.
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Boston University. University Professors Program Senior theses.PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.
2031-01-02
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Malata, Address M. "The development and evaluation of a childbirth education program for Malawian women." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2004. https://ro.ecu.edu.au/theses/826.
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Childbirth education provided to women is an Integral aspect of the childbirth experience. In Malawi, midwives face a major challenge because one of their major roles is to provide childbirth information to women. However, there are no existing Childbirth Education Programs to facilitate this process. The purpose of this study was, therefore, threefold. First, it explored childbirth Information needs of Malawian mothers from the perspectives of both mothers and midwives, as well as strategies that would be appropriate to disseminate this childbirth information to Malawian women. Second, it developed a Childbirth Educational Program (CEP) to meet the specific needs of Malawian women as previously identified. Third, the CEP was implemented and evaluated for it’s effectiveness in increasing Malawian women’s knowledge of childbirth. The study was conducted in three phases. In Phase One, childbirth information needs of Malawian women were determined using findings from previous studies, focus groups and individual interviews of Malawian midwives. In Phase Two, data obtained from Phase One was used to develop a CEP as well as pretest/posttest questionnaire. In Phase Three, a quasi-experimental study using sequential sampling was conducted to implement and evaluate the CEP. Participants Included pregnant women who attended antenatal clinics at the Ndirande and Limbe Health Centres in Blantyre (Malawi). Following informed consent, 125 women from the Ndirande Health Centre were Invited to participate in the study and recruited to a control group. Another 125 women were also recruited to an intervention group at Limbe Health centre. A pretest was administered to both groups of women to determine their childbirth knowledge prior to implementation of the study. Women In the control group were exposed to routine antenatal education from both hospital and traditional non-hospital sources. Therefore, an increase in childbirth knowledge was anticipated. Additionally, women in the intervention group were exposed to both routine antenatal education as well as a systematic and comprehensive CEP. It was anticipated the degree to which knowledge increased in this group would be higher than in the control group, thus demonstrating the effectiveness of the CEP.
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Dunbar, Sheryn. "Midwives 'with' women in the obstetric high dependency unit a qualitative descriptive study of midwifery care for women in an obstetric high dependency unit : a thesis submitted in partial fulfilment of the requirements for the degree of Master of Health Science, Auckland University of Technology, 2004." Full thesis. Abstract, 2004.
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Vague, Stephanie. "Midwives' experiences of working with women in labour interpreting the meaning of pain : this thesis is submitted to Auckland University of Technology in partial fulfilment of the degree of Master of Health Science (Midwifery), 2003." Full thesis. Abstract, 2003.
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Johnston, Athalie. "A comparison of three midwifery interventions on the continuity and knowledge of breast feeding." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 1993. https://ro.ecu.edu.au/theses/1144.
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Although it is widely recognised that breast milk is biologically perfect to provide nutrition for the newborn infant many new mothers do not continue to breast feed throughout the postpartum period. A possible influencing factor is the decreased length of hospital stay, whereby new mothers are discharged home away from the supportive-educative role of the midwife before they are ready to learn the art of breast feeding. The purpose of this study was to determine the influence of three midwifery interventions on the continuity and knowledge of first time breast feeding mothers at 6 weeks postpartum. A convenience sample of 162 first time breast feeding mothers was divided into three groups: conventional discharge (n = 59), teaching intervention (n = 51) and planned early discharge (n =52). Mothers and babies in all groups were well and declared fit for discharge on day 3 postpartum. Using a quasi experimental, post-test-only design two questionnaires were completed, one at a personal interview prior to discharge from hospital and one telephone interview at 6 weeks postpartum. At 6 weeks postpartum it was found that only 63% of subjects were successfully breast feeding. Those that were successfully breast feeding also had a significantly higher breast feeding knowledge (p =.01). Although more subjects in the planned early discharge group were still breast feeding there was no significant difference between the three groups (p = > . 05). On the other hand, there was a significant difference between the breast feeding knowledge of subjects in the three groups (p = < . 05) with those subjects in the planned early discharge group having greater breast feeding knowledge. Data analysis also revealed that age and income had a significant relationship to both successful breast feeding and breast feeding knowledge while level of education only influenced breast feeding knowledge. Subjects in the planned early discharge group were very satisfied with their care and verbalised appreciation for the opportunity to speak with the visiting midwife in their own home.
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Cooper, Melanie. "Meeting the health and social needs of pregnant asylum seekers : midwifery students' perspectives : a critical discourse analysis of language use by midwifery students in their social constructions of the health and social needs of asylum seekers accessing maternity services." Thesis, University of Bradford, 2011. http://hdl.handle.net/10454/5364.
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Current literature has indicated a concern about standards of maternity care experienced by pregnant asylum seeking women. As the next generation of midwives, it would appear essential that students are educated in a way that prepares them to effectively care for pregnant asylum seekers. Consequently, this study examined the way in which midwifery students constructed a pregnant asylum seeker's health and social needs, the discourses that influenced their constructions and the implications of these findings for midwifery education. For the duration of year two of a pre-registration midwifery programme, eleven midwifery students participated in the study. Two focus group interviews using a problem based learning (PBL) scenario were conducted. In addition, three students were individually interviewed and two students' written reflections on practice were used to construct data. Following a critical discourse analysis, dominant discourses were identified which appeared to influence the way that pregnant asylum seekers were perceived. The findings suggested an underpinning discourse around the asylum seeker as different and of a criminal persuasion. In addition, managerial and medico-scientific discourses were identified, which appeared to influence how midwifery students approach their care of women in general, at the expense of a woman centred, midwifery perspective. The findings from this study were used to develop 'the pregnant woman within the global context' model for midwifery education and it is recommended that this be used in midwifery education, to facilitate the holistic assessment of pregnant asylum seekers' and other newly arrived migrants' health and social needs.
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Haith-Cooper, Melanie. "Meeting the health and social needs of pregnant asylum seekers - midwifery students' perspectives. A critical discourse analysis of language use by midwifery students in their social constructions of the health and social needs of asylum seekers accessing maternity services." Thesis, University of Bradford, 2011. http://hdl.handle.net/10454/5364.
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Current literature has indicated a concern about standards of maternity care experienced by pregnant asylum seeking women. As the next generation of midwives, it would appear essential that students are educated in a way that prepares them to effectively care for pregnant asylum seekers. Consequently, this study examined the way in which midwifery students constructed a pregnant asylum seeker's health and social needs, the discourses that influenced their constructions and the implications of these findings for midwifery education.
For the duration of year two of a pre-registration midwifery programme, eleven midwifery students participated in the study. Two focus group interviews using a problem based learning (PBL) scenario were conducted. In addition, three students were individually interviewed and two students' written reflections on practice were used to construct data. Following a critical discourse analysis, dominant discourses were identified which appeared to influence the way that pregnant asylum seekers were perceived. The findings suggested an underpinning discourse around the asylum seeker as different and of a criminal persuasion. In addition, managerial and medico-scientific discourses were identified, which appeared to influence how midwifery students approach their care of women in general, at the expense of a woman centred, midwifery perspective. The findings from this study were used to develop 'the pregnant woman within the global context' model for midwifery education and it is recommended that this be used in midwifery education, to facilitate the holistic assessment of pregnant asylum seekers' and other newly arrived migrants' health and social needs.Became: Haith-Cooper, Melanie. Please search under Haith-Cooper for later articles.
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Payne, Julie. "The lived experience of being pregnant for women under the age of nineteen young and pregnant : a thesis submitted to Auckland University of Technology in partial fulfillment of the degree of Master of Health Science (Midwifery), 2005." Full thesis. Abstract, 2005.
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Thesis (MHSc--Health Science) -- Auckland University of Technology, 2005.Appendices not included in e-thesis. Also held in print (iii, 154 leaves, 30 cm.) in Akoranga Theses Collection (T 618.24 PAY)
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Sundholm, Anna, and Akar Jalal. "Transkulturella möten inom mödravården : Barnmorskors egna erfarenheter." Thesis, Uppsala University, Department of Public Health and Caring Sciences, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-104446.
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The purpose of this study was to look at the experiences of midwives in maternalhealth care encounters with non-european-born women and men, and to determine ifmidwives deem any special competence necessary to handle these encounters well.We gathered information by means of qualitative interviews and semi structuredquestions with eight midwives all of whom matched the inclusion criterias and gavetheir personal consent. Midwives from four district health care centers in Uppsalawere included. The interviews were transcribed and analyzed by means of qualitativecontent analysis.The results reveal the experiences from encounters with non-european patients to betwofold. On one hand the encounter is a positive, exiting experience with anopportunity to learn more about a foreign culture and exchange experiences. On theother hand complications can occur as patients may have unexpected expectationsregarding the health care, have great difficulties with the language or haveexperienced traumatizing incidents, all on top of coming to Sweden alone withoutrelatives.In the encounter with non-european-born patients the midwives consider it importantto have special competence in form of knowledge of other cultures and religions asthis provides a greater understanding of the reasoning behind the patients’ decisions.Cultural competence is also important as it helps avoid inadvertently insulting thepatient during the encounter.The special competence held by the midwives has been attained from their basic andspecialist education as well as from self acquired experiences and interests. A lifelongeducation is required to uphold this competence as well as a dialog betweenmidwives at the health care clinic.
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Groves, Winnifred. "Diagnosing and prescribing by nurses in different health care settings : perceptions and experiences of key stakeholders in Cameroon." Thesis, Kingston University, 2012. http://eprints.kingston.ac.uk/24622/.
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Declining resources are a global phenomenon. One of the consequences has been the reorganization of health care provision in different countries. Doctor shortages and scarcity of resources particularly in developing countries like Cameroon have resulted in nurses providing frontline care to patients and taking on roles traditionally performed by doctors in developed economies, such as diagnosing and prescribing. However, little is known about the exact role of nurses, the process of providing care, how key stakeholders influence the nurse’s role and the consequences of this role of nurses on the various parties concerned in the context of Cameroon. An empirical study was conducted with (n= 42) key stakeholders; (government representatives, doctors, nursing managers, nurses and patients). Semi-structured taped-recorded interviews were carried out on a one-to-one basis to explore the perceptions of multiple key stakeholders of the role of nurses in diagnosing and prescribing. Interviews were transcribed and data analysed using framework analysis. Nurses are the first point of contact for patients in Cameroon in all health care settings and most have a far greater role in diagnosing and prescribing than their counterparts in developed economies. However their involvement was found to vary significantly depending on a number of factors, including: the organisational context, the type of facility (whether public / private or mission owned), individual nurse characteristics, doctors’ attitudes and practices, resources and experience of nursing managers, level of income and characteristics of patients. Most patients (including women) prefer to consult with doctors and in their absence, male nurses rather than female nurses. Some nurses, patients and doctors felt that a preoccupation with diagnosing and prescribing left nurses with little time for compassion and caring. In addition, the key stakeholders felt that some nurses were overstepping their professional boundaries, or had inadequate knowledge and were acting in a manner detrimental to patient care. Extended roles for nurses have the potential to enhance accessibility to care, to enhance the status and job satisfaction of nursing staff and maximise the use of scarce resources. Despite the benefits, there is growing concern that nurses do not have the advanced level of training and behaviour necessary to take on this expanded role and that some are neglecting the traditional caring side of their profession in pursuit of a more medical oriented disease-focused approach.
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Thompson, Faye E. "The ethical nature of the mother-midwife relationship: a feminist perspective." University of Southern Queensland, Faculty of Sciences, 2001. http://eprints.usq.edu.au/archive/00001517/.
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This research explored the ethical nature of the mother-midwife relationship in order to refine our understanding of the place of ethics in the context of everyday midwifery practice – the practice of ‘being with woman’ in childbirth. The ethics explicitly available to midwives are derived from practices such as moral philosophy and bioethics, whose ethical frameworks are reductionist in their exclusion of context and relationship. Given that the midwifery profession is currently promoting a model of practice built on partnership and relationship, existing codes and frameworks are examined for their adequacy. An assumption of the study was that a distinctive midwifery ethic was implicitly available in the lived realities and shared engagement of mothers and midwives, embedded in practice. Conceptual theoretical research methodology facilitated exploration of the taken-for-granted assumptions of established theory, official policies such as Codes, and the profession’s literature. Feminist-constructivist theory formed the epistemological basis for gaining insight into the implicit ethics of midwifery. Personal narratives of mothers and midwives were analysed and interpreted for meaning, and transcripts returned to participants for validation. These constructed meanings were then compared and contrasted with those explicit in Codes and current literature. The central theme to emerge from the narratives was the use and abuse of power in relationships. Other major themes were institutional dominance consistently used to describe the status quo, values conflict especially linked to workplace/service provider versus personal/professional midwifery ethics, and the ethical adequacy of a ‘being with woman’ relationship. Findings indicate that midwifery does need a different ethic to that of bioethics and problem-solving principlism, and that such a new ethic would look like those promoted by feminist-virtue ethics. The latter not only redress the politics of the existing hegemonic maternity services system, but they also place women’s concerns central to practice and deliberation. The aspirations, values and lived reality of mothers and midwives, and the commitment of the professional-friend midwife to the particularity of the birthing woman, are the focus of a reconstructed ethic for midwifery practice, an ethic which reunites morality and personal interest. Implications and recommendations are discussed.
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Sheridan, Valerie. "The cultural context of breastfeeding on the labour ward." Thesis, Kingston University, 2008. http://eprints.kingston.ac.uk/20341/.
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This study examines labour ward culture on two British labour wards, in terms of mother-baby contact and breastfeeding, which has not been empirically researched since 1985 (Garforth & Garcia 1989). ‘Aims’: to investigate the organisational culture; examine mothers' beliefs and experiences; and midwives' knowledge, beliefs and practices. ‘Objectives’: To compare organisational cultures; identify if midwifery practice is evidence based and factors which facilitate or detract from it; identify mothers' preferences, beliefs and levels of satisfaction. ‘Study Design’: Ethnography with case study and diagnostic analysis also utilised. Methods: observation and interviews: purposive sample of mothers (n = 50) and midwives (n = 51); interviews with Heads of Midwifery (n = 2); focus groups with midwives (n = 3); and documentary analysis. ‘Results’: Despite Trust strategies and Heads of Midwifery support for evidence-based practice, clinical guidelines and midwifery beliefs about mother-baby contact and early breastfeed were not usually congruent. Mother-baby contact after birth is usually interrupted for completion of tasks and some babies have multiple contact episodes, which has not been previously described in the literature. Completion of routine tasks for transfer of mothers and babies to postnatal ward takes precedence, because of organisational demands and insufficient resources. However, most mothers expressed feeling satisfied with contact achieved and support for breastfeeding. ‘Conclusion’: Findings of the study have contributed new insights and knowledge of labour ward culture. It is not conducive to uninterrupted mother-baby contact and is not evidence-based. ‘Recommendations’: The development of a learning culture and clinical leadership to promote evidence-based practice and woman-centred care is recommended. The unique period after birth should not be disturbed, to prioritise routine tasks.
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Way, S. "Women's experiences of their perineum following childbirth : expectations, reality and returning to normality." Thesis, Bournemouth University, 2006. http://eprints.bournemouth.ac.uk/10544/.
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Women's experiences of their perineum following childbirth: expectations, reality and returning to normality The aim of the study was to explore the feelings, perceptions and experiences of women in relation to their perineum following childbirth in the early postnatal period. A grounded theory approach was used for collecting and analysing data from eleven diaries and seven interviews with broad questions about how the perineum, following a vaginal birth, affected the way daily living activities were carried out. Initially purposeful sampling was utilised to recruit women but as important issues emerged recruitment continued through theoretical sampling. Following childbirth women expressed a strong desire to get back to normal reflecting the core theme `striving for normality'. Normality in this context meant doing normal things and feeling like their normal selves. Much of what the women described doing during the early postnatal period was related to achieving that goal and linked to the following categories: `preparing for the unknown', `experiencing the unexpected', `adjusting to reality', `getting back to normal' and `recovery of self'. The main theoretical idea that emerged from this study and derived directly from the data is that: If women are able to successfully adjust to their new and often unexpected reality after the birth of their baby, and begin to reclaim their selves and their world, then they experience a return to their normality. The data demonstrates and clarifies three distinct but related aspects. Firstly, coping with the unexpected consequences of childbirth meant that the women frequently made adjustments to how they carried out essential activities such as walking, sitting and passing urine, in order to try and carry on as normal. The second aspect related to daily activities that were not essential but which women felt necessary to undertake because of social expectations. These included housework and shopping. The third aspect related to how the women felt about their body as a result of the perineal trauma they sustained, and what helped them to feel like their `normal selves' again. These interrelated stages form a framework that reflects Maslow's lower order, hierarchy of needs, within the humanistic psychology paradigm. Implications for practice include the need to improve care in areas of preparing women having their first baby, listening to women as part of the assessment of perineal pain following birth and the need for continuity of care from the same midwife in order for women to appropriately manage their perineal experience.
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Bluff, Rosalind. "Learning and teaching in the context of clinical practice : the midwife as role model." Thesis, Bournemouth University, 2001. http://eprints.bournemouth.ac.uk/339/.
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The purpose of this study was to develop a theory in order to explain the meaning and process of learning the role of the midwife from midwives in the clinical setting. To achieve the depth and detail required in the absence of literature on this topic, the grounded theory approach was adopted. The sample consisted of twenty student midwives and seventeen midwives. Data were collected by means of unstructured interviews which were tape-recorded. Each participant was interviewed on a minimum of two separate occasions. The constant comparative method was used to analyse the data. The findings of the research contribute to knowledge by making explicit how the role of the midwife is interpreted and enacted, the effect this has on what role students learn, how it is learned and hence how the role is transmitted from one generation of midwives to the next. The `emic' perspective facilitated the emergence of a number of theoretical ideas. Central to these are the rules of practice. When midwives rigidly follow written and unwritten rules they prescribe midwifery care which corresponds to the medical model. In doing so they act as obstetric nurses or handmaidens to the doctor. When everything is interpreted as rules to be followed prescriptive midwives appear to be uncaring and detached from the experience of childbirth. The individual needs of women are not met and the relationship between midwife and client is superficial. Midwives who rigidly follow the rules inhibit the growth and development of students providing them with few opportunities to achieve beyond the level of their role model. Midwives are flexible when they interpret the rules for the benefit of women and provide a woman-centred model of care. These midwives therefore act as autonomous practitioners. When rules are interpreted and adapted to meet the needs of women, flexible midwives demonstrate involvement in women's experiences and are empathic, supportive and caring. Midwives who use professional judgement to interpret the rules provide an environment in which senior students can become autonomous practitioners. When midwives demonstrate the role of autonomous practitioner, practise a woman-centred model of care and meet the learning needs of students, they are appropriate role models and teachers. There is conflict in the clinical setting when practitioners who hold opposing attitudes, values and beliefs practice together. Conflict can be avoided when flexible midwives adopt strategies that involve becoming prescriptive or practising by subterfuge. In accordance with Bandura's social learning theory students learn by observing and emulating the example of their role models. Learning is vicarious when students observe the consequences of their role models' actions. When learning the role from a role model is interpreted as a passive process, a behaviourist and pedagogical approach to learning and teaching ensures perpetuation of the obstetric nurse role that is no longer considered acceptable. Role modelling serves as a vehicle for transmitting new behaviour when learning is perceived to be an active process. In this case a humanistic, andragogical and cognitive approach to learning and teaching is adopted giving students the freedom to determine their own role. Practice from a number of role models is emulated. In this way each midwife acquires a unique identity which is derived from an abstract role model rather than a particular person. Students are prepared for the autonomous role of the midwife, and it is this role they wish to emulate.
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Musacchio, Marilyn Jean. "The organization characteristics and practice outcomes of hospital-based and freestanding birth center nurse-midwifery practices." Case Western Reserve University School of Graduate Studies / OhioLINK, 1993. http://rave.ohiolink.edu/etdc/view?acc_num=case1060609038.
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Wiley, Lisa Maureen. "An Exploration of Power Within the Student-Preceptor Relationship of Direct-Entry Midwifery Students in the United States." Thesis, Bastyr University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=1551912.
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It is widely acknowledged that the preceptorship model is the primary mode of transmission of clinical knowledge within the profession of midwifery. It is natural that a power imbalance resides between preceptor and student; however, research has revealed that this inequality bears not only the potential for facilitating the conveyance of wisdom, but as well for mishandling. The concept of power within the student-preceptor relationship of Direct-Entry Midwives (DEMs) within the U.S. has not been explored through existing literature, despite the fact that increased understanding of this educational relationship may impact the institution of DEM education. Qualitative inquiry was conducted in collaboration with individuals who recently concluded a course of DEM education, and phenomenological analysis of the findings was performed. A summary of themes was compiled, eliciting insight into the nature of power within this relationship and as well the implications of this dynamic upon the profession.
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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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Rowe, Rachel E. "Transfer from midwifery unit to obstetric unit during labour : rates, process and women's experience." Thesis, University of Oxford, 2011. http://ora.ox.ac.uk/objects/uuid:bc7776ef-1e6e-46d0-9fa7-c62e653920b3.
Full textAbstract:
Background Midwifery units (MUs) provide midwife-led care for women at low risk of complications. They may be located on the same site as an obstetric unit (OU), in a hospital without obstetric services or separate from any hospital. In MUs, if unforeseen complications arise, transfer to an OU may be necessary. Aim To provide evidence to contribute to the improvement of the transfer process, help make transfer safer and less distressing for women, thereby improving the care and experience of women planning to give birth in MUs. Methods A structured literature review of existing evidence was followed by three integrated component studies using different methods. The content and quality of local NHS transfer guidelines were evaluated. Data from the Birthplace national prospective cohort study were analysed to estimate transfer rates, describe the transfer process and identify factors associated with transfer. The experiences of women transferred were explored in qualitative interviews. Findings Transfer is a common event, affecting around 25% of women planning birth in MUs, although rates in different units vary. Primiparous women are more likely to be transferred than women having a second or subsequent baby. The risk of transfer for primiparous women increases with increasing age; around 50% of women having their first baby aged 40 years or over are transferred. Local NHS transfer guidelines are generally of poor quality and pay little attention to women’s experience. Women interviewed after transfer report feeling unprepared for transfer. Sensitive care and clear communication from midwives during labour facilitate feelings of control in women and help women accept transfer as the right decision and not a 'negative' event. Transfer that is perceived by women as “too late” can have potentially serious and long-lasting negative effects. Women’s experience of the transfer journey could be improved by the offer of choice in a number of areas which would help women feel 'cared for' rather than 'transported'. Having the MU midwife continue to care for the woman after transfer should be considered 'best practice'; where this is not possible a good handover is essential. Women who have experienced transfer should be offered the opportunity to talk to a midwife about their experience.
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Höglund, Berit. "Pregnancy, Childbirth and Midwifery Care among Women with Intellectual Disability in Sweden : Epidemiological and Descriptive Studies." Doctoral thesis, Uppsala universitet, Institutionen för kvinnors och barns hälsa, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-183388.
Full textAbstract:
The overall aim of this thesis was to investigate pregnancy and childbirth in women with intellectual disability (ID), in Sweden, the health of their newborns and midwifery care for these women. Two register studies and two descriptive studies are included. Pregnancy and birth outcomes as well as data on the newborns’ health were examined by linking data from the National Patient Register and the Medical Birth Register (I-II). The women’s experience of pregnancy and delivery was investigated with repeated interviews (III). Midwives’ knowledge of, experience of and attitudes towards pregnancy and childbirth in women with ID were evaluated with questionnaires (IV). Mothers with ID were more often teenagers, smoked more during pregnancy and had more Caesarean Sections. Their children had a higher proportion of pre-term births, were small-for-gestational-age, stillborn or died in the perinatal period. The women with ID struggled to attain motherhood and feared to lose custody of the child. The pregnancy was seen as a happy event, even though relatives did not always approve. Parent education was considered important, but not adequately adapted to their needs. The birth process was overwhelming and difficult to understand, but the child was welcomed with warm feelings, and breastfeeding was natural. Midwives stated it was different to care for women with ID and requested additional knowledge. The majority of midwives affirmed that women with ID could not manage the mother role satisfactorily, and one-third expressed that women with ID should refrain from having children. A majority of the midwives considered that the children should grow up with the parents with support from family and society, but one out of five stated that the children should grow up in foster care. Conclusion: Women with ID and their children should be considered as risk groups in pregnancy and childbirth. Professionals in maternity services need to elucidate their knowledge and skills for counselling and supporting this particular group of pregnant women in pre-, intra- and post-partum care.
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Loewenberg, Weisband Jiska. "Midwives as prenatal care providers in the United States." The Ohio State University, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=osu1491485404224992.
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Jambert-Gray, Rosemary Anne. "The lived experience of breastfeeding methadone-treated mothers in early motherhood." Thesis, University of Brighton, 2014. https://research.brighton.ac.uk/en/studentTheses/19b756fb-59b2-4cb5-a5ba-d8338cc71759.
Full textAbstract:
Previously documented evidence suggests that motherhood is potentially an important time for change in drug-using behaviour. My research interest for this longitudinal phenomenological study stemmed from practice observations where methadone-treated women struggled to prove their trustworthiness as mothers. They consistently reported frustration in the face of continued professional suspicion of their identity as drugusers. The essence of the phenomenon is therefore described as an existential tension experienced by breastfeeding mothers in methadone maintenance treatment during the first 12 weeks of motherhood. The aim of this thesis is to reveal the previously hidden inter-subjective and social realms of their lived worlds.
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Mason, Nicola Anne. "Women's stories of planned Caesarean birth in their first pregnancy." Thesis, University of Brighton, 2015. https://research.brighton.ac.uk/en/studentTheses/25d9db17-afb8-40cb-b7d8-ac0ea265cc1d.
Full textAbstract:
Caesarean birth accounts for a quarter of all births in England and is the most commonly performed operation. Despite this, little is known of how individual women experience planned Caesarean birth. Reviews of the literature reveal that rising rates of Caesarean birth are preceived to be problematic by women ,clinicians and policy makers but women's experiences are either absent from this debate or perceived as universally realised. This qualitative study involved listening to the stories of eight women to reveal how planned Carsarean birth was experienced, understood and constructed.