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Storrie, Leslie H. "Learning midwifery : perceptions of the registered midwife". Thesis, University of Strathclyde, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.428171.
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Stevens, Trudy. "Midwife to midwíf : a study of caseload midwifery". Thesis, University of West London, 2002. https://repository.uwl.ac.uk/id/eprint/1079/.
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This thesis explores the implications of individual caseload practice for midwives. Over the past fifty years childbirth in England has become predominantly hospital oriented, with midwives forced to meet the needs of the institution rather than those of childbearing women. In 1994, a change in government policy for the maternity services attempted to address the dissatisfaction felt by mothers and midwives. The model for caseload midwifery was developed from their recommendations. Midwifery retains an ideology of independent practice yet the reality of working in a subservient position to obstetricians and controlled by the dictates of an institution have been seen in some studies to have undermined midwives' practice. However, their willingness and ability to work in a more independent manner was questioned. This study explored the implementation of caseload midwifery within a highly medicalised inner-city NHS maternity service. Working in partnership, within small groups, each midwife carried a caseload of 40 women per year. No longer based in the conventional hospital or community services, the midwives worked where and when appropriate, to meet the needs of their women. The research was undertaken over 46 months using an ethnographic approach and a variety of data collection methods. The prolonged study period facilitated an understanding of the development of caseload practice from its implementation into an established service. This thesis explores the adaptations the midwives needed to make on moving from conventional practice into caseload practice. Comparison of the difference services offers an understanding of the ways in which organisational features can influence the practice and meaning of midwifery. The control over and uses of time emerged as an important theme in this regard. Of particular note was the high level of job satisfaction expressed by the caseload midwives and their consideration that this model enabled them to practice "real midwifery", phenomena which are explored within the thesis. In working 'with' women, it is argued, the midwives developed a form of authority that had not been facilitated with the conventional services, and which contributed towards a new form of professionalism for the midwives. Although considered by many to be independent and 'isolationist', the strengths of caseload practice were seen to be in the context of group and inter-professional relationships, and the relationships midwives formed with mothers and their families as their work became re-embedded in the society in which childbirth occurred and had its meaning.
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Bäck, Lena. "Confidence in Midwifery : Midwifery students and midwives’ perspectives". Licentiate thesis, Mittuniversitetet, Avdelningen för omvårdnad, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:miun:diva-33560.
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A confident midwife has an impact on a pregnant woman’s clinical outcome and birth experience. Knowledge acquisition, competence, and confidence develops over a lifetime and is of great importance in developing and forming personal skills and allowing the personal traits to grow and mature. Previous international studies have shown that midwifery students do not feel confident in many areas in which they are supposed to practice independently. The aim of this thesis was to investigate confidence levels in basic midwifery skills in Swedish midwifery students in their final semester just before entering the midwifery profession. An additional aim was to describe clinical midwives’ reflections about learning and what factors that developes professional competence, and confidence. Study I was a cross-sectional survey with Swedish midwifery students (n=238). They assessed their own confidence in all competencies that a midwife should have and could practice independently. The results of study I confirmed that Swedish midwifery students feel confident in dealing with the most common procedures during normal pregnancy, childbirth, and postpartum and newborn care. However, they do not feel fully confident in cases in which there are deviations from the normal procedures and obstetric emergencies. When comparing groups of midwifery students, the younger group of midwifery students felt more confident in general compared to the older group. Students at a university with a medical faculty were also more confident than the students at a university without a medical faculty. In study II, focus group discussions were held with 14 midwives emphasizing the way in which midwives reflect on learning and the development of competence and confidence. Content analysis was used to analyze the focus group discussions. Four categories were identified as a result of study II: 1.) feelings of professional safety evolve over time; 2.) personal qualities affect professional development; 3.) methods for knowledge and competence expansion; and 4.) competence as developing and demanding. The conclusion of this thesis is that more practical and clinical training during education is desirable. Midwifery students need to have access and the opportunity to practice obstetrical emergencies within a team of obstetricians and pediatricians. Learning takes time, and one improvement is to extend midwifery education to include and increase in clinical training. This would strengthen the students theoretical, scientific, and clinical confidence. Clinical midwives claim that it takes time to feel confident and that there is a need to develop professionalism.En trygg barnmorska har en positiv inverkan för förlossningsutfall samt förlossningsupplevelse. Kunskap, kompetens och trygghet är ett livslångt lärande och har stor betydelse för att utveckla och forma personliga färdigheter, att låta de personliga egenskaperna växa och mogna. Tidigare internationella studier har påvisat att barnmorskestudenter känner sig otrygga inom områden där förväntas vara självständiga. Syftet med denna avhandling var att undersöka graden av trygghet hos svenska barnmorskstudenter strax innan de var färdigutbildade. Ett annat syfte var att utforska hur kliniskt verksamma barnmorskor reflekterar över lärande och vilka faktorer som bidrar till att utveckla yrkesmässig kompetens och trygghet. Studie I var en tvärsnittsundersökning med svenska barnmorskestudenter (n = 238). De bedömde egen trygghet inom alla kompetenser som en barnmorska förväntas kunna samt utföra självständigt. Resultaten av studie I bekräftade att svenska barnmorskestudenter känner sig trygga att hantera de vanligaste rutinerna vid normal graviditet, förlossning, eftervård samt nyföddhets vård. De känner sig emellertid inte fullt så trygga när något avviker från det normala samt vid obstetriska nödsituationer. Vid jämförelse mellan yngre och äldre barnmorskestudenter samt grad av trygghet, var det den yngre gruppen av barnmorskestudenter som kände sig tryggare i allmänhet jämfört med den äldre gruppen. Studenter vid ett universitet med en medicinsk fakultet var också mer trygga än studenterna vid ett universitet utan en medicinsk fakultet. I studie II hölls fokusgrupper med 14 barnmorskor, de diskuterade och reflekterade över hur barnmorskor utvecklar kompetens. Metod för att analysera var innehållsanalys, i resultatet framkom fyra kategorier 1.) känslor av professionell trygghet utvecklas över tid ; 2.) Personliga kvaliteter påverkar yrkesutveckling. 3.) metoder för kunskap och kompetensutveckling; och 4.) Kompetens som utveckling och krävande. Slutsatsen av denna avhandling är att mer klinisk träning under utbildning är önskvärt. Barnmorskestudenter behöver tillgång och möjlighet att öva obstetriska nödsituationer tillsammans i team bestående av förlossningspersonal och barnläkare. Det tar tid att lära samt att känna trygghet, en möjlighet att underlätta för studenter vore att utöka samt förlänga barnmorskeutbildningen, att inkludera mer klinisk träning. Detta skulle innebära att stärka studenters möjligheter till en utökad klinisk trygghet. Kliniska barnmorskor hävdar att det tar tid att känna sig trygg och att det ett finns behov av att utveckla professionalism.
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Barnes, Margaret. "Becoming a midwife : a case study of a women-centred midwifery curriculum". Thesis, Griffith University, 1998. http://hdl.handle.net/10072/380712.
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Midwifery education is in transition in Australia. Courses are being implemented in the university sector at a time when there is increasing debate and concern over the provision of maternity services. The idea of women-centred midwifery practice is developing as a guiding philosophy for midwifery, in order to focus the activities of midwifery practice on the needs of the childbearing woman. In response to these issues in midwifery, the Graduate Diploma Of Midwifery (Griffith University) was developed and implemented with an underpinning philosophy of women-centred practice and a commitment to teaching and learning approaches which emphasised self-direction, reflection and the idea of praxis. This research project has sought to under students' experiences of learning midwifery. In doing so, particulars of the curriculum are evaluated. The research approach draws on a feminist theoretical underpinning and uses processes and approaches congruent with qualitative evaluation.
The findings of this research are expressed in terms of students' experience of learning midwifery in this program but reflect broader concerns of the profession. These broader concerns include the potential of the relationship between woman and midwife and the issues of power in the progression. These issues have an impact on students' impressions of midwifery and their ability to interact with the midwifery community in the process of learning. The findings in relation to what helps students learn midwifery point to a different perception of clinical learning and have significance for developments of relationships between university and clinical agencies.
The findings of the study will contribute to midwifery knowledge as new insights, particularly in relation to the midwifery relationship and professional issues, are drawn. In considering the students experiences, professional concerns and the identified needs of childbearing woman, a theoretical framework for midwifery education is proposed. This theoretical framework has significance for the profession as it is applicable at the level of curriculum development, course planning or development of learning activities, and importantly, it contributes to knowledge in area of midwifery as a beginning theory of midwifery education.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Health and Behavioural Sc.
Griffith Health
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Vuso, Virginia Zanyiwe. "Enhancing clinical preparedness of basic midwifery students: perceptions of midwifery educators". Thesis, Nelson Mandela Metropolitan University, 2016. http://hdl.handle.net/10948/13204.
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Since the inception of the student supernumerary status, both globally and in South Africa, nursing and midwifery educators have been concerned about the clinical competencies of their students. Student clinical competency levels in South Africa are critical to midwifery practice, especially as most litigation against the Department of Health in South Africa concerns negligence in midwifery practice. In addition, the litigations mostly involve newly qualified midwives, thus suggesting a link with practice competency levels. Several challenges exist in the academic and practice environments regarding student learning, practice and clinical preparedness. Lack of support during clinical placement and a lack of facilities for use during clinical practice modules are among these challenges. Some students, due to the challenges they face with clinical learning and practice, fail to meet the practical competencies for examination entry requirements. Consequently, some of these students have to repeat the year or exit the programme. The current study sought to identify how to assist midwifery educators in their activities to prepare students for clinical placement readiness. The first objective of the study was to explore and describe the perceptions of midwifery educators regarding the need for additional measures to enhance the clinical preparedness of basic midwifery students before they are allocated to the clinical areas. The second objective sought to make recommendations that would further assist the midwifery educators to clinically prepare midwifery students before being allocated and placed in different clinical areas. A qualitative, explorative, descriptive and contextual research design was used for the study and the study was conducted at a nursing college in the Eastern Cape Province from August 2014 to January 2016. The research population consisted of midwifery educators at a nursing college and a purposive sampling technique was used guided by set criteria. Data were collected using focus group interviews. Four focus groups were used making a total of 17 participants. The principles applied for data analysis were those of Tesch’s method of data analysis, which were used to develop the themes and sub-themes. An independent coder assisted with the coding of the data for the purposes of trustworthiness. In addition, Lincoln and Guba’s model of trustworthiness consisting of the criteria of credibility, transferability, dependability and conformability was used to confirm the validity of the study while the ethical principles adopted were informed consent, justice, non-maleficence, privacy and confidentiality. The study found that the participants perceived numerous challenges that hindered the clinical preparedness of their students. These related to increased workload, lack of support from management and a lack of commitment on the part of students towards their studies. The participants also identified inconsistencies in clinical practice between the clinical midwives and the educators, and even among the educators themselves. This lack of consistency in turn causes confusion among the students and thus impacts negatively on their clinical practice preparedness. Based on these findings recommendations for clinical nursing practice, nursing education and research were made.
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Phiri, Wendy Augusta. "Perceptions and experiences of undergraduate midwifery students concerning their midwifery training". Thesis, Stellenbosch : University of Stellenbosch, 2011. http://hdl.handle.net/10019.1/6659.
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Thesis (MCur)--University of Stellenbosch, 2011.ENGLISH ABSTRACT: During the period 2006-2008 more than 50% of midwifery students at the college under study failed the midwifery training programme. The academic performance of students can be attributed to various factors, ranging from personal uniqueness and institutional aspects to the course content itself. Accordingly, this study aims to explore the perceptions and experiences of student midwives with reference to their training programme. The objectives set for the study were set to determine the perceptions and experiences of the student midwives with regard to: • guidance in the practical field, • classroom experiences • assessment procedures and • whether the students attribute their academic successes or failures to the training programme. A qualitative approach with a descriptive design was applied to determine the perceptions and experiences of the undergraduate midwifery students concerning their training programme. The population of this study was fourth-year students who have successfully completed their midwifery-training programme. Nineteen students consented to participate in the study. The trustworthiness of this study was assured by using the Lincoln and Guba’s criteria of credibility, transferability, dependability and conformability. A pre-test was completed. All ethical principles were met. Data was collected through focus group interviews, using an interview guide. The analysis of the data revealed that students attributed their academic failures and success to guidance received in the theoretical as well as the practical field. The findings displayed the frustration that the students experienced with the lecture method as a teaching strategy. Discontentment was perceived among the participants regarding the demarcation, which differed among lecturers. Students were of the opinion that certain content of the curriculum was intended for the doctors, and they indicated a need for the extension of class time, for the instruction of the theory, as the curriculum was perceived as “content heavy”. Guidance in the clinical field, by the clinical educators, was perceived as being positive, yet the student-clinical educator ratio was proving to be a challenge. Marking of tests and examination answer sheets was perceived as too strict. Recommendations Students must be active participants in the learning process, not passive recipients of information. Teaching methods (such as role-play, brainstorming, case studies, simulations, and group work), that expand and reinforce basic communication, intellectual and interpersonal skills, should be employed. Uniformity amongst midwifery facilitators, in terms of content selection, demarcations, classroom activities and assessment techniques, should be agreed upon prior to the commencement of a block period.
AFRIKAANSE OPSOMMING: Tydens die periode 2006-2008 was meer as 50% van die verloskunde studente by die kollege waar die studie gedoen was, onsuksesvol in die verloskunde program. Akademiese prestasie van studente kan aan verskillende faktore toegeskryf word. Hierdie kwessies wissel van persoonlike uniekheid en institusionele aspekte tot die kursus inhoud self. Dus poog hierdie studie om die persepsies en ervaringe van die student vroedvroue ten opsigte van hul opleidingsprogram te verken. Die doelwitte van die studie was om die persepsies en ervaringe van die student vroedvroue met betrekking tot: • praktiese leiding, • klaskamerondervinding, • assesseringsprosedures te bepaal en • of die studente hul akademiese suksesse en mislukkings aan die opleidingsprogram toe skryf. ʼn Kwalitatiewe benadering met ʼn beskrywende strategie was gebruik om die persepsies en ervaringe van die voorgraadse studente rakende hul opleidingsprogram vas te stel. Die populasie van hierdie studie was studente, in hul vierde jaar, wat reeds die verloskunde opleidingsprogram suksesvol voltooi het. Negentien studente het ingestem om aan die studie deel te neem. Die vertrouenswaardigheid van die navorsing is verseker deur van die Lincoln en Guba kriteria – geloofwaardigheid, oordraagbaarheid, betroubaarheid en bevestiging – gebruik te maak. ʼn Voorafgaande toets is voltooi. Al die etiese beginsels is nagekom. Data is ingesamel deur onderhoude met fokusgroepe te voer. ’n Onderhoudsgids is vir die doeleinde gebruik. Die data-ontleding het getoon dat studente hul akademiese mislukkings en suksesse aan die leiding wat hulle op teoretiese en praktiese gebiede ontvang het, toeskryf. Die bevindinge het die frustrasie wat die studente met die lesmetode as ’n onderrigstrategie ervaar, getoon. Ontevredenheid rakende die werkafbakening, wat verskil van lektor tot lektor, is ook waargeneem. Studente voel dat dele van die kurrikuluminhoud vir dokters bedoel is. Hulle is van mening dat meer klastyd nodig is om teorie te onderrig, aangesien die kurrikulum oorvol is. Hoewel die leiding op kliniese gebied, deur die kliniese opvoeders, positief ervaar is, is die student-opvoeder verhouding as ʼn uitdaging beskou. Die studente het gevoel dat hul toetse en eksamenantwoordstelle te streng nagesien was. Aanbevelings: Studente moet aktief by die leerproses betrek word en moet nie bloot passiewe ontvangers van inligting wees nie. Onderrigmetodes, wat basiese kommunikasie-, intellektuele en interpersoonlike vaardighede aanvul en versterk (soos byvoorbeeld rolspel, dinkskrums, gevallestudies, simulasies en groepwerk), moet ingespan word. Die fasiliteerders moet ooreenkom en ʼn eenvormige beleid, betreffende die kurrikuluminhoud, afbakening van werk, klaskameraktiwiteite en assesseringsmetodes, voor die aanvang van die blokperiode, daarstel.
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Bale, Barbara. "A comparative study of caseload managed midwifery care and team midwifery". Thesis, University of South Wales, 1999. https://pure.southwales.ac.uk/en/studentthesis/a-comparative-study-of-caseload-managed-midwifery-care-and-team-midwifery(580d8718-263f-4010-8914-ce59541327ec).html.
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Objective: To compare the efficacy, maternal satisfaction and midwife acceptability of caseload managed midwifery care and team midwifery. Design: Two midwives providing caseload care for 35 - 40 women were studied as were six whole time equivalent midwives providing team midwifery care. Women from each group completed questionnaires at set intervals. Individual interviews were carried out with the midwives and other maternity service providers. The key principles of safety (i.e. obstetric outcome) satisfaction, continuity of carer, communication, choice and control were the focus for comparison. Other outcomes were also measured. Participants: Seventy - nine women who were receiving care from caseload holding midwives were matched with the same number of women from the control group. The same caseload women (the intervention group) were sent questionnaires at 20 and 36 weeks of pregnancy and at 10 days and 6 weeks postnatally. Setting: Urban South Wales. Findings: Results suggested that women have positive views about midwifery care regardless of caseload or team care. Their level of satisfaction was enhanced by caseload care which also facilitated continuity of carer. Obstetric outcomes in terms of complication rates and patterns of care delivery were similar for both groups. However, women in this study who received caseload care, had more interventions such as induction or augmentation of labour, continuous fetal monitoring and systemic analgesia. Key conclusions: Improvements in care from the maternal perspective could be attributed to the attitudes and personal philosophy of the midwife in her willingness to share information, perhaps more so than to the model of care. Caseload midwifery however makes it easier to establish a supportive relationship. The personality of a midwife who chooses to work within a continuity scheme also appears to be an influencing factor. Finally, within this study, it is possible that the efforts to achieve better psychological outcomes were to the detriment of physical outcomes. Implications for practice: Any organisation of maternity care must prioritise the need for competent and supportive midwives above schemes that simply maximise continuity of carer. Any organisation of care should promote opportunities for information sharing, unity of care and a philosophy of individualised care.
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Garratt, Rosemary. "Connecting with women : the working lives of independent midwives and their perceptions of the mother-midwife relationship". Thesis, De Montfort University, 2014. http://hdl.handle.net/2086/9707.
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This study aimed to explore the lived experience of the working lives of midwives in the UK who practice independently of the NHS. It was designed to understand their motivations for working in this way and to explore their beliefs and values about midwifery care with particular emphasis on their perceptions of building and maintaining relationships with childbearing women. Hermeneutic phenomenology informed the methodology for the study and an adapted biographical narrative interpretive method (Wengraf 2001) was used for data collection. In depth qualitative interviews were carried out with twenty Independent midwives in the UK between 2007 & 2009. Data were analysed using Ricoeur's theory of interpretation (Ricoeur 1981). Keys findings indicate that motivated by a very strong sense of what it means to be 'with woman'; these midwives initially chose a career path in the NHS that enabled them to better enact this philosophy. However, constraints on their ability to enact this philosophy in the NHS combined with a desire to form more meaningful relationships with childbearing women and to support their individual needs informed a final move from the NHS into independent practice. Independent midwifery is experienced as very positive career move which results in considerable job satisfaction and an opportunity to use the full range of midwifery skills. Formation of the mother midwife relationship is perceived as a pivotal midwifery tool which facilitates understanding of individual childbearing women and their needs. Ricoeur's theory of interpretation (1981) is utilized to explain how Independent midwives form relationships with their clients in this context. The concepts of 'time', 'autonomy' and 'risk' are discussed in the light of study findings, contributing a unique insight into the working lives of Independent midwives, the mother midwife relationship and enactment of the 'with woman' philosophy in this context. The study also demonstrates that whilst there are many positive aspects of working as an Independent midwife there are also several constraints and potential vulnerabilities. These include the blurring of work/life boundaries, financial insecurity and the consequences of working with clients who often have very complex needs and particular expectations of the midwife-client relationship. Supporting women's choices, working flexibly to meet the needs of clients and respecting their right to autonomous decision making can place Independent midwives in a position of potential vulnerability and leave them subject to professional criticism.
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Blake, Jacqueline Diana. "Midwifery integration into hospital services". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/MQ59495.pdf.
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Sosa, Georgina. "Midwifery one-to-one support in labour : ethnographic study of midwife-led birth environments". Thesis, University of East Anglia, 2016. https://ueaeprints.uea.ac.uk/63941/.
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Background: This research is about midwifery one-to-one support in labour. One-to-one support in labour is associated with improved birth outcomes. Uncertainty exists however as to what it is that produces such positive birth outcomes. UK publications advocate the midwife to provide one-to-one support in labour, but research findings question their ability to focus entirely on women due to their medical, technological and documentation responsibilities. All of these studies were based within hospital environments and none were completed in the UK. This indicates a gap in knowledge concerning how midwifery one-to-one support translates into practice in the UK and within midwife–led environments. Methods: The aim of this research was to explore midwifery one-to-one support in labour in a real world context of midwife-led care. An ethnographic approach was completed over three case study sites (Alongside midwife-led unit, freestanding midwife-led unit and women’s homes) each including ten labouring women receiving midwifery one-to-one support in labour. Findings: Two main themes: Balancing the needs of the woman and balancing the needs of the NHS organisation. Inside the birth environment midwives used their knowledge, experience, intuition and motivation to synchronise six components. These included presence, midwife-woman relationships, coping strategies, labour progress, birthing partners and midwifery support. Outside the birth environment midwives experienced surveillance and territorial behaviours which were heightened during transfer from a midwife-led birth environment to the labour ward. Conclusion: When a ratio of one midwife to one woman was achieved, midwives were 100% available for a woman in their care. This enabled midwives to be constantly present when required and provide total focus to tune into the needs of women and synchronise their care. Although midwives balanced the needs of the NHS organisation this did not impact on midwives capability to be present with women in labour.
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Moore, Anne. "Pioneering a new model of midwifery care: A phenomenological study of a midwifery group practice". Thesis, Australian Catholic University, 2009. https://acuresearchbank.acu.edu.au/download/c1ec20c97ec4363469b02328dc65ba4dff9056fa30826fa9b06d89ff045d851b/2285618/65006_downloaded_stream_231.pdf.
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This study explores the essence of the experience of midwives working within a new midwifery model of care: A Midwifery Group Practice (MGP) and is one component in a quality assurance project to evaluate the new service. In March 2005 the Re-Birthing Report was released in Queensland. This report reviewed maternity services in Queensland and contained key recommendations and guiding principles which were subsequently endorsed by the Queensland Government. The Re-Birthing Report clearly articulates that maternity care in Queensland must change to meet the needs of women and families birthing in Queensland in the 21st Century (Hirst, 2005). Consequently this report was the catalyst for the metropolitan hospital in Queensland where this study was conducted, to implement a Midwifery Group Practice (MGP) model of care. A recently published Federal Government Review of Maternity Services in Australia has also made recommendations that will potentially enable midwifery models of care to be implemented throughout Australia (2009). An extensive review of the literature outlined relevant key issues including significant gaps in Australian research relating to case-load midwifery practice. No Australian research was found to specifically explore the midwives' experiences when pioneering new midwifery models of care, such as a MGP. The philosophical approach adopted for this study is Hermeneutics (interpretive) phenomenology. Hermeneutics is considered most relevant to this research as it is grounded on the ontological view that the interpretive process is the experience. Therefore, through phenomenology this study interpreted the essence of the experience of midwives pioneering a new model of midwifery care (the phenomena). Purposeful sampling was employed for this study as each participant was 'selected' purposefully for the contribution he or she could make towards the emerging theory.;The study received ethical clearance and approval by the Health Service Human Research Ethics Committee and the Australian Catholic University Human Research Ethics Committee. Semi-structured interviews were conducted, recorded and the information deidentified when transcribed, providing a rich source of data for analysis. The chosen method of data analysis employed was guided by Gadamer's theoretical model. This model is underpinned by the hermeneutic circle of understanding as proposed by Heidegger, which is viewed as one between pre-understanding of the phenomena and understanding. The hermeneutical circle is a circle of interpretation that moves forward and then backward beginning at the present and it is never closed or complete. Through this process of rigorous understanding and interaction the phenomenon under study was uncovered. The researcher became immersed in the data whereupon after transcribing the data further reflected and identified categories and themes. This process allowed a highly fluid process until a point of data saturation was reached. Essential elements which emerge from the midwives' experiences are revealed in this study and these will potentially impact on the sustainability of new MGP services. These essential elements are: work/life balance, shared group philosophy, group antenatal care, peer support/ case management, and organisational support. Notably and fundamental to all the elements that emerged from the midwives' experiences, was a Cultural of Trust.
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Hoffman, Bruce Lowell. "The cultural power of law : the criminalization, organization, and mobilization of independent midwifery /". Thesis, Connect to this title online; UW restricted, 2004. http://hdl.handle.net/1773/8852.
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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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Carter, Amanda. "Measuring Critical Thinking in Midwifery Students". Thesis, Griffith University, 2017. http://hdl.handle.net/10072/376220.
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Well-developed critical thinking skills are essential for autonomous midwifery practice but
strategies to develop these skills are often not made explicit in undergraduate education.
There is a dearth of studies investigating the development of critical thinking in
undergraduate midwifery students and no published tools that specifically measure critical
thinking in relation to midwifery practice.
This program of work aimed to evaluate and measure midwifery students’ critical thinking
skills in preparation for autonomous midwifery practice. The thesis is presented as a series
of published and unpublished works, comprising of six sequential and interlinked studies
with five overarching aims.
The methodology used in this body of work was a sequential mixed methods design, where
the data and results from one study provided a basis and direction for the next study. Initially,
a pilot study examined the effectiveness of an innovative assessment item involving root
cause analysis on the development of critical thinking abilities of undergraduate midwifery
students. Although the results indicated that this assessment item increased critical thinking
skills, only participants’ perceptions were measured and there was no validated measure of
critical thinking. There was also no baseline and post-intervention measure of critical
thinking to demonstrate causal effects of the teaching intervention.
In recognition of the need to use robust, reliable and valid tools to measure critical thinking,
the second study involved a systematic review of the literature. This review aimed to identify
an appropriate tool to measure critical thinking in midwifery. The review is presented in two
publications on 1) the reliability and validity of tools used to measure critical thinking in
nursing and midwifery undergraduate students; and 2) the efficacy of teaching methods
used to improve critical thinking in nursing and midwifery undergraduate education. These
systematic literature reviews found no measures specifically for midwifery and no tools that
measured the application of critical thinking in midwifery practice. Conclusions of the
reviews established the need to develop discipline specific instruments to explicitly measure
the application of critical thinking in midwifery practice. Given the complexity of critical
thinking in midwifery practice, a multimethod approach to the measurement of students’ critical thinking was chosen.
The next three studies involved the development, piloting and testing of three tools designed
to measure critical thinking in midwifery practice for undergraduate midwifery students. The
tools were named the Carter Assessment of Critical Thinking in Midwifery (CACTiM) -
(Preceptor/Mentor, Student, and Reflection). Psychometric testing of the three tools during
each pilot study provided preliminary evidence that all tools were reliable and valid measures
of critical thinking skills in midwifery practice.
The final study aimed to further establish the validity and reliability of the three CACTiM
tools. A matched cohort of students (n = 55) was used. Positive correlations were found
between the three scales and student characteristics, including Grade Point Average, year
level and previous qualifications. Results also indicated good reliability and concurrent
validity.
Critical thinking skills are vital for safe and effective midwifery practice. Assessment of
midwifery students’ critical thinking development throughout their degree program makes
these skills explicit, and could guide teaching innovation to address identified deficits.
Adopting a multimethod approach to the measurement of critical thinking in midwifery
captures the complexity of critical thinking in midwifery practice, and provides students with
useful and objective feedback from multiple sources. The use of reliable, valid and freely
available tools promotes and facilitates ongoing research into the development of critical
thinking in education and practice. It is therefore recommended that the three CACTiM tools
are implemented routinely and used in the longitudinal measurement of students’ critical
thinking development throughout midwifery education programs. The tools could also be
used to measure critical thinking for midwifery graduates and midwives in practice. Further testing of these tools with a larger, more diverse student sample is recommended.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Nursing & Midwifery
Griffith Health
Full Text
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Davies, Jacqueline. "Blurring the boundaries between midwifery and obstetrics : an exploration of the role of midwife practitioner in a maternity unit in Wales". Thesis, University of South Wales, 2008. https://pure.southwales.ac.uk/en/studentthesis/blurring-the-boundaries-between-midwifery-and-obstetrics(40182058-a1b5-4628-961a-5a5d7ab92fc6).html.
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This thesis explores the newly established role of midwife practitioner (MP) and its impact on midwives and obstetricians in a maternity unit in Wales. MPs manage the care of women at high obstetric risk and carry out aspects of care, such as assessment, diagnosis and the development of management plans, which in the past were predominantly performed by obstetricians. This qualitative study employs a focused ethnographic approach and uses a purposive sample. Phase one consisted of seven focus groups, which were held between May and August 2004, with midwives (n=48) from maternity units in Mid and South Wales. In Phase two, participant observation was undertaken with MPs (n=3) over a two-week period encompassing eight 12-hour night shifts, during November and December 2004. For Phase three, semi-structured interviews were conducted with midwives (n=10), clients (n=10) and obstetricians (n=7), between July and December 2005. Phases two and three were carried out in a maternity unit in South Wales. The key findings of this study demonstrate that the lack of planning for the MP role inadvertently resulted in the creation of a distinct health care role, which encompasses positive aspects of both midwives' and obstetricians' work to provide safe and acceptable care for clients. The MPs in this study are committed to providing holistic care that takes into consideration the emotional and social needs of women and their families. In addition, these MPs are developing confidence and analytical skills, normally demonstrated by medical staff. However, further initiatives such as allowing MPs to prescribe, or to refer to other specialties, have not yet been adapted to support these new roles. It is too early to see the full impact of this role, but it is argued that it will have no significant effect on the work of the other midwives. MPs, however, do have the potential to impact upon the work of the obstetricians. This study contributes to the current body of knowledge concerning policy and practice for maternity care by examining a new role early in its genesis. This study makes a number of recommendations, including extending the number of MPs employed in Wales, the need for careful planning of future extensions to the midwives' role and further research into the safety and effectiveness of the MP role.
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Olsson, Pia. "Antenatal midwifery consultations : a qualitative study". Doctoral thesis, Umeå universitet, Institutionen för omvårdnad, 2000. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-96903.
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Magill-Cuerden, Julia. "Educational relationships : a study in midwifery". Thesis, University College London (University of London), 2002. http://discovery.ucl.ac.uk/10019239/.
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At its inception in 1902, formal midwifery training developed within hospital midwifery services. With the development of a theoretical base, training became education during the 1980s. During a period of economic and societal changes in the 1990s, midwifery education was incorporated into higher education, separating education from health service practice. There were consequences for midwifery education especially the structure of pedagogical relationships. This thesis looks at key sets of relationships in midwifery education between the three main groups of actors: academics, clinicians and students. In so doing, the inquiry utilises a grounded theory approach and embraces disciplines of education, social sciences, social psychology, management and philosophy. The study confirms the importance of relationships between the key actors as part of a student's learning experiences. However, these relationships have become more problematic as a result of the organisational separation between the academic and professional components. A framework is proposed to describe educational relationships in midwifery. The framework has six dimensions; (i) a core component of personal traits, (ii) a secondary component of social and communication abilities and four subsidiary components of (iii) professional expertise, (iv) personal knowledge, (v) education knowledge and skills and (vi) a vision for practice. Realisation of the components by one person of another within the three groups aids mutuality in understanding. General principles are offered that include notions of encounter, exchange, rules, boundaries, reciprocity and reinforcement that aid in constructions of relationships. Though these conditions, in themselves, aid the formation of learning relationships, two processes occur in these relationships through encounters, that is, complementation (a unity of meanings between actors) and complementarity (a matching of understandings). These require a forum for encounters. A model of education is proposed that offers just such a forum aiding positive encounters to promote learning between the three groups of actors. Features of this model are the development of teachers within clinical practice, accreditation of practitioners as educators and the education of students primarily in clinical situations with interactive learning.
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Monk, Amy Rachel. "Evaluating midwifery units (EMU): a prospective cohort study of freestanding midwifery units in New South Wales, Australia". Thesis, The University of Sydney, 2014. http://hdl.handle.net/2123/13285.
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Objective: To compare maternal and neonatal birth outcomes and morbidities associated with the intention to give birth in two freestanding midwifery units and two tertiary level maternity units in New South Wales, Australia. Design: Prospective cohort study. Participants: 494 women who intended to give birth at freestanding midwifery units and 3157 women who intended to give birth at tertiary level maternity units. Participants had low risk, singleton pregnancies and were less than 28+0 weeks gestation at the time of booking. Results: Women who planned to give birth at a freestanding midwifery unit were significantly more likely to have a spontaneous vaginal birth and significantly less likely to have a caesarean section. There was no significant difference in the adjusted odds ratio of 5 minute Apgar scores. Babies from the freestanding midwifery unit group were significantly less likely to be admitted to neonatal intensive care or special care nursery. The freestanding unit group had similar or reduced odds of other intrapartum interventions and similar or improved odds of other indicators of neonatal wellbeing. Conclusions: The results of this study support the provision of care in freestanding midwifery units as an alternative to tertiary level maternity units for women with low risk pregnancies at the time of booking.
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Harvey, Sheila. "The relationship between outcomes and midwifery models". Thesis, University of West London, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.512009.
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Robilliard, Gabrielle. "Midwifery in early modern Germany, 1650-1810". Thesis, University of Warwick, 2010. http://wrap.warwick.ac.uk/55878/.
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This thesis explores the occupational structure and culture of urban midwifery practice in early modern Germany between 1650 and 1810. Following the Thirty Years War many larger cities began to reform midwifery provision. They were motivated partly by depopulation anxieties and partly by burgeoning civic confidence and prosperity. In the late seventeenth and early eighteenth century the Leipzig Council began to appoint midwife apprentices, introduced a municipal obstetrician (Stadtaccoucheur) to supervise its licensed midwives and carry out difficult operative deliveries, and began to provide its midwives with formal anatomical and obstetric instruction through the new Stadtaccoucheur. Drawing on municipal council records in the city of Leipzig, this thesis traces the varieties and forms of midwifery practice that existed within the urban setting and examines the impact of these reforms on the traditional culture of urban midwifery. It explores the structure of formal and informal midwifery, the socioeconomic and life cycle of midwives, client networks and the way in which midwives demarcated their occupational territory amongst themselves and with other practitioners. This thesis argues that these reforms were not driven by the state but were rather motivated by the Leipzig Council, the citizenry and midwives themselves. Moreover, these reforms served to reinforce rather than change the existing occupational structure and culture of urban midwifery in Leipzig, which was grounded in the moral economy of livelihood.
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Lehrman, Ela-Joy. "A theoretical framework for nurse-midwifery practice". Diss., The University of Arizona, 1988. http://hdl.handle.net/10150/184546.
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The purpose of this research was to test the predicted relationships among a component of nurse-midwifery care, psychosocial health outcomes and other maternal psychosocial variables. The theoretical framework for the research was the Intrapartum Care Level of the Nurse-Midwifery Practice Model, a middle range theory. Previous nurse-midwifery research had been based on theories and models not specific to nurse-midwifery practice. A nonexperimental, correlational design was used, with measures in the last trimester of pregnancy and the first month following birth. The psychosocial variables measured were prenatal care satisfaction, personable environment, positive presence, labor support, transcendence, labor satisfaction and enhanced self-concept. Purposive sampling was used at a birth center in a Southwestern city where women received nurse-midwifery care for pregnancy, labor and birth. The sample of 89 women consisted of 35 primiparas and 54 multiparas, with a mean age of 29 years; 46.1% gave birth at the birth center and 53.9% gave birth at a local hospital. The primary instruments for the research included the Prenatal Satisfaction Questionnaire, the Attitude Toward Issues in Choice of Childbirth Scale, the Positive Presence Index, the Labor and Birth Support Inventory, the Coping in Labor and Delivery Scale, the Labor and Delivery Satisfaction Questionnaire, and the Self-Confidence Scale of the Adjective Check List. The secondary instruments, used for the evaluation of construct validity, included the Positive Presence Index - Alternate Format, the Labor and Birth Coping Index, the Labor and Birth Satisfaction Index, and the Self-Concept Index - Alternate Format. Acceptable levels of reliability and validity were obtained for the instruments. The predicted relationships from the Model were tested with causal analysis using multiple regression and residual analysis. The empirical rather than the theoretical model was supported by the data. Prenatal care satisfaction, personable environment, positive presence and transcendence explained 66% of the variance in labor satisfaction, with an additional 2% explained variance with the addition of the situational variable of consultation. Positive presence had the greatest direct effect (B =.70) and also explained 5% of the variance in enhanced self-concept. The empirically significant relationships were clinically relevant.
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Fannin, Maria. "Midwifery as mediation : birthing subjects and the politics of self-determination /". Thesis, Connect to this title online; UW restricted, 2006. http://hdl.handle.net/1773/5619.
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Duffy, Elizabeth P. "Bottle-feeding mothers' experiences of coping in a pro-breastfeeding context : the case for a caring-options-responsive model of midwifery services". Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2002. https://ro.ecu.edu.au/theses/750.
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The original contribution of this qualitative study is that it sketches the front-line of the contested domain of infant feeding choices by exploring the under-researched experiences and perceptions of mothers who actively choose to bottle-feed their babies. Twelve bottle-feeding mothers in Western Australia participated in open-ended, in-depth interviews. The interview findings were further explored using participant observations of relevant hospital practices and critical, hermeneutic re-readings of midwifery's professional and policy documents. The thesis argues that bottle-feeding is marginalised by the midwifery profession that currently defines its practices in accordance with policies such as the Baby Friendly Hospital Initiative. Bottle-feeding mothers described experiencing negative, antagonistic encounters with midwives moralising about infant feeding choices, pressuring them to choose breastfeeding, and obstructing rather than supporting their infant feeding choice. The bottle-feeding choice is often marginalised in the literature by the deployment of nebulous concepts about parental emotions, most notably so-called "mother-child bonding". However, the mothers presented an identifiable "bottle-centric" perspective by which they considered bottle-feeding the best choice to support their priorities of overall life-style organisation, avoidance of discomfort and anxiety, and optimal family inter-relationship dynamics. Notably, the bottle-centric perspectives described breastfeeding as a threat to those goals and values. This study also identifies a previously unexplored phenomenon of the mothers' concept of “father bonding" with its symbolic meanings of bottle-feeding for the mother desiring the father's emotional involvement with the baby. A speculative theory of an evolved socio-biologic concept of "Father bonding/bondage" is forwarded. Theoretical dimensions of current health belief models, especially that underlying the BFHI, cannot adequately recognise or service this client group's needs. Bottle-feeding mothers intelligently engage in health decision-making processes when deciding their infant feeding options, considering a broad range of factors to optimise their family relationships. However, the mothers' value systems are diametrically opposed to those of the midwifery profession. Midwifery's approach to limiting information and practical educational demonstrations of bottle-feeding is a key aspect of marginalisation. The mothers strongly criticised bias in antenatal classes, poor support for their own training in bottle-feeding, experiences of learning by making mistakes, and some mothers afforded more credibility to advice from sources outside midwifery. These alarming findings appear to result from WHO/UNICEF anti-marketing principles mistakenly being generalised to educational functions in the BFHI policy. Variations in the mothers' levels of satisfaction with their experiences in hospitals depended upon whether facilities suited or inconvenienced their needs, how efficiently hospital administrative procedures upheld their choice, and staff attitudes towards them. Major differences appeared related less to public or private sector differences and more to how well facilities were oriented towards either bottle~ feeding or breastfeeding. Exemplary support should be provided to both breast- and bottle-feeding client groups but will require a more sophisticated approach. Practical suggestions for developing and disseminating more timely and relevant information and support for bottle-feeding, and suggested research projects to expand the present study's findings are forwarded. The thesis proposes a "Caring Options- Responsive" model of Midwifery services suited to fully informing and respectfully supporting clients in their choice.
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Rattray, Janene. "A grounded theory study of midwives' decision-making: Use of continuous electronic foetal monitoring on low risk labouring women". Thesis, Australian Catholic University, 2006. https://acuresearchbank.acu.edu.au/download/010c47186c8b7d38e2c3a06ec2a8ebb7db6b0ca9bfa78129b7ef18ca85856b36/1452927/65059_downloaded_stream_284.pdf.
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Many midwives continue to use Continuous Electronic Foetal Monitoring (CEFM) on low risk women in labour, despite overwhelming clinical evidence that it is unnecessary. The use of CEFM on low risk labouring women has been linked to rising rates of medical intervention during labour and birth with no improvement in long term neonatal outcomes. This study examined the decision-making processes of midwives who used CEFM on low risk labouring women. Whilst a number of previous studies have examined various aspects of CEFM, none specific to midwives' decision-making and CEFM on low risk labouring women. This study contributes to the literature in this specific area. The theoretical origins of Symbolic Interactionism and Grounded Theory (GT) methods underpin this study. SI, a sociological theory that emphasises meaning in human interactions and behaviours is used in this study to focus on the behaviours and interactions of five midwives'when deciding to use CEFM on low risk labouring women. Primary data were collected by conducting unstructured interviews and systematic analysis was undertaken using GT methods to generate a substantive theory of: Midwives' CEFM decision-making despite evidence based guidelines. The midwives made the decision that led to CEFM at two key points in the woman's labour care. Firstly, during the initial assessment of the woman and foetus, some midwives decided to use a baseline CTG rather than intermittent auscultation (IA). Secondly, following initial assessment, the midwives made an individualised assessment and decided whether to use CEFM as the method to monitor the foetus during labour. Trust was identified as the core variable, having a profound effect on the midwives' decision-making at these two points. Another significant factor that impacted on decision-making was staff workload.;Recommendations relating to these findings promote that labouring women be central and intimately involved in decisions about foetal monitoring. Workplace reforms, such as the introduction of midwifery led models of care for women within a community setting are recommended to address professional trust and workload issues. Through the implementation of these recommendations it is expected that midwives will embrace the notion of woman centred care and that the unnecessary use of CEFM on low risk labouring women will be reduced.
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Gillen, Patricia A. "The nature and manifestations of bullying in midwifery". Thesis, Ulster University, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.487401.
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Bullying in midwifery is a stark reality for many midwives, yet it is relatively unchartered and poorly understood. The aim of this study was to define and examine the nature and manifestations of bullying in midwifery. Literature on bullying in schools and other workplace bullying literature was reviewed to determine what is already known about bullying in the workplace. This study used an exploratory descriptive design and took· a mixed method approach in four sequential phases. A tentative framework took a timeline (before/during/after) approach. In Phase one, in-depth telephone interviews were undertaken with midwives from practice and academia. In Phase two of the research.a concept analysis using Walker and Avant's (1995) framework provided a sound theoretical basis for the study. Phase Three confirmed, validated and contextualised the findings of the concept analysis through focus groups with practicing midwives, midwife managers, academic midwives and union representatives. A more substantial theory emerged at this stage. In order to develop a survey tool to measure the defining attributes of bullying, a self-administered questionnaire was developed, piloted and distributed to a convenience sample of student midwives (n=400) at a student conference. The response rate was 41% (n=164). This work confirmed the theoretical development comprehensively. Bullying in midwifery has now been identified, defined, validated and confirmed. The defining attributes were confirmed as being a repeated behaviour which had a negative effect on the victim and against which the victim found it difficult to defend themselves. Intention of the bully was also considered to be an important defining attribute with more than half of the student midwives who had been bullied (53%; n=31) perceiving the bullying behaviour experienced to be intentional. Recommendations for research, education and practice are made. This research contributed to knowledge through the completion of a concept analysis of workplace bullying which had not been done before. An additional confirmatory process was designed and incorporated within the concept analysis process and a new model of bullying in midwifery has been formulated.
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Burtch, Brian E. "Midwifery practice and state regulation : a sociological perspective". Thesis, University of British Columbia, 1987. http://hdl.handle.net/2429/26966.
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Midwifery practice in Canada is anomalous in that, unlike other industrialized nations, a distinct legal status for nurse-midwives and community midwifery has yet to be established. Despite this constraint, community midwifery has survived the lack of institutional support for home births and legal prohibitions directed against it the manner of State regulation of midwives is a central issue in this study. It is shown that the State shapes the possibilities of midwifery in a contradictory manner, promoting midwifery on the one hand, and prosecuting and restricting midwifery practice on the other. A modified structuralist perspective on the State is developed with respect to midwifery. The Canadian State serves to limit possibilities for midwifery through various provincial enactments in quasi-criminal law, through the greater likelihood of criminal prosecution of midwives than physicians or nurses, and through funding of the established professions and hospitals.
This thesis then, offers a critical examination of the anomalous occupational and legal status of Canadian midwives, using historical materials on the development of midwifery practice and cross-cultural data on the role of midwives in traditional cultures. It is argued that many of the reservations about community (lay) midwives are no longer applicable, and that the containment of nurse-midwives reflects an historical accommodation between the nursing and medical professions in Canada. This accommodation meets the need for highly-skilled obstetrical nurses or nurse-midwives within the tradition of physician dominance in health care.
A major empirical focus of the study is a documentary analysis of birth records from community midwives, primarily in British Columbia and Ontario, between 1972 and 1986. Analysis of the data confirms that qualified community midwives, working under normal circumstances, manage births safely and with a minimum of interventions during labour and delivery, and during the prenatal and postpartum periods. Where comparisons with provincial and national populations are available, women attempting home birth under the care of a community midwife tend to have lower rates of forceps delivery, caesarean section, and episiotomy. These women are also likely to deliver their babies in positions other than the standard lithotomy position or prone position, and to have a lower incidence of perineal tears. Nevertheless, difficulties associated with the unregulated and often idiosyncratic situation of community midwives are underscored, particularly with regard to establishing guidelines for domiciliary midwifery.
Data from the Low-Risk Clinic at Vancouver's Grace Hospital, together with reports on other nurse-midwifery programmmes, reinforce the claim that nurse-midwives can practice autonomously in providing prenatal care, assistance in labour and delivery, and postnatal care. The likelihood of realizing autonomous midwifery practice depends upon the particular agendas of the State, the structural interests of the professions, and the initiatives of midwives and health consumers who lobby for certification of safe alternatives in maternal and infant care.Arts, Faculty of
Anthropology, Department of
Graduate
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Hancock, Heather Ann. "Discovering opus - exploring creativity in midwifery and nursing". Title page, table of contents and abstract only, 2002. http://web4.library.adelaide.edu.au/theses/09PH/09phh2346.pdf.
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"June 2002" Bibliography: leaves 478-504. The aim of the research for this thesis was to enable midwives and nurses to express and explore their feelings, thoughts and perceptions about their roles, work and themselves as professionals through a focus on creativity. 227 nurses and midwives were involved in considering diverse perspectives of their professional practice and personal lives, and creativity touched a particular chord with them. The research included a critical history of nursing and midwifery over the last 25 years in Australia, a phenomenological study into nurses' and midwives' lived experiences of creativity, and a quantitive investigation assessing their self-perceived creativity. This was followed by a grounded theory inquiry pertaining to creativity in practice and related personal perspectives.
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James, Susan Gail. "With woman, the nature of the midwifery relation". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp05/nq21582.pdf.
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Butler, Michelle. "Definitions of midwifery competence : implications for professional learning". Thesis, University of Nottingham, 2001. http://eprints.nottingham.ac.uk/11243/.
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This study explores the nature of competence required to fulfil the role of the midwife, learning to become competent, and professional learning beyond registration. The research was undertaken through a qualitative, case study approach, exploring competence as a phenomenon, as experienced by thirty-nine student midwives as they went through the final stages of pre-registration midwifery education programmes, were assessed to be competent, and took on the role of the midwife. The views of the thirty-nine participants of competence and of their own capability, development and learning, were compared with the views of teachers, assessors, other midwives, and supervisors of midwives, working with participants. Also explored are the characteristics of the expert and the characteristics of good and bad midwives. The case is made early on in the thesis that a definition of competence is required for midwifery to develop as a profession, to protect the public, and to facilitate midwife development pre and post registration. Towards achieving this, the research begins to construct a model of midwifery competence as an integrated, holistic concept. The research explores the relationship between the various components and dimensions in the integrated model and the factors involved in being competent across contexts and from situation to situation. Factors involved in the maintenance of competence over time and in learning beyond registration are identified by exploring the nature of learning beyond registration and the characteristics of good and bad midwives.
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Harris, Tina. "Midwifery practice in the third stage of labour". Thesis, De Montfort University, 2005. http://hdl.handle.net/2086/3350.
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This thesis investigated practice variation among midwives during the third stage of labour. The study aimed to identify and explain the variety of ways midwives managed the third stage and to see if it was possible to identify midwife characteristics associated with different third stage management practices. Initially emphasis was placed on models of midwifery care in labour and the mechanism by which midwives developed expertise in third stage management. A qualitative approach was used based upon the principles of grounded theory with the constant comparative method utilised to collect and analyse multiple types of data simultaneously. Fifty one midwives employed in two NHS trusts were interviewed with the practice of a further seven midwives observed. An analysis of computer records also took place together with analysis of twenty eight editions of two midwifery textbooks published throughout the 20th century. Multiple types of third stage management were described with inter and intra practice variation revealed among midwives. The complexity of third stage care was exposed through the identification of 22 aspects to third stage practice with between two and five care options available for each aspect. A theory of contingent decision making for the third stage of labour was revealed which explained how midwives adopted different forms of care through a complex decision making process which was contingent on the learning opportunities midwives were exposed to, the context in which practice decisions were made and the philosophical underpinnings of midwifery care. Practice variation was explained within this multi-factorial framework. The thesis highlights the difficulties in standardising midwifery practice and questions the validity of doing so. In this study practice variation in third stage care was a reflection of the individuality of midwives and the way midwives chose to individualise the care of women. In light of this a reappraisal of comparative studies in third stage management is needed together with an evaluation of the role of practice guidelines which attempt to standardise practice.
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Surtees, Ruth Joy. "Midwifery as Feminist Praxis in Aotearoa/New Zealand". Thesis, University of Canterbury. Educational Studies and Human Development, 2003. http://hdl.handle.net/10092/1662.
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This thesis highlights the ways in which the practices of contemporary midwives in
Aotearoa/New Zealand are caught within the intersection of an array of competing
discourses. The context for this is the reconstruction of midwifery in Aotearoa/New Zealand
as an autonomous feminist profession founded on partnership with women. Interviews and
participant observation with midwives, based mainly in one New Zealand city, are the basis of
an analysis of the complexity of midwives’ praxis as professionals. The analysis draws on
insights from critical and feminist approaches to Foucault’s theories of discourse, power and
the subject. It includes discussion of the conditions which came to produce and authorise the
concept of ‘partnership’. Which subjects can speak about partnership, and when? What claims
are made about it? What challenges it?
Partnerships between midwives and women are theorized in the thesis as highly complex and
contingent networks of strategic and productive relations. Differing sites of
practice/negotiations are analysed as spaces of/for governance. For midwives this negotiative
work takes place within the contested terrain of what is (re)constructed as ‘normal birth’. This
includes the provision of, or resistance to, epidural analgesia/certification and defensive
practice. These practices and knowledges are undertaken within professional discourses of
women’s/consumer choice and midwifery accountability. While midwifery’s theoretical and
emancipatory political projects are articulated as a counter discourse to medical hegemony,
some midwifery practices inadvertently re-inscribe pregnant/birthing bodies within medicolegal
frameworks. This is an outcome, not of the sovereign power of obstetrics over
women/midwives, but of attempts by midwives themselves to negotiate heterogeneous forms
of risk and keep birthing women, and their own practices, safe. Within these relationships and
practices of freedom, the midwife performs professionally to construct herself as what I call
an ‘auditable subject’. These processes produce self-regulation and the disciplinary
normalisation of midwives/midwifery. The technologies of the midwife/self occur within the
relations of ruling that render the pregnant/birthing bodies of women, and the labouring
bodies of midwives, increasingly amenable to subtle forms of liberal governance.
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Hollins, Martin Caroline J. "An analysis of social influence in midwifery practice". Thesis, University of York, 2006. http://etheses.whiterose.ac.uk/14088/.
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Fleming, Tania Dawn. "Enhancing Awareness of Cultural Safety Among Midwifery Academics". Thesis, Griffith University, 2018. http://hdl.handle.net/10072/382674.
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This PhD aimed to improve awareness of Cultural Safety amongst midwifery
academics. The provision of culturally safe educational experiences and learning and teaching practices are key strategies to improving the academic success of First Peoples students. This PhD thesis with publication is presented in nine chapters and consists of six manuscripts which have been published or are under review. The first chapter introduces the background, aim, significance, and an overview of the studies.
Chapter two is presented in three parts. Part one explores the intersection between my PhD research program, my position as a non-Indigenous researcher, and my
reflexive self. Part two outlines the development of a conceptual framework that underpins this research. A reframed standpoint theory was developed that blends
cultural, Indigenous and feminist standpoint theories. This reframed standpoint theory
guided the mixed methods used across this PhD program and is described in Part three.
Study one was an integrative systematic review of educational strategies to promote academic success and resilience in undergraduate Indigenous students. The included papers were critiqued from a standpoint theory approach that reflected
feminism, cultural respect, and humanism. Key strategies for Indigenous student success were found to be multi-faceted and underpinned by principles of respect, relationships, and responsibility. The review identified a relative lack of published research in this field and few validated measures.
Study two was an integrative review of the literature on the scope and efficacy of professional development interventions to increase awareness of Cultural Safety by
midwifery academics. Papers were assessed using the Critical Appraisals Skills
Program (CASP) guidelines. Concepts were mapped thematically. Five broad themes
emerged: Cultural Terms, Knowledge of Culture, Cultural Education, Cultural Aspirations/Desire and Culture in Curricula. This study found no agreed best practice framework to support awareness of Cultural Safety for midwifery academics. Cultural Safety needs to be embedded into professional development plans for midwifery
academics.
Study three aimed to develop a tool measuring awareness of Cultural Safety. A staged model for tool development included; generation of items, content validity
testing and expert First Peoples cultural review, administration of items to a convenience sample of academics, and psychometric testing. An online survey was
completed by academics (n = 42). The Awareness of Cultural Safety Scale (ACSS)
was found to be reliable (Cronbach’s alpha of 0.87) and valid. Three factors were generated with sound internal reliability. There was a significant correlation between ACSS and Awareness of Racism scores.
Study four implemented and evaluated a continuing professional development intervention to improve midwifery academics’ awareness of Cultural Safety. A prepost intervention mixed methods design was used. The intervention consisted of two workshops and five yarning circles across a semester. Data included responses on the ACSS, self-assessment on cultural knowledge and perceptions of racism, evaluation of the intervention, participants’ journal entries, and researcher’s
reflections. Participants awareness of Cultural Safety improved after attending the professional development program. Participants reported a high level of satisfaction with the workshops and yarning circles.
Study five explored the impact of yarning circles within a professional development program to enhance midwifery academics’ awareness of Cultural Safety with eight
participants. Interviews were analysed using a staged thematic analysis process. Six
key themes that centred on participants’ sense of belonging, sense of safety, sense knowing, sense of support, sense of difference, and sense of challenge were identified. These concepts were supportive of participants’ developing awareness of Cultural Safety.
Study Six examined awareness of Cultural Safety within the broader midwifery
profession. An online survey design included the Awareness of Cultural Safety Scale – Revised (ACSS-R), Self-assessment of Cultural Knowledge and Perceptions of Racism scales. Members of the Australian College of Midwives or the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives were invited to participate.
The ACSS-R was found to be reliable and valid, but the low response rate (n=92) may reflect implicit bias in the workforce towards Cultural Safety. The thesis concludes with a discussion of the overall findings and conclusions. The limitations of the program of work are outlined. Implications and recommendations for further research, education and practice are outlined.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Nursing & Midwifery
Griffith Health
Full Text
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Wier, Jacqueline Alyson. "Protecting the public : the current regulation of midwifery". Thesis, University of Kent, 2015. https://kar.kent.ac.uk/54351/.
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Throughout the 20th century, the regulatory frameworks that govern midwifery in the UK have grown, such that the current practice of midwifery and the provision of maternity care are now influenced by a myriad of regulation. Despite these controls there is little empirical data, especially in relation to the practice of midwives, which demonstrates the effectiveness of these systems and strategies. Whilst maternal mortality rates are at an all-time low, patient safety incidents still occur and claims of clinical negligence have continued to climb over the past thirty years. This raises the question of whether the regulatory mechanisms which are designed to ensure the health and wellbeing of the pregnant woman undermine or promote quality care and, whether the current statutory aim of ‘protecting the public’ is being realised. Whilst this is too ambitious a question to resolve fully in a doctoral thesis, I aim to make a contribution to answering it by giving voice to one specific group who are particularly well placed to comment but to whose voices are rarely heard, namely midwives. The study offers a socio-legal exploration of midwifery governance through an examination of the understanding and experience of a group of midwifery practitioners. The study gathered both quantitative and qualitative data from a cohort of midwives practising in the South East of England between the period of May 2012 and March 2013. This data was analysed in order to establish the views and opinions of the midwives in relation to the regulatory frameworks. As a result, a complex picture of regulation emerged, with a particular focus on the importance of clinical governance, the Nursing and Midwifery Council and statutory supervision of midwives. The themes that emerged included: the impact of regulation on the provision of care, the role of regulation in facilitating woman centred care, and the unease about mechanisms used to address issues of poor practice. Whilst good practice was evident, concerns and challenges also arose in terms of the regulatory framework, which, to the study participants, at times did not appear to support the provision of safe quality care.
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Cornell, Peta Kathleen. "An exploration of midwifery students’ perceptions of clinical facilitators and experiences of clinical facilitation during midwifery clinical placements in Perth, Western Australia". Thesis, Curtin University, 2022. http://hdl.handle.net/20.500.11937/89146.
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Clinical facilitation is a model of supervision for students during professional practice experiences, with little known about this important aspect of midwifery education. A qualitative descriptive exploratory approach with thematic analysis was used to develop knowledge and understanding of undergraduate midwifery students’ experiences with such supervision in Western Australia. Midwifery clinical facilitation was highly valued by midwifery students. Respondent insights and recommendations will be instrumental in further developing and enhancing midwifery models of clinical supervision.
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Sembou, Evangelia. "'Midwifery' and criticism in G.W.F. Hegel's Phenomenology of spirit". Thesis, University of Oxford, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.323747.
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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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Gcawu, Luleka Patricia. "Factors affecting quality of care in a midwifery practice". Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/71815.
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Thesis (MCurr)--Stellenbosch University, 2012.ENGLISH ABSTRACT: The midwives are the backbone of midwifery practice with needs and opportunities to create a tradition of caring in midwifery. However, there are problems that affect the midwifery practice. These problems include the increased maternal and perinatal mortality rate, shortage of material and human resources and poor implementation of policies and guidelines. The purpose of this study was to investigate factors that affect quality of care in a midwifery practice at a hospital complex in the Eastern Cape Province, South Africa. The objectives of the study focused on the structure and process standards. - 1 Structure Standards: To determine whether • policies and procedure manuals are available and updated • support from the supervisor is available • there is adequate staff • the required qualifications were available • the required experience of registered midwives were available • in-service training was being given - 2 Process standards : To determine whether • patients were assessed according to the national guidelines for maternity care • patients were diagnosed according to the national guidelines for maternity care • patients’ care plans were formulated according to the national guidelines for maternity care The descriptive research design with a quantitative approach was applied in this study. The target population (N=172) were the registered midwives working in the maternity department at a particular hospital in the Eastern Cape Province. A specific sampling method was not applied in this study as the total population of 155 was included and17 in the pilot study with a response rate of 81.3%. A self-administered structured questionnaire was used to collect the data. The researcher distributed the questionnaires personally to all respondents who met the criteria. Reliability and validity were assessed by means of a pilot study and the use of experts in Nursing Education, Midwifery, Research Methodology and Statistics. Ethical approval was obtained from Stellenbosch University and all other relevant parties. Computerized data analysis software namely the SPSS programmes and Stastica version 9 were used to analyze the data. The results of the study were interpreted, discussed and presented in tables and frequencies. The data was predominantly presented in a quantitative form with responses to a few close-ended questions. A confirmatory analysis to test the quality of properties across a level of variables was carried out. The Chi-square test was used to test association of variables between demographic data and the responses of midwives to factors affecting quality of care. A p-value of p< 0.05 represents statistical significance in hypothesis testing and 95% confidence intervals were used to describe the estimation of unknown parameters. Results showed that the majority of respondents had an experience of 2 to 5 years (n=34/27.0%) and (n=32/25.4%) more than 14 years working in the maternity department. The minority of respondents were those that are highly skilled. Only (n=4/3.2 %) of the midwives were registered in neonatology nursing and (n=9/7.1%) in advanced midwifery. The majority of respondents (n=118/93.7%) recorded that there was not enough staff to provide quality nursing care. Some respondents recorded that comprehensive in-service education was not offered in the hospital (n=18/14.3%). Recommendations include improvement of staffing, adherence to policies and guidelines, proper implementation of staff development and quality improvement programmes. In conclusion, in order to reduce high infant and maternal mortality rates and to reach the millennium development goals, shortcomings in midwifery should urgently be addressed.
AFRIKAANSE OPSOMMING: Die vroedvroue is die ruggraat van die verloskunde-praktyk met behoeftes en geleenthede om ’n tradisie van versorging in verloskunde te skep. Nietemin is daar uitdagings wat die praktisering van verloskunde beïnvloed. Hierdie uitdagings sluit in die toenemende moeder en perinatale mortaliteit, ’n tekort aan materiële en menslike hulpbronne, en die swak toepassing van beleid en riglyne. Die doel van hierdie studie was om die faktore te ondersoek wat die kwaliteit van sorg in ’n verloskunde-praktyk by ’n hospitaalkompleks in die Oos-Kaap in Suid-Afrika, beïnvloed. Die doelwitte van die studie was op struktuur en proses standaarde gefokus. - 1 Struktuur standaarde: Om te bepaal of • beleid en prosedure handleidings beskikbaar en opgedateer is • daar ondersteuning van die toesighouer is • daar voldoende personeel is • daar voldoen is aan die vereiste kwalifikasies • die vereiste ondervinding van geregistreerde vroedvroue teenwoordig • is indiensopleding gegee - 2 Proses standaarde: Om te bepaal of • pasiënte assesseer is volgens die nasionale riglyne vir verloskunde • pasiënte gediagnoseer is volgens die nasionale riglyne • pasiëntversorgingsplanne geformuleer is volgens die nasionale riglyne vir verloskunde. Die beskrywende navorsingsontwerp met ’n kwantitatiewe benadering is in hierdie studie toegepas. Die teikenbevolking (N=172) is die geregistreerde vroedvroue wat in die kraamafdeling van die spesifieke hospitaal in die provinsie van die Oos-Kaap werk. ‘n Spesifieke steekproefmetode is nie vir die studie toegespas nie maar wel die hele populasie is betrek van 155 en 17 in die lootsstudie met ‘n respons van 81.3%. ’n Self-geadministreerde gestruktureerde vraelys is gebruik om die data te versamel. Die navorser het die vraelyste persoonlik aan al die beskikbare respondente wat aan die kriteria voldoen het, versprei. Betroubaarheid en geldigheid is geassesseer deur middel van ’n loodsondersoek en deur gebruik te maak van spesialiste in Verpleegopleiding, die Navorsingssentrum en Statistiek. Etiese goedkeuring is verkry van die Universiteit Stellenbosch en al die ander relevante partye. Gerekenariseerde data-analise sagteware, naamlik die SPSS programme en Statistica uitgawe 9 is gebruik om die data te analiseer. Die resultate van die studie is geïnterpreteer, bespreek en aangebied in tabelle en frekwensies. Die data is oorwegend in ’n kwantitatiewe formaat aangebied met response op ’n paar geslote vrae. ’n Bekragtigingsanalise om die eienskappe oor ’n vlak van veranderlikes te toets, is gedoen. Die Chi-kwadraat toets is gebruik om assosiasie van veranderlikes te toets tussen demografiese data en die response van vroedvroue vir faktore wat die kwaliteit van versorging beïnvloed. ’n P-waarde van p<0.05 verteenwoordig statistiese beduidendheid in hipotese-toetsing en 95% sekerheidsintervalle is gebruik om die beraming van onbekende parameters te beskryf. Resultate dui aan dat die meerderheid van respondente 2 tot 5 jaar werkervaring (n=34/27.0%) het en (n=32/25.4%) meer as 14 jaar in die kraamafdeling het. Die minderheid respondente is diegene wat hoogsbekwaam is. Alleenlik (n=4/1.0%) vroedvroue is in neonatale verpleging gereistreer en (n=9/7.1%) in gevorderde verloskunde geregistreer is. Die meeste respondente (n=118/93.7%) het aangedui dat daar nie voldoende personeel is om kwaliteit verpleegsorg te gee nie. Sommige respondente het aangedui dat omvattende indiensopleiding nie in die hospitaal aangebied is nie (n=18/14.3%). Aanbevelings sluit in die verbetering van personeelvoorsiening, die nakoming van beleid en riglyne, behoorlike implementering van personeelontwikkeling en gehalte verbeteringsprogramme. Ten slotte, om die hoê insidensie in moeder en kind mortaliteit te verminder en die millennium ontwikkelingsdoelwitte te bereik, moet die tekortkomings in verloskunde dringend aangespreek word.
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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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Henshaw, Anne-Marie. "The midwifery statutory supervisory review meeting : fit for purpose?" Thesis, University of Leeds, 2015. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.699231.
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This thesis investigates the contribution of the midwifery statutory supervisory review meeting to the core function of the Nursing and Midwifery Council: protection of the public from unfit practitioners. At the outset of the study, the positive influences of . statutory supervision on patient safety and care quality were widely cited in policy and practice literature. Regulatory and local failings by the Nursing and Midwifery Council, Local Supervising Authorities and supervisors' of midwives, highlighted across a number of systematic inquiries into the statutory supervision of midwives, midwifery practice and maternity care, meant that this position changed during the course of the research. The research was undertaken in two phases. In phase one a systematic review investigated midwives' and supervisors of midwives' perceptions of statutory supervision. Review findings informed design of the phase two study. Phase two used Constructivist Grounded Theory methods to explore midwives' and supervisors of midwives' attitudes towards, and understanding of, the statutory supervisory review process, and their views about the impact of the process on subsequent practice. In- depth interviews and focus groups were used to generate data from 34 participants (24 midwives and 10 supervisors of midwives) from two Local Supervising Authority areas in England. Participants included newly qualified midwives; independent midwives and lecturers. Findings suggested that there are several areas where the supervisory review process is fallible. These include the lack of consistency in sources of evidence used to review midwives practice; complexity of the process itself due to the dual regulatory and supportive functions of statutory supervision, and variable midwifery, supervisory and regulatory interpretations of the intention of the statutory supervisory review meeting. As the midwifery profession moves towards a legislative separation of the regulatory and supportive supervisory functions and revalidation, this study highlights the need for further research into revalidation processes to assure the public that only those professionals who are fit to practice are able to continue to do so.
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Cullen, Miriam C. "Australian midwives' practice domain". Thesis, Curtin University, 1997. http://hdl.handle.net/20.500.11937/51.
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This exploratory, descriptive research used a case study approach to analyse the role of the midwife in providing maternal and infant care in Australia. Midwives from the states of New South Wales, Victoria and Western Australia comprised the target population. These midwives were considered to be representative of the general midwifery population practising in the diverse settings of Australia.A triangulation of methods (Denzin, 1970) was used for data collection. This included observational field work, a questionnaire survey of a randomly selected sample of registered midwives (n=1754), and in-depth interviews (n=75), using a grounded theory approach (Glaser and Strauss, 1967; Strauss and Corbin, 1990).The questionnaire, in-depth interviews and observational field work addressed the practice of midwives:1. as documented in policies and procedures in practice settings.2. as defined by the Australian College of Midwives Incorporated in Standards for the Practice of Midwifery (1989), based on the International Confederation of Midwives' Definition of a Midwife (World Health Organisation, 1976).Data obtained through the survey questionnaire were analysed using descriptive analysis (Wilson, 1985) to portray a summarization of the entire data set. A thematic content analysis was used for the open-ended questions of the survey (Burnard, 1991). In an attempt to discover the 'how and why' questions associated with the study's survey findings, the constant comparative method of analysis of data from in-depth interviews was deemed appropriate (Glaser, 1978; Field and Morse, 1985; Chenitz and Swanson, 1986). This allowed a more abstract level of conceptualization that led to the development of a paradigm reflective of the midwives' practice domain (Strauss and Corbin, 1990).Lack of opportunities to practise throughout all stages of pregnancy and childbirth was identified as the major problem limiting the Australian midwives' practice domain. An explanatory process of Optimising Opportunities for Holistic Midwifery Practice emerged explaining midwives' actions and interactions throughout the four stages of optimising: revealing the image; influencing decision making; changing the paradigm; and expanding the profession.The findings of the study provide an analysis of Australian midwifery practice that considers factors facilitating and/or impeding the professional role and development of Australian midwives, and their ability to provide care that meets consumer needs.
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Mlotana, Pumla Princess. "Motherhood experiences of teenagers : a Xhosa perspective". Thesis, Nelson Mandela Metropolitan University, 2012. http://hdl.handle.net/10948/d1019998.
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In South Africa and worldwide high rates of teenage pregnancy and motherhood remains a concern. According to Mkhwanazi (2010:349) most of teenage pregnancy occurs among poor black and coloured communities. The majority of these pregnancies are unwanted and unplanned resulting teenage mother experiencing problems with motherhood. The relationship in family peers and communities are adversely affected. Teenage motherhood seen as to be socially economically and physically delirious for the teenage mother and her baby. Teenage motherhood became a burden not only on the teenage mother but also to the family and the State. Cultural issues aggravated the situation in which the teenage mother finds herself in which is the lack of support from the communities in which they live. This results to the teenage mother having a feeling being alienated. The researcher as a midwife working in labour ward observed that the teenagers of younger ages are frequently admitted in labour wards in one of the hospitals in Nelson Mandela Metropolitan Municipality. The researcher became interested to conduct a study on mother hood experiences of teenage mothers: A Xhosa Pespective. The first objective of the study was to explore and describe the motherhood experiences of Xhosa teenagers. The second objective was to make recommendations to assist the midwives to help teenage mothers cope with motherhood. These recommendations could be used by health professionals to address the research findings. A qualitative, explorative descriptive and contextual research design was used to reach the objectives of the study. The research population consisted of Xhosa speaking teenage mothers who were residing at Kwazakhele Township and whose age was between 12 -16 years. Teenage mothers who gave birth to live babies during the last 6-12 months. Ethical considerations were maintained throughout the research study .Semi- structured interviews were conducted before data saturation was reached. The data collected during the interviews were transcribed and analyzed using Tech’s model of data analysis. The aspect of trustworthiness according to Guba’s model was implemented in the research study and included credibility, applicability, consistency and neutrality.
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Gholitabar, Maryam. "Why women do not adopt upright positions during labour and birth : an exploratory study". Thesis, University of West London, 2009. https://repository.uwl.ac.uk/id/eprint/398/.
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The position in which a woman births her baby is considered to be influenced by her social environment. The position adopted by a woman in labour has not only physiological stimuli but socio-cultural ones as well. Throughout the twentieth century women have been encouraged to remain in bed during labour and for the birth, which can be viewed as a position more convenient for the accoucheur, as this enabled easier access to undertake continuous fetal monitoring, intravenous therapy, vaginal examinations and to administer analgesia. A review of history however suggests today's birth postures were decreed and adopted on the basis of custom and convenience rather than physiological and anatomical indications and scientific data. There has been no study to examine the social context of women's choice of birth position or the influence of birth setting. This study was undertaken to explore what concerns, principles and environmental factors guide women in their choices regarding birth positions. The study used qualitative methods of data collection and employed induction rather than deduction in the analysis. Clarification of these factors may influence the future provision of care by midwives, in addition to highlighting factors which may enhance maternal satisfaction. A grounded theory approach was utilised in this study by means of antenatal and postnatal interviews in two different hospital settings. Several factors that influenced women's choice of birth position were identified, some of which were interrelated. These included physicial and social environment, disciplinary power present in the medical system and related technology. The midwife and her support are also important factors affecting women's choice of birth position. A decision making typology that can be utilised by midwives to enhance their practice and assist women in their choice of birth position had been developed from this study.
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Ólafsdóttir, Ólöf Ásta. "An Icelandic midwifery saga : coming to light : "with woman" and connective ways of knowing". Thesis, University of West London, 2006. https://repository.uwl.ac.uk/id/eprint/1080/.
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The aim of this thesis was to explore storytelling of Icelandic midwives' working lives, in the period from the mid twentieth century to the present time. This ethnographic narrative study was designed with a broad perspective looking at birth stories of midwives as mine full of their knowledge to identify and uncover. Interviews were conducted with twenty midwives to collect birth-stories that represent the social and cultural world of childbirth and midwifery in Iceland, and theory was to arise inductively from the midwives' own telling. Furthermore, one focus group interview with six midwives was conducted and field notes were used to gather more stories. The narrative analysis was designed by means of identifying the plot of the midwives' birth stories, which was identified as being "with woman", leading the focus towards midwives' relationship with women and their inner ways of knowing. The findings suggest that Icelandic midwives have a common philosophy of care that is associated with a midwifery partnership model, incorporated in the ideological statements of the Icelandic midwifery education in Iceland. Yet, in a diverse culture of changing childbirth, the birth stories illustrated the complexity of maintaining balance being pressed to base their work on conflicting models of care, including the social narrative of medical dominance. The research adds information and a deeper understanding of inner knowing of midwives, intuition and spiritual awareness in practice. The "act of being with" or yfirseta "sitting over" at birth was identified as being crucial for preserving and developing this kind of midwifery knowledge integrated with other kinds of knowledge systems. The midwives' storyline demonstrated three different types; one developed by learning from practice experience and the second was of more spiritual nature, even transcendence. The third type referred to the connective knowing where the two types overlap based on a reciprocal relationship with the woman - their connective way of knowing, which needs to be explored further. It is imperative to develop further narrative methodologies in different cultural context, to identify the central concepts of the midwife-with-woman relationship. Furthermore, research is needed on how the relationship affects development of midwifery knowledge, including the intuitive and spiritual, which provides safety of chidbirth.
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Hunter, Louise. "Supporting teenage mothers to initiate breastfeeding and developing a support intervention to increase breastfeeding rates in a vulnerable group : the importance of place". Thesis, University of West London, 2014. https://repository.uwl.ac.uk/id/eprint/1057/.
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Background: Not being breastfed is internationally considered to have a lifelong impact on morbidity and mortality. In the UK and other developed nations, adolescent mothers are among those least likely to breastfeed and require additional support to do so due to their unique developmental position. Evidence indicates that many young mothers who intend to breastfeed never initiate breastfeeding or stop soon after giving birth, and there may be factors in the UK health system or wider society preventing the success of breastfeeding support interventions. These considerations led to a two-phase investigation which aimed to study the context of breastfeeding support and evaluate a targeted breastfeeding support intervention for young women. Methods: A realist evaluation framework was used. 83 UK health professionals responded to an e-questionnaire. Focus groups and interviews were conducted with 15 young mothers (aged 16-20) in Oxford, England. A breastfeeding support package was then developed and implemented on a UK postnatal ward for six months. A concurrent mixed methods evaluation was carried out. Each component of the investigation was analysed thematically using inductive content analysis. Ethical approval was received. Findings: Young women appear motivated to breastfeed to show that they are good mothers. However, breastfeeding can alienate them from their families at a time when they need to be accepted in their new mothering role. Young mothers can feel disempowered after birth and like ‘fish out of water’ on the postnatal ward. A need was identified for proactive breastfeeding support from health professionals focusing on relational care, particularly as some maternity professionals displayed negative attitudes to teenage mothers and breastfeeding. Despite staff training developing a more positive and enabling attitude towards young women, much of the proposed support package proved impossible to implement in a busy, task-orientated medical environment where time, convenience, control, and individual staff beliefs were used as yardsticks to determine the acceptability of different aspects of care. Conclusion: This study highlights the importance of proactive, relational breastfeeding support for young mothers. Such support requires a facilitative environment in order to be implemented successfully. It is suggested that such an environment could be created on the postnatal ward if midwives and MSWs created workplace communities and claimed ownership of their time and space. Action Learning may facilitate this process.
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Kay, Lesley. "Engaging with the 'modern birth story' in pregnancy : a hermeneutic phenomenological study of women's experiences across two generations". Thesis, University of Central Lancashire, 2016. http://clok.uclan.ac.uk/15479/.
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This in-depth qualitative study considered how women from two different generations came to understand birth in the context of their own experience but also in the milieu of other women’s stories. For the purposes of this thesis the birth story (described as the ‘modern birth story’) encompassed personal oral stories as well as media and other representations of contemporary childbirth, all of which had the potential to elicit emotional responses and generate meaning in the interlocutor. The research utilised a hermeneutic phenomenological approach underpinned by the philosophies of Heidegger and Gadamer. This methodology allowed the significance of the experience of engaging with stories to be grasped, and in-depth insights into the meanings and lived experience for women of the phenomenon to be made. Twenty participants were purposively selected, recruited and interviewed. In phase one ten women who were expecting their first baby in 2013 were recruited in order to explore how they understood birth prior to the event and in the light of other women’s stories. Birth stories were revealed as one of many ‘voices’ offering ‘advice’ to women about birth. The women also talked about classes they had attended, books they had read, websites and online forums they had accessed, as well as television programmes and films they had watched. The conversations with the first cohort of women led to further questions about whether the information gleaned from media and virtual birth story mediums creates meaningful knowledge about birth for women. The second phase evolved from this thinking. In phase two interviews with an older cohort of women (who were pregnant in the 1970s –1980s) were undertaken to determine whether women from a different era were more able to translate knowledge into meaning. This was based on the belief that, for this 4 generation of women, stories were mediated by personal contact and not though virtual technologies as in the previous generation of women. Phenomenological conversations with the participants took place in the iterative circle of reading, writing and thinking. This revealed the experience of ‘being-in-the-world’ of birth for the two generations of women and the way of communicating within that world. From a Heideggerian perspective, the birth story was constructed through ‘idle talk’ (the taken for granted assumptions of how things are which come into being through language) and took place across a variety of media accessed by women, as well as through face to face conversations. Five central and interrelated interpretive findings emerged. Firstly the stories the women engaged with, had a significant role to play in their understanding and expectations of birth. The ‘norm’ as portrayed in the stories circulating in 2013, for instance, was one which perpetuated what one participant described as the ‘drama of birth’. Secondly, the modern ‘landscape’ of birth (populated with many media representations) created and perpetuated fear of childbirth for many of the women. The stories shared were lacking in detail about women’s lives, and did not necessarily help them to become ‘knowers’ and gain wisdom about birthing. Thirdly, the women birthing in the present day were overloaded with information amassed in an attempt to manage their anxieties about birth as well as to fit the role of the informed patient, and demonstrate their competency as mothers. Fourthly the cultural and spiritual significance of birth was not shared in the circulating stories in either generation. Finally, some of the birthing women felt secure in the ‘system’ of birth as constructed, portrayed and sustained in the stories widely circulated. The data revealed that the lifeworld of birth being sustained in stories (for both generations) was one of product and process, concentrating on the stages and 5 progression of labour and the birth of a healthy baby as the only significant outcome. Taken as a whole this thesis revealed that the information gleaned from birth stories did not in fact create meaningful knowledge and understanding about birth for these women. The study is unique in that no other published research has explicitly identified the premise of the ‘modern birth story’ or the notion of ‘idle talk’ in relation to childbirth. Further no other study has considered the phenomenon of engaging with these types of stories whilst pregnant. This study reveals how engaging with the ‘modern birth story’ and the ‘idle talk’ of birth may influence women’s expectations and consequent experience of birth.
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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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Martin, Kerstin. "The midwife as teacher : dialogue with and confidence in the woman". Thesis, McGill University, 2002. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=79794.
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Midwifery care is often described as "woman-centred" and "empowering," yet the concrete or specific practices underlying this kind of care are not well understood. The study examined what midwives say and do in the process of care-giving during pregnancy, and how their care enhances clients' sense of personal competence and capability. Using qualitative methods, the researcher observed, recorded, transcribed and analyzed prenatal visits with nine midwives and their clients in Quebec birth centres. Findings revealed that relaxed conversation was a pivotal feature of the visits and primarily served the client's purposes. At multiple levels, the reciprocal, genuinely dialogic nature of the conversational process allowed the client to take charge and encouraged her to name her world. Educational aspects of care started with the client's agenda, assumed that she had expertise of her own, and affirmed that she could know and act for herself. The key characteristic of midwives' work was the communication of confidence in the essential normalcy of pregnancy and birth, and in the inherent strengths of women in these experiences.
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Betts, Helen Joan. "A biographical investigation of the Nightingale School for Midwives". Thesis, University of Southampton, 2002. https://eprints.soton.ac.uk/427100/.
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The thesis considers primary, contemporaneous documents and secondary sources concerning Florence Nightingale, her motives and experiences with the profession of midwifery. The thesis sets Nightingale within her family context and that of mid Victorian England, drawing on previous biographies, an autobiographical account (Cassandra), historical evidence and literature. The main events investigated take place following her return from the Crimean War and are focused on the work of Nightingale in relation to the profession of midwifery, childbirth, infection and maternal mortality, placing Nightingale in the English and European nineteenth century midwifery context and investigating the rationale for the commissioning of the Nightingale School for Midwives at King's College Hospital, London in 1862 followed by its subsequent closure five years later and the publication of Notes on Lying-in Institutions in 1871. The two events are linked, although the focus of the research is an investigation of evidence to substantiate Nightingale's reason for commissioning a training school for midwives. Evidence is ascertained through life documents including biographies, letters and other contemporaneous documents written by and to her or pertaining to the work, in particular, of the Nightingale Fund. These are reviewed using the biographical method and Nightingale's rationale is finally exposed within a complex web of personal and organisational inter-relationships.
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Lee, Lai Yin Irene. "The experience of pain in the context of childbirth for Hong Kong Chinese women : a longitudinal cohort interview study". Thesis, University of Central Lancashire, 2017. http://clok.uclan.ac.uk/21045/.
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Childbirth, the biggest life event for a woman, is a complicated process. Childbirth pain not only involves physiological sensations, but also psychosocial and cultural factors. In addition, the way the woman handles the pain is affected by the meaning she attributes to it. In order to understand the experience of Hong Kong Chinese women in terms of childbirth in general and childbirth pain in particular, and to learn the meanings attributed, a longitudinal qualitative descriptive study was conducted with the aim of exploring the experience and meaning of pain in the context of childbirth for Hong Kong Chinese women. The study was informed by a systematic review and metasynthesis of existing relevant literature. Since people’s attitudes, beliefs and behaviours may change over a period of time, data were collected from the participants at 4 different time points: around 36 weeks of pregnancy; on postnatal day 3; 6-7 weeks after birth; and 10-12 months after birth. Purposive sampling was employed and a total of 10 Hong Kong Chinese women (5 primiparous and 5 multipararous women) were recruited for the study. The data were collected via semi-structured interviews, informed by phenomenological principles. The resulting data were described using thematic analysis The results from the metasynthesis together with the four interviews yielded 5 meta-themes: The cultural norms; The trajectory of pain sensation; Facing or escaping the pain; Someone to be with me; and Achievement and growth through the unforgettable experience. For these participants, satisfaction with their childbirth experience was not related to the pain they experienced, but to the care they received from their husbands and midwives, as well as to their own sense of achievement. Although the women remembered the fact of their pain over time, their affective noxious memories decreased as their concentration was on their Finally, the meta-themes were interpreted in the light of Maslow’s hierarchy of needs, and a model was proposed to help women to handle childbirth pain in the future.