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1
Byrskog, Ulrika. "’Moving On’ and Transitional Bridges : Studies on migration, violence and wellbeing in encounters with Somali-born women and the maternity health care in Sweden". Doctoral thesis, Uppsala universitet, Institutionen för kvinnors och barns hälsa, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-259881.
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During the latest decade Somali-born women with experiences of long-lasting war followed by migration have increasingly encountered Swedish maternity care, where antenatal care midwives are assigned to ask questions about exposure to violence. The overall aim in this thesis was to gain deeper understanding of Somali-born women’s wellbeing and needs during the parallel transitions of migration to Sweden and childbearing, focusing on maternity healthcare encounters and violence. Data were obtained from medical records (paper I), qualitative interviews with Somali-born women (II, III) and Swedish antenatal care midwives (IV). Descriptive statistics and thematic analysis were used. Compared to pregnancies of Swedish-born women, Somali-born women’s pregnancies demonstrated later booking and less visits to antenatal care, more maternal morbidity but less psychiatric treatment, less medical pain relief during delivery and more emergency caesarean sections and small-for-gestational-age infants (I). Political violence with broken societal structures before migration contributed to up-rootedness, limited healthcare and absent state-based support to women subjected to violence, which reinforced reliance on social networks, own endurance and faith in Somalia (II). After migration, sources of wellbeing were a pragmatic “moving-on” approach including faith and motherhood, combined with social coherence. Lawful rights for women were appreciated but could concurrently risk creating power tensions in partner relationships. Generally, the Somali-born women associated the midwife more with providing medical care than with overall wellbeing or concerns about violence, but new societal resources were parallel incorporated with known resources (III). Midwives strived for woman-centered approaches beyond ethnicity and culture in care encounters, with language, social gaps and divergent views on violence as potential barriers in violence inquiry. Somali-born women’s strength and contentment were highlighted, and ongoing violence seldom encountered according to the midwives experiences (IV). Pragmatism including “moving on” combined with support from family and social networks, indicate capability to cope with violence and migration-related stress. However, this must be balanced against potential unspoken needs at individual level in care encounters.With trustful relationships, optimized interaction and networking with local Somali communities and across professions, the antenatal midwife can have a “bridging-function” in balancing between dual societies and contribute to healthy transitions in the new society.
2
Lafrance, Josee. "Mother-baby togetherness: A survey of women's postpartum experiences in four maternity units". Thesis, University of Ottawa (Canada), 2003. http://hdl.handle.net/10393/26506.
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Purpose. To describe women's postpartum experiences with mother-baby togetherness in hospital, and the concordance of their experiences with the recommendations from Health Canada (2000a) on family-centred maternity and newborn care (FCMNC).
Design. Descriptive study based on secondary analysis of a telephone survey conducted at one week and six weeks postnatally. Five elements reported by women were examined: the timing of first physical contact, physical proximity during the first few hours, transfer together to postnatal unit, rooming-in, and combined mother-baby care.
Setting. Four maternity units in Ottawa (Ontario, Canada) including two level I units, one level II and one level III unit. A proportionate sample was drawn from each unit. The overall response rate to both interviews was 88.3%.
Participants. Women (N = 552) who returned home with their babies within the first postnatal week, between October 2000 and March 2001.
Findings. While in hospital, 95.8% of mothers and babies were separated. Combined care was reported by 84.7% of women and rooming-in by only 33.9% of women. Only 8.8% of women experienced all five FCMNC recommended practices. Practices varied between the units (p < .001). Women who had a caesarean birth were more likely to be separated from their infants than those who had a vaginal birth. Routine procedures performed in the nursery was the most frequently reported reason (55.8%) for the first separation of mothers and babies.
Conclusion. Few women reported receiving care based on the FCMNC recommendations about mother-baby togetherness. Hospital practices varied considerably. It is recommended that healthy newborns receive care at their mothers' bedside. Further research is recommended to study the relationship between unit policy, actual practices, nurses' beliefs and women's preferences about the elements of mother-baby togetherness.
3
Ngula, Asser Kondjashili. "Women's perception on the under utilization of intrapartum care services in Okakarara district, Namibia". Thesis, University of the Western Cape, 2005. http://etd.uwc.ac.za/index.php?module=etd&.
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Maternal health care services are one of the health interventions to reduce maternal and infant morbidity and mortality. The health of mothers of childbearing age and of the unborn babies is influenced by many factors some of which include the availability and accessibility of health services for pregnant women. Low quality of health services being provided, and limited access to health facilities is correlated with increases maternal morbidity and mortality. This situation is caused by long distances between facilities as well as the people's own beliefs in traditional practices. This study was about the assessment of the women's knowledge on benefits of delivery in a hospital, the barriers to delivery services, and the perception of the delivery services rendered in the maternity ward of Okakarara hospital.
4
Brooks, Fiona M. C. "Alternatives to the medical model of childbirth : a qualitative study of user-centred maternity care". Thesis, University of Sheffield, 1990. http://etheses.whiterose.ac.uk/2970/.
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This thesis sets out to explore some important gaps in the sociological and feminist understanding of the provision of maternity care and of women's health needs. The research was concerned with an exploration of the implementation of proposals for the provision of user-centred maternity care which emerged from the critiques of current medicalised provision. It evaluates the effects of an attempt to provide user-centred maternity care within the Primary Health Care sector (PHC) from both the women's and workers' perspectives and experience. The central questions addressed within the research have been: Firstly, to assess the degree to which such models of service delivery provide a user centred approach. Secondly, to identify the form of the relationship between the women users and providers from the practices and to develop an understanding of the mechanisms of interaction between them. Thirdly, to explore the extent to which the provision of such care is appropriate to match women users' self identified needs. Finally, to assess the potential of female health workers to adopt a form of provider and user relationship where the balance of power is altered in the users' favour. The main body of the research consisted of a qualitative study conducted in two general practices. These were chosen as specific examples of innovative practices attempting to provide a genuinely user-centred maternity service. The fieldwork consisted of three methodological components: Firstly, unstructured interviews were conducted with women users and workers. A sample of 30 women who were pregnant for the first time were interviewed on three occasions during their pregnancy and in the immediate post-natal period. In addition, 10 second time mothers were also interviewed post-natally. In terms of the workers', in depth interviews were conducted with midwives, GPs and practice nurses within the PHC setting. Secondly, observations were undertaken on the interactions between the women and workers and between members of the PHC team during the course of the women's antenatal and post-natal care. Finally, a structured questionnaire was used with a sample of women from one of the practice's well woman clinic. The research findings indicate the existence of a user-centred frame of reference held by female health workers - especially the midwives - for the provision of health care to women, which was opposed to the medical model. It explores the translation into practice of this model of maternity care and identifies the way that it functioned to enable women to exercise greater control over their health care and experience of pregnancy. Within this model the traditional 'with woman' role of the midwife was found to be central. Considerable convergence was found between the models held by the main parties in the interaction - issues concerned with choice, control and the provision of information were all found to be central to the care provided and to women's and workers' models. However, constraints on the effective implementation of the model were found in terms of the influence of professionalism (particularly on the GPs) and the dominance of the hospital system. These resulted in limits to the women workers' ability to meet the needs of women users.
5
Mendoza, Jennifer Adams. "Rationality and Reproduction: Health Insurance Coverage and Married Women's Fertility". Diss., CLICK HERE for online access, 2008. http://contentdm.lib.byu.edu/ETD/image/etd2617.pdf.
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Birch, Katherine Emma. "Great expectations : a sociological analysis of women's experiences of maternity care in the 'new' NHS". Thesis, University of Liverpool, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.266197.
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Miller, Michelle L. "A comprehensive examination of anxiety and its risk factors in the perinatal period". Diss., University of Iowa, 2018. https://ir.uiowa.edu/etd/6473.
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The perinatal period is increasingly recognized as a vulnerable time for the development and exacerbation of psychopathology symptoms. Research has often focused on perinatal depression, with limited information on perinatal anxiety. This study examined the psychometric structure of all anxiety and depressive disorder symptoms as well as explored the relation between perinatal internalizing symptoms and sociodemographic, obstetric, and psychological risk factors. Obsessive-Compulsive Disorder (OCD) is a common perinatal anxiety disorder that is now classified with the Obsessive-Compulsive Spectrum (OCS) (hoarding, body dysmorphic, trichotillomania, and excoriation disorders). This study also aimed to determine the prevalence of clinically significant OCS symptoms and their association with postpartum adjustment.
Participants recruited from the University of Iowa Hospitals and Clinics (N =246) completed an online questionnaire and a structured clinical interview during pregnancy (28-32 weeks gestation) and the postpartum (6-8 weeks). Questionnaires assessed demographics, pregnancy complications, anxiety sensitivity, coping strategies, maternal attitudes and experiential avoidance. Clinical interviews dimensionally assessed all anxiety and depressive symptoms as well as past psychiatric diagnoses.
Confirmatory factor analyses identified three factors: Distress (depression, GAD, irritability, and panic); Fear (social anxiety, agoraphobia, specfic phobia, and OCD); and Bipolar (mania and OCD) during pregnancy and the postpartum. During pregnancy, structural equation modeling demonstrated that past psychiatric history predicted Distress and Fear symptoms. Experiential avoidance mediated the relation between negative coping strategies and Fear symptoms. In the postpartum, negative maternal attitudes predicted Distress symptoms. Experiential avoidance mediated the relation between negative coping strategies and Fear symptoms as well as between anxiety sensitivity and Fear symptoms. There were low rates of clinically significant OCS symptoms, except for body dysmorphic disorder symptoms. Elevations in all OCS disorder symptoms were significantly associated with more difficulty adjusting to the postpartum.
Past psychiatric history, negative maternal attitudes, and experiential avoidance are particularly important risk factors for perinatal anxiety. Future clinical research should be aimed at identifying at-risk women and modifying experiential avoidance during the perinatal period. Elevated OCS symptoms, particularly body dysmorphic disorder symptoms, affect postpartum adjustment. Future intervention work should focus on assessing and treating perinatal body dysmorphic disorder symptoms.
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Reddish, Alison. "Women's experiences of perinatal mental health : a qualitative exploration of women's experiences of mental health during pregnancy and a review of women's views of peer support interventions and their effectiveness". Thesis, University of Edinburgh, 2018. http://hdl.handle.net/1842/33245.
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Background and Aims: Mental health difficulties during the perinatal period (pregnancy to 1 year postnatal) are commonplace and are associated with significant impacts for mothers and infants. There is an acknowledgement that more needs to be understood about perinatal mental health, particularly during pregnancy, and that service and treatment options need to be improved. Women's lived experience of difficulties during pregnancy, particularly when experiencing moderate to severe mental health difficulties, is a little researched area. A need for wider treatment options than medication alone has been highlighted and Peer Support Interventions (PSIs) are often considered within this area. Despite this, there is yet to be a review of their effectiveness to date that also considers women's views of such interventions. Therefore, this thesis aimed to systematically review literature focused on women's views of PSIs and their effectiveness. In addition, it also aimed to explore the lived experience of women with moderate to severe difficulties with their mental health during pregnancy, with a focus on trying to establish any psychological needs/needs they may have. Methods: A mixed methods systematic review was conducted to meet the aims on PSI interventions. This involved searching electronic databases, quality assessment of included papers and summarising results, including a meta-synthesis for qualitative findings. The empirical project, on women's lived experiences, utilised an Interpretative Phenomenological Analysis approach to explore the lived experience of women experiencing moderate to severe mental health difficulties during pregnancy. Semi-structured interviews were conducted with 11 women recruited via a specialist perinatal mental health service. Results Thirteen studies were included in the review. Results highlighted the heterogeneity of types of PSIs and methodologies employed to evaluate these. Most studies focused on PSIs for the postnatal period and were often aimed at depression. There was a lack of research on PSIs targeted antenatally, or for other types of mental health difficulties. There was tentative evidence for the use of telephone based PSIs in reducing depressive symptomatology postnatally, but less evidence for the use of other types of PSI, or for interventions during pregnancy. The qualitative evidence highlighted the acceptability of PSIs to women and a meta-synthesis of qualitative research identified a number of themes representing women's views of PSIs. From the empirical project, several Superordinate themes were identified: Need for acceptance, Need for awareness, Search for explanations, What helped, Emotional intensity, Societal influences and Service provision. Within these a range of emergent themes were also found. These themes highlighted possible psychological needs and other needs during this time, as well as providing a greater understanding of women's lived experience. Conclusions: There is a need for more research to establish effectiveness of PSIs during pregnancy and of other modes of delivery and to build on existing findings on the effectiveness of telephone based PSIs. Women viewing PSIs as highly acceptable for perinatal mental health difficulties, should cause services to consider their use, or other opportunities for sharing of peer advice/information. Themes identified from the empirical project highlight the need for greater awareness and acceptance of mental health difficulties during pregnancy, as well as the impact of societal influences on women during this time, and the role clinicians and services could play in achieving greater awareness. Small changes within services could help raise awareness levels and help women feel less isolated.
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Hassan, Shaima M. "A qualitative study exploring British Muslim women's experiences of motherhood while engaging with NHS maternity services". Thesis, Liverpool John Moores University, 2017. http://researchonline.ljmu.ac.uk/7412/.
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Women in the UK have access to NHS maternity services and most will attend hospital to give birth in the NHS. Much effort has been undertaken over several decades to improve childbirth and to enhance the experiences of those using NHS maternity services. However, while most women report positive experiences of maternity care, existing evidence suggests that women from ethnic minority groups in the UK have poorer pregnancy outcomes, experience poorer maternity care, are at higher risk of adverse perinatal outcomes and have significantly higher severe maternal morbidity than the resident white women (Puthussery, 2016; Henderson et al, 2013; Puthussery et al., 2010; Straus et al., 2009). Muslim women of child-bearing age make up a significant part of UK society, yet their health needs and their experiences of health services have not been extensively researched. The term ‘Muslim’ is often combined with ethnic group identity, rather than used to refer to people distinguished by beliefs, practices or affiliations. Muslim women commonly observe certain religious and cultural practices during their maternity journey and the little research there is in this area suggests that more could be done from a service provision perspective to support Muslim women through this, spiritually and culturally significant life event (McFadden et al., 2013; Alshawish et al., 2013). This study explores Muslim women’s perceived needs and the factors that influence their health seeking decisions during their transition to motherhood. Using a generic qualitative approach, seven English-speaking first time pregnant Muslim women and a Muslim mother who is second time pregnant but experiencing motherhood as a Muslim for the first time, were interviewed at different stages of their maternity journey (antenatal, post-labour and postnatal); five focus groups were conducted with Muslim mothers; and 12 semi-structured interviews were conducted with healthcare professionals. Thematic analysis of the transcripts revealed that Muslim women: 1) had a unique perspective on motherhood based on Islamic teaching; 2) sourced information from a number of sources, additional to midwives; 3) experienced difficulty expressing their religious requirements when preparing a birth plan; 4) assumed that healthcare professionals would have a negative view of Islam and Islamic birthing practices. While one-to-one interviews revealed that healthcare professionals: 1) varied in their perceptions of Muslim women; 2) had a general awareness of Muslim women’s Islamic practices but not specific to motherhood; 3) sourced cultural and religious information to enhance their understanding of women’s needs and their specific practices; 4) had some challenges when addressing women’s specific religious practices such as fasting; 5) would benefit from cultural/religious competency training that incorporates lived experience and group discussion. The implications for institutions, midwifery practice and further research are outlined. The study concludes that transcultural knowledge and specifically Muslim women’s worldview incorporated into healthcare professional training would enhance the competency and quality of healthcare services.
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Nicholl, Katherine Louise. "Is women's legal right of access to informed decision making in maternity care assured in New Brunswick?" [Moncton, N.B.] : New Brunswick Office of the Ombudsman, 2007. http://site.ebrary.com/lib/librarytitles/Doc?id=10222487.
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Burkey, Doris. "Evidence Based Perinatal Bereavement Education for Women Treated for Miscarriage in The Preadmission Testing Unit| A Pilot of a System Change". Thesis, West Virginia University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3618086.
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Background: Each year, perinatal loss affects one million women and their families (National Vital Statistic Reports, 2011). Perinatal loss is the death of a fetus/infant during pregnancy or soon thereafter (Koppmans, Wilson, Cacciatore & Flenady, 2013). There are several different types of perinatal loss, including miscarriage, stillbirth, and neonatal death. Bereavement education related to miscarriage will be the main focus of this project. Miscarriage, also known as spontaneous abortion, is the body's natural termination of a pregnancy before 20 weeks gestation (Geller, Psaros, & Kornfield, 2010).
Objective: The clinical problem to be addressed by this project is the lack of a system of evidence based bereavement education for women who experience miscarriage and subsequent treatment when they are admitted to the hospital through the Pre-Admission Unit (PAU)at WVU Healthcare. The project plan involves the development, implementation, and evaluation of an evidence based bereavement education system for women who are treated in the PAU prior to surgical intervention for a miscarriage. This intervention has been designed to address knowledge, skills, and attitudes of staff in the PAU related to providing bereavement support for women who experience a miscarriage.
Methods: A computerized literature search of CINAHL, PUBMED, National Guideline Clearinghouse, and the Cochrane Library data bases were performed using the key words miscarriage, spontaneous abortion, emotional experience, grief, education of providers, and bereavement education. Search limits were set which included the dates of 2002–2013, peer reviewed, full text, and English language. Selection criteria included the provision of grief interventions to women and their families who have suffered a perinatal loss and staff who cared for women who suffered a miscarriage. These searches produced 58 hits. After reviewing abstracts and article fourteen articles were chosen for the review. There were five systematic reviews, two randomized controlled trial (RCT) studies, six descriptive qualitative studies, and one non-experimental, correlational study.
Results: Strong evidence existed that grief education could assist healthcare providers to be able to provide evidence based interventions to women and families with a miscarriage. This project validated the literature by indicating that healthcare providers that were given bereavement education were much more comfortable presenting this education to women who suffered a miscarriage and required surgical intervention. The increase in knowledge of the healthcare providers was established with a pre-test, intervention of providing bereavement education, and a post-test. A t-test was used to compare means of the pre and post-tests and conclude that there was statistical significance in the mean scores of the pre and post-tests.
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Brooks, Janette. "A comparison of anxiety, stress and depression, across the perinatal period, in mothers of twins and singletons". Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2009. https://ro.ecu.edu.au/theses/184.
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Although efforts have been made to reduce the incidence of multiple pregnancies, the number of confinements resulting in twins continues to increase. Increased maternal age and assisted reproductive technology (ART) are considered to be the major contributing factors. A twin pregnancy poses a higher risk to a woman’s health than a singleton pregnancy; risks to fetuses are also increased and maternal concern about the health of the fetuses is subsequently expected to be intensified.
With a substantial body of research available, the physical risks and potential complications of a twin pregnancy are well understood, yet the psychological risks for mothers of twins are yet to be adequately investigated. This is despite a substantial body of evidence indicating that maternal mental health during the perinatal period may involve significant and complicated outcomes for women and their families.
This PhD hypothesised that twins and ART would place women under additional stress and thus additional risk of anxiety and depression throughout the perinatal period, that is, during pregnancy and in the months following delivery. A total of eight research hypotheses were proposed, and levels of stress, anxiety, and depressive symptomatology were measured with self-report scales in a sample of 53 women pregnant with twins and 53 women pregnant with a singleton (matched on use of ART) twice during pregnancy and once postpartum to examine these hypotheses.
Stress levels were found to be highly correlated with levels of anxiety and depressive symptomatology at each time of assessment, and scores on the anxiety and depression scales were also highly correlated. Women pregnant with twins reported significantly higher levels of state anxiety than women pregnant with a singleton during the second and third trimesters of pregnancy after controlling for the effect of ART, parity, planned pregnancy, and history of depression or anxiety. Further analyses revealed that women pregnant with twins as a result of ART reported significantly higher levels of stress and state anxiety during the third trimester than women pregnant with a singleton who had conceived without assistance.
Furthermore, women expecting twins as a result of ART reported higher levels of pregnancy specific anxiety during the third trimester than women who had not used ART and women having a singleton.
After controlling for parity, history of depression and/or anxiety, planned pregnancy, and ART, significantly higher levels of postpartum stress and depressive symptomatology were recorded by mothers of twins. Interestingly, women who became mothers of twins without ART reported the highest levels of stress, anxiety, and depressive symptomatology postpartum.
13
Asif, Akila. "Maternal satisfaction and recommendation of perinatal health facility : A cross sectional study measuring perceptions of mothers experiences of maternity care at tertiary care hospitals in Nepal". Thesis, Uppsala universitet, Internationell mödra- och barnhälsovård (IMCH), 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-385122.
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Background: To achieve better health outcomes it is important to identify those aspects of health care delivery system that determines patient satisfaction. The health care planners must therefore be cognizant of the opinions and expectations of those who utilize health care facilities to achieve better health outcomes. This also applies to maternal satisfaction. The study aimed to measure mothers satisfaction with maternity care and its association with various socio-demographic characteristics. Method: The study presented here is a quantitative cross-sectional study that utilizes secondary data from facility-based survey conducted in 12 different tertiary hospitals of Nepal and included client exit interviews (n=43756). The maternal satisfaction association with different exposures and potential confounders was determined using multivariate logistic regression analysis. Statistical Package for Social Sciences (SPSS) was used for data analysis. Results:. Better information and counselling is seen to be associated with higher satisfaction and recommendation [AOR: 1.67 [1.60-1.75]] and [1.68[1.57-1.80], respectively. Higher level of delivery preparation indicates lower overall satisfaction [AOR: 0.70 [0.66-0.74]]. Mothers were seen to be less satisfied with the religious and cultural aspects of the maternal health services. Mothers age and sex of child was not seen to be significant with any outcome. Conclusion: Better information and counselling indicates more satisfaction and recommendation. Mothers delivery preparation is seen as a significant predictor of their overall satisfaction; therefore, this should be a part of education and information strategy for mothers from the different backgrounds.
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Byatt, Nancy. "Rapid Access to Perinatal Psychiatric Care in Depression (RAPPID): A Master’s Thesis". eScholarship@UMMS, 2015. https://escholarship.umassmed.edu/gsbs_diss/731.
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Depression is the leading cause of disability among women of reproductive age worldwide. Upwards of 1 in 5 women suffer from perinatal depression. This condition has deleterious effects on several birth outcomes, infant attachment, and children’s behavior/development. Maternal suicide causes 20% of postpartum deaths in depressed women. Although the vast majority of perinatal women are amenable to being screened for depression, screening alone does not improve treatment rates or patient outcomes. Obstetrics/Gynecology (Ob/Gyn) clinics need supports in place to adequately address depression in their patient populations. The primary goal of this thesis is to develop, refine, and pilot test a new low-cost and sustainable stepped care program for Ob/Gyn clinics that will improve perinatal women’s depression treatment rates and outcomes. We developed and beta tested the Rapid Access to Perinatal Psychiatric Care in Depression (RAPPID) Program, to create a comprehensive intervention that is proactive, multifaceted, and practical. RAPPID aims to improve perinatal depression treatment and treatment response rates through: (1) access to immediate resource provision/referrals and psychiatric telephone consultation for Ob/Gyn providers; (2) clinic-specific implementation of depression care, including training support and toolkits; and (3) proactive depression screening, assessment, and treatment in OB/Gyn clinics. RAPPID builds on a low-cost and widely disseminated population-based model for delivering psychiatric care in primary care settings. Formative data and feedback from key stakeholders also informed the development of RAPPID. Our formative and pilot work in real-world settings suggests RAPPID is feasible and has the potential to improve depression detection and treatment in Ob/Gyn settings. The next step will be to compare two active interventions, RAPPID vs. enhanced usual care (access to resource provision/referrals and psychiatric telephone consultation) in a cluster-randomized trial in which we will randomize 12 Ob/Gyn clinics to either RAPPID or enhanced usual care.
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Byatt, Nancy. "Rapid Access to Perinatal Psychiatric Care in Depression (RAPPID): A Master’s Thesis". eScholarship@UMMS, 2004. http://escholarship.umassmed.edu/gsbs_diss/731.
Texto completo da fonteResumo:
Depression is the leading cause of disability among women of reproductive age worldwide. Upwards of 1 in 5 women suffer from perinatal depression. This condition has deleterious effects on several birth outcomes, infant attachment, and children’s behavior/development. Maternal suicide causes 20% of postpartum deaths in depressed women. Although the vast majority of perinatal women are amenable to being screened for depression, screening alone does not improve treatment rates or patient outcomes. Obstetrics/Gynecology (Ob/Gyn) clinics need supports in place to adequately address depression in their patient populations. The primary goal of this thesis is to develop, refine, and pilot test a new low-cost and sustainable stepped care program for Ob/Gyn clinics that will improve perinatal women’s depression treatment rates and outcomes. We developed and beta tested the Rapid Access to Perinatal Psychiatric Care in Depression (RAPPID) Program, to create a comprehensive intervention that is proactive, multifaceted, and practical. RAPPID aims to improve perinatal depression treatment and treatment response rates through: (1) access to immediate resource provision/referrals and psychiatric telephone consultation for Ob/Gyn providers; (2) clinic-specific implementation of depression care, including training support and toolkits; and (3) proactive depression screening, assessment, and treatment in OB/Gyn clinics. RAPPID builds on a low-cost and widely disseminated population-based model for delivering psychiatric care in primary care settings. Formative data and feedback from key stakeholders also informed the development of RAPPID. Our formative and pilot work in real-world settings suggests RAPPID is feasible and has the potential to improve depression detection and treatment in Ob/Gyn settings. The next step will be to compare two active interventions, RAPPID vs. enhanced usual care (access to resource provision/referrals and psychiatric telephone consultation) in a cluster-randomized trial in which we will randomize 12 Ob/Gyn clinics to either RAPPID or enhanced usual care.
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Rahman, Elizabeth Ann. "Made by artful practice : health, reproduction and the perinatal period among Xié river dwellers of north-western Amazonia". Thesis, University of Oxford, 2014. http://ora.ox.ac.uk/objects/uuid:0c6e924d-f526-4f94-b1dc-bb40319a7d30.
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This thesis is an ethnographic study of a little documented indigenous group, the Warekena people, who live on the Xié River in north-western Amazonia. Examining the mythic histories of the animate riverscape, my work offers an overview of the emergence of riverside dwelling: starting with a macro view of Xié river lifestyles, I explain how seasonal and distinguishing historic-mythic narratives tie in to wider idioms, and to experiences of social reproduction. I focus on reproductive processes and the perinatal period, highlighting methods used by Xié dwellers to nurture healthy, quality-conscious lifestyles, and I examine Xié aetiologies and pathologies. Mindfulness, or awareness, is viewed as a key component of good health. In this context, healthy childbirth is for the birthing mother an art form, a practice for which her total life experience has prepared her. Childbirth is ranked with such other painful experiences as snakebite, and both childbirth and snakebite are opportunities for personal growth. Infant care is seen through the lens of specific, hands-on techniques that promote mindful states in both the carer and the cared for. Mindfulness emerges as a heuristic device that allows us to scrutinize the Amerindian soul and body, also elucidating soul-loss in the ‘animist’ lived world. I argue that mindfulness is a core characteristic of the ‘cool’ hydrocentric and status-conscious lifestyles of Xié river dwellers, and that it defines what it means to be a person, the Xié way.
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Pombo, de Barros Carolina. "Keeping head above water : Social presence in the transitions of Brazilian women to motherhood : Comparing experiences in Brazil, France, Portugal and Sweden". Thesis, Paris, EHESS, 2017. http://www.theses.fr/2017EHES0181/document.
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L’objectif principal de cette thèse était de caractériser et d’analyser la présence sociale dans la / les transition(s) de femmes brésiliennes de classes aisées à la maternité, au Brésil, en France, au Portugal et en Suèdedans des années récentes. L'objectif final était de contribuer à la déconstruction du modèle hégémonique de la «bonne maternité» au Brésil, établi à partir des expériences de femmes brésiliennes blanches de la classe moyenne.en. En tant que stratégie méthodologique, elle a mis l’accent sur les expériences de présence des mères brésiliennes, en utilisant la communication par ordinateur et trois méthodes en parallèle: une recherche documentaire de rapports de travail de recherches sur la santé périnatale et les politiques familiales des institutions nationales et internationales, des entretiens biographiques et enregistrement des journaux quotidiens; les trois méthodes sont articulés dans une perspective phénoménologique. Ainsi, à partir de mon travail de terrain, j’ai cherché, comme une dérive en spirale, comment certaines rhétoriques morales associées aux normes de genre, de classe et de race sont reproduites par des mères privilégiées en transition maternelle. Au-delà de ce processus de reproduction de la représentation hégémonique de la maternité, j’ai également constaté des hésitations et des mises en oeuvre éthique de ces femmes vis-à-vis des mères marginalisées telles que les femmes racialisées, célibataires et pauvres. Enfin, cette thèse développe la manière dont l’éthique du care découle des relations parentales quotidiennes et aussi comment l'intensification de la présence sociale est importante pour la promotion de cette éthique au-delà du travail genréThe main objective of this thesis was characterizing and analysing social presence in the transition(s) of Brazilian women from privileged classes to motherhood, in Brazil, France, Portugal and Sweden, inrecent years. As a final goal, it intended to contribute to de-construct the hegemonic model of ―good motherhood in Brazil, which is established from the experiences of middle-class white Brazilian wom-en. As methodological strategy, it focused on Brazilian mothers‘ experiences of presences, using Computer-Mediated Communication and three methods in parallel: a documentary research on official re-ports of perinatal health and family policies, biographical interviews and recording of daily diaries, articulated through a phenomenological perspective. Therefore, in my fieldwork I searched, in a spiral drift-ing, how certain moral rhetorics associated to gender, class and racial norms are reproduced by privileged mothers in maternal transitions. Beyond of this process of reproducing hegemonic representation of motherhood, I also found generating hesitations and ethical enactment among these women towards marginalized mothers such as racialized, single and poor ones. Finally, this thesis discusses how care ethics raise from daily parental relationships and how improving responsive social presence is quite significant for the promotion of such ethics beyond of feminine care work
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Queiroz, Patricia Helena Breno 1963. "As avós na gestação e no aleitamento materno de suas filhas adolescentes". [s.n.], 2014. http://repositorio.unicamp.br/jspui/handle/REPOSIP/310894.
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Orientadores: Maria de Lurdes Zanolli, Roberto Teixeira MendesTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
Made available in DSpace on 2018-08-26T12:51:00Z (GMT). No. of bitstreams: 1 Queiroz_PatriciaHelenaBreno_D.pdf: 2651235 bytes, checksum: 6f5fb1ee7f755286f20c3b8766b25740 (MD5) Previous issue date: 2014
Resumo: Este trabalho teve como objetivo geral compreender a influência das avós de bebês, filhos de mães adolescentes, no exercício e duração do aleitamento materno nos primeiros seis meses de vida; buscando entender na perspectiva das avós e das mães adolescentes o papel que as avós desempenham na gestação e maternidade adolescente e as concepções destas mulheres acerca do estabelecer e vivenciar a amamentação. A pesquisa seguiu um delineamento de caráter exploratório e natureza qualitativa. As adolescentes e as avós dos bebês foram convidadas a participar da pesquisa, a partir do último trimestre de gestação e conceder mais quatro entrevistas orientadas por roteiro semiestruturado, no puerpério imediato, aos 30, 120 e 180 dias após o nascimento, entre 14 de fevereiro de 2012 e 14 de maio de 2013. O material produzido após a leitura das transcrições das entrevistas foi agrupado em categorias e subcategorias e interpretado utilizando-se da Análise de Conteúdo Temático. Participaram do estudo 25 duplas de adolescentes e suas mães ou sogras. Quando perguntadas durante o pré-natal se sabiam o que era aleitamento materno (AM), 05 adolescentes reconheceram o conceito e 13 só o fizeram após uma explicação. Durante a visita no pós-parto imediato, 22 "recém-mães" informaram que não foram orientadas sobre AM durante o pré-natal, mas todas indicaram a equipe de enfermagem do Alojamento Conjunto do hospital, como responsável pelas orientações sobre amamentação. Na visita de 30 dias, 15 jovens referiram terem frequentado o ambulatório de AM no puerpério mediato, o que foi considerado importante para adequar a técnica de amamentação; duas relataram não terem continuado a amamentação de seus bebês quando em suas casas; quatro não completaram 30 dias de AM e substituíram por fórmulas introduzidas sob a recomendação de profissionais de saúde (farmacêutico, enfermeiro, pediatra). Dez de 19 de adolescentes que mantiveram o AM até o quarto mês foram orientadas pelo pediatra para a introdução de alimentos complementares. Somente nove bebês foram amamentados exclusivamente por seis meses. As mães e sogras atuam na retaguarda porque precisam retornar às suas atividades cotidianas e as adolescentes assumem o cuidado do bebê e muitas vezes, o trabalho doméstico. Neste contexto, os papéis de mãe e avó são definidos e a avós respeitam as escolhas de suas filhas. Intervenções dirigidas tanto para as adolescentes quanto para as avós, durante o período perinatal podem ter um efeito prolongador na amamentação, principalmente em famílias de mulheres-avós trabalhadoras que vão além do papel de "mãe de família" e contribuem para a subsistência desta
Abstract: This study aimed to understand the influence of grandparents of babies, children of adolescent mothers, exercise and duration of breastfeeding in the first six months of life; seeking to understand the perspective of grandparents and teenage mothers the role that grandparents play in pregnancy and teen motherhood and the conceptions of these women about the experience and establish breastfeeding. The research followed an exploration of character design and qualitative nature. The teenagers and grandmothers invited to participate in the study, from the last trimester of pregnancy and give four interviews guided by semi-structured, postpartum, 30, 120 and 180 days after birth, between February 14 2012 and May 14, 2013. The research design followed an exploratory and qualitative nature. The teenagers and grandmothers invited to participate in the research, from the last trimester of pregnancy and grant four semi-structured interviews guided by, postpartum, 30, 120 and 180 days after birth, between February 14 2012 and May 14, 2013. The material produced after reading the transcripts of the interviews, clustered into categories and subcategories and interpreted using the Thematic Content Analysis. The study included 25 pairs of adolescents and their mothers or mothers in law. When asked during the prenatal whether they knew what breastfeeding (BF) was, 05 adolescents recognized the concept and only 13 did so after an explanation. During the visit in the immediate postpartum period, 22 "new mothers" reported that were not oriented on BF during the prenatal, but all indicated the nursing staff of the hospital rooming, as responsible for the hospital on the guidelines breastfeeding. In 30-day visit, 15 young people reported having attended the outpatient clinic mediate the puerperium, which was considered important to adequate breastfeeding technique; two reported not have continued breastfeeding their babies while in their homes; four did not complete 30 days of BF and replaced by formulas introduced on the recommendation of health professionals (pharmacist, nurse, pediatrician). Of the19 adolescent, 10 maintained their AM until the fourth month, told by the pediatrician for the introduction of complementary foods. Only nine babies were exclusively breastfed for six months. Mothers and mothers in law act in rearward backwards because they need to return to their daily activities and teenagers take care of the baby and often the housework. The roles of mother and grandmother defined and grandparents respected the choices of their daughters. Interventions aimed both to teens and to grandparents during the perinatal period can have an effect on prolonging breastfeeding, especially in families of working women-grandmothers who go beyond the role of "mother of the family" and contribute to the subsistence of this
Doutorado
Saude da Criança e do Adolescente
Doutora em Ciências
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Masters, Grace A. "Bipolar Disorder in the Perinatal Period: Understanding Gaps in Care to Improve Access and Patient Outcomes". eScholarship@UMMS, 2021. https://escholarship.umassmed.edu/gsbs_diss/1127.
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Background:
Bipolar disorder (BD) is a significant cause of perinatal morbidity and mortality. Because BD is hard to detect and treat, these individuals often go without care. This dissertation was designed to: (1) identify the prevalence rates of BD and bipolar-spectrum mood episodes in perinatal individuals, (2) understand pertinent barriers to mental healthcare, and (3) elucidate how to bridge healthcare gaps.
Methods:
Data sources included: primary qualitative and quantitative data from obstetric clinicians, encounter data from Massachusetts Child Psychiatry Access Program (MCPAP) for Moms, a program aimed at helping clinicians to provide mental healthcare to perinatal patients. Analyses included: descriptive statistics, systematic review and meta-analysis, qualitative data analyses, longitudinal regression analyses, and group-based trajectory modeling.
Results:
The prevalence of BD in perinatal individuals was 2.6% (95% CI: 1.2 to 4.5%). Twenty to 54.9% were found to have a bipolar-spectrum mood episode. Barriers to mental healthcare for perinatal patients with BD included the paucity of psychiatric resources, difficulties in assessing BD, and stigma towards pharmacotherapy. Obstetric clinicians reported that MCPAP for Moms has helped them feel more comfortable in treating patients with BD. Longitudinal analyses of encounter data corroborated these findings - utilization of the program predicted increased clinician capacity to treat BD.
Conclusion:
Clinicians for perinatal individuals are being called upon and stepping up to care for complex illnesses like BD. Programs like MCPAP for Moms can help them feel more confident in this role, helping to bridge gaps in perinatal mental healthcare and ensuring that individuals with BD are able to receive appropriate care.
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Haque, Hena Wali. "Factors influencing South Asian women's access to maternity related health services : a mixed methods study in an ethnically diverse urban setting in the UK". Thesis, University of East London, 2018. http://roar.uel.ac.uk/7801/.
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Background: Women of South Asian heritage are more likely to experience adverse pregnancy outcomes than White British women. Poor access and engagement with maternity services may be one reason for this. A key measure of access in relation to maternity care is the initiation of antenatal care within the first trimester of pregnancy and late initiation has been linked to adverse pregnancy outcomes. The importance of positive experiences of care is also recognised for improving outcomes. The sociological concept of candidacy was used to understand how women of South Asian heritage access and experience maternity services. Access through a candidacy lens is defined as a dynamic and contingent process, constantly being defined and redefined through interactions between individuals, professionals and the service provision. Aims: This thesis aimed to investigate factors that influence access to and engagement with maternity services for South Asian women living in a deprived, ethnically diverse urban setting. Setting: The setting for this study is an inner-city borough in the UK, one of the poorest boroughs in London. Design and methods: Mixed methods were used in this thesis. There were two components: (i) a quantitative analysis of anonymized maternity data of 11,768 women to examine the predictors of early initiation of antenatal care and (ii) a qualitative study of 30 semi-structured face to face interviews with South Asian women to examine their experiences with maternity services. Data were analysed by means of thematic synthesis of women’s journeys into and through antenatal care, labour, delivery and post-natal care. Findings: Findings from the quantitative analysis of the predictors of late initiation of antenatal care found that late initiation amongst women of South Asian heritage was linked to not being able to speak English (p=0.000 ; 95% CI: 4 0.56-0.82), higher parity (p=0.002; 95% CI: 1.31-3.47), younger maternal age (p=0.005; 95% CI: 0.42-0.86), housing status (living in rented accommodation) (p=0.000; 95% CI:1.51-2.74), being a current smoker (p= 0.010; 95% CI: 1.10- 2.31), experiencing domestic violence (p=0.021; 95% CI: 0.45-0.57), and using alcohol (p=0.047; 95% CI: 0.01-0.97). Findings from the qualitative study identified four key themes these were women’s ethnic and /or migrant identities, permeability of services (the unhelpful features of a service), adjudication (cultural biases of health providers), and the local operating conditions of the services (lack of continuity of care, shortage of resources). Explanatory subthemes related to the cultural distinctness of women where issues with access came to the fore in light of women’s diasporic and compounded identities. For women born and raised in the UK achieving access meant continuous negotiation and renegotiation of their identities in a contextual and contingent way. For recent migrants’ language was an additional barrier. Difficulties in navigating the services were linked to inability to speak English fluently, subjecting them to provider judgements. Women wanted to be taken seriously. They emphasised the importance of continuous care to enable them to develop a relationship with service providers and make informed choices. Conclusion: The candidacy frame provides a balanced platform to detect vulnerabilities associated with access to maternity services for women of South Asian heritage. Findings suggest that women’s needs were not static but are ever changing at each stage of their journey, both groups of women were faced with similar challenges when engaging with the services. This study reiterates the need to embrace the notion of super diversity and promote cultural health capital in health service settings.
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Mogilevkina, Iryna. "Some reproductive health indicators in Ukraine : A study with special emphasis on factors behind induced aboartion and perinatal mortality". Doctoral thesis, Uppsala University, Department of Women's and Children's Health, 2002. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-3219.
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Objectives: To study indicators specifically reflecting the reproductive health of Ukrainian women and to analyse factors behind the indicators.
Methods: Induced abortion and maternal mortality were studied in some countries/regions of the former Soviet Union, using official statistics. Abortion rates, contraceptive practices and intentions in Ukrainian women were analysed by a large self-completion survey in 1996, and by a classroom questionnaire to first year medical students in 1999 in Donetsk, Ukraine. Totally, 1694 women and 689 students participated. Perinatal mortality was studied, applying the Nordic-Baltic perinatal death classification to all cases in the Donetsk region in 1997-98 (n=1126) and in Denmark in 1996 (n=540). Clinical guidelines, use of technology and rates of interventions in the two regions were analysed.
Results: Abortion remains a major method of fertility control and abortion-related mortality contributes to maternal deaths. Perinatal mortality rate is twice as high in the Donetsk region as in Denmark. A substantial proportion of sexually active women do not practice contraception. Modern methods of contraception are not widely used. There is a lack of knowledge in reproductive health issues and negative attitude to OCs. There is a positive attitude towards abortion as an acceptable fertility control method and of having abortion instead of using OCs or IUD. Poor economy is an obstacle to the use of contraceptive methods associated with a cost. Lack of experience with contraception reduces the intention to use any method in the future. Being single, younger than 19 years, living with parents, having a positive attitude towards abortion as fertility control method, having a history of previous childbirth and/or abortion are important factors associated with pregnancy termination. Antepartum deaths of growth-retarded fetuses, intrapartum and neonatal deaths associated with asphyxia are more common in Ukraine than in Denmark, particularly among premature infants. Lack of evidence-based clinical guidelines and adequate resources for fetal monitoring during pregnancy and labour, together with negative attitudes towards, and limited resources for, instrumental delivery, contribute to high perinatal mortality.
Conclusion: Better reproductive education/information of all strata of society is needed. Implementation of evidence-based guidelines in perinatal medicine, where international collaboration can be of great value, should be a matter of high priority.
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Johnsson, Kajsa. "Icke farmakologiska behandlingsmetoder vid depression under graviditet : En systematisk litteraturöversikt". Thesis, Uppsala universitet, Institutionen för kvinnors och barns hälsa, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-368309.
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SAMMANFATTNING Bakgrund Depression är vanligt bland unga kvinnor i fertil ålder vilket innebär att barnafödande infaller under en del av livet då många kvinnor är psykisk sårbara. Cirka 10 till 20 procent av alla gravida kvinnor drabbas av depression av varierande grad under den antenatala perioden. Depression ökar risken för tillväxthämning hos fostret, prematur förlossning och postpartum-depression samt försvårar anknytningen mellan mor och barn. Den rådande uppfattningen är att kvinnor som medicinerat med antidepressiva läkemedel innan graviditet bör fortsätta medicinera samt att insättning bör göras när behov finns. Många kvinnor vill dock inte använda antidepressiva läkemedel under graviditet av rädsla för negativ påverkan på fostret och för dessa kvinnor behövs alternativ. I barnmorskans arbete ingår att stödja och vårda kvinnor under graviditet varför kunskap om behandlingsalternativ är vikt för yrkesgruppen. Syfte Syftet med detta examensarbete var att undersöka vilka icke-farmakologiska behandlingar som finns för depression under graviditet samt dess för- och nackdelar. Metod En systematisk litteraturstudie har gjorts där 28 artiklar inkluderades av totalt 659 granskade titlar, 110 granskade abstracts och 44 artiklar granskade i sin helhet. De inkluderade artiklarna analyserades med kvalitativ innehållsanalys och kvalitetsgranskades i enlighet med Willman, Stoltz och Bahtsevani, (2016). Resultat Analysen av studiernas resultat visade attmånga former av ickefarmakologisk behandling kan ha mildrande eller botande effekt vid depression under graviditet. Det framkommer att behandling med yoga, behandling med mind-body terapi, behandling given till par, behandling given digitalt, behandling given i grupp samt behandling med psykoterapi eller samtalsstöd har positiv effekt om än i olika grad.Resultatet ger stöd för att komplement till basprogrammet vid sedvanlig mödrahälsovård är eftersträvansvärt och hjälper kvinnor med antenatal depression och att den positiva effekten ofta kvarstår efter förlossningen. Slutsats Detta examensarbete visade att många icke-farmakologiska behandlingsmetoder kan hjälpa kvinnor med antenatal depression. Tilltron till behandlingsmetoderna var oftast hög och få negativa effekter framkom. Kvinnor kan utifrån detta informeras om att forskning visat att utöver antidepressiv medicinering finns icke-farmakologiska behandlingsmetoder med god effekt på depression under graviditet. Vidare forskning får visa om behandlingsformerna skulle kunna erbjudas inom ramen för mödrahälsovårdens basprogram, samt om det är möjligt att genom dessa alternativa terapier minska graviditetskomplikationer orsakade av depression. NYCKELORD Antenatal depression, behandling, depression, graviditet, moderskap, perinatal terapiABSTRACT Background Depression is common among young women of childbearing age, which means that childbirth occurs during a part of life when many women are mentally vulnerable. About 10 to 20 percent of all pregnant women suffer from depression of varying degree during the antenatal period. Depression increases the risk of growth retardation in the fetus, premature birth and postpartum depression and complicates the bonding between mother and child. The current perception is that women who are taking antidepressants before pregnancy should continue to medicate and that insertation should be made when needed. However, many women do not want to use antidepressant drugs during pregnancy out of fear of adverse affects on the fetus, and for these women more options are needed. Midwifery includes supporting and nursing women during pregnancy, why knowledge about treatment options is important to the occupational group. Purpose The purpose of this thesis was to investigate the non-pharmacological treatments available in pregnancy depression and their advantages and disadvantages. Method A systematic review has been made where 28 articles were included in a total of 659 reviewed titles, 110 reviewed abstracts and 44 articles reviewed in full text. The included articles were analyzed with qualitative content analysis and quality assayed according to Willman, Stoltz and Bahtsevani, (2016). Results The analysis of the results showed that many forms of non-pharmacological treatments may have mitigating or curing effects in the event of depression during pregnancy. It appears that treatment with yoga, treatment with mind-body therapy, treatment given to couples, treatment given digitally, treatment given in a group and treatment with psychotherapy or counseling has a positive effect, albeit to a different extent. The result provides support for complementing the basic program of customized maternity care, which is desirable and helps women with antenatal depression and that the positive effect often persists after childbirth. Conclusion This degree project showed that many non-pharmacological treatment methods can help women with antenatal depression. Access to treatment methods was usually high and few negative effects were observed. Women can from this be informed that research has shown that in addition to antidepressant medication there are non-pharmacological treatment methods that have a good effect on depression during pregnancy. Further research can show whether treatment options could be offered within the framework of maternal health care programs, and whether it is possible to reduce pregnancy complications caused by depression through these alternative therapies. KEYWORDS Antenatal depression, depression, maternity, perinatal depression, pregnancy, therapy, treatment
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Anderson, Lynda May. "Privacy needs of women hospitalized for gynecological surgery". Thesis, University of British Columbia, 1990. http://hdl.handle.net/2429/28720.
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This phenomenological study was designed to explore the privacy needs of gynecological patients, as perceived by the clients during hospitalization, for the purpose of adding to knowledge and understanding of patients' privacy.
Data were collected through sixteen in-depth interviews with eight recently hospitalized patients. The interviews were tape-recorded and transcribed verbatim for each participant.
Data were analyzed using Giorgi's (1975) procedure. Analysis of participants' accounts revealed that privacy was important to participants' maintenance of their self-identity. Characteristics of privacy that participants identified as helping to maintain their self-identity included providing time alone for contemplation and helping to control interactions with others. Participants reported that privacy was important for their comfort during situations involving nursing care, basic needs and social interactions with others. Participants suggested that even though they reduced their expectations of privacy during the hospital stay, their privacy needs in hospital were at times still not met. Factors within the hospital setting that contributed or detracted from participants' hospital privacy included behavior of the nurses, doctors, roommates and the physical environment of the hospital. Participants
indicated that nurses were the main factor in meeting privacy needs especially while caring for participants and participants' roommates.
The findings of this study indicated that participants were willing to trade some privacy for health care. However, participants still valued privacy and considered it important during their hospital stay.
There is a lack of research on privacy and acute care hospitalization. Recommendations for further nursing research, nursing practice, nursing education and nursing administration, based on the findings of this study, are presented in the final chapter of the study.Applied Science, Faculty of
Nursing, School of
Graduate
24
Xu, Wanlu. "Patient Perspectives on Barriers and Facilitators to Mental Health Support after a Traumatic Birth". eScholarship@UMMS, 2021. https://escholarship.umassmed.edu/gsbs_diss/1126.
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Background
Up to 34% of perinatal individuals experience childbirth as traumatic. These individuals are at increased risk for developing depression, anxiety, and posttraumatic stress disorder (PTSD) after the traumatic event. The objective of this study was to elicit the perspectives of individuals with a traumatic birth experience on barriers and facilitators to receiving mental health support in the postpartum period after a traumatic delivery.
Methods
Individuals who delivered within the last three years and perceived their birth experience to be traumatic (n=32) completed an hour-long semi-structured phone interview. The interview included screening for PTSD, depression, and anxiety with validated instruments including the Posttraumatic Stress Disorder Checklist for DSM-V (PCL-5), the Patient Health Questionnaire depression scale (PHQ-8), and the Generalized Anxiety Disorder scale (GAD-7), respectively. Qualitative data was analyzed using a modified grounded theory characterizing participants’ barriers and recommendations for mental health support after traumatic births.
Results
Among participants, 34.4% screened positive for PTSD, 18.8% screened positive for major depressive disorder, and 34.4% screened positive for anxiety. Qualitative themes revealed multi-level barriers involving lack of communication, education, and resources which prevented obstetric professionals from recognizing and supporting patients’ mental health needs after a traumatic birth. Recommendations from participants included that 1) obstetric professionals should acknowledge trauma experienced by any individual after childbirth, 2) providers of multiple disciplines need to be integrated into postpartum care, and 3) mental health support is needed before the ambulatory postpartum visit.
Conclusions
There are multi-level barriers toward detecting and responding to individuals’ mental health needs after a traumatic birth. Obstetric professionals need to use a trauma-informed approach and proactively follow-up and assess mental health care in the postpartum period.
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Salmon, Chris. "An investigation into the willingness of mothers from lower socioeconomic groups in the Western Cape region of South Africa to pay for private maternity care". Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/95624.
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Thesis (MBA)--Stellenbosch University, 2012.An exploratory, cross-sectional, qualitative survey was conducted to describe the market of lower income mothers who had recently given birth to a child in a state hospital in the Western Cape (WC) region of South Africa. These mothers were viewed by the researcher as potential consumers of low cost maternity plans which would provide for maternity care in Active Birthing Units (ABUs) in the private healthcare sector in South Africa. The motivation behind the research stems from various sources. The currently inequitable healthcare system in South Africa, which has been described as a two tier system in the recent Policy Paper on National Health Insurance (Republic of South Africa, 2011: 4-5), is one such source. Reports of poor maternity care in the South African public healthcare system (Vogel, 2011: E1097-E1098), is another source of motivation behind the research report. It was apparent to the researcher that given the low quality of maternity care in state hospitals, a potential market of healthcare consumers – who would be willing to pay a small premium for what they considered to be a more acceptable level of maternity care in the private healthcare sector – could exist. This view was supported by research conducted by Joan Costa and Jaume Garcia (2003: 587-599) in which the “quality gap” was confirmed as a driving force behind the demand for private health care. This focus on the lower socioeconomic groups as a market for private sector goods and services was found to be well described by Prahalad (2005). The researcher conducted interviews amongst mothers who had delivered a child in a public hospital in the previous two years. A convenience sample of 100 mothers was selected in a shopping mall in the Western Cape (WC). The researcher administered a structured questionnaire during a face-to-face interview with each of the 100 respondents. The respondents were rewarded with a shopping voucher to the value of 50 ZAR, which was both a prerequisite specified by the management of the shopping mall and consistent with rewards offered in similar studies (Francis, Battle-Fisher, Liverpool, Hipple, Mosavel, Soogun, & Nokuthula, 2011). Data collected from the questionnaire included both data on willingness to pay (WTP), as well as demographic data, which provided interesting insights into a relatively under-researched market segment. A statistical analysis of the data collected revealed that 31 respondents (31%) reported a positive WTP for private maternity care. A statistically significant relationship was revealed between respondents’ WTP and the birth experience the respondents had had during their most recent pregnancy, whereby mothers who had described their most recent birth experience as “poor” were significantly more likely to exhibit a positive WTP for private maternity care (p=0.00006). Significant relationships between respondents' WTP for private maternity care and their age and household size were also discovered, whereby younger mothers were more likely to be willing to pay than older mothers (p=0.02) and mothers from smaller households were also significantly more likely to be willing to pay than mothers from larger households (p=0.02). Amongst a sub group of 32 respondents deemed to have potential monthly savings, those with a higher monthly household income were more likely to exhibit positive WTP (p=0.02753) than were those with higher levels of monthly expenditure (p=0.04093). The researcher acknowledged that the limitations of the research included the fact that respondents were selected non-randomly, as a small isolated sample, which made the extrapolation of the results to the larger population of South African mothers impossible. The research did, however, serve to describe the demographic characteristics of a new and relatively under researched target market of mothers from the lower socioeconomic segment of the WC. Data gleaned from this survey will serve to inform further research into this target market, so as to complete a more comprehensive feasibility analysis for the establishment of low cost maternity care packages and ABUs in South Africa.
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Sadicario, Jaclyn S. "PREDICTORS OF EXPERIMENTAL AND CONTROL GROUP ATTENDANCE: FINDINGS FROM AN HIV/STD PREVENTION RCT WITH PREGNANT WOMEN AT RISK FOR SUBSTANCE USE". VCU Scholars Compass, 2019. https://scholarscompass.vcu.edu/etd/5703.
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Efforts to improve inclusion in research have included mandating the recruitment of ethnic minorities and women into NIH funded studies. However, little research has been completed on who attends such interventions. This is particularly worrisome in populations for which attendance to interventions can have dire consequences. HIV is a public health concern for pregnant women in substance using communities, as pregnant women are much less likely to use condoms during intercourse to prevent HIV. Group modular HIV prevention interventions have long been the standard for HIV prevention. However, little attention in research on HIV prevention interventions RCTs has been focused on attendance to these interventions. This study examined predictors of intervention and control group attendance in a randomized controlled trial comparing a 5-session Safer Sex Skill Building (SSB) intervention to a 1-session HIV education control group in a sample of pregnant women at risk for prenatal substance use. This study identified psychosocial and mental health variables associated with both 1 session control group and 5-session SSB intervention attendance as well as endeavored to identify the number of sessions necessary to attend to achieve an adequate dose in treatment. Findings include younger age and marital status as being predictive of participation in the one session HE control group and having a trade, skill, or profession as being predictive of participation in the five session SSB intervention group. Further research is needed to understand what factors may impact five-session SSB group attendance.
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Pilling, Stacey A. "A Qualitative Analysis of Migrant Women Farmworkers' A Qualit ative Analysis of Migrant Women Farmworkers’ Perceptions of Maternal Care Management". ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/300.
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The purpose of this phenomenological study was to examine migrant women farmworkers' views of perinatal care management while working in the fields. Like men, women migrant farmworkers are exposed to many physical, chemical, and biological hazards that pose human health risks. However, women of childbearing age are at an increased risk of having reproductive health difficulties and adverse pregnancy outcomes, and the infant mortality rate among migrant farmworkers is estimated to be twice the national average. Perinatal care is a critical factor in reducing adverse outcomes for perinatal and newborn mortality. Face-to-face interviews were conducted with 15 migrant women farmworkers between the ages of 18 to 40 years who had experienced at least 1 gestational period during while working in the Midwest agricultural stream. Participants were voluntarily recruited from farms in Northern Ohio using purposeful sampling techniques. Guided by the social ecological model, data were analyzed via inductive coding techniques to tease out common themes. All participants reported a basic understanding of prenatal care but due to numerous occupational, community, and access barriers, could not participate in what they perceived as normal prenatal care. Also, participants stated when in gestation they were expected to perform the same jobs as women not in gestation. These findings may inform the work of public health providers and migrant healthcare clinicians of migrant women farmworkers' challenges while receiving perinatal care in Northern Ohio; results can also be used to influence local and national migrant healthcare policies on comprehensive maternal healthcare for migrant women farmworkers in Ohio and across the United States.
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Graner, Sophie. "Reproductive outcomes in rural Vietnam. Perspectives and experiences by pregnant women and health care professionals on pregnancy promotion and maternal health care". Doctoral thesis, Umeå universitet, Obstetrik och gynekologi, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-37266.
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Background Reproductive health and health events associated with pregnancy including induced abortions are among the most important factors for the health of fertile women. Adverse outcomes have an impact on women’s reproductive health and their overall health as well as the health of their offspring. Pregnancy and child bearing take place within a cultural context. Risk factors for adverse pregnancy outcomes depend on factors both associated with the individual woman as well as contextual factors. Aims This thesis investigates reproductive health indicators and their determinants for women in a rural district in Vietnam with special focus on adverse pregnancy outcomes and their determinants. In addition, this thesis explores the perspectives and experiences among pregnant women and health care professionals on maternal health care in Vietnam and risks during pregnancy and delivery. Methods The studies used quantitative and qualitative methods. In the quantitative studies a total of 4,396 women reporting 5,838 pregnancies, and 5,521 infants were included. Parametric and non parametric tests and univariate and multivariate logistic regression analysis was performed. For the estimation of small for gestational age a population-specific reference curve was constructed based on the mean birth weight at term in the study population. In the qualitative studies data were collected from eight focus group discussions, four with pregnant women and four with health care professionals. Manifest and latent content analysis was applied. Main findings Women belonging to an ethnic minority or women giving birth at home were at increased risk of stillbirth. The risk of induced abortion increased with maternal age. Neonatal mortality was estimated to 11.6 per 1000 live births and perinatal mortality to 25.0 per 1000 births. The prevalence of small for gestational age was estimated to 6.4%. Risk factors for small for gestational age included women in farming occupations and post-term birth. There was a marked decrease in perinatal mortality after 33 weeks of gestation. Contextual conditions influenced both pregnant women’s use of maternal health care and the performance of the health care professionals. The use of maternal health care was influenced by economical conditions as well as cultural norms that impeded women’s autonomy. Structural constraints included inadequate financing of the health system, including lack of staff, insufficient professional re-training, and inadequate equipment. Pregnant women in rural Vietnam created a strategy to promote a healthy pregnancy through lifestyle adjustments, gathering of information, and seeking timely medical care. Insights in pregnancy-related conditions were sought from various sources and were influenced both by Vietnamese traditions and modern medical knowledge. Conclusions Knowledge about pregnancy complications and their related signs and symptoms, and a high confidence in the maternal health care probably contribute to the relatively good maternal health status and pregnancy outcomes in Vietnam. To improve perinatal and neonatal outcomes there is a need to ensure access for all pregnant women to delivery units with surgical capacity in case of an obstetrical emergency. Also, a higher proportion of premature infants need to be born at units with access to neonatal care. This may be achieved by an improved system for referral including capacity of medical care during transportation. Other desirable improvements include antenatal identification of small for gestational age foetuses. In our study the induced abortion rate increased with maternal age and was highest among married women, indicating that induced abortions may be used as a method for family planning. The cultural norms in Vietnam limit women’s autonomy and reduce their possibility to make independent decisions about their reproductive health. Our studies emphasize the importance of adequate access for all women to maternal health care adjusted for their individual needs. A better understanding is needed of context-specific factors that influence couples’ choice of family planning methods, place of birth, and maternal health care. The communication between pregnant women and health care professionals needs further investigation. This knowledge is essential in order to develop reproductive health services that are accessible, acceptable and affordable to all.
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Taveras, Janelle. "HIV Risk Behaviors, Previous HIV Testing and Positivity among Hispanic Women Tested for HIV in Florida, 2012". FIU Digital Commons, 2017. http://digitalcommons.fiu.edu/etd/3456.
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The prevalence of female adults and adolescents living with diagnosed HIV infection continues to rise. Latina women in the United States (US) are not only disproportionately affected by human immunodeficiency virus (HIV) infection, but also underutilize HIV prevention services, such as HIV testing. Data are limited on the differences in HIV risk among Latinas by country of birth, and opportunities still exist to prevent transmission of HIV and reduce HIV-related disparities. This dissertation describes the risk behaviors, testing behaviors, and test results among women tested for HIV at public sites in Florida. Additionally, it compares these characteristics by HIV testing site type among pregnant women. Multivariable logistic regression was used to estimate the adjusted odds ratios (AOR) and associated 95% confidence intervals for the outcome variables of risk behaviors, previous testing, and positive HIV test results.
Of the total 209,954 records, 184,037 were from women not currently pregnant, of which 87,569 (45.6%) were among non-Hispanic Blacks (NHBs), 47,926 (26.0%) non-Hispanic Whites (NHWs), and 41,117 (22.3%) Latinas. Women who reported previous HIV testing had decreased odds of being Latina compared to NHW women (AOR 0.90; 95% confidence interval [CI] 0.87, 0.94), and testing event results indicate that foreign-born Latina women were significantly less likely to report partner risk (AOR 0.42; 95% CI: 0.40-0.54) than US-born Latina women. Of the 24,863 records of pregnant women, 10,199 (41.1%) were among Latinas, 6,796 (27.4%) were among NHB, and 6,631 (26.7%) were among NHW. The testing records indicated that Latina and NHB women had decreased odds of reporting partner risk than NHW women (Latina: AOR 0.20; 95% CI: 0.14-0.28; and NHB: AOR 0.14; 95% CI: 0.10-0.21), and records of women tested in prisons/jails had higher odds of reporting previous HIV testing compared to prenatal care sites (AOR 1.86; 95% CI: 1.03-3.39).
Reported risk behaviors varied by race/ethnicity and Latina country of origin. Knowledge of these differences can enhance current testing and prevention strategies for women, and aid in targeting HIV prevention messaging, program decision-making, and allocation of resources, corresponding to the central approach of High Impact Prevention and the National HIV/AIDS Strategy.
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Darwin, Zoe. "Assessing and Responding to Maternal Stress (ARMS) : antenatal psychosocial assessment in research and practice". Thesis, University of Manchester, 2013. https://www.research.manchester.ac.uk/portal/en/theses/assessing-and-responding-to-maternal-stress-arms-antenatal-psychosocial-assessment-in-research-and-practice(f58f4ced-df4e-49d6-ba08-24f24fade0a5).html.
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Background: Antenatal Psychosocial Assessment (APA) has recently been introduced into routine antenatal care, but the ways in which maternity service providers assess and respond to maternal stress are subject of debate. There is a lack of consensus on the instrument(s) of choice and lack of evidence regarding appropriate interventions. Further, national guidelines have not kept apace with the conceptual shift from ‘postnatal depression’ to ‘perinatal anxiety and depression’. Adopting the Medical Research Council Complex Interventions Framework, the ARMS research aimed to inform the development of interventions that support women who are experiencing, or at risk of, mild-moderate mental health disorder in pregnancy. Methods: A mixed methods approach was adopted. In the quantitative element (Study Part 1) participants (n=191) completed a questionnaire when attending for their first formal antenatal appointment, using a procedure and materials that had been previously tested in a pilot study. Details including mental health assessment and referrals were obtained from their health records, following delivery. In the qualitative element (Study Part 2) a sub-sample of women (n=22) experiencing high levels of maternal stress took part in up to three serial in-depth interviews during pregnancy and the early postnatal period.Findings: Maternal stress was found to be common. Using the Edinburgh Postnatal Depression Scale (EPDS) threshold of ≥10, approximately 1 in 4 women were classed as high depression (halving to 1 in 8 at the more conservative threshold of ≥13). Almost 1 in 3 women were classed as high anxiety, using the state scale of the State-Trait Anxiety Inventory (STAI-S, threshold ≥41), compared with 1 in 5 using the two-item GAD (threshold ≥3). Fewer than half of the women identified as high anxiety were identified by both measures. Factor analyses of the symptom measures were consistent with wider literature suggesting a three-item anxiety component of the EPDS; however, concurrent validation using regression analyses did not indicate that the EPDS could be used as an anxiety case finding instrument. Women reported that maternal stress had significant impact on their lives that may not be captured with existing clinical approaches. Women commonly found it difficult to self-assess severity of maternal stress and the assessment process could itself act as an intervention. The research provided the first validation of the depression case finding questions in UK clinical practice. The Whooley items completed in clinical practice identified only half of the possible cases identified by the EPDS, at both commonly adopted EPDS thresholds. Inclusion of the Arroll 'help' question as a criterion improved specificity of the assessment completed in clinical practice but substantially compromised sensitivity, missing 9 in 10 possible cases. Women’s mental health history and treatment history were similarly under-reported, particularly concerning anxiety. APA was introduced into routine clinical practice without attention to topics of relevance to women, context of disclosure or to provision of adequate resources for consistently responding to identified need. Women experiencing, or at risk of, mild-moderate disorder were thus usually ineligible for further support. Implications: Care pathways are needed that encompass both assessing and responding to maternal stress, where communication with health professionals, subsequent referral and management are addressed. The development, implementation and evaluation of low-cost resources embedded in such pathways are a priority and the research presented in the thesis offers a foundation on which to build.
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Mukherjee, Soumyadeep. "Antenatal Stressful Life Events and Postpartum Depression in the United States: the Role of Women’s Socioeconomic Status at the State Level". FIU Digital Commons, 2016. http://digitalcommons.fiu.edu/etd/2631.
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The purpose of this dissertation was to examine patterns of antenatal stressful life events (SLEs) experienced by women in the United States (U.S.) and their association with postpartum depression (PPD). It further explored the role of women's state-level socio-economic status (SES) on PPD; the racial/ethnic dispartites in SLE-PPD relationship; and the role of provider communication on perinatal depression.
Data from 2009–11 Pregnancy Risk Assessment Monitoring System (PRAMS) and SES indicators published by the Institute of Women’s Policy Research (IWPR) were used. Latent class analysis (LCA) was performed to identify unobserved class membership based on antenatal SLEs. Multilevel generalized linear mixed models examined whether state-level SES moderated the antenatal SLE-PPD relationship. Of 116,595 respondents to the PRAMS 2009-11, the sample size for our analyses ranged from 78% to 99%.
The majority (64%) of participants were in low-stress class. The illness/death related-stress class (13%) had a high prevalence of severe illness (77%) and death (63%) of a family member or someone very close to them, while those in the multiple-stress (22%) class endorsed most other SLEs. Eleven percent had PPD; women who experienced all types of stressors, had the highest odds (adjusted odds ratio [aOR]: 5.43; 95% confidence interval [CI]: 5.36, 5.51) of PPD. The odds of PPD decreased with increasing state-level social/economic autonomy index (aOR: 0.75; 95% CI: 0.64, 0.88), with significant cross-level interaction between stressors and state-level SES. Among non-Hispanic blacks and non-Hispanic whites, husband/partner not wanting the pregnancy (aOR: 1.47; 95% CI: 1.14, 1.90) and drug/drinking problems of someone close (aOR: 1.37; 95% CI: 1.21, 1.55) were respectively associated with PPD. Provider communication was protective.
That 1 out of every 5 and 1 out of every 8 women were in the high- and emotional-stress classes suggests that SLEs are common among pregnant women. Our results suggest that screening for antenatal SLEs might help identify women at risk for PPD. The finding that the odds of PPD decrease with increasing social/economic autonomy, could have policy implications and motivate efforts to improve these indices. This study also indicates the benefits of antenatal health care provider communication on perinatal depression.
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Torres, Ospina Sara. "Uncovering the Role of Community Health Worker/Lay Health Worker Programs in Addressing Health Equity for Immigrant and Refugee Women in Canada: An Instrumental and Embedded Qualitative Case Study". Thèse, Université d'Ottawa / University of Ottawa, 2013. http://hdl.handle.net/10393/23753.
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“Why do immigrants and refugees need community health workers/lay health workers (CHWs) if Canada already has a universal health care system?” Abundant evidence demonstrates that despite the universality of our health care system marginalized populations, including immigrants and refugees, experience barriers to accessing the health system. Evidence on the role of CHWs facilitating access is both lacking and urgently needed. This dissertation contributes to this evidence by providing a thick description and thorough analytical exploration of a CHW model, in Edmonton, Canada. Specifically, I examine the activities of the Multicultural Health Brokers Co-operative (MCHB Co-op) and its Multicultural Health Brokers from 1992 to 2011 as well as the relationship they have with Alberta Health Services (AHS) Edmonton Zone Public Health. The research for this study is based on an instrumental and embedded qualitative case study design. The case is the MCHB Co-op, an independently-run multicultural health worker co-operative, which contracts with health and social services providers in Edmonton to offer linguistically- and culturally-appropriate services to marginalized immigrant and refugee women and their families. The two embedded mini-cases are two programs of the MCHB Co-op: Perinatal Outreach and Health for Two, which are the raison d’être for a sustained partnership between the MCHB Co-op and AHS. The phenomenon under study is the Multicultural Health Brokers’ practice.
I triangulate multiple methods (research strategies and data sources), including 46 days of participant and direct observation, 44 in-depth interviews (with Multicultural Health Brokers, mentors, women using the programs, health professionals and outsiders who knew of the work of the MCHB Co-op and Multicultural Health Brokers), and document review and analysis of policy documents, yearly reports, training manuals, educational materials as well as quantitative analysis of the Health Brokers’ 3,442 client caseload database. In addition, data include my field notes of both descriptive and analytical reflections taken throughout the onsite research. I also triangulate various theoretical frameworks to explore how historically specific social structures, economic relationships, and ideological assumptions serve to create and reinforce the conditions that give rise to the need for CHWs, and the factors that aid or hinder their ability to facilitate marginalized populations’ access to health and social services.
Findings reveal that Multicultural Health Brokers facilitate access to health and social services as well as foster community capacity building in order to address settlement, adaptation, and integration of immigrant and refugee women and their families into Canadian society. Findings also demonstrate that the Multicultural Health Broker model is an example of collaboration between community-based organizations and local systems in targeting health equity for marginalized populations; in particular, in perinatal health and violence against women. A major problem these workers face is they provide important services as part of Canada’s health human resources workforce, but their contributions are often not recognized as such. The triangulation of methods and theory provides empirical and theoretical understanding of the Multicultural Health Brokers’ contribution to immigrant and refugee women and their families’ feminist urban citizenship.
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Smith, Karen L. "Perinatal staff nurses' perceptions related to pregnant women who use illegal substances a report submitted in partial fulfillment ... Master of Science (Maternal-Child Health Nursing) ... /". 1993. http://catalog.hathitrust.org/api/volumes/oclc/68796560.html.
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Wijaya, Hardy. "Rural Women's and Care Providers' Experiences of Maternity Care". 2009. http://hdl.handle.net/2429/6812.
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It’s not easy being a pregnant woman in rural British Columbia. With 10–20% annual attrition of family physicians in rural BC, and 17 rural hospitals having ceased maternity care services since 2000, many women lose the ability to deliver in their own community even if local hospitals exist. What are the causes and consequences? We investigated rural maternity care from the perspective of parturient women and care providers. Through a series of interviews and focus groups in 14 communities across BC, we learned about the current state of maternity care in rural BC and investigated how the reduction in maternity care services has impacted women’s lives, physician’s confidence, and community ethos.
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Hoang, THH. "Maternity care and services in rural Tasmania : the perspectives of rural women and health professionals". Thesis, 2012. https://eprints.utas.edu.au/14706/2/whole-hoang-thesis-exc-pub.mat.pdf.
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Despite strong records of safety and quality maternity care, maternity care in Australia is not meeting the needs of rural and remote women as evidenced by poor access and outcomes. Rural communities have experienced substantial and ongoing loss of maternity services for more than a decade. Consequently, rural women have to leave their community and support networks to go to distant centres to give birth. The loss of these critical health services has adversely affected rural women, families and communities. Workforce shortages, safety and quality considerations and cost considerations are the three interrelated reasons which have led to the loss of small rural birthing services in Australia. To improve maternity services in rural communities, it is important that women’s needs for the services are identified and catered for as much as possible.
This study aims to: (i) identify the needs of women in maternity care in rural areas, (ii) examine the current available maternity health services in rural Tasmania and (iii) identify the gaps between the needs and services. A conceptual frame work based on a literature review was constructed to guide the study. The study employed a mixed methods design with a self-administered mailed survey and semi-structured interviews as data collection methods. Six rural communities which are representative of all rural Tasmania were chosen to conduct the study. Through the health care and child health centres in these communities, 600 survey questionnaires were sent out to women. The survey response rate was 35%. Semistructured interviews were conducted with 22 women and 20 health professionals.
Descriptive statistics and Chi Square tests were used to analyse the survey data with the use of SPSS 15. The interview data were analysed using grounded theory and thematic analysis with the use of NVivo v8.0.
The findings indicate a set of unmet maternity needs of women in rural Tasmania namely (i) access needs, (ii) safety needs, (iii) needs for small rural birthing services, (iv) information and support needs, and (v) needs for quality services. The study suggests that the lack of maternity services in the Tasmanian rural areas transfer risk from the health care system to rural families because of privileging of medical model over a feminist theorising or primary care approach. The study provides important recommendations for bridging the gaps between the women’s needs and currently available maternity services. Firstly, antenatal, postnatal and support services should be provided in the local communities through outreach or visiting services. Secondly, rural hospitals without maternity services should be properly equipped and prepared to deal with unexpected emergency childbirths to ensure the safety for women and babies. Appropriately equipped and skilled ambulance services should be in place for all rural hospitals. In addition, further withdrawal of rural birthing services should be challenged and consideration given to reopening closed rural services. Furthermore, women should be informed about all options and services available through the collaboration of health professionals in local areas and the regional hospital. Finally, child health services in rural communities should provide quality services for women throughout their pregnancy and postnatal period as part of continuity of care.
In summary, this study makes a contribution to the enhancement of maternity care and services in rural Tasmania and consequently to improve access and outcomes for rural women and their families.
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Cooklin, Amanda Ruth. "Women's employment in pregnancy and following birth: effect on psychological well-being". 2010. http://repository.unimelb.edu.au/10187/8524.
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Currently in Australia, 80% of women are employed during first pregnancy, and 40% resume employment in the postpartum. The first aim of this study was to identify which of a broad range of factors, including maternal preferences, maternal separation anxiety and maternity entitlements, contributed to maternal employment in the first 10 postpartum. The second aim was to identify the contribution of women’s satisfaction with employment arrangements to their psychological well-being. Participants were 165 employed pregnant women over 18 years of age and with sufficient English for completion of study materials, systematically recruited in the third trimester of pregnancy. Data were collected in pregnancy and at 3 and 10 months postpartum. Maternal preferences, not or no longer breastfeeding and lower maternal separation anxiety were associated with significantly increased likelihood of resuming postpartum employment when maternal age, educational attainment and occupational status were controlled for. A constellation of adverse employment conditions made independent contributions to measurably worse maternal mood including experiencing sexual discrimination in pregnancy, no maternity entitlements when known determinants of poorer maternal well-being were controlled in regression analyses. These findings provide evidence about the relevance of structural determinants to maternal well-being, and highlight the urgency of a national paid parental leave scheme in Australia.
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Frost, Jordana. "Equitable access to maternity care practices that promote high-value family-centered intrapartum care". Thesis, 2018. https://hdl.handle.net/2144/32699.
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BACKGROUND: Despite large investments in maternity care services, perinatal health outcomes in the U.S. are among the worst compared to other industrialized countries, with documented perinatal health disparities disproportionately impacting racial and ethnic minorities. Midwifery-led freestanding birth centers (FSBC) have emerged as an underutilized model for the safe and cost-effective care of women with low-risk pregnancies. Despite approximately 85% of all US pregnancies being considered low-risk, only 0.5% of all US births occurred in a FSBC in 2016. The goal of the study is to elucidate strategies used to develop and sustain freestanding birth centers (FSBCs) that are seeking to serve high proportions of publicly-insured women and women of color.
METHODS: I conducted an embedded unit case study, including semi-structured in-depth interviews and focus groups with 49 stakeholders from three exemplary FSBCs. Supplemental interviews were led with five key informants from three additional FSBCs and a relevant national membership organization. Additional data sources used to complete this case study include, where relevant and permitted, observations of maternity care settings, patient-provider encounters, management meetings, community events, and review of pertinent documents. Qualitative analysis methods were used to identify common themes and variations.
FINDINGS: Midwifery-led birth center care can improve the experience and outcomes of maternity care among publicly insured women of color. The study revealed persistent multi-level challenges, as well as the use of common approaches to overcome these organizational, financial, and cultural barriers, resulting in greater, yet still fragile, access to family-centered intrapartum care within the communities in which these FSBCs operate.
CONCLUSIONS: The careful integration of FSBCs into health systems such as a Federally Qualified Health Center (FQHC) may contribute to the broad scale-up of this underutilized model of care. While integrating FSBCs into FQHCs may be helpful in expanding equitable access to birth center care, it is not necessary, and also not sufficient. Expansion efforts should include additional deliberate processes and strategies to ensure equitable uptake and sustainability of birth center care.2020-10-23T00:00:00Z
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Mianda, Solange. "Measuring skilled attendance in the uThungulu District, KwaZulu-Natal in 2008". Thesis, 2010. http://hdl.handle.net/10413/1609.
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Background The Millennium Development Goals call for two-third and three-quarter reductions in Perinatal Mortality Rates and Maternal Mortality Ratios. The main strategy towards achieving these reductions is to increase access to skilled attendance. However, it cannot be confirmed that all health professionals are skilled in managing women in labour, nor that they are functioning in enabling environments. To measure the provision of skilled attendance, this study was undertaken in five Level 1 Hospitals in the uThungulu Health District of KwaZulu-Natal. The objectives of the study were: 1. To establish perinatal outcomes for each Level 1 Hospital in uThungulu Health District. 2. To evaluate the quality of intrapartum care provided in Level 1 Hospitals in uThungulu Health District. 3. To evaluate the obstetric knowledge of health workers attending births in Level 1 Hospitals in uThungulu Health District. 4. To evaluate the obstetric skills of health workers attending births in Level 1 Hospitals in uThungulu Health District. 5. To evaluate the environment in which births are attended in Level 1 Hospitals in uThungulu Health District. 6. Compare the quality of care, the knowledge, skills and environment with perinatal outcomes. Methods Perinatal outcomes (PNMR, FSBR, ENNDR and PCI) were calculated for each hospital; maternity case records of women who have delivered in these Level 1 Hospitals were audited to assess the quality of intrapartum care; obstetric knowledge and skills of midwives were assessed; as was the enabling environment within which midwives worked, which included a measurement of their workload. A correlation between perinatal outcomes and the quality of intrapartum care, knowledge and skills and the enabling environment was performed to determine whether variables were associated. Results The overall PNMR for five hospitals in uThungulu Health District was 31 per 1000 births. Three hospitals demonstrated PNMRs below 30 per 1000, while the other two showed rates above 45 per 1000. The combined FSBR for the five hospitals was 6 per 1000 births, the combined ENNDR was 12 per 1000 live births. The PCI in all hospitals ranged between 3 and 4. An audit of maternity case records revealed that all hospitals have a high overall mean percentage score per record. However, analysis of subsets showed good performance in recordings on the labour graph, but poor performance in the admission assessment and in the management of labour. The Kruskal-Wallis Non-Parametric Test showed a statistically significant difference in overall scores amongst hospitals (p=0.01), suggesting differences in performance in all five hospitals in terms of the quality of care provided. Overall, all hospitals scored poorly on tests of obstetric knowledge and skills. There were no statistically significant differences in the overall knowledge median scores and subsets median scores amongst hospitals (p=0.07), indicating that all five hospitals performed on a similar level in terms of obstetric knowledge. However, all hospitals performed differently in relation to obstetric skills, as there was a statistically significant difference in the overall skill median scores amongst hospitals (p=0.002). Three hospitals met the enabling environment standard. All hospitals but one scored poorly on referral, and the availability of supervision on both shifts. One hospital scored poorly on drugs and supplies. Overall no hospitals reported the presence of all the elements of the enabling environment. Three hospitals had acceptable workloads. No association could be detected between variables. However, there were trends that can be traced in different hospitals. Conclusions In South Africa, from the Demographic and Health Survey, 84% of deliveries are assisted by skilled attendant. While an attendant may be present, one cannot say that skilled attendance has been provided, as it has been shown for uThungulu Health District.Thesis (MMed.)-University of KwaZulu-Natal, Durban, 2010.
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"Expecting The Unexpected: Testing a Theoretical Model of Postpartum Depression". Doctoral diss., 2014. http://hdl.handle.net/2286/R.I.24767.
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abstract: Postpartum depression has been described as one of the most common complications related to childbirth (Beck, 2008). To understand better the theoretical underpinnings of the disorder, the current study used a vulnerability-stress conceptualization to develop a theoretical model of postpartum depression. The predictive model was tested on 144 mothers with infants under 12-months of age using structural equation modeling. Four alternative models were also tested. A variation of the original theoretical model was found to have the best fit. Consistent with past research, this model indicated that need for approval, relationship conflict, and maternal-efficacy directly predicted postpartum depressive symptoms. Need for approval also moderated the relation between maternal-efficacy and postpartum depressive symptoms, so that this relation was stronger for mothers with high need of approval than for mothers with low need for approval. The role of these risk factors, particularly negative maternal perceptions and cognitions, is highlighted in relation to developing clinical interventions to treat postpartum depression. Limitations of this study are discussed and suggestions are made for future models to be tested through empirical research.Dissertation/Thesis
Ph.D. Psychology 2014
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Van, der Westhuizen Werner Lukas. "Women's experiences of hypnotherapy as psychological support for high-risk pregnancy". Diss., 2014. http://hdl.handle.net/10500/14144.
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In this study, the use of hypnotherapy in high-risk pregnancy is explored from an ecological systems perspective through two case studies. Each case study is described in detail. They explore the experiences of two women during their pregnancy and giving birth, with specific reference to the pregnancy risks and their use of hypnotherapy. The study provides the reader with an in-depth understanding of the use of hypnotherapy before, during and after birth.Psychology
M.A. (Psychology)
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Mabunda, Sonia Sokufa. "Factors contributing to sub-standard intrapartrum care in maternity wards of selected hospitals in the Mopani District, Limpopo Province". Diss., 2017. http://hdl.handle.net/11602/976.
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Sidumo, Euginia Motlalepule. "An investigation into the Saudi Arabian cultural knowledge among non-Muslim nurses working in the obstetric units". Thesis, 2007. http://hdl.handle.net/10500/798.
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The study was conducted with the aim of assessing the Saudi Arabian cultural knowledge among the non-Muslim nurses. These nurses work in the obstetric units at the King Faisal Specialist Hospital and Research Centre, Jeddah and come from different cultural groups and are caring for the Saudi Arabian Muslim women. In order for care to be congruent, comprehensive and of a high quality, the patients' needs should be met at the best attainable level.
Nurses in all health care settings are expected to demonstrate knowledge of the culture that they serve in order to eliminate barriers.
Data analysis was facilitated with the use of the SPSS 11.5 computer program. The study findings may suggest the development of educational guidelines, which will direct the activities of an educational intervention.Health Studies
M.A. (Health Studies))