Aims : The aims of the study were to describe the experiences of the midwives who were part of the first Australian CenteringPregnancy Pilot Study and to inform the future development of CenteringPregnancy. Background CenteringPregnancy is a model of group antenatal care that has evolved over the past two decades in North America. A pilot study that explored the feasibility of implementing CenteringPregnancy in Australia was undertaken in 2006-2008. I was the research midwife employed to coordinate this study and I explored the experiences of the midwives who were participants as the focus of my Master of Midwifery (Honours) research. Method : An Action Research approach was undertaken to study the implementation of CenteringPregnancy in Australia. This included a qualitative descriptive study to describe and explore the experiences of the midwives who were participants. The study was set in two hospital antenatal clinics and two outreach community health-care centres in southern Sydney. Eight midwives and three research team members formed the Action Research group. Data collected were primarily from focus groups and surveys and were analysed using simple descriptive statistics and thematic content analysis. Findings : CenteringPregnancy enabled midwives to develop relationships with the women in their groups and with their peers in the Action Research group. The group antenatal care model enhanced the development of relationships between midwives and women that were necessary for professional fulfilment and the appreciation of relationship-based care. The use of supportive organisational change, enabled by Action Research methods, facilitated midwives to develop new skills that were appropriate for the group care setting and in line with a strengths-based approach. Issues of low staffing rates, lack of available facilities for groups, time constraints, recruitment difficulties and resistance to change impacted on widespread implementation of CenteringPregnancy. Conclusions : The experience of the midwives who provided CenteringPregnancy care suggests that it is an appropriate model of care for the Australian midwifery context, particularly if organisational support and recruitment strategies and access to appropriate facilities are addressed. The midwives who undertook CenteringPregnancy engaged in a new way of working that enhanced their appreciation of relationship-based care and was positive to their job satisfaction. Implications for practice Effective ways to implement CenteringPregnancy models of care in Australia were identified in this study. These included a system of support for the midwives engaging in facilitating groups for the first time. It is important that organisations also develop other supportive strategies, including the provision of adequate group spaces, effective recruitment plans and positive support systems for change management. In the light of current evidence the development of continuity of care models which enhance the relationship between an individual women and her midwife, it is important to explore the effects of group care on this unique relationship.

Background: The initiation of antenatal care (“booking”) is universally recommended in the first trimester. While working in the Michael Mapongwana antenatal clinic (ANC) in Khayelitsha, the researcher noticed that late booking was prevalent, with consequent impaired antenatal care and increased potential for adverse outcomes. The objective of this qualitative study was to understand why women book late at this specific ANC. Methods: Twenty-three in-depth, open-ended interviews were conducted with 23 late bookers (i.e. who booked after 18 weeks) who attended the ANC between June and October in 2009. The interviews were recorded, transcribed, and analysed according to the “Framework” model. Results: The mean gestational age at booking was 26,4 weeks (range: 20 to 34 weeks). The majority were multigravid, unmarried and unemployed. A high incidence of previous or current obstetric problems was noted. Important personal barriers included ignorance of purpose of antenatal care, ignorance of ideal booking time, and denial or late recognition of an unplanned pregnancy. Provider barriers appeared to be significant, especially the cumbersome booking system, absence of an ultrasound service, and perceived poor quality of care. Conclusion: A combination of personal and provider barriers contributed to late booking at this clinic - it seems that the perceived effort of attending this antenatal service outweighed the perceived value thereof. Provider barriers should be addressed by accommodating patients’ needs, optimising nurse-patient interaction, provision of an ultrasound service and improvement of the booking system. Public awareness of early booking and the holistic value of antenatal care should also be enhanced.

The purpose of this study is to extend knowledge concerning the health of expectant and nursing mothers and infants in working-class districts of Wales, particularly mothers and infants residing in the county of Monmouthshire during the 1920s and 1930s. The thesis covers the period 1900-1938 and considers the implementation of various Acts of Parliament and the effects of the legislation on the lives of women and infants. The main Acts covered are the Midwives Act 1902 and 1936, the Notification of Births Act 1907 and 1915, the Maternity and Child Welfare Act 1918 and the 'Special Areas' Act of 1934. Through the use of mainly primary sources and oral testimony, it will be argued that these social policies did extend the welfare system and bring benefits to mothers and infants. However, at the same time, the implementation of the policies exerted control over the realm of motherhood to such an extent that pregnancy, child-birth and infant care were irrevocably transported from the natural and familiar domestic sphere, into the unnatural and unfamiliar sphere of the public, male-dominated medical world. Furthermore, the policies which were initially introduced to improve the health of both mothers and infants were limited, discriminatory and did little to address the poverty, which was a reality of life for mothers in the working-class districts of Wales.

The term eclampsia is derived from the Greek eklampien meaning a flesh, and its etymology suggests the acute onset of the convulsions. On the surface, therefore, it would appear paradoxical to define any state as being one of "imminent eclampsia". However, although the aetiology is unknown, sufficient knowledge of the preceding history and manifestations of eclampsia has accumulated to justify such a specific term. In a subsequent chapter, these symptoms and signs will be assessed and discussed in detail. Where the net of antenatal care is widespread and where such services are accepted and utilized by all who are pregnant in a community, the incidence of severe toxania and eclampsia is minimal. Few obstetricians in highly developed, civilized areas are afforded the opportunities for studing and treating any large numbers of cases of imminent eclampaia

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For monitoring the spread of HIV epidemic, both national population-based surveys and antenatal clinics (ANC) are used. However, in all cases, there are potential biases. Bias associated with ANC data includes whether the pregnant women who attend public ANC are representative of all pregnant women. Reduced fertility among HIV-infected women, selection for sexual activity and under-representation of smaller rural sites in surveillance systems are other factors that may be source of biases (Boerma et al. 2003 & Walker et al. 2003). So, the question arising is how women who attend ANC could be representative of the general female population. Evidently, not all women become pregnant and not all pregnant women attend ANC. This research project has been designed to address those biases especially in Rwanda and Malawi. It focused on investigating the significance of this bias by doing a comparative analysis of sero prevalence between both those using ANC and those who do not. This study, therefore, intends to test whether women attending ANC may be representative to the general female population of both Rwanda and Malawi using respectively 2004 MDHS and 2005 RDHS. Using statistical techniques with the aid of STATA software program, univariate, bivariate and logistic regression (bivariate and multivariate) were performed for 11321 women in Rwanda and 11698 in Malawi aged between 15 and 49. However, among them, those who had live birth in last five years prior to the surveys were the most interested on in this study; that is especially, 5390 in Rwanda and 7304 in Malawi. Besides, HIV status of respondents was an important variable. Considering both women who had live birth and those who did not have live birth, I find that women who had live birth in Rwanda are 0.62 times less likely to be HIV positive and 0.48 times less likely to be infected for those who had live birth in Malawi. When controlling for women who had live birth, I find that in both countries women who use ANC are less likely to be infected compared to those who do not (0.53 times less likely in Rwanda and 0.58 times less likely in Malawi). Based on these findings, relying only on data from ANC may lead to biases in HIV prevalence estimates; particularly referring to 2004 MDHS and 2005RDHS. Besides, considering the level of significance of the difference between HIV status between those who use ANC and those who do not, I find that this is not identical in Rwanda (5% level of significance) and in Malawi (10% level of significance). Thus, these results suggest, briefly, that not only the degree of ANC data representativeness is changing depending on various stages of HIV epidemic as Fylkesnes said (1998), but also is affected by the amount of women who had live birth and their respective HIV status. In fact, this difference may be based on the fact that in Malawi, HIV prevalence is high compared to Rwanda and those who had live birth were in high percentage comparing to Rwanda.

Untreated depression in pregnancy may result in adverse health outcomes to both the mother and her unborn child. Pharmacotherapy with antidepressants is the most common treatment option for depression; however, the decision to treat with medication becomes complicated by pregnancy. Risk benefit assessments are critical tools to guide the treatment decision. Factors that should be included in these analyses include the pharmacokinetics and pharmacodynamics of antidepressants in pregnancy and their maternal and fetal safety. The economic cost of untreated maternal depression is also important to keep in mind. When the pharmacokinetics of the antidepressants venlafaxine and bupropion were studied in pregnancy it was found that the apparent oral clearance rate of bupropion was increased in late pregnancy when compared to early pregnancy (p = 0.03). There was a trend for lower area under the curve for these medications when the third trimester was compared to the first trimester. When the metabolism of antidepressants was investigated using hair analysis it was found that there was increased metabolism in pregnancy when compared to the postpartum period for citalopram (p = 0.02) but not venlafaxine (p = 0.77). Follow up of depressive symptoms throughout pregnancy identified that depression scores were highest in the first trimester of pregnancy, which may be due to concurrent nausea and vomiting of pregnancy. A meta-analysis of paroxetine use in early pregnancy demonstrated that there was no increased risk for cardiac malformations; case-control studies had an odds ratio of 1.18 (CI95: 0.88 – 1.59) while a weighted average difference of 0.3% was found in case-control studies (CI95: -0.1 – 0.7%, p = 0.19) The direct medical costs incurred by the Ontario government due to discontinuation of antidepressant medications in pregnancy was estimated to exceed $20,000,000 CAD. The management of depression in pregnancy with pharmacotherapy is an important and complex issue. My study documents the advantages of conducting risk benefit assessments for vulnerable populations such as pregnant women with depression.