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In a time where emphasis on personal choice is highly valued, the setting in which a woman chooses to give birth is a subject that has come to the fore in the public's attention. The aim of this research was to study the experience of women wanting to give birth at home by introducing a qualitative perspective into the area, based upon nine semi-structured interviews. A grounded theory method (Glaser & Strauss, 1967; Rennie, 1988) was applied to analyse the data. One main core category emerged from the data: "Philosophy of Control", which described the overall perspective of the participants on having a sense of control in planning and giving birth at home. This core category was based on a dynamic relationship between the perceived 3 stages of having a home birth: (1) preparing for the challenges (2) developing resilience strategies and (3) the outcome of the home birth experience. Therapeutic implications for counselling psychologists working with this group are discussed along with methodological limitations

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It is well-established that a medical model of childbirth shaped maternity policy during the second half of the twentieth century. However, alongside this narrative of medicalised childbirth, an idea emerged that was to challenge medical hegemony in maternity care provision. In 1933 British doctor Grantly Dick-Read published his first book, Natural Childbirth, detailing his theories on pain during childbirth and its remedy. Natural childbirth was a controversial idea and was not well-received by the medical profession. Nevertheless, some women were enthusiastic about the nonmedical approach suggested by Dick-Read and by the 1950s natural childbirth was recognised as a distinct method of coping with the rigours of labour and birth. The term later became synonymous with a range of alternative ideas about the management of childbirth. Such ideas were disseminated through literature advising women about childbirth, and through antenatal education, which aimed to inform, enlighten and empower childbearing women. Childbirth alternatives were consistently regarded with scepticism and the medical establishment remained critical of them. Midwifery was surprisingly ambivalent, given that it shared some of its core values with the principles of natural childbirth. Nevertheless, a vocal minority continued to enthuse about childbirth alternatives, and a handful of consumer organisations committed to promoting them emerged. By the 1970s and 1980s, a backlash against medicalised childbirth in contemporary Britain provided a platform for such organisations to push their agenda even further. Natural childbirth discourse provided the means to express dissatisfaction with the medical system of childbirth; it also helped to give form to disillusionment with contemporary maternity services by shaping expectations. By the late 1980s, policy makers attempted to address the groundswell of discontent amongst childbearing women by alluding to childbirth alternatives and offering a choice of services. Still, as their shared history suggests, the relationship between the medical and natural models of childbirth remained complex and littered with paradoxes.

Childbirth is an emotional and physical experience, which may have permanent or longterm positive or negative consequences. Key predictive factors of traumatic and positive childbirth have been previously identified. Criticisms however have been levied towards the pre-dominantly quantitative-based, pathological focus of the literature. Few empirical studies have examined the positive nature of childbirth. Research has also focused on isolated aspects of the pre, intra and post-partum period, as opposed to women's global perceptions. The need to consult with women who have endured traumatic and non-traumatic childbirth and to identify the complex interplay of factors associated with these events has been highlighted in the literature. This research comprises an interpretive phenomenological study. By recruiting and interviewing women who had experienced a self-defined traumatic and positive birth, the research aimed to generate a deeper understanding of the meanings and lived experiences of diverse childbirth events. A further aim was to explore how women achieved a subsequent positive birth following a traumatic episode, as well as the impact of this experience on maternal wellbeing. Through purposive sampling methods, a total of fourteen women were engaged over two recruitment phases. In phase one an interview was held with ten women who had already experienced a self-defined traumatic and positive birth. In phase two, four vomen were recruited on a longitudinal basis; interviews were held after a traumatic (interview 1) and subsequent birth (interview 2). In addition, all women (across both phases) were also involved in a final interpretation meeting. Thirty-two interviews were held in total. Data were collected through in-depth interviews. Data analysis was undertaken through an interpretive framework based on Heideggerian and Gadamerian hermeneutics. The findings present the women's childbearing journey of tragedy and joy through seven interpretive themes. A theoretical framework has re-conceptualised the women's birth narratives as a hero's tale. This represents a heroic journey of adversity, trials, courage, determination and triumph. A unique psychosocial model has been synthesised by integrating aspects of the theories of Carl Jung (1968, 1989, 2006), Abraham Maslow (1962, 1970a&b) and Martin Heidegger (1962, 1976, 1977). This model has provided a holistic conceptual framework of women's childbirth experiences. The framework explores the psychosocial motivators and influences on women's childbirth experiences. It emphasises the importance of socio-contextual factors to determine a woman's growth potential during childbirth; as well as how growth-inhibiting (traumatic birth) and growth-enhancing (joyful birth) experiences are internalised by women. This model offers the basis through which a whole systems salutogenic orientation to maternity care can be achieved. Original insights into the transformative, cathartic and self-validating nature of a redemptive birth are also presented. The practical implications of these findings and suggestions for future research have been offered.

Childbirth holds short and long-term physical and psychological effects for women. Yet, numerous investigations into childbirth have overlooked the delicate interrelated psychological and emotional interplay that women experience, in favour of the physical, such as the outcomes of birth, maternal mortality, and the physical skills of healthcare providers. Although quantitative measures derived from these are important to establish and evaluate maternal health, they are not adequate to explain the complexity of the human experience of childbirth. Without this understanding there is inadequate guidance about how to proceed to achieve the Sustainable Development Goals targeting maternal health. The aim of this study was to explore childbirth experiences of women giving birth in Zambia, in order to better understand how they experience and give meaning to the phenomenon. The study was guided by an interpretive phenomenology approach. This type of phenomenology was found to be appropriate because the study sought to understand childbirth within the context of everyday lives of women birthing in Zambia. Purposive sampling was utilised to recruit 50 women aged between 16 and 38 years. The women had birthing experiences that occurred between 2005 and 2011. The birthing experiences were from all the ten provinces of Zambia. Data were collected through in-depth unstructured interviews, which were tape recorded. Data analysis was guided by van Manen’s six steps of analysis. Seven themes namely: 1) Conforming to societal norms, 2) Clash between traditional and contemporary childbirth practices, 3) Being in a dilemma, 4) Loss of dignity, 5) Feeling insecure, 6) Inadequate service provision, and 7) Being there for the woman, emerged from the analysis. Each theme had several sub-themes that provided a clearer picture of how participants experienced the phenomenon. The embodied experiences of participants illuminated the complex context of childbirth, whereby, the phenomenon was experienced in private, behind the closed door of secrecy that encompassed difficulties and issues such as, lack of choice, sub-standard care, discrimination, fear and conflicting information. The findings revealed that there was a need for an attitudinal change in maternity care professionals towards a more caring approach, as well as a parallel need to build agency and autonomy in women. For women, the change needs to be addressed at an individual and societal level, beginning with simple things, such as assertiveness training through to educational opportunities, so that they develop economic independence. Macro-reforms (top-down change) need to be combined with micro-reforms (bottom-up change) to challenge existing discriminatory, oppressive and patriarchal attitudes and practices that impact on women’s birth experiences. Women’s voices need to be heard. Understanding maternal outcomes at a micro level can help inform decisions and influence policy at the larger macro levels of institutions and government. Overlooking this intrinsic level represented an important barrier to utilisation of skilled birth care and constituted a common cause of suffering and human rights violations for birthing women. The key implications for practice pointed to a need for all maternity care stakeholders in Zambia to have an understanding of how women birthing in Zambia experience and give meaning to the childbirth phenomenon. This could start by re-examining current approaches to improving reproductive health, and addressing the contextual factors and community based issues that have been brought to light in this study. In the absence of such an understanding it is difficult to map out interventions that do not infringe on women’s beliefs and practices.

Successful childbirth depends on precisely coordinated uterine contractions during labour. Calcium indicator fluorescence imaging is one of the main techniques for investigating the mechanisms governing this physiological process and its pathologies. The effective spatiotemporal resolution of calcium signals is, however, limited by the motion of contracting tissue: structures of interest that are of the order of microns can move over a hundred times their width during a contraction. The simultaneous changes in local intensity and tissue configuration make motion tracking a nontrivial image-analysis problem and confound many of the standard techniques. In this thesis I present a method that tracks local motion throughout the tissue allowing for an almost complete removal of motion artifacts. This provides a stabilised calcium signal down to a pixel resolution which, for the data examined, is of the order of a few microns. As a byproduct of the image stabilisation, a complete kinematic description of the contraction-relaxation cycles is also obtained containing novel information about the mechanical response of the tissue, such as the identification of a characteristic length scale, of the order of 40-50 microns, below which tissue motion is homogeneous. This kinematic information will help to fill the gaps in experimentally recorded mechanical properties of contracting myometrium. Applying the algorithm to over twenty datasets, I show that for the first time unrestricted single-cell calcium measurements can be taken from myometrial tissue slices over multiple contraction-relaxation cycles. I investigate single-cell calcium signals in between contractions and compare single-cell calcium dynamics in control and oxytocin-treated myometrium. Additionally, I use the kinematics of tissue motion to compare calcium signals at the subcellular level and local contractile motion. Freely modifiable code written in the MATLAB environment was published under the GNU General Public license in the hope that it will be useful to researchers analysing these or similar datasets.

Background: Some women develop symptoms of posttraumatic stress following childbirth. There is preliminary evidence that cognitive variables may be associated with the development or maintenance of these symptoms. Research indicates that symptoms of posttraumatic stress following childbirth may have negative consequences for mother-infant relationship outcomes. However, these may be attributable to comorbid symptoms of depression. Further evidence is required regarding the nature of the relationships between these variables. Methods: An internet based cross-sectional questionnaire design was employed to test hypothesised relationships between maternal attachment experiences, metacognition, symptoms of PTSD and depression and perceptions of the mother-infant bond, in an analogue sample of new mothers. Structural equation modelling was employed for the principal analysis. Results: The final structural model demonstrated a good fit to sample data. Metacognition fully mediated the relationship between attachment experiences and postnatal psychological outcomes. The association between posttraumatic stress and maternal perceptions of the mother-infant bond was fully mediated by depression. Conclusions: Metacognition may have a key role in the development and maintenance of postnatal psychological distress. If clinically significant postnatal depression is identified, screening for posttraumatic stress is strongly indicated.

Research into birth plans has considered women’s experiences of their usefulness as an aid to communicating preferences for childbirth. It has also evaluated implications for post-natal well-being based on the realisation of expressed preferences in labour and delivery. The current study aimed to identify the psychosocial profile of birth planners and to explore the outcomes for these women as compared with non-planners post-natally. It also compared the psychological constructs measured in the sample with a non-pregnant population to see differences between pregnant, post-natal and non-pregnant women on these dimensions. A sample of 140 women who had not been pregnant in the past year completed a questionnaire measuring: Age, occupational group; ethnic group; general health status, health knowledge, attitudes towards doctors and medicines; locus of control; coping style; perceived social support; and beliefs about pain control. A questionnaire was also given to 120 women in four antenatal clinics across a primary care trust in the North West of England. This questionnaire produced data on all of the variables in the comparison questionnaire, plus: Parity; antenatal education; birth plan use; medical conditions; information seeking; and childbirth self-efficacy. Women also described in text their preferences for birth. At least four weeks after delivery these women completed a further questionnaire consisting of the seven measures used in both the previous two questionnaires, plus: experience of birth; usefulness of birth plan; and post-natal depression. They also described in text their experience of birth. Results showed that birth planners were younger and had lower levels of internal health control than non-birth planners. Birth planners tended to use problem focussed coping styles, perceived less support from their significant other and perceived doctors as more powerful in pain control than non-birth planners. More positive psychological post-natal outcomes were experienced by women who valued their birth plans if they had one but overall birth planners experienced more negative psychological post-natal outcomes than non-birth planners. The non-pregnant sample was comparable in demographic terms to the pregnant sample but differed in most subscales across all measures to the pregnant sample pre-natally and to a lesser extent post-natally. The factors implicated in birth planning and psychological post-natal outcomes are discussed both in terms of the literature and possible implications for the training and practice of midwives.

This qualitative study was aimed at exploring midwives’ responses and attitudes towards women in labour, as well as their perception of the pain experienced during labour. A non-probability purposive sampling method was followed, and the data collection methods selected were in-depth individual interviews and focus-group interviews, with the aid of an interview guide for both methods, the researcher being the main data collecting instrument. More than one data collection method (triangulation) was used to ensure the trustworthiness of the study. Concerning the perception of midwives towards women experiencing labour pain, the study revealed that firstly, labour pain is unique to individual women, it is natural and bearable. Secondly, labour pain may be unbearable, and the women in labour need to be given medication for pain. Furthermore, certain behaviour was identified and viewed as unacceptable by participating midwives because it could put both the lives of the mother and the unborn baby at risk; these include: drinking herbal medicines during pregnancy and childbirth; extreme activities like jumping out of bed and rolling on the floor. These behaviours were sources of frustration to midwives. / Health Studies / M.A. (Health Studies)