Childbirth, the biggest life event for a woman, is a complicated process. Childbirth pain not only involves physiological sensations, but also psychosocial and cultural factors. In addition, the way the woman handles the pain is affected by the meaning she attributes to it. In order to understand the experience of Hong Kong Chinese women in terms of childbirth in general and childbirth pain in particular, and to learn the meanings attributed, a longitudinal qualitative descriptive study was conducted with the aim of exploring the experience and meaning of pain in the context of childbirth for Hong Kong Chinese women. The study was informed by a systematic review and metasynthesis of existing relevant literature. Since people’s attitudes, beliefs and behaviours may change over a period of time, data were collected from the participants at 4 different time points: around 36 weeks of pregnancy; on postnatal day 3; 6-7 weeks after birth; and 10-12 months after birth. Purposive sampling was employed and a total of 10 Hong Kong Chinese women (5 primiparous and 5 multipararous women) were recruited for the study. The data were collected via semi-structured interviews, informed by phenomenological principles. The resulting data were described using thematic analysis The results from the metasynthesis together with the four interviews yielded 5 meta-themes: The cultural norms; The trajectory of pain sensation; Facing or escaping the pain; Someone to be with me; and Achievement and growth through the unforgettable experience. For these participants, satisfaction with their childbirth experience was not related to the pain they experienced, but to the care they received from their husbands and midwives, as well as to their own sense of achievement. Although the women remembered the fact of their pain over time, their affective noxious memories decreased as their concentration was on their Finally, the meta-themes were interpreted in the light of Maslow’s hierarchy of needs, and a model was proposed to help women to handle childbirth pain in the future.

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.

The specific aim of this thesis was to explore the culture, beliefs, values, customs and practices around the birth process within a free-standing midwifery-led birth centre (FSBC). It was done to shed light on the workings of this little known model of maternity service provision and to build on the small amount of qualitative research in this field to date. Using ethnography, I undertook participant observation within a FSBC in England over a nine month period. I interviewed thirty women who gave birth at the centre and fifteen members of staff who worked there. The birth centre rejected bureaucratic, institutional and hierarchical modes of management commonly seen in hospitals and was run more in accord with postmodern organisational attributes of devolved decision-making and teamworking. Leadership was transformational and decentred. The birth centre staff had powerful sense of identity and ownership of the facility, forged partly through a successful campaign to resist its closure over recent years. They had a strong commitment to creating an optimum birthing environment for normal birth to flourish, which may be explained by a vicarious 'nesting' instinct on behalf of women giving birth at the centre. The model of care contrasted with Fordist assembly-line birth in larger hospitals with the staff having time to 'wait on birth' and to 'be with women'. Their relationships with women were marked by equality and altruism. Their relationships with each other reflected communitarian values and a shared purpose that I theorized was an example of social capital. Childbirth for many women at the birth centre rejected the technocratic model, connecting more to birth's social origins. Finally, a defining characteristic of birth centre care appeared to be 'matrescence' wherein staff nurtured the 'becoming of a mother. The study provides an important insight into the values and benefits of small scale maternity care provision and the findings contrast sharply with much mainstream provision today based on large, obstetric-led hospitals.

Substantial benefits can be gained by participating in regular physical exercise, however only a minority of women meet current pregnancy exercise recommendations and there is limited understanding of women’s decision-making regarding exercise in pregnancy. The purpose of this constructivist grounded theory study was to develop a theoretical insight into the factors that influence women’s decisions regarding exercise in pregnancy and how they process the influences and multiple alternatives they encounter. The constructivist approach drew on the subjective researcher/participant interrelationship to co-construct meaning from the data and ultimately render the women’s experiences into theoretical interpretations. The theory presented was built inductively from the experiences of 10 pregnant women who exercised regularly, supplemented by insights from theoretical sampling of fitness experts, internet forums and extant literature. Longitudinal, audio-recorded semi-structured interviews occurred twice during each pregnancy and 6-8 weeks postnatal. Data generation and data analysis ran concurrently and iteratively using the constant comparative method of analysis. Theoretical constructs generated by the data were progressively amplified and clarified through a series of inductive-deductive cycles and theoretical sampling that drove the evolving interview schedules. Theorising ideas in the form of detailed memos was a fundamental part of the analysis and enabled a detailed audit trail to be established. The resultant substantive theory of ‘Accommodating the pregnant self’ conceptualises pregnancy as a transitional period during which women’s self-identity is modified. ‘The exercising self’ was a salient and valued facet of the women’s self-identity and continuing to exercise enabled women to maintain a degree of continuity and control that was integral to their sense of maintaining and to a degree regaining their past valued self. Decisions regarding exercise were influenced by a complex interplay of contextual factors that simultaneously encouraged exercise and rest. This consequently triggered a degree of identity conflict between two domains of their self-identity, ‘the exercising self’ and ‘the pregnant self’. The women reacted to the challenges to their identity through the process of self-identity regulation. Through this process they gradually re-constructed their self-identity to accommodate their pregnant self while contemplating possible future selves against various self and social normative standards. Negotiating conflicting identities was an integral component of the decision-making process, and ultimately resulted in many of the women modifying their activities to accommodate the pressures they faced to conform to social ideologies of ‘the pregnant self’. The theory explores a range of strategies that the women used to deal with identity conflict, particularly drawing on selective perception and self-justification to resolve cognitive dissonance. It also highlights a duality in the factors that influenced their decisions which suggests women’s identity characteristics resulted in a propensity for behaviour to be steered by either internal (personal) or external (relational and environmental) influences. The substantive theory underscores the significance of self-identity in steering the decisionmaking process. The findings provide insight into how women might be better supported to make informed and assured decisions regarding lifestyle choices. The theoretical potential to inform interventions to enhance activity levels in a wider population is highlighted.

Healthy Start is the United Kingdom government’s food voucher programme for low-income, pregnant women and young children. Eligible women receive vouchers worth £3.10 per week, which can be exchanged for fruit and vegetables, plain cow’s milk or infant formula. There has been no robust evaluation of the impact of Healthy Start on nutritional outcomes since its introduction in 2006. Therefore, this study aimed to explore potential outcomes of the programme (including intended and unintended outcomes) and develop explanations for how and why these outcomes might occur. A realist review was conducted in two iterative and overlapping stages: 1) developing theories or hypotheses about how the Healthy Start programme works, for who, in what circumstances and why; 2) testing those theories using relevant evidence from existing studies of Healthy Start and a similar food voucher programme in the United States. The review findings comprised three ‘evidence-informed programme theories’ about how low-income pregnant women use Healthy Start vouchers and why. A qualitative study was undertaken to further refine and consolidate the programme theories derived from the realist review, and to develop new and emerging programme theories. Semi-structured interviews were conducted with 11 low-income women from North West England, who received Healthy Start vouchers during pregnancy. An innovative combination of realist interview techniques and vignettes was used to communicate and exchange theories with low-income women. A realist logic of analysis was applied to generate clear and transparent linkages between outcomes and explanations. Five ‘evidence-based programme theories’ were developed to explain why low-income pregnant women may experience one or more of the following outcomes from the Healthy Start programme: dietary improvements, shared benefits, financial assistance, stockpiling formula, misuse of vouchers. These programme theories were integrated with existing behaviour change theories and an overarching theoretical model for Healthy Start was developed. This model illustrates the combination of context and resources needed to generate the intended outcome of dietary improvements for low-income pregnant women, and the mechanisms by which this outcome may be generated.