Thesis (MPH.) -- University of Limpopo, 2021 / Pregnancy and childbearing are most of the crucial milestones in women’s lives as they look forward to becoming mothers. During this time, they have positive expectations while pregnant, however, the physical, hormonal, neurotransmitters and psychosocial changes that occur can make pregnancy to be stressful and overwhelming. The disability associated with depression and its impact on maternal and child health has important implications for public health policy. While the prevalence of postnatal depression is high, there are no prevalence data and associated risk factors on antenatal depression in Helen Franz Hospital of Limpopo Province, South Africa. The purpose of this study was to determine the prevalence and factors associated with depression amongst pregnant women at Helene Franz Hospital. Methodology: A quantitative retrospective design was used in the study and a sample size of 336 was required which was calculated based on the 95% confidence interval, 5% sampling error and 38.5% prevalence of depression amongst pregnant women in KZN. A self-administered questionnaire with close-ended questions which was adopted from the Edinburgh postnatal depression scale was given to the participants to complete. The scoring of the questionnaire was that the maximum score was 30 and the persons who scored 10 or greater were considered depressed according to the Edinburg scale for assessing depression. Data were analysed using SPSS V.21.0 and a p-value of less than 0.05 was considered statistically significant. Results: The participants ranged from 18 to 47 years with the mean age of 27.8±6.9 years. The majority of the pregnant women were in the age groups 20-24 years and 25-29 years. The mean depression score for pregnant women was 7.87±5.2 and ranged from 0 to 23. The prevalence rate of depression symptoms was 31%. Maternal age was not significantly associated with depression and a significantly higher proportion of married pregnant women were depressed as compared to unmarried women at p=0.017. Pregnant women who smoke were significantly more likely to be depressed than those who do not smoke at p=0.002. Pregnant women without financial support from partnerwere significantly likely to be depressed than those who receive financial support at p-=0.002. A significantly greater proportion of pregnant women with partner violent were likely to be depressed than those with non-violent partner at p <0.001. Pregnant women in relationships with unemployed spouses were significantly likely to experience depression than the employed spouse at p=0.035. lastly, pregnant women in relationship with a spouse with lower educational level were significantly likely to be depressed than the other groups at p-.006. Conclusion: The prevalence of depression among pregnant women was high and the main risk factors involved in the onset of antenatal depression have highlighted a complex multifactorial aetiology. These are related to different sources of chronic diseases, psychosocial, environmental, obstetric and pregnancy- related risk factors have been highlighted. Correctly identifying women at risk of suffering from depression would provide an opportunity to target those women who would benefit from preventive and supportive interventions. Therefore, a psychosocial assessment, in the sense of a comprehensive and multidimensional evaluation of a woman's psychosocial circumstances should be common practice for all women during the antenatal period. Key concepts Antenatal care; Pregnancy; Childbearing; Depression; Psychosocial

The aim of this study was to examine how expectations may affect a new mother during postnatal depression, both her own expectations and he expectations she feels from her surroundings. The result is based on seven interviews with mothers who have had postnatal depression. It is not uncommon for women to suffer from postpartum depression after childbirth, studies show that approximately ten percent of all new mothers are affected. Symptoms of postpartum depression are, besides the symptoms for regular depression also feelings of worthlessness and hopelessness or she might difficulties feeling happy about the situation and the baby. Qualitative content analysis was used to analyse the material. The study shows that those feelings does not go well together with the so called mother myth, that the new mother is supposed to feel instant love towards the baby and be the more responsible parent. This leads to the mother feeling guilty and ashamed. Because of this, several mothers feel reluctant to seek help. This is due to emotions of guilt and shame. The study also showed that the women felt a lack of professional care and the need for development in the professional field. Three important factors in the care were presented: Information, knowledge and understanding.

[pt] O presente estudo busca compreender os significados atribuídos por mulheres de camadas populares e médias ao chamado parto humanizado, que ganhou terreno no Brasil coma criação da Rede pela Humanização do Parto e do Nascimento (ReHuNa). O termo parto humanizado, de maneira geral, é compreendido como o parto em que a mulher tem suas escolhas e seus direitos respeitados. Na maioria das vezes, engloba a ideia de parto natural, expressão que denota o compromisso com um mínimo de intervenções médicas e farmacológicas possível. Os significados atribuídos aos termos, contudo, se aproximam e se distanciam, segundo o contexto em que são utilizados, o que ficou evidenciado nesse estudo por envolver dois campos: um curso de preparação para o parto na Zona Sul, coordenado por uma ativista e frequentado por mulheres de camadas médias, e uma casa da parto pública, considerada pela ReHuNa referência de humanização. Esta localiza-se na Zona Oeste e sua clientela é composta principalmente por mulheres de camadas populares. Os resultados sugerem que a proposta de parto é atualizada da maneira diferenciada pelos dois grupos. Enquanto no primeiro as entrevistas atribuem grande valor à desmedicalização e à experiência corporal, considerada enriquecedora do ponto de vista subjetivo, no segundo valoriza-se principalmente o tratamento dispensado pela equipe. Para ambas, contudo, a experiência parece ter um efeito positivo no que se refere à auto-estima, na medida em que, quando conseguem dar à luz da maneira proposta, passam a se perceber e a serem percebidas pelos demais como guerreiras ou supermulheres. / [en] This study aims to understand the meanings given by poor and midle class Brazilian women to the so called humanizes birth, which became popular in Brazil upon the foufation of a civil organization called Rede pela Humanização do Perto e do Nascimento (ReHuNa). According to activists, the expression humanized birth, in general, refers to situations in which women s rights and choices are taken in consideration at the time of birth. More frequently, howere, it refers also to the idea of a natural birth, an expression that means the commitment to minimal medical and pharmacological interventions. The meanings given to these expressions become respectively more and less approximated according to the context in which they are used. This became particularly evident in this research, since it involves two fieldworks: the first are prenatal preparation classes, mainly attended by middle income women, offered in the Southem Zone of Rio de Janeiro by an activist. The Second is public birth center that is considered a reference by the humanization movement. This birthcenter is situated in the Wesrem Zone and is mainly attended by low income womem. The Study s results suggest that the humanization birth approach has different meanings for women according to the socioeconomic group of which they are part. Middle class women give special importance to the reduction in pharmacological intervention and to the body experience, considered to provide a subjective growth. The poor women value specially the way in which they are treated by the nurses/midwives.

[pt] A tese investiga o ativismo em prol da humanização do parto na cena contem-porânea, analisando as ações e as narrativas relativas ao parto humanizado e ao corpo junto aos sujeitos políticos da Rede Parto do Princípio (PP), que agenciam práticas e modos de existência no âmbito desse ativismo. O coletivo em questão tem no ambien-te sócio comunicacional digital da internet seu principal locus de composição, discussão e deliberação. Locus que escapa de frágeis antinomias como real versus virtual, tal espaço abre-se como um potencial ambiente comunicacional onde um comum é possível para o compartilhamento de experiências entre mulheres que ativam outros modos possíveis de pensar os direitos reprodutivos e sexuais. Leva-se em conta questões teóricas que atravessam a comunicação nas últimas décadas tais como: sociedade em rede e as novas modalidades de ação coletiva e de ativismo. São expostos tensões, dissensos e controvérsias comunicacionais em torno de uma problemática: o que dizem tais mulheres, quando falam parto humanizado? E quando falam meu corpo, minhas regras? Procura-se entender: 1. os processos comunicacionais que agenciam a construção de pautas e discussões; 2. as articulações entre experiências pessoais de assistência à gravidez e parto e o ativismo; 3. as formas de ação, engajamento e tomadas de decisões; 4. as negociações de sentidos e pertinências entre humanização do parto e direitos sexuais e reprodutivos; 5. as controvérsias entre direitos à saúde reprodutiva e sexual e as demandas do crescente mercado da humanização do parto e do nascimento. Metodologicamente, recorremos a uma etnografia virtual, com participação ativa da pesquisadora nos diversos ambientes da Rede Parto do Princípio e com a produção de entrevistas diretas e posterior análise de conteúdo, além de um estudo crítico sobre os documentos produzidos. Desse compósito, a pesquisa estipulou cinco categorias de análise: ação cívica; mercado/consumo; compartilhamento de experiências; gestão em rede; motivações/pautas. / [en] The dissertation investigates the activism in favor of the humanization of birth in the contemporary scene, analyzing the actions and narratives related to humanized birth and the body along with the political subjects of Rede Parto do Princípio (PP), who assemble practices and modes of existences within the scope of this activism. The investigated collective has in the socio-communicational digital environment of Internet its main locus of composition, discussion and deliberation. Locus that escapes from fragile antinomies as real versus virtual, such a space opens up as a potential communicational environment where a common is possible for sharing experiences among women that activate other possible ways of thinking about reproductive and sexual rights. It takes into account theoretical issues that cross communication in the last decades such as: network society and the new modalities of collective action and activism. We expose tensions, dissensions and communicational controversies around an issue: what do such women say when they speak of humanized childbirth? And when they say my body, my rules? We try to understand: 1. the communicational processes that assemble the construction of political repertory and discussions; 2. the articulations between personal experiences of assistance to pregnancy and childbirth and activism; 3. forms of action, engagement and decision-making; 4. the negotiations of meanings and pertinences between the humanization of childbirth and sexual and reproductive rights; 5. the controversies between rights to reproductive and sexual health and the demands of the growing market of the humanization of childbirth. Methodologically, we carried out a virtual ethnography, with active participation of the researcher in the different environments of Rede Parto do Princípio and with the production of direct interviews and later analysis of content, as well as a critical study on the documents produced. From this composite, the research stipulated five categories of analysis: civic action; market / consumption; sharing of experiences; network management; motivations / guidelines.

MSc (Statistics) / Department of Mathematics and Natural Sciences

[pt] Partindo de relatos de parto de mulheres brasileiras circunscritas em diferentes realidades sociais, o presente trabalho, de cunho qualitativo e interpretativista tem como objetivo analisar a construção e os efeitos dos discursos hegemônicos (Foucault, 1988) em falas sobre experiências de gestação e parto. Observaremos em performances narrativas emergentes em dez entrevistas de pesquisa (offline e online), a construção da agentividade das narradoras em conexão com as relações corpo/afeto. Narrativas de mulheres de lugares socias diversos (diferentes raças, classes, sexualidades, faixas etárias, usuárias de organizações de saúde públicas e privadas) serão analisadas sob uma lente interseccional de gênero, raça e classe, focalizando como tais narrativas constroem inteligibilidades que regem a vida social e, assim, cerceiam corpos – o que induz à reflexão sobre a soberania do discurso médico hegemônico e seus impactos na experiência da maternidade. Nossa compreensão de gênero se pauta em feminismos matricêntricos – se propondo, assim, a dar centralidade a mulheres mães sob uma perspectiva interseccional. Sob a perspectiva interdisciplinar, indisciplinar e mestiça da Linguística Aplicada Contemporânea (Moita Lopes, 2006), alinhamo-nos à Análise de Narrativa por entendermos que, contando histórias, construímos a nós mesmos, nossa percepção de identidade, além de construirmos o mundo ao redor. A análise das narrativas examina a construção da avaliação – componente narrativo que imprime dramaticidade e razão de ser ao que se narra, contemplando a dimensão discursiva dos afetos. Dessa forma, foi possível observar, no âmbito das inter-relações entre cultura–discurso–corpo–afeto, como os atravessamentos discursivos deixam marcas: seja reprimindo, constrangendo e destituindo as mães da gestão de sua própria corporeidade; seja, por outro lado, instando autonomia e agentividade às mães em seus relatos. Assim, compreender os rastros discursivos pela via dos afetos possibilita ao analista interpretar, reelaborar e redimensionar a experiência vivida. / [en] The aim of this qualitative-interpretive study is to analyse the construction and effects of normative discourses) regarding pregnancy and birth by analysing labour narratives of Brazilian mothers located in distinct social contexts. In the narrative performances that emerge from three research interviews (conducted both on and offline), we observe how speakers build agency in relation to body/affect. The narratives of these women - from diverse social backgrounds (in terms of race, class, age, private/public health system users) - are analysed focusing on how these stories build intelligibility that governs social life and which can curtail bodies – leading us to reflect on the pervasiveness of medical discourse and its impacts on the experience of mothering and maternity. Our understanding of gender is based on matricentric feminisms and aims at furthering mothers visibility from an intersectional perspective. As part of an emerging tradition of undisciplined, Contemporary Applied Linguistics of Latin America, this study draws on Narrative Analysis, aiming at the further understanding of locally constructed identities and their relationship with the surrounding world. Our analysis examines the building of evaluation - a narrative component which heightens drama, conveying the story s very raison d être - as to consider the discursive dimension of affect. Our examination of the relationship between culture, discourse, body and affect, enables us to identify the way these insidious discourses leave their mark on mothers; either through reprimands, constraints and the erasure of control over their own corporeality or otherwise by prompting autonomy and agency. Medical discourse, as we observe, is a powerful institution which serves as underlying other major overwhelming discourses, such as the patriarchal and the racist. Thus, by building the bridges between the micro and macro dimensions it is possible to realise that what happens in social interactions reveals a lot from a complex broader scenario as much as the major institutions have a great impact on social life. The observation of the discursive scars left makes way to analyse, interpret, rework and reimagine the lived experience of labour.

The main objective of the study is to analyze the role of family planning program in reducing maternal mortality in Bangladesh. A conceptual framework has been developed in which family planning is shown to be integrated in reducing maternal mortality. This study found that the risk factors of maternal mortality e.g. unwanted pregnancy, high parity, and early and old age at child birth still prevail in Bangladesh. It is hypothesized that the prevalence of these factors can be substantially reduced by a proper practice of family planning. There is a high level of unmet need for family planning Bangladesh, and its removal will substantially help in reducing maternal mortality in the country. The risk factors of maternal mortality are strongly associated with lack of family planning practice and other socio-economic and demographic background characteristics of women. By using data from the Bangladesh Demographic and Health Survey (BDHS) of 2004 and the Bangladesh Maternal Health and Maternal Mortality Survey (BMMS) of 2001 the study has analyzed the relationship of the risk factors of maternal mortality, namely wantedness of pregnancy, age at child birth, parity and birth interval with various socio-demographic factors. The analysis has shown that use status of family planning is influenced by the risk factors of maternal mortality. Wantedness of pregnancy has been found to be significantly related with age at birth, parity and birth interval. It has been also found that the risk factors of maternal mortality also affect on antenatal care. The study has identified some policy implications regarding family planning and maternal mortality, and has made appropriate recommendations. One of the major aspects of the strategies to reduce maternal mortality through family planning is to provide family planning services to all women, regardless of any group affiliation. Fulfilment of unmet for family planning has been recommended as an important strategy to reduce maternal mortality in the country. It addition, it is also recommended to raise the age at marriage and child birth, to space births and to limit family size by empowering women through education.

Background Globally, about 800 women die daily from complications arising during labor or within 42 days of childbirth. These deaths can be prevented by ensuring that women give birth in a safe environment in the presence of Skilled Birth Attendants (SBAs). SBAs are efficient to manage pregnancy, child birth and postnatal complications or refer in very complicated cases. Only about half of the women use SBAs in Kakamega County, Kenya. The study aim was to describe the determinants of utilization of SBA in Kakamega County. Method A cross sectional design was used. Data was obtained from Multiple Indicator Cluster Survey (MICS) conducted in the year 2014. A sample of 295 women were selected through two-stage cluster sampling. Standardized questionnaire was used to collect data from women who had given birth two years prior to the survey. Univariate and multivariate analysis was used to analyze the data. Results There was an association for use of SBAs with lower parity Odds Ratio (OR) 3.11(95% CI,1.82-5.52), early Antenatal Care (ANC) attendance OR 0.49(95% CI,0.27-0.88), secondary education OR 1.89(95% CI, 1.16-3.05) and high wealth index OR 2.87(95% CI,1.76-4.69). There was no association with ANC visits OR 1.3 (95% CI, 0.80-2.24) and place of residence OR 1.50 (95% CI,0.93-2.41). Conclusion Being in higher quartile, exposure to secondary education and low parity were key influencers of SBA use while place of residence did not show any association. There is an association between use of SBA and timely ANC attendance but not with number of ANC visits.

Bakgrund: I Sverige är det vanligt att drabbas av förlossningsskada framförallt för förstföderskor. Allvarliga bristningar kan leda till lidande på lång och kort sikt som smärta, sexuell dysfunktion, sänkt livskvalitet, inkontinens och psykiskt lidande. Syf- tet med magisteruppsatsen var att undersöka och beskriva förstföderskors perspektiv på förlossningsskador och deras tankar om fysioterapins plats i förlossningsvården vad gäller förebyggande av förlossningsskador och deras egna önskemål om yrkets behjälplighet i ämnet. Metod: En deskriptiv kvalitativ fokusgruppsintervju genomför- des med semi-strukturerade frågor. Förstagångsgravida kvinnor 18-46 år gamla, bo- satta i Sverige, svensktalande, ej uttalad förlossningsrädsla, ej förlöst dödfött barn, i trimeter två eller tre inkluderades från en Facebook-annons med bekvämlighetsurval. Fyra förstagångsgravida inkluderades i fokusgruppen. Intervjun hölls med Skype som videokonferens och transkriberades sedan. Grundad teori användes för att analysera datan. Resultat: Huvudtemat som uppstod var; Tilltro till svensk förlossningsvård trots nya erfarenheter och bristande information. Ur data-analysen framkom även fem underkategorier; Från oro/rädsla till pepp och informationssökande, Källan och typ av information påverkar sannolikheten att till sin den, Egen hälsa riskeras nedprioriteras, Kommunikation ger tillit och minskad oro/rädsla, Fysioterapeuter besitter viktig kun- skap som bör ges till samtliga gravida. Konklusion: slutsatsen kan dras att hos delta- garna i fokusgruppen finns en tilltro till förlossningsvården men även utrymme till förbättrad information vad gäller förebyggande och behandling av förlossningsskador samt att de önskar fysioterapi som en del i förlossningsvården. / Background: In Sweden it is common with delivery damage to the pelvic floor especially for primiparous women. It variates throughout the country when it comes to risk in percentage of severe damage, grade 3-4. Such impairments can lead to suffering in both short term but also long term perspective as pain, sexual dysfunction, decreased quality of life, mental disorder and incontinence. The aim with this master first year thesis was to explore and describe primapara ́s perspective on delivery impairments on the pelvic floor during vaginal child birth. Also to seek understanding of their thoughts regarding physiotherapy in obstetric healthcare and how a physiotherapists knowledge and skills could be helpful in preventing delivery damage and further how the occupation could fit their ideas and wishes in the field. Method: With a qualitative approach data were collected through a focus group interview via Skype video-conference. Result: Four primaparas were conducted through Facebook recruitment and included in the focus group interview. The main theme that appeared through data analyses were; Credence in Swedish obstetric health care despite new experiences and lack of information. Through analysis five subcategories came through; From anxiety/fear to pep and seeking information, The Source and type of information affects likelihood of receiving it, One ́s own health risks getting a reduced priority, Communication provides confidence and reduces anxiety/fear, Physiotherapists posses important knowledge that should be given to all pregnant women. Conclusion can be drawn that in the participants of the focus group there is confidence in childbirth care but also space to experience better information and that they wish for physio- therapy as being part of obstetric health care.

[pt] A assistência ao parto no Brasil hoje é pautada predominantemente pelo modelo tecnocrático, com alto índice de intervenções desnecessárias e promotoras de iatrogenia. Os aspectos subjetivos inerentes ao nascimento tendem a ser desconsiderados neste cenário, o que produz riscos para a saúde psíquica da mãe, do pai, e do bebê. Nesse sentido, o objetivo deste estudo foi pesquisar as experiências subjetivas de pais e mães acerca do parto na atualidade no Brasil. Para isso, foi realizado um estudo de caso coletivo no qual foram analisados 30 relatos de parto publicados em blogs pessoais sobre experiências de gestação, parto e parentalidade, sendo 15 escritos por mulheres e 15 por homens. Os resultados apontaram para o desamparo sentido por pais e mães diante de uma assistência tecnocrática, e para a idealização dos cuidados ofertados pelos profissionais que atuam de acordo com o paradigma de humanização. A ideia de escolha apareceu com frequência no discurso dos sujeitos, apontando para um cenário em que a cesariana é entendida como um bem de consumo. A importância do respeito à temporalidade do parto apareceu como sendo fundamental para que este não seja vivenciado de forma traumática e a dor foi relatada como elemento central na elaboração da morte simbólica inerente ao processo de apropriação da parentalidade. A falta de suporte do ambiente apareceu como um fator constitutivo da experiência de violência obstétrica e a escrita dos relatos como um recurso para elaboração dessa experiência traumática. Concluímos que procedimentos médicos como a episiotomia, a anestesia e a cesariana, quando realizados de forma rotineira, sem compartilhamento de decisões e sem amparo psíquico, constituem uma forma de ritualização para manter inconsciente a representação sexual do parto. Tal forma de ritualização conduz à iatrogenia no parto, causando prejuízos psíquicos à saúde materno-infantil. Nesse sentido, o cuidado e o respeito nas relações interpessoais devem ser valorizados como requisitos fundamentais para a atenção ao parto. É de extrema importância que os profissionais que assistem o parto sejam capacitados para compreenderem os aspectos emocionais inerentes ao nascimento, e as trocas interdisciplinares são um recurso potente para garantir a boa qualidade da assistência. / [en] Childbirth assistance in Brazil today is predominantly ruled by the technocratic model, generating a high rate of unnecessary interventions and promoting iatrogenesis. In this context, the subjective aspects that are typical of childbirth tend to be disregarded, which poses risks for the mental health of the mother, father and child. The purpose of this study was to investigate the subjective experiences of parents regarding childbirth in Brazil today. In order to do so, we examined an colective case study in which we analyzed 30 childbirth reports published in personal blogs about gestation, birth and parenthood experiences, in which 15 accounts written by women and 15 written by men. The results showed the helplessness felt by parents in the face of a technocratic assistance, and the idealization of the care offered by professionals who act according to the humanization paradigm. The idea of choice appeared often in the reports of the subjects, pointing towards a scenario in which the cesarean section is understood as a consumer good. Respect towards the temporality of childbirth appeared as a main issue in order to avoid a traumatic experience. Pain was shown as a key element for the elaboration of the symbolic death, a structural part of the process of parenthood appropriation. The lack of support of the environment was a major contributor to the experience of obstetric violence, in which written accounts served as a means for the elaboration of this traumatic experience. We concluded that medical procedures such as episiotomy, anesthesia, and cesarean section, when performed routinely and with no decision sharing or psychological support, represent a form of ritualization to keep unconscious the sexual representation of childbirth. This ritualization leads to iatrogenesis in childbirth, harming the mother-child health. Therefore, care and respect in interpersonal relationships should be seen as fundamental requirements for childbirth support. Professionals that aid in childbirth need to be qualified to understand the emotional aspects inherent to childbirth. Finally, we also understand that interdisciplinary exchange is a powerful tool to guarantee high-quality assistance.