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The condition of the fetus during labour is inferred from the continuous plot of fetal heart rate and uterine contractions (cardiotocogram, CTG). This can be _ difficult to interpret which results in both unnecessary intervention and a failure to intervene when necessary causing potentially preventable neurological damage and mortality. Conventional computing approaches have not been successful in addressing these problems. This is perhaps because the correct interpretation of fetal condition requires physiological knowledge, considerable practical experience and knowledge of the specific patient. The work described in this thesis is concerned with the investigation of artificial intelligence techniques to assist in the interpretation of fetal condition and advise on labour management. A fundamental investigation examined the performance of five types of scalp electrodes for obtaining the fetal electrocardiogram (ECG), from which heart rate is derived, and examined the factors which hamper fetal ECG data acquisition. New methods were developed to classify the important features from the CTG and included an investigation using neural networks. Other CTG features were classified using novel numerical algorithms developed closely with experts. An expert system, guided by a database of rules obtained from experts, was used to process and interpret changes in the CTG features by taking account of patient specific information. This hybrid approach was adopted to improve performance and reliability. After two internal evaluations had found the system obtained a performance comparable with local experts, an extensive external validation was undertaken. This study involved 17 experts from 16 leading centres within the UK. Each expert and the system reviewed 50 cases twice, at least one month apart which contained those considered most difficult to interpret selected from a database of 2400 high risk labours. A novel method was developed to present all the relevant clinical information in a way which approximated the clinical situation. The reviewers scored each 15 minutes of recording according to the concern they had for the fetus and the management they considered appropriate. In this respect, this is the first reported study to examine the performance of expert obstetricians in the management of labour. A new method was derived to measure the agreement between the scores obtained and is applicable to other areas where it is required to measure the similarity between time related sequences. This study found that the experts agreed well and were consistent in their management of the cases. The system was indistinguishable from the experts, except it was more consistent, even when used by an engineer with little knowledge of labour management. This study has shown that expertise in fetal monitoring is achievable in which case the current evidence suggests that this is not being adequately transferred to clinicians. The challenge remains to formulate a method to effectively transfer knowledge to the labour ward and thereby address the real and practical problems which face fetal monitoring today. This study demonstrates that intelligent systems could provide the vehicle to achieve this. I dedicate this work to the memory of my father, Bradley Kenneth Keith with a hope that he always believed it possible. I know he would have had some interesting comments to make and I sadly miss the opportunity of discussing them with him. I also dedicate this work to my mother for always being there, and to my wife Michelle for her unwavering support, patience and most of all her encouragement throughout this work.

Research Doctorate - Doctor of Philosophy (PhD) / The thesis involves a re-examination of feminist views of the childbearing body from a post-structuralist perspective and applies these theoretical ideas to an empirical investigation into contemporary childbirth and midwifery. Critiques of medicalised childbirth developed in Australia, Britain and the USA in the 1970s are related to debates within feminism about appropriate ways to theorise motherhood and the female body as well as to understand the role played by midwives and doctors in childbirth. It is argued these critiques were the product of three strands of feminism that differed in their analysis of gender politics, their philosophy of knowledge and their understanding of power. The three critiques are also related to differences between the USA, Britain and Australia in respect of their medical system, ways in which the history of childbirth practices are viewed and differences between the professional roles of midwives. It is argued that these critiques need to be modified by more recent post-structuralist feminist approaches, particularly the way in which bodies are shaped by language and power is related to the distribution of knowledge The empirical study concentrates on a maternity unit in a regional town in New South Wales. The unit was studied through repeat interviews with mothers attending the hospital for the birth of their second or a later child, interviews with the midwives and doctors working in the unit and observations over several months. Childbirth is re-imagined as a drama and found to be an intense embodied experience shaped in turn by the practices of the hospital and the changing boundaries between medicine and midwifery, relationships of the women with the staff and the women’s own diversity. This approach to the analysis of the interview data demonstrates the limitations of the liberal feminist critique that there is insufficient rational and ‘scientific’ evaluation of childbirth practices, the radical feminist critique that the key issue is men’s domination of women’s bodies and the materialist feminist critique of the lack of fairness and support given to childbearing women, while showing how these discourses continue to circulate in debates over the management of childbirth.

Research Doctorate - Doctor of Philosophy (PhD) / The thesis involves a re-examination of feminist views of the childbearing body from a post-structuralist perspective and applies these theoretical ideas to an empirical investigation into contemporary childbirth and midwifery. Critiques of medicalised childbirth developed in Australia, Britain and the USA in the 1970s are related to debates within feminism about appropriate ways to theorise motherhood and the female body as well as to understand the role played by midwives and doctors in childbirth. It is argued these critiques were the product of three strands of feminism that differed in their analysis of gender politics, their philosophy of knowledge and their understanding of power. The three critiques are also related to differences between the USA, Britain and Australia in respect of their medical system, ways in which the history of childbirth practices are viewed and differences between the professional roles of midwives. It is argued that these critiques need to be modified by more recent post-structuralist feminist approaches, particularly the way in which bodies are shaped by language and power is related to the distribution of knowledge The empirical study concentrates on a maternity unit in a regional town in New South Wales. The unit was studied through repeat interviews with mothers attending the hospital for the birth of their second or a later child, interviews with the midwives and doctors working in the unit and observations over several months. Childbirth is re-imagined as a drama and found to be an intense embodied experience shaped in turn by the practices of the hospital and the changing boundaries between medicine and midwifery, relationships of the women with the staff and the women’s own diversity. This approach to the analysis of the interview data demonstrates the limitations of the liberal feminist critique that there is insufficient rational and ‘scientific’ evaluation of childbirth practices, the radical feminist critique that the key issue is men’s domination of women’s bodies and the materialist feminist critique of the lack of fairness and support given to childbearing women, while showing how these discourses continue to circulate in debates over the management of childbirth.

A key midwifery activity is the support of a woman in labour. Pain in labour has been extensively researched from the woman's perspective, but less has been explored in relation to the midwife and her approach to pain. The way in which the midwife works with a woman and her pain in labour is the focus of this qualitative study, using Heideggerian hermeneutic phenomenology. This philosophical approach seeks to uncover or illuminate aspects of the midwife's practice which are frequently taken for granted in their everydayness. Seven midwives, including both independent practitioners and hospital-employed, were interviewed. Their narratives were analysed to uncover the meaning of the way in which midwives work with women and their pain in labour. The findings of this thesis suggest that midwives work by interpreting the woman's pain. Before the pain begins, they 'leap ahead' to help them anticipate the pain and how they will confront it. During labour, midwives give pain meaning by translating its purpose in that context. They 'leap in' when required, sometimes using 'self as an intervention. Midwives interpret women's pain through their understanding of lived time. They know how the perception of time passing changes depending on the setting for labour or the amount of anxiety and pain the woman is experiencing. Midwives use time in their work. They break it down to help a woman focus on a single contraction rather than looking too far ahead toward the unknown. Time can be a midwife's friend when the arrival of the baby replaces the urgent need for pain relief. It can also be her enemy if her interpretation of a woman's pain differs from the woman's perception. The memory of pain may persist for the woman, after labour has finished, with a backlash for the midwife. Some midwives believe in the process of birth and the woman's ability to labour with such conviction that they gain a woman's complete trust. At her most vulnerable time, they encourage the woman to call upon inner reserves and be truly empowered by her experience.

Univ., Diss. 2003--Göteborg, 2003.

Thesis (Ph. D.)--Michigan State University. College of Nursing, 2007. / Title from PDF t.p. (viewed on Apr. 16, 2009) Includes bibliographical references (p. 159-169). Also issued in print.

Thesis (Ph. D.)--University of Texas at Austin, 2008. / Vita. Includes bibliographical references.

Thesis (Ed.D.)--Teachers College, Columbia University, 1974. / Typescript; issued also on microfilm. Sponsor: Alice R. Rines, . Dissertation Committee: Paul Vahanian. Includes bibliographical references (leaves 141-153).

Thesis (M.S.)--University of Michigan, 1993.