Thesis (Ph. D.)--University of Washington, 2007. / Vita. Includes bibliographical references (leaves 232-247).

In many African countries, women’s disempowerment and subjugation affect their reproductive health services utilization. This situation becomes even more problematic for women during their vulnerable moments of childbirth. Although copious literature exists on women’s experiences in navigating socio-cultural, religious, economic and structural barriers during childbirth, there is paucity of literature on women’s perceptions of childbirth globally. Extant studies generally focus on health professionals’ and researchers’ perspectives on childbirth. This case study was conducted in two rural communities in Girar Jarso woreda of Ethiopia to explore women’s experiences and perceptions of childbirth. The purpose of this study was to understand the local contexts in which women live and their implications for women’s choice of place of birth and/or birth attendants in Girar Jarso woreda. It is hoped that this study would inform efforts to improve maternity health services delivery and uptake in Ethiopia. This case study was conducted within intersectionality theoretical framework. Data were collected through focus group discussions, in-depth interviews, observation, fieldnotes and cultural interpretations. The data were analyzed and interpreted through social constructionist epistemological lens. This study employed inductive thematic analytical approach. The findings of this study were presented under themes consistent with research questions and were later analyzed and discussed in detail. The findings revealed that institutional birth is gaining popularity in Girar Jarso woreda in the face of socio-cultural, religious, economic, structural and personal barriers. The improvements in institutional birth can be attributed to the Ethiopian government’s persistent efforts to improve maternal, newborn and child health through policies, programs and initiatives. Despite improvements, transportation, health system characteristics, communal decision-making, preference for traditional birth among others, impede efforts to increase institutional birth. This study concluded that women’s experiences and perceptions of childbirth in Girar Jarso woreda are varied. Women’s powerlessness and men’s dominant decision-making position in Ethiopian society affect women’s birth experiences. To improve women’s overall birth experiences, mechanisms need to be established to address patriarchy, women’s rights, transportation challenges, and attitudes of health professionals towards laboring women. The health development program needs reconfiguration to involve men, elderly women and community leaders in reproductive health communication efforts. Efforts should be made to integrate traditional birthing practices into modern obstetric services in the health system. Finally, there is a need for greater collaboration between health extension workers, traditional birth attendants and women development armies in the delivery of community maternity health services.

Thesis (M.S.)--Boston University

Made available in DSpace on 2014-06-11T19:27:44Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-02-15Bitstream added on 2014-06-13T19:56:28Z : No. of bitstreams: 1 manzini_fc_me_botfm_prot.pdf: 622868 bytes, checksum: c8c7a71fc1e19cd72b4cf9ff6eb3f01b (MD5) / Descrever a estrutura e o processo da assistência ao parto e recémnascido no Hospital das Clínicas da Faculdade de Medicina de Botucatu-UNESP. Métodos: trata-se de estudo descritivo e transversal. Para análise da estrutura, entrevistou-se o responsável pela maternidade e utilizou-se instrumento de observação do serviço. Realizou-se análise do processo a partir de dados obtidos de prontuários de partos amostrados e da observação de partos realizados em 2004. Resultados: A análise da estrutura evidenciou disponibilidade de equipamentos, instrumentais e medicamentos. A equipe conta com obstetra, pediatra e anestesista na sala de parto e estas são adequadas para partos vaginais e cesáreas. Não há lavabos individuais, nem quartos de pré-parto, parto e puerpério. (PPP) Com relação ao processo, a análise dos prontuários mostrou que na admissão 86,3% das parturientes tiveram sua pressão arterial aferida e 78,8% passaram pelo exame de toque vaginal; 87% dos fetos foram auscultados. No trabalho de parto, segundo os observadores, 62,1% das mulheres permaneceram em jejum, o controle não farmacológico da dor foi observado em 13,8% dos casos e em 96,6% deles havia partograma preenchido; para todos os recém-nascidos, realizou-se: índice de Apgar, administração de vitamina K e cálculo da idade gestacional segundo exame físico e para mais de 99% deles realizou-se antropometria, para 28,7% exame anti-HIV e 98,6% tipagem sangüínea. Conclusões: os resultados apontam a necessidade de quartos PPP e a precariedade dos registros nos prontuários. Sugere-se a implantação de um sistema de informações que viabilize a pronta avaliação de indicadores de qualidade da atenção. / Evaluate the infra-structure and the process of childbirth and nursery in the Medical School at Sao Paulo State University, 8otucatu, SP. Method: This is a descriptive and transversal study. The supervisor of the nursery was interviewed and the service as a whole was observed. The analysis of the process was done based on the data collected from childbirth diaries and childbirth observation since 2004. Results: The maternity area consists of equipments, instruments, and medicines. The team consisted of an obstetrician, pediatrician, and anesthetist in the delivery room and they were prepared for vaginal delivery and cesarean section. There are no private lavatories, pre-childbirth rooms, childbirth rooms or puerperium rooms. Analysing the flow, the analyze of diaries pointed out that during the admission of the pregnant women 86.3% of them had their blood pressure taken, 78.8% had a vaginal touch exam, and 87% of the embryos were listened. During the birth delivery, 62.1% of the women fasted, 13.8% did not take any medicine for pain, and 96.6% had the partograph filled. The following measures were taken in ali newborns, the Apgar index, vitamin K ingested, and gestation age based on physical exercise. 99% had an anthropometry exam, 28.7% had HIV exam, and 98.6% blood type exam. Conclusion: The final results shown that there is a necessary to have private lavatories, pre-childbirth rooms, childbirth rooms or puerperium rooms and the data in the diaries are insuficient. There is a need to implement a information system that can better measure the indicators of quality.

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.

D.Cur. / Midwives are responsible to assess pain before treating it; then they should reassess the pain to evaluate the effectiveness of the interventions and plan future therapy. Accurate and objective measures of labour pain continue to be scarce and the discrepancy in labour pain perceptions between parturients and health-care providers remains challenging. Various pain measurement tools are currently in use measuring chronic and acute pain, but many problems were encountered applying these methods to the woman in labour. The charts were detailed and required too much time to complete. The aim of the study was to develop a multidimensional labour pain assessment instrument to assist clinicians and midwives with labour pain control. Objectives for developing a valid and reliable instrument to accurately measure labour pain included refinement of the labour pain assessment instrument developed from literature, testing of the refined instrument on patients during labour, compilation of a final instrument and development of guidelines on how to implement the labour pain assessment instrument in nursing practice. A descriptive and exploratory approach was used to describe, evaluate, observe, explore and assemble new knowledge on assessment and measurement of pain during the first stage of labour. Development of the instrument was addressed in the literature chapter. The research was conducted in three phases, combining qualitative and quantitative research.During phase one, the instrument was refined in two stages. Focus group interviews were conducted with members regarded as knowledgeable in the field of normal labour who evaluated the face and content validity of the instrument. The most senior people teaching Midwifery at all South African universities evaluated the face and content validity of the instrument with an open-ended questionnaire thereafter, using the Delphi technique. The analysis of the first Delphi round was compared to the focus group analysis. The instrument was altered and submitted to the Delphi experts in a second open-ended questionnaire to confirm the alterations.

M.A. / This study was conducted in light of several feminist texts that have critiqued the diagnostic criteria for posttraumatic stress disorder in the DSM-IV-TR. These texts have argued that the current criteria, particularly Criterion A, are gender-biased and exclude many of the kinds of life events that are unique to women. This study sought to conduct an in-depth exploration of life events that do not meet the DSM-IV-TR‟s Criterion A but that nevertheless precipitated all of the other manifestations of PTSD. For the purpose of this study, two gender-specific traumatic events were selected, namely childbirth and miscarriage or stillbirth. A feminist and phenomenological approach was taken and the study was formulated as a critique of the DSM-IV-TR diagnostic criteria of PTSD. The research question was formulated as follows: Should the Criterion A definition of a traumatic event be expanded to include any experience that an individual defines as traumatic? A semi-structured interview was conducted with three participants complying with the specific population criteria. The interviews were transcribed and analysed through qualitative data analysis processes. The research methodology and analysis processes needed to be adapted due to the phenomenological nature of the research study. A comparison between the symptoms presented by the participants and the diagnostic criteria of PTSD, revealed that all three participants complied with all the DSM-IV-TR criteria except for Criterion A(1) and therefore could not be formally diagnosed with PTSD. It was also revealed that the women‟s experiences and reactions to the traumatic events were very similar, especially the fear caused due to feeling out of control. Therefore it was concluded that the essence of the traumatic experience was loss of control. The research question was positively answered, because it was concluded that each individual experiences events differently due to internal perceptions and the individualised meanings which are allocated to the event. Therefore the Criterion A definition of a traumatic event should be expanded to include any experience that an individual defines as traumatic.

This study examines the psychological issues of personal responsibility and control in the childbirth process. It examines the implications of the woman's preparation process and the choices she makes during pregnancy and childbirth. It also explores the way in which the birthing environment and the woman's interpersonal relationships affect her experience of personal control within the context of the childbirth period. Use was made of the case study research design. This qualitative design involved indepth exploration, of cases in which the women had recently given birth to their first child in the local hospital of a small town. The data analysis involved the use of a "reading guide", established by the researcher to allow for the examination of the data specifically in terms of the themes in question. Within the study the importance and value of the woman's accurate and sufficient preparation for the birth was seen to facilitate a realistic sense of predictability, which led to an increased awareness and ability of the woman to remain in control. This, along with the active participation of the husband and supportive network in the hospital, allowed for a sharing of the responsibility within the labour situation. This taking and appropriately yielding of control and responsibility had positive effects on the woman's experience of the event and for initial mother-infant bonding

This research project explored how mothers experiencing depression after childbirth perceived their mental illness. Illness perceptions were assessed across the dimensions outlined within the Self-Regulatory Model (SRM, Leventhal, Nerenz & Steele, 1984) via the use of the Revised Illness Perceptions Questionnaire (IPQ-R, Moss-Morris, Weinman, Petrie, Horne, Cameron & Buick, 2002). The psychometric properties of the IPQ-R within this clinical sample and relationships between illness perceptions, depression severity and maternal bonding were assessed. A literature review of the use of the IPQ and IPQ-R within mental health identified that these measures with modifications (in particular to the causal and identity subscales) were largely reliable and valid measures of assessing illness perceptions in mental health. The illness dimensions outlined within the SRM were largely endorsed within the clinical populations sampled, offering support of the applicability of the SRM within mental health. Mental illnesses were consistently viewed as chronic with serious negative consequences. Perceptions regarding mental illness consequences, chronicity and controllability were associated with coping strategies and help-seeking. Treatment adherence and attitudes towards taking medication were associated with illness controllability beliefs. The IPQ-R modified for depression after childbirth was shown to be a reliable measure for assessing illness perceptions within this clinical sample and was shown to be reliable over a four-week time period.Mothers experiencing depression after childbirth perceived their depression as having a moderate number of symptoms, a high number of negative consequences and responded to their depression with a number of emotions. Mothers perceived having a coherent understanding of their difficulties, believing that depression was amenable to treatment and personal control and that depression was cyclical in nature. Commonly reported symptoms experienced attributed to depression included depressed mood, difficulties concentrating, loss of interest/pleasure in activities, fatigue/loss of energy and sleep difficulties. Frequently endorsed causes of depression included stress or worry, hormonal changes, own emotional state, family problems, mental attitude and own behaviour. Interestingly, no significant difference was found between illness perceptions of mothers who previously experienced psychological problems and mothers who had not.Mothers who perceived having many symptoms and a high emotional response to depression were more likely to report higher depression severity. Whereas mothers who believed they had control over their depression were more likely to report lower depression severity. Illness identity and consequence beliefs were associated with maternal bonding difficulties. The project's findings were presented with reference to previous literature with implications for theory and clinical practice explored. Difficulties and limitations of the research and its related theory were discussed in addition to reflections upon the research project. Possible improvements to the research procedure and areas for future research were also identified.

This dissertation is an investigation of doulas as agents of social change through the lens of feminist theory. Doulas are nonmedical health care workers who provide physical, emotional, and informational support during pregnancy, childbirth, and/or the postpartum period. Because of doulas' willingness to work within the structures of the hospital setting, some have questioned the effectiveness of doulas as change-makers. While much feminist scholarship on the politics of birth centralizes the issue of medicalization, I demonstrate that expanding this line of analysis aids in better understanding the cultural impact of doula care as part of a larger picture of reproductive health advocacy. Through discourse analysis, participant observation, face-to-face ethnographic interviews, and online surveys, I track the goals and effects doulas ascribe to their work, both activist and professional, and on both an individual and group level. Rather than asking whether doulas can successfully challenge the medicalization of birth, I seek to understand how the doula movement contributes to social justice through challenging various overlapping axes of inequality, related to race, class, gender, and sexuality. This analysis highlights the work of doulas in marginalized communities that is, as yet, under-researched and under-appreciated, while also illuminating the multifaceted effects of the dominant medical model of birth. I observe that doulas are increasingly working to empower people in multiple facets of their lives, beyond the birthing room. Rather than being incapable of, or uninterested in, creating social change, doulas are increasingly bringing a new political consciousness into birth work, as evidenced by the emerging designations of "radical doula" and "full spectrum doula." I argue that this movement among doulas represents a new paradigm in birthing rights activism, which connects childbirth choices to a larger reproductive justice agenda and forges connections between birthworkers and activists for causes such as LGBT rights, abortion rights, prisoners' rights, and economic and racial justice. By reimagining the reach of their work, many doulas are drawing necessary connections to social justice issues that are often overlooked in the childbirth reform movement, which tends to focus on medicalization as the primary issue.