The aim of this study was to explore the factors that influenced women to choose care in a birth centre in the South Wales Valleys, and to ascertain their expectations and experiences of care in the antenatal period and during labour. The possibility of complications arising during normal pregnancy is a well-known phenomenon, leading to a woman‘s care being transferred from a midwife to an obstetrician. For women intending to give birth in the birth centre, this also meant having care transferred to the District General Hospital eight miles distant. Experiences of those women who had care transferred were of a particular interest. Even though transfer is a common occurrence, little research exploring the effects of this from the woman‘s perspective has been carried out. The study was qualitative, using thematic analysis based on Gadamerian phenomenological principles. Semi-structured interviews were carried out with a purposeful sample of twenty women who described their antenatal experiences. Five of the women were later transferred from midwifery-led to obstetric-led care in the obstetric unit, with three of the transfers occurring during labour. A second interview was held with these five women to explore their experiences further. Key findings indicate that women choose the birth centre for its friendly, welcoming environment and woman-centred midwifery care. The influence and importance of family around the time of birth was a notable feature. Women transferred in labour subsequently experienced a different model of care, which for one woman meant that she remained empowered to make choices and decisions about her labour, whilst two other women felt some aspects of care to be mechanistic and impersonal. Recommendations from the study include further, larger scale research into women‘s experiences of transfer. Areas where specific guidance and education may be beneficial are suggested, to give a better understanding of those aspects of transfer that might affect women.

This thesis examines the development of the Edinburgh Royal Maternity Hospital in the context of medical care in Edinburgh during the period 1844-1914. It is based primarily on casebooks of the hospital and, in particular, on in-depth micro-studies of all of the hospital's Indoor and Outdoor cases in four discrete years, at approximately 20-year intervals. The central argument of the thesis is that Over the period 1844- 1914, professionals and patients at the hospital came to understand birth as a medical rather than a social event, and that this had repercussions for both groups as well as the institution itself. Chapter 1 places the thesis in the context of other secondary uork on the development of maternity hospitals and care, and examines the use of casebooks as primary sources. Chapter 2 considers the hospital and its staff in relation to the city and the Edinburgh medical community in particular. Chapter 3 examines the patients who attended. It argues that, in the nineteenth century, their perception of the hospital was as a place of social shelter. However, by 1912 a greater number attended for otherwise unaffordable medical care at birth. Chapter 4 examines the medical treatment given to patients. It argues that there was increasing acceptance of medicalisation by patients in the period studied, and increasing confidence in giving such treatment by the professionals involved. Chapter 5 discusses the staff and male and female trainees at the hospital. It suggests that, prior to the introduction of national requirements, the provision of training was driven by commercial concerns, and therefore varied throughout the period studied, particularly in the amount of practical experience offered. The relationship between the different grades of staff and the treatment they offered, described in the chapter, suggests increasing stratification in the roles of doctors and nurses at delivery and during the puerperium. The increase in nursing care following the birth indicates the creation of a professional role that among the poor had previously been undertaken by family members. The role played by increasing anxiety over infection following the introduction of strict antiseptic measures is discussed. The thesis concludes that in Edinburgh the medicalisation of childbirth among the poor was well-advanced by 1912, and suggests that this was a result of increasing patient acceptance combined with the increasing professionalisation of care.

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This research study explored the meanings attributed by migrant Arab Muslim women to their experiences of childbirth in the UK. The objectives of the study were: • To explore migrant Arab Muslim women's experiences of maternity services in the UK. • To examine the traditional childbearing beliefs and practices of Arab Muslim society. • To suggest ways to provide culturally sensitive care for this group of women. An interpretive ontological-phenomenological perspective informed by the philosophical tenets of Heidegger (1927/1962) was used to examine the childbirth experiences of eight Arab Muslim women who had migrated to one multicultural city in the Midlands. Three in-depth semi structured audiotaped interviews were conducted with each woman; the first during the third trimester of pregnancy (28 weeks onwards), the second early in the postnatal period (1-2 weeks after birth) and the third one to three months later. Each interview was conducted in Arabic, then transcribed and translated into English. An adapted version of Smith’s model of interpretive phenomenological analysis (Smith 2003) together with the principles of Gadamer (1989) were used to analyse the interview data, aided by the use of the software package NVivo2. The analysis of the women’s experiences captures the significance of giving birth in a new cultural context, their perception of the positive and negative aspects of their maternity care and the importance of a culturally competent approach to midwifery practice. Six main themes emerged from analysis of the interviews: ‘displacement and reformation of the self’, ‘by the grace of God’, ‘the vulnerable women,’ ‘adaptation to the new culture,’ ‘dissonance between two maternity health systems’ and ‘the valuable experience’. These themes reflected the women’s lived experiences of their childbirth in the UK. The implications for communities, institutions, midwifery practice and further research are outlined. The study concludes that in providing culturally competent care, maternity caregivers should be aware of what might be significant in the religious and cultural understandings of Arab women but also avoid cultural stereotyping by maintaining an emphasis on individualised care.

Submitted in fulfillment of requirements for the Degree of Master of Health Sciences: Nursing, Durban University of Technology, Durban, South Africa, 2016. / Introduction Through centuries the birth of a baby has been considered as a deeply felt spiritual experience. Childbirth is not merely a physiological experience; it also embraces social, emotional, psychological, spiritual and religious aspects. In most Western societies the sacred moment of birth dissipates within the context of a pressured hospital environment. Whilst literature and empirical research has proliferated on midwifery very little has been done to explore how women experience childbirth personally and more importantly how spirituality interfaces within the context of the childbirth experience and midwifery care. There is a growing body of literature on spiritually sensitive care. However, there remained a need to inquire about mother’s personal experience and how spirituality interfaces with the childbirth experience in the hospital context. Problem statement Whilst empirical research in the field of midwifery, has grown, research pertaining to the spiritual aspects related to women’s diverse spiritual needs during childbirth is sparse (Crowther and Hall 2015). Furthermore little attention has been paid to issues relating to how women experienced childbirth in the public sector, and how religion and spirituality influence and impact on childbirth. It is against this background that the current study was conceived. Purpose of the Study The purpose of this study was to explore and describe the experience of childbirth amongst women from diverse spiritual or religious backgrounds viz. Christianity, Islam, African Traditional Religion and Hinduism, at public hospitals in the uMgungundlovu District of KwaZulu-Natal. Methodology A qualitative, explorative, descriptive and contextual study design was used. A total sample of twenty-two postnatal mothers from the following common spiritual backgrounds in South Africa viz. Christianity, Islam, African Traditional Religion and Hinduism were purposively chosen. Data was collected until saturation. Participants were selected from three public hospitals in the uMgungundlovu District of KwaZulu-Natal. Data was collected by means of semi-structured interviews conducted six weeks post-delivery at the six-week health check, but within three months of delivery. Interviews were transcribed manually; the data was analysed through thematic analysis. Findings The main themes drawn from the data reflected that childbirth was a deeply personal and meaningful experience. It was seen as a spiritual experience and spirituality was seen as a vital support system in enabling mothers to cope better with pain and other challenges. Emotional and comfort needs were also identified by mothers as being very important to cope with pain and an easier delivery. The presence of midwives and the need for partner and family support were also seen to be important. More importantly the study found that their spirituality and spiritually based activities and rituals were an important aspect of the overall birth experience. The study found a diverse range of spiritual practices and rituals that were salient across all the spiritual worldviews during childbirth and post-delivery. It also found that mothers often resorted to alternate and traditional therapies to help cope with labour and delivery all of which have salience to midwifery practice that is both respectful and sensitive to the diverse worldviews of mothers. Conclusion Collectively the data reflected that childbirth was a holistic experience that cannot be separated also from partner, family and medical support. Whilst traditionally effective midwifery practice may have been so to focus on primarily physical care, the study found that the physical component is interrelated with the psychological, social and cultural aspects as well. Hence effective and ethical midwifery practice is inseparable from these facets but most importantly inseparable from the spiritual worldviews that most mothers follow and ascribe to. Contemporary education needs to recognize the current move towards spiritual care and provide knowledge and skill to deal with patients from diverse spiritual backgrounds. Finally it needs to recognize as this study has found, that childbirth is a multifaceted experience which is spiritual in nature. Viewed in this way both midwives and the management of public hospitals should then make every effort to create spiritually sensitive care during the childbirth experience. / M

A prospective study of pregnant women was undertaken to provide an estimate of rates of Posttraumatic Stress Disorder after childbirth that takes into account pre-existing trauma; to explore risk factors associated with the development of traumatic stress after birth; and to better understand incidence and risk factors associated with fear of childbirth, which is thought to contribute to postpartum Posttraumatic Stress Disorder. Ninety participants in their last trimester of pregnancy completed questionnaires that included depression, trait anxiety, PTSD, anxiety sensitivity, childbearing fear, and self-efficacy for labor. Four weeks after delivery 73 of these women completed questionnaires concerning delivery, posttraumatic stress related to childbirth, and depression. Levels of childbearing fear were similar to studies of non U.S. women but did not predict traumatic reactions to childbirth. First-time mothers and those with prior miscarriage, traumatic birth, and childhood sexual assault were not more fearful of childbirth although women reporting repeat sexual victimization that started in childhood were. Women with comorbid Posttraumatic Stress Disorder and depression during pregnancy were significantly more fearful of childbirth. Higher trait anxiety and anxiety sensitivity, and lower labor self-efficacy predicted greater fear of childbirth. Women who underwent operative deliveries became more fearful of childbirth after delivery whereas women who underwent unassisted vaginal deliveries showed a reduction in fear. Five percent of women developed new cases of Posttraumatic Stress Disorder attributable to childbirth. An additional five percent who had received a trauma diagnosis during pregnancy met criteria for Posttraumatic Stress Disorder resulting from childbirth. Higher trait anxiety predicted postpartum trauma symptoms and greater self-efficacy for childbirth moderated this relationship. Women assigned a diagnosis of Posttraumatic Stress Disorder or co-morbid PTSD and depression during pregnancy, and women who underwent operative or instrument deliveries (i.e. caesarian section, forceps deliveries, or vacuum extraction), were significantly more likely to receive a diagnosis of PTSD or trauma-related Adjustment Disorder as a consequence of their experience of childbirth. Results suggest that increasing self-efficacy for labor and treating psychopathology present during pregnancy may be fruitful targets for efforts to prevent the development of traumatic reactions to childbirth.

Within the past twenty years, a great deal of research has addressed pregnancy and childbirth in the United States. Often, however, prior studies have focused on white middle-class women and have neglected the experiences of women of color and low-income women. Teen mothers have also been marginalized in past research. With few exceptions, the limited research that does exist on African American teen mothers is usually framed around the "teen pregnancy crisis" in the U.S; seldom are teens included in studies dealing with the overall issue of medicalization. In an effort to understand the extent to which the medical model of childbirth shapes teens' understandings and experiences of prenatal care, this paper analyzes in-depth interviews with 40 pregnant or parenting African American adolescents attending a Teen Parenting Program. The analysis focuses on teens' accounts of their experiences with the patient provider relationship and their interpretations of and responses to the medicalization of pregnancy and birth contextualized in teens' encounters with medical providers during pregnancy. Overall, the adolescents accepted the medical model of pregnancy and childbirth. There were, however, acts of resistance and defiance of medical authority.

Magister Curationis - MCur / Globally, there has been significant progress in reducing preventable maternal deaths and disability, and growing attention on improving the quality of care in maternal health care facilities. The World Health Organization (WHO) describes quality care as delivering healthcare that is effective, efficient, accessible, acceptable, patient–centred, equitable and safe (WHO, 2014). Midwives are the backbone of midwifery and therefore the primary care giver for pregnant women accessing maternal care and women’s ability to access quality midwifery care during the antenatal, labour and postnatal period is the key component in midwifery care. The Primary Level Protocol of South Africa is under the umbrella of the Primary Health Care System, and according to this system low risk women are expected to seek antenatal, intrapartum and postnatal care from the nearest Midwife Obstetric Unit (MOU). The choice a woman makes regarding access to maternity care depends on the social norms in her society and what services are offered. However, the services that are available may not meet the needs of pregnant women. Women may need detailed information about the availability of the maternity care system in order to make an informed decision on where to access the health system. The gap between the perceived needs of pregnant women and the care provided by midwives can be bridged by listening to women to create a reciprocal understanding of quality care. In South Africa, limited research has been conducted on midwives and women’s perceptions of maternity care. In the absence of such information, this study was conducted at an MOU in the Western Cape, with the aim of exploring women and midwives’ perceptions of quality care during childbirth.

A thesis Submitted to the Faculty of Arts University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of Master of Arts / The aim of this study was to investigate the effects of social support for African women labouring aione in a Westernized hospital setting. Two high stress groups of first-time mothers, were studied; a mildly hypertensive group and a teenage group. the results indicated support to be moderately effective in both groups. Factors such as the cultural background, the apartheid system, social influences and the environment in which the mothers live may have impacted on the effectiveness of the support. / AC 2018

The transition to parenthood has been noted to be a significant milestone in an individual’s life that can have varying effects on the marital relationship. The marital relationship has further been noted to have implications on father involvement with children, where such involvement allows for better health and well being of the child. Sexual intimacy has been noted to be a significant aspect of a marital relationship that has an impact on marital satisfaction. As such the aim of this study was to explore father’s experience and understanding of fatherhood as well as their perceptions of the marital relationship post birth of the first child. The marital relationship was explored through understanding how the birth experience and presence of the baby influence fathers’ perceptions of their wife’s desirability’s, of marital intimacy and how sexual intimacy fits into the relationship post birth of the baby. The study consisted of a qualitative design and eight fathers were interviewed using a semi structured interview schedule. The data was then analysed using thematic content analysis. Findings suggested that whilst fathers reported a distinct decline in sexual intimacy there was no decline in marital satisfaction. Decline in marital satisfaction may have been buffered against, as fathers seemed to prepare for the birth of their child and held realistic expectations of the adjustments that would be required post birth of the baby. In addition, their view of intimacy had broadened to include sensuality where spending alone time with their wife and communication were seen as equally significant to sexual intimacy. The results from the study further indicated that fathers are becoming more involved in their parental role. In this regard fathers tended to create an individual space between them and their baby. This finding is in direct contrast to psychodynamic theories which discuss the father as involved in a triadic relationship with his child and hence relating only through the mother.