published_or_final_version / Politics and Public Administration / Master / Master of Public Administration

published_or_final_version / Politics and Public Administration / Master / Master of Public Administration

published_or_final_version / abstract / Statistics and Actuarial Science / Master / Master of Philosophy

Within this thesis I examine Western practices and conceptualizations of childbirth from three distinct angles, with the goal of better understanding how one can negotiate agency in contemporary childbirth. First, I outline the history of the medicalization of childbirth in the West, using a reference frame of the famous second wave feminist text, Our Bodies, Ourselves. Next, I conceptualize agency in the context of contemporary childbirth, first defining the ‘agency’ that I am working with, and then outlining some of the factors that play into the negotiation of agency in one’s childbirth; some of these factors include race, class, location, and information provided about specific medical and physical procedures. Finally, I destabilize the hegemonic Western understanding of labor and birth pain by situating pain as culturally constructed and contextually specific. I provide a few examples of ways in which we can reconceptualize pain in a way that situates it as a unique experience for each individual. The end goal of this thesis is to contextualize current childbirth practices within a specific history of medicalization, and to illustrate the complex nature of agency, but the importance of it to a childbirth in which the mother feels as safe and supported as possible.

This project examines midwifery in the precolonial setting, the nature of Christian missionary activities in Southeastern Nigeria, the colonial process of erecting the maternity, and the collaborations between traditional and Western midwives. The colonial history of Nigeria can be traced to 1885 when British claims to a West African sphere of influence received international recognition. However it was not until 1900, following the British government's acquisition of the Royal Niger Company's territories, that Nigeria was officially considered a British colony. Nonetheless, the groundwork of colonial rule in Southeastern Nigeria predated these eras and is attributed to the establishment of the London-based Church Missionary Society (CMS) at Onitsha in 1857, followed by the Roman Catholic Missions (RCM) in 1885. The rivalry that ensued between them led to the development of a medical mission and the launching of the Western maternity in Southeastern Nigeria, undermining traditional childbirth practices, and providing new forms of training and facilities for a new class of midwives. / text

The purpose of this study is to describe characteristics of childbirth pain communicative behaviors among laboring Thai women, determine mode of pain communication, and determine relationships among behaviors and parturients, age, parity, education, and occupation. This study employed an exploratory description design. Direct structural observation was used to collect data. The study was conducted at a general hospital in Bangkok, Thailand, with 32 subjects participating. The "Observation Checklist of Laboring Women's Behavior" was used to record the subjects' behaviors. Descriptive statistics, the t test, and Pearson product moment correlation were used to analyze data. Data analysis indicated that the subjects of this study communicated pain via nonverbal channels and in a quiet manner. The range of nonverbal behaviors ranked from the greatest to the least frequent occurrences and included tactual, facial, lips, body movements, eyes, and respiratory behaviors. The range of verbal reports ranked from the greatest to the lowest frequencies and included reports of sensation, self evaluation of tolerance of pain, asking for information, requesting help and comfort, and asking for permission. Reports of pain were the most predominant of all the verbal reports. There were no statistically significant differences between behaviors and age, parity, education, and occupation. Pain behaviors were more prevalent among primiparae. Subjects who were younger or had fewer years of education ask for more information relating to the childbirth process compared with their counterparts. The younger subjects tended to communicate their pain via verbal mode; the older subjects tended to communicate their pain through nonverbal channels. Information derived from this study contributed to clinical practice, research, and theoretical knowledge of nursing. The information will help nurses understand about pain communication among the Thai women. Findings also will serve as empirical data for future investigations and can be used as a basis for childbirth pain assessment. The findings of this study are not generalizable because subjects were not randomly selected and the sample size was small. Recommendations for future study include the use of larger sample sizes, refinement of the checklist, and the use of multiple methods to collect the data.

The purpose of the research was to develop and test a scale to index the concerns of first-time expectant parents. The two-phase research design included (1) an inductive concept generation phase, consistent with the status of knowledge in the field, and (2) a quantitative deductive instrument test of the concepts from phase 1. In the inductive phase, grounded theory analysis using interviews from a theoretical sample of ten expectant parents, provided data to generate a conceptual model. The three induced constructs were Support Cycling, Transition to First-Time Parenthood and Success at Parenting. In the quantitative deductive phase, 45 female and 36 male first-time expectant parents, volunteered from childbirth classes to test the Imle Transition to Parenthood Concerns (ITPC) scale, which indexed the second of the three major constructs generated in the inductive phase. Preliminary internal consistency and content validity assessments of the scale yielded an 87 item paper and pencil scale that would measure intensity of concern about each item. Separate testing for male and female subjects was supported by Hotelling's T² in MANOVA tests of the effects of sex and measured but uncontrolled testing situation variables. Reliability estimates of the ITPC scale, with seven subscales, indicated acceptable coefficient alphas for females and males of .95 and .93, respectively. The seven subscale coefficient alphas ranged from .79 to .92 for females and from .84 to .91 for males. Concurrent criterion-related validity estimates, using one criterion item per subscale, exceeded the criterion of at least .55, ranging from .58 to .83 for females and from .59 to .86 for males. The ITPC scale met preliminary tests of reliability and concurrent criterion-related validity. Since the subject test sample was representative of the middle class, educated type of person, who usually attends childbirth education classes, scale testing results cannot be generalized to other types of samples without testing. Psychometric testing indicated clinicians can use small sub-sets of items to index expectant parent concerns in a quick, easy-to-score, valid and reliable manner. Results could offer sound information to facilitate patient counseling.

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