Fathers' attendance at childbirth is almost universal in the United States, but few researchers have addressed the role that males play in childbirth decision making. The number of technological interventions available to birthing women is increasing, as is the utilization of those interventions. The degree to which women choose or agree to these interventions plays a major role in individual and societal health outcomes. Therefore, health care policy makers and educators must find ways to help childbearing couples navigate the complex maze of decisions related to childbirth. However, policies and programs to increase shared decision making may not function as intended if they do not consider the role that fathers play in making decisions about their children's birth. This study used qualitative methods to explore the perspectives of 15 couples prior to and after the delivery of their first child. Findings identified values and beliefs held by men that influenced their input into decisions, as well as the roles they fulfilled in decision making. Results of this study can help policy makers, health care providers and health educator identify ways to encourage effective, empowered joint decisions on the part of childbearing couples.

This dissertation explores the British colonial government’s attempt to reconstruct women’s reproductive behaviors in colonial Ghana through the sites of maternal and infant welfare services and western midwifery education. In the early 1920s, the fear that the high maternal and infant mortality rates in the Gold Coast would have repercussive effects on economic productivity caused the colonial government to increasingly subject women’s reproduction to medical scrutiny and institutional care. I argue that female reproduction was selected as a site of intervention because the British colonial government conceived of it as a path of least resistance to social reconstruction, economic security, and political dominance. The five chapters have been designed to analyze colonial reproductive intervention as a socio-economic and political exigency of colonial rule. This dissertation speaks to the fact that cross-culturally, the female body has been politicized through narratives of power, culture, tradition, modernity, race, disempowerment, and empowerment. / text

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

The purpose of the study was to develop and test a self-report instrument that describes the frequency that intrapartum nurses perform labor support and physiologic interventions and the nurses' beliefs of the helpfulness of their interventions. The Labor Support and Physiologic Intervention Scale (LSPIS) uses a Likert-style format in a 5-category range of answer options to collect data on nurses' practices to enhance the progress and process of women's labors. Social support theory and physiologic theory provided a conceptual foundation, while the scientific literature on labor support and intrapartum care provided a basis for the original 57 items used in the pilot (n=10) and the Phase I study (n=307). Five labor support experts evaluated the items, with an interrater agreement of .95 and a content validity index of .93. The 57-item LSPIS had an internal reliability of .93 and .95 for the frequency and helpfulness portions (respectively). Exploratory factor analysis identified a 6-factor solution accounting for 48% of the variance that matched the social support and labor support dimensions. The LSPIS was revised and shortened to 26 items based upon the Phase I data analyses. The Phase II study had 472 respondents recruited from two professional listserves. The internal consistency reliability of the revised LSPIS was .90 and .91 for the frequency and helpfulness portions (respectively). Construct validity was evaluated by exploratory factor analysis, which found several acceptable factor solutions that were consistent with the theoretical framework. A six-factor solution accounted for 59% of the variance and had the following components: instrumental or physical support, emotional support, partner support & information/advice, advocacy, mother-directed pushing, and sustenance. Known groups technique and content analysis of nurses' responses to open-ended questions further evaluated construct validity, while discriminant validity was ascertained using a short version of the Marlowe-Crowne Social Desirability Scale. Further data analyses explored relationships among LSPIS scores and various organizational, geographic, and provider variables. In both phases, instrument psychometrics were acceptable and the scale demonstrated acceptable content and construct validity. Further revisions and future uses of the instrument can be guided by the recommendations provided. / text

Syfte: Att kartlägga förutsättningarna för gravida kvinnor att använda dusch och bad som smärtlindring på Sveriges förlossningsavdelningar. Metod: Deskriptiv tvärsnittsstudie genomfördes med telefonintervjuer utifrån ett frågeformulär. Deltagare: Alla 48 Sveriges förlossningsavdelningar deltog i studien. Respondenter var chef för förlossningsavdelning alternativt barnmorska som arbetar på förlossningsavdelning. Resultat: Förutsättningarna för att nyttja dusch och bad som smärtlindring varierar i Sverige. Många undantag finns för vem som får bada. Dusch och bad används tämligen frekvent. Infor­mation om denna smärtlindringsmetod ges mestadels muntligt. Detta har ändå inträffat senaste året. Riktlinjer för dusch och bad som smärtlindring finns på färre än hälften av för­lossnings­avdelningarna och enbart fem av dessa riktlinjer har referenser till forskning. Ingen förlossnings­avdelning bedriver vård med vattenförlossningar men detta har ändå skett på tio för­lossnings­avdelningar senaste året. Ingen avdelning har riktlinjer för hur vattenförlossning ska handläggas. Slutsats: Möjligheterna till dusch och bad som smärtlindring är mycket olika i landet. Eftersom vården ska vara lika oavsett hemort bör detta ses över. Riktlinjer bör utarbetas för ett gemensamt arbetssätt baserad på aktuell forskning. / Objective: To chart the possibilities for hydrotherapy, i.e. bathing or showering, during labour in Swedish labour wards. Design: Descriptive, cross-sectional interview study involving short phone interviews based on an interview schedule. Participants: All 48 labour wards in Sweden participated. Head of labour ward or midwife working in labour ward was interviewed. Findings: The possibilities for hydrotherapy varied. Many women are for various reasons not allowed to bathe. Hydrotherapy is relatively commonly used in Sweden. Information about hydrotherapy is mostly given verbally. Less than half of the labour wards have guidelines for hydrotherapy, only five have references to current research. Water births are not allowed but have despite this occurred in ten labour wards during the last twelve months. None of the labour wards have guidelines for management of water birth. Key conclusions and implications for practice: The Swedish government has decided that all individuals should receive equal care. There is much to be done to nationally achieve equal possibilities for hydrotherapy during childbirth. Guidelines based on current research for handling hydrotherapy and water birth are needed.

No description available.

The purpose of this study was to develop and test an index of primigravidas' Performance Incongruency as represented by the difference between the scores on the two forms of the Schroeder Labor Locus of Control Scale (SLLOC). The first form measured primigravidas' expectations for control during labor and delivery. The second form indexed primiparas' perceptions of the actual control they had during their childbirth experience. The convenience sample of primigravida included 34 subjects from one prenatal clinic and 27 from another. Of this sample of 61, 50 delivered during the study and comprised the primipara sample. A descriptive design was used for validity and reliability estimates. The results indicated that the content validity of the pre-labor form of the SLLOC met the established criterion of 90% interrater agreement. Criterion validity estimates on both forms did not achieve the established criterion nor did the convergent-discriminant estimates of construct validity within the instrument. Convergent-discriminant validity external to the scale, however, approached the established criterion. Test-retest reliability estimates of the pre-labor form demonstrated stability (r = .81). The Internal subscale of both forms of the SLLOC was internally consistent with coefficient Alphas of .81 for the pre-labor form and .71 for the post-delivery form. The External-Chance subscale of both forms approached the criterion for internal consistency, but the External/Powerful Others subscale did not. The findings for the index of Performance Incongruency supported literature reports suggesting that primigravidae who had participated in childbirth education classes experienced less control than they had anticipated whereas those who had not participated in childbirth education classes experienced more than they expected.

This thesis examines childbearing and first birth in Scotland. A description of empirical patterns and trends in childbearing and first birth in Scotland is given. Unique and appropriate analyses of data sources are presented. This includes analysis of the Scottish Longitudinal Study (SLS) and Scottish Social Attitudes Survey: Fertility Module (SSAS). The thesis clearly demonstrates the relationship between social stratification and childbearing within Scotland. This is apparent longitudinally, examining timings of first birth using the SLS, and in cross-sectional data using the SSAS, and comparing childbearing ideals and intentions with achieved numbers of children. The evidence suggests inequalities at play on parenthood. Those relatively less advantaged on measures of social stratification, for instance using data on occupations or educational attainment can be observed as starting families earlier than those more educationally or occupationally advantaged. Whether, and how, standard measures of geography relate to fertility outcomes is examined across several chapters and findings suggest that they offer some explanation relating to individual processes of first birth. A latent class approach is outlined which shows that economic theories of fertility can be reconciled with attitudinal indicators of opportunity cost and financial constraint. A distinctive theoretical position is also taken which culminates in the exposition of the position that childbearing can be usefully conceptualised in terms of a threshold effect.

The establishment of effective relationships is fundamental to good nursing practice and the fulfillment of nurses’ moral responsibilities. While intrapartum nurses are uniquely placed to establish relationships that can directly influence the woman’s experience of childbirth, there has been limited investigation of the relationships, identities and values that underlie nurses’ varied approaches and responses to labouring women. The purpose of this study was to explore intrapartum nurses’ understanding of their moral responsibilities from a social-moral perspective, using Margaret Urban Walker’s “expressive-collaborative” model of morality. Interviews were conducted with fourteen registered nurses working in a birthing unit of a Canadian teaching hospital. Four themes were identified that captured nurses’ moral responsibilities, including: organizing and coordinating care, responding to the unpredictable, recognizing limits of responsibilities to others, and negotiating care with women and families. Nurses enacted their moral responsibilities to labouring women in a variety of ways depending on their personal and professional experience, the circumstances, the people involved and the context of care. A key factor influencing responses to women was the degree to which understandings and expectations related to birth were deemed to be reasonable and mutually agreed upon among nurses, physicians, women and their families. Nurses also described limits on their responsibilities to others. Their choice of response to circumstances in which practice was constrained departed from the idealized expectations and ‘expert’ practices often reflected in professional guidelines. While nurses were able to identify contextual influences that constrained their ability to maintain effective relationships with women, the influence of their own values on the care they provided was less apparent. This suggests a need to challenge normative assumptions related to care of women in childbirth, including the provision of choice and family centred care, in order to create environments that can support and sustain practices that build understanding, mutuality and trust between nurses and birthing woman. In addition, given the contested nature of childbirth and the lack of shared understandings of what constitutes ‘best’ care, there is a need to develop collaborative models of inter-professional maternity care that include the voices of women as a central component.

No description available.