published_or_final_version / Medicine / Master / Doctor of Medicine

This thesis traces and analyses the evolution of obstetrical and midwifery doctrine and use of episiotomy in the United States and United Kingdom. In the U.S., the routinization of episiotomy resulted from strenuous lobbying efforts of a small group of obstetrician/gynecologists between 1915 and 1935. These physicians claimed episiotomy prevented perineal lacerations, infant mortality and morbidity, and gynecological problems. In the U.K., the liberal use of episiotomy came about during the 1970s from pressure from obstetricians although no overt campaigning for the practice occurred. In both countries adoption of routine episiotomy was encouraged by social forces which involved changes occurring in the dominant belief system in obstetrics, maternity care practices, and the obstetrics and midwifery professions. Questioning of the practice by childbirth activists and others eventually led to declines in episiotomy. This was facilitated, particularly in Britain, by midwifery interest in resisting obstetrical control. Neither the adoption nor rejection of routine episiotomy was informed by scientific evidence. This study contributes to understanding the process of innovation in maternity care.

Thesis (M.S.)--University of Michigan, 1996.

Thesis (M.S.)--University of Michigan, 1996.

No description available.

Thesis (M. Cur.) --University of Limpopo, 2015 / The purpose of this study was to determine the factors that were contributing to selfreferrals of antenatal women at the Dilokong Hospital in the Tubatse Local Municipality. By employing a quantitative, non-experimental research method, 360 women completed and submitted a structured questionnaire. Validity and reliability were insured by pre-testing the data collection instrument on respondents who were not part of the main study. Data was analysed by using the SPSS and Excel computer programs with the assistance of a statistician. The age group between 21 and 30 years 197 (54.7%) was larger than the other age groups. Primigravida women represented less than half 147 (40.3%) of the respondents. These women were also supposed to be referred to the hospital for delivery; however, only 23.3% of the women were referred to the hospital for delivery. The choice of the delivery site was influenced by a lack of women’s knowledge about the referral system and of services offered at the clinics, as well as the unavailability of doctors, midwives, food, equipment, enough space for delivery at the clinics, and the perceptions that nurses and midwives were rude. The government should ensure that the clinics are provided with adequate human resources and other resources that are needed for providing these health services. Pregnant women should be given referral letters and information with regard to where they are supposed to deliver. Key concepts: Antenatal women, self-referral, referral system, and Primary Health Care (PHC).

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

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

The World Health Organization (WHO) recommends that of all the live births per year no more than 10-15% of these should be delivered by caesarean section. Despite this recommendation there has been a global increase in the percentage of caesarean section deliveries over the past few decades. In South Africa the percentage is as high as 70% in certain health care institutions which is of concern to midwives. Caesarean section deliveries are needed when the life of the baby, mother or both are at stake. However, this method of delivery bears more disadvantages than advantages to the baby and mother. Despite these disadvantages, some women request a caesarean section in their birth plans while others are influenced by health professionals to request a caesarean section. Therefore, there is a need for labouring women to be guided where possible to have vaginal birth because of its many advantages. This study sought to explore and describe the perceptions of the midwives regarding their role in facilitating the choice of delivery mode for labouring women in public hospitals and midwifery obstetric units (MOUs) of the Nelson Mandela Bay and Sarah Baartman districts. Based on the results of the study, guidelines for midwives in this role were developed. Maputle’sWoman-Centred Childbirth Model (2010) was used as the theoretical lens through which this study was viewed. The researcher selected a quantitative survey design using an explorative, descriptive and contextual research approach. The population consisted of midwives who were working in labour wards at public hospitals and midwife-led MOUs. A non-probability convenience sample was used to collect data using a structured, self-administered questionnaire. The reliability and validity of the data collection instrument were ensured by using various means including a pre-test and an expert panel. Altogether, 300 questionnaires were distributed and 288 were returned. This number excluded the pilot study. Data was collected over a period of three months using the assistance of two fieldworkers. Data was captured and analysed under the supervision of the statistician and supervisors. Analysis was done by means of descriptive analyses that involved the production of frequencies and presented using charts, figures and tables. The major findings of the study are: -The midwives perceived themselves as the main facilitators of a suitable decision by the labouring woman for a safe delivery method - The midwives emphasised the importance of the delivery position preferred by the labouring woman -The midwives indicated that a collaboration between doctors, senior midwives, midwives and midwives in management positions could assist with a decision for a suitable delivery mode option. -The midwives agreed that the culture of the labouring woman should be considered when deciding on a delivery mode and therefore midwifery curriculum should include lessons about cultural diversity. Three principal guidelines were developed, namely: 1. Create an environment that promotes acceptance of a woman’s choice of a delivery mode. 2. Create an environment promoting a collaborative health care relationship 3. Create an environment that is sensitive to cultural needs in the maternity unit Ethical considerations in this study were upheld by maintaining the principles of beneficence, maleficence, autonomy and justice.

Made available in DSpace on 2016-06-07T17:12:13Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-04-28. Added 1 bitstream(s) on 2016-06-07T17:16:49Z : No. of bitstreams: 1 000864246_20170424.pdf: 489469 bytes, checksum: c19a08a315ad19ed3168af383d6f2c4c (MD5) Bitstreams deleted on 2017-04-24T11:16:42Z: 000864246_20170424.pdf,. Added 1 bitstream(s) on 2017-04-24T11:17:27Z : No. of bitstreams: 1 000864246.pdf: 2233958 bytes, checksum: ab77439a6a7146a93b82b0e490020b02 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Introdução: A prematuridade é a principal causa de mortalidade neonatal e os riscos de complicações decorrentes são inversamente proporcionais à idade gestacional na qual o parto ocorre. Diversos estudos na literatura demonstram o papel da resposta imune inata e dos receptores Toll-like (TLRs) durante a gestação normal e na presença de complicações gestacionais. A expressão de TLRs vem sendo avaliada principalmente nos tecidos da interface materno-fetal e os resultados de tais estudos são conflitantes. A investigação da expressão de TLRs em tecidos gestacionais é de grande importância para o entendimento da participação da imunidade inata em gestações normais e com desfechos gestacionais adversos, porém tais tecidos permitem análise somente após a resolução da gestação. Nesse contexto, uma possível fonte de estudo para análise de TLRs no decorrer da gestação em curso são as células do sangue periférico materno, uma vez são facilmente obtidas por punção venosa, além de possuírem papel fundamental na reposta imune inata e expressarem diversos tipos de TLRs. Objetivo: Traçar o perfil de expressão gênica e proteica de receptores Toll-like 1, -2, -4 e -6 em células mononucleares (PBMCs) e em neutrófilos do sangue periférico materno ao longo da gestação normal e na prematuridade. Materias e métodos: Foram incluídas no estudo 119 gestantes normais, as quais foram subdivididas em trimestres de acordo com sua idade gestacional. Além disso, foram avaliadas 20 gestantes em trabalho de parto pré-termo e 18 gestantes de termo. A análise de expressão gênica foi realizada por PCR em tempo real e a avaliação da expressão proteica por citometria de fluxo. Para a análise dos dados foram empregados os testes não paramétricos de Kruskal-Wallis e Mann-Whitney através do software SigmaStat 3.1. Resultados: Em relação às PBMCs, não foram observadas diferenças significativas nas expressões gênica e... / Introduction: Prematurity is the leading cause of neonatal mortality and serious neonatal morbidity worldwide and the risk is inversely proportional to gestational age at birth. Several studies demonstrate the role of innate immune response and Toll-like receptors (TLRs) in normal and complicated pregnancies, however most studies have focused on the tissues of the maternal-fetal interface. Research of the expression of TLRs in gestational tissues is of great importance for understanding the involvement of innate immunity in normal pregnancies and adverse pregnancy outcomes, but the analysis of these tissues allows for results only after the complete resolution of gestation. In this scenario, a potential biological sample of interest for analysis of TLRs in the ongoing gestation are maternal peripheral blood cells, since they play a crucial role in the immune system and express high levels of many of the TLRs. Main: Evaluate the profile of gene expression of TLR-1, -2, -4 and -6 in peripheral blood mononuclear cells (PBMCs) and polymorphonuclear cells (PMNs) and compare these expressions between preterm and term pregnancies. Materials and methods: 119 normal pregnant women were included in the study, subdivided into three groups according to the gestational trimester. In addition, 20 pregnant women in preterm labor and 18 pregnant women at term were evaluated. Gene expression analysis was performed by real-time PCR and protein expression evaluation by flow cytometry. Statistical analyses were performed using the nonparametric Kruskal-Wallis and Mann-Whitney tests by SigmaStat 3.1 software. Results: Regarding PBMCs, there were no significant differences in gene and protein expressions of TLR-1, TLR-2, TLR-4 and TLR-6 among the trimesters. The same was observed when comparing PBMCs of preterm and term pregnancies. In relation to neutrophils, gene and protein expressions of TLR-1, TLR-2, TLR-4 and TLR-6 remained unchanged throughout normal ...