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M.Cur. (Midwifery and Neonatal Nursing) / The purpose of this study is to determine the experiences of the parents after the death of a congenital abnormal baby. Parents who have lost a baby go through a process of grief. This also applies to parents of a baby with congenital abnormalities. Parents whose congenital abnormal baby dies, not only grieve because of the abnormality of their baby, but also because it died Unstructured in-depth interviews were held with six couples within a year after the death of their babies. The experiences of the six couples were afterwards compared. A literature study was undertaken in order to determine what the conclusions of other researchers field were. The result of the literature study was compared with that of the present study. Recommendations are made at the end of this study on the practical applications, education and further research that can be undertaken on this subject.

Thirteen nurses were interviewed over an eight week period to explore their adaptive responses to neonatal death. A process of adaptation was identified that included several phases through which these nurses proceeded before they finalized the death experience for themselves. These phases included responses to the resuscitation of the infant; the measures taken to console the bereaved parents; feelings associated with difficult moments during the dying process; the behaviors utilized to strengthen themselves before and after the death; reactions to the silence in the unit that occurred afterwards; the values they discovered when reflecting on how the death was handled; and the development of a philosophical meaning from their experiences. Data were collected and analyzed using grounded theory methodology.

The mechanical function of the uterine cervix is critical for a healthy pregnancy. During pregnancy, the cervix undergoes a significant remodeling from a mechanical barrier into a compliant structure to allow for a successful delivery. A too early or too late cervical softening will lead to spontaneous preterm births (sPTB) or dystocia. PTB is a leading cause of neonatal death, affecting 15 million newly born babies each year around the world. According to CDC, the rate of PTB increases in recent years. Dystocia increases the risk to both mother and newborn babies, leading to neonatal asphyxia, neonatal infection, uterine rupture, or other dangerous sequelae. Therefore, it is significant to have a better correlation of the mechanical properties change and the biological remodeling process of the cervix during pregnancy. This thesis will focus on (1) mechanical experiments of the human cervix, and (2) the development of a material constitutive model for cervix to characterize the complex microstructure-related mechanical property of the cervix. In this thesis, a spherical indentation test was designed and conducted on human cervical samples sliced perpendicular to the axial direction, to characterize the compressive mechanical behavior of the human cervix. A uniaxial tensile was designed and conducted on the strip samples cut along and perpendicular to the preferential fiber direction from the indentation samples, to characterize the tensile mechanical behavior of the cervix. Based on the detailed experimental investigation, a nonlinear time-dependent anisotropic microstructure-inspired constitutive model has been developed. The basic idea of the model is that the mechanical behavior of the human cervix can be decomposed into an equilibrium and a time-dependent part, and the tension and compression mechanical behaviors are caused by disparate mechanisms. Specifically, the collagen fibrous network plays a major role in the tensile mechanical response, while proteoglycans (PGs), glycosaminoglycans (PGs),, and liquid cause the compressive mechanical response. The tensile time-dependent mechanical behavior of the human cervix is mostly attributed to the interactions between the collagen fiber and other components, while the compressive time-dependent mechanical behavior is mainly attributed to the porous effect. The equilibrium and time-dependent mechanical responses have been well captured using the model, and the results reveal the connection between the ECM microstructure remodeling and mechanical properties change during pregnancy.

In this study, the experiences and perspectives of 10 bereaved mothers were investigated. The research was guided by a feminist and contextual perspective. A contextual theory of stress supports an examination of the perspectives of individuals in families regarding the impact of stressful circumstances. Individuals are assumed to be both active and responsive to the social system which includes individual, dyadic, familial, social, community, and cultural levels of analysis. A feminist perspective emphasizes reflexivity, collaboration, emotionality, and accessibility in the process of research and focuses attention to broader cultural ideologies which influence the lives of individuals. Women's lives carry with them the assumption of motherhood and the protection of children. When a young child dies, mothers find themselves in a marginalized social category / Ph. D.

Thesis (M Social Work)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: According to South African annual statistics, stillbirth is a relevant issue and National health policies, social welfare services and health care providers should place special focus on pregnant women to avoid the possible occurrence of a negative pregnancy outcome such as a stillbirth. An event that should have been a joyous birth, ended in a tragic death, forcing the mother to deal with the emotions of birth and death simultaneously. The bereaved mother needs to receive special care and support as soon as possible and the crisis intervention approach is seen as being helpful to regain a sense of equilibrium in her and the family’s life before starting to adapt to the new situation. This study explores and describes the lived experience of 25 mothers who experienced a stillbirth. Focus was given to the psychosocial implications of stillbirth on mothers and their families. This study examined the mothers’ feelings about the stillbirth six months or longer after the event, as well as its impact on relationships with partners and other children. By adopting a crisis intervention approach, the effectiveness of crisis intervention shortly after the stillbirth could be investigated. This study used a combination of quantitative and qualitative research approaches and assumed an exploratory and descriptive research design to provide a detailed description of the phenomenon being studied, i.e. the psychosocial implications of stillbirth. A questionnaire was used to obtain demographic (quantitative) data and a semi-structured questionnaire – the design based on information from literature - was administered during individual interviews. Obtained data was both measurable and rich in description and revealed that mothers still longed for their stillborn babies after a period of six or more months had passed. It also indicated that the father or partner of the baby and other children were affected by a stillbirth. Gender differences in how stillbirth is experienced by each partner, consequently adds extra tension on the relationship. Most of the mothers experienced the stillbirth as a crisis and found support in their mothers, family and a counsellor. Significantly, mothers felt crisis-intervention was beneficial, but preferred that crisis intervention be followed by on-going therapy. The stillbirth also resulted in feelings of alienation from community, friends and family - who did not know how to approach them. Generally, mothers were satisfied with medical care received but several issues regarding autopsy consent and guilt feelings surrounding this are highlighted. Important recommendations resulting from the study indicate that the crisis-intervention approach as method in social work is effective when rendering service for bereaved mothers and families after a stillbirth. It helps to regain a sense of equilibrium, but further intervention is recommended to facilitate the grief process. In addition, the study emphasizes the importance of social workers being aware that the stillbirth causes tension in partner- and family relationships. Receiving social work intervention is not only highly effective, but allows bereaved mothers to feel empowered and encouraged to openly grieve for their stillborn babies - much needed in an environment where a stillbirth is seen as a silent birth. / AFRIKAANSE OPSOMMING: Volgens jaarlikse Suid-Afrikaanse statistieke, is stilgeboorte ‘n relevante onderwerp en die Nasionale gesondheidsbeleid, maatskaplike welsynsdienste en gesondheidssorgverskaffers moet fokus op swanger vroue ten einde moontlike negatiewe swangerskapuitkomstes, soos stilgeboorte, te voorkom. Tydens ‘n stilgeboorte, eindig die heuglike vooruitsig van ‘n geboorte in die tragiese afsterwe van die baba en word die moeder geforseer om emosies van geboorte en sterfte gelyktydig te hanteer. Sulke moeders benodig spesiale versorging asook ondersteuning so spoedig moontlik. Krisis intervensie is ‘n effektiewe metode om die moeder te help om ‘n mate van balans in haar en haar gesin se lewe te herwin voordat hulle kan begin aanpas by die nuwe situasie. Hierdie studie ondersoek en beskryf ervarings van 25 moeders wat ‘n stilgeboorte ervaar het. Fokus word geplaas op die psigososiale effek van stilgeboorte op moeders en hul gesinne. Moeders se gevoelens rakende die stilgeboorte ses maande of langer na die geboorte, is ondersoek, asook die effek daarvan op hul verhoudings met lewensmaats en ander kinders. Deur die krisis intervensie benadering te gebruik, kon die effektiwiteit daarvan kort na die stilgeboorte ondersoek word. Kwantitatiewe en kwalitatiewe navorsingsmetodes is in hierdie studie gebruik. Die studie veronderstel ʼn verkennende en beskrywende navorsingsontwerp om sodoende ʼn uitvoerige beskrywing van die psigososiale implikasie van stilgeboorte te verskaf. Data word verkry deur ʼn vraelyste - demografiese (kwantitatiewe) data, asook semigestruktureerde vraelyste (kwalitatief) wat tydens individuele onderhoude toegedien is. Die ontwerp van die semi-gestruktureerde vraelys is gebaseer op inligting vanuit die literatuurstudie. Die bevindinge van die empiriese ondersoek dui aan dat moeders na ses maande of langer steeds hunker na hul stilgebore babas. Geslagsverskille rakende die wyse waarop moeders en vaders die stilgeboorte ervaar dra gevolglik by tot ekstra spanning in die verhouding. Die meeste moeders het die stilgeboorte as ‘n krisis ervaar en het ondersteuning gevind by hulle moeders, gesinne en ‘n berader/maatskaplike werker. ‘n Beduidende bevinding was dat moeders krisis intervensie as voordelig beskou het, maar verkies dat dit opgevolg moet word deur deurlopende terapie. Die stilgeboorte veroorsaak ook dat die moeders ‘n gevoel van vereensaming van die gemeenskap, vriende en familie ervaar het. Volgens hulle was mense te bang en onseker in hoe om hulle te benader. In die algemeen was moeders tevrede met die mediese sorg wat hulle ontvang het, maar kwessies rakende toestemming en skuldgevoelens rondom nadoodse ondersoeke word uitgelig. Belangrike aanbevelings dui aan dat krisis intervensie as metode in maatskaplike werk effektief is ten opsigte van dienslewering vir ‘n moeder en haar gesin na ‘n stilgeboorte. Dit help om ‘n mate van balans te herstel, maar verdere intervensie word aanbeveel om die rouproses te fasiliteer. Die studie beklemtoon ook dat dit belangrik is dat maatskaplike werkers bewus moet wees dat ‘n stilgeboorte spanning veroorsaak in huweliks- en gesinsverhoudings. Die ontvangs van maatskaplike werk intervensie is nie net hoogs effektief nie, maar bemagtig en motiveer moeders om openlik te rou vir hulle stilgebore babas, iets wat nodig is in ‘n samelewing waar stilgeboorte as ‘n geboorte beskou word waaroor daar nie gepraat word nie.

This study was designed to discover parents' experience following a stillbirth or early infant death. The conceptualization of the research problem was based on Kleinman's (1978) cultural system model which directed the researcher to elicit directly from clients their explanatory models, or their way of viewing the experience. The specific research questions were (1) How do couples perceive and interpret their experience following stillbirth or early infant death? and (2) How do couples view the social support they have received at the time of their infant's death? Six couples, who were recruited primarily from bereavement support groups, participated in the study. Each couple had experienced a stillbirth or early infant death between four months and four years prior to the study. Data were collected from the subjects with the use of unstructured interviews, allowing the experiences to unfold as they were perceived by the participants. Four main themes that evolved from the data were (1) anticipation of parenthood and the shattering of hopes with the death or knowledge of impending death of the infant; (2) a multidimensional personal grief experience; (3) an interpersonal grief exerience influenced by the social support of health care professionals, of friends and family and of the spouse; and (4) reflection and search for meaning in the experience. The discovery of couples' perceptions of their bereavement experience and their view of the support received will assist in enhancing the ability to provide more effective nursing care to bereaved families. Implications for nursing practice, research and education are delineated. / Applied Science, Faculty of / Nursing, School of / Graduate

Thesis (MPhil)--University of Stellenbosch, 2004. / ENGLISH ABSTRACT: This thesis discusses the value of medical futility as an action guide for neonatal endof- life decisions. The concept is contextualized within the narrative of medical progress, the uncertainty of medical prognostication and the difficulty of just resource allocation, within the unique African situation where children are worse off today than they were at the beginning of the last century. parties actively engage in an interactive deliberation for a plan of action. Both parties ought to accept moral responsibility. Such a model of deliberation has the added advantage of transcending the limitations of the participants to arrive at a higher-level solution, which is considered more than just a consensus. It has been argued that medical progress has obscured the basic need for human compassion for the dying and for their loved ones. The literature furthermore reports that the quality of end-of-life care is unsatisfactory for both patients and their families. It is within this context that the concept of medical futility is positioned as a useful action guide. As we do not have the luxury of withdrawing from the responsibility to engage in the deliberation of end-of-life decisions, such responsibility demands an increasing awareness of ethical dilemmas and a model of medical training where communication, conflict-resolution, inclusive history taking, with assessment of patient values and preferences, is focussed on. The capacity for empathetic care has to be emphasized as an integral part of such approach. Finally, in this thesis, the concept of medical futility is tested and applied to clinical case scenarios. It is argued that the traditional medical paradigm, with its justification of an 'all out war' against disease and death, in order to achieve utopia for all, is outdated. Death in the neonatal intensive care unit is increasingly attributed to end-of-life decisions. Futile treatment could be considered a waste of scarce resources, contradicting the principle of nonmaleficence and justice, particularly in an African context. The ongoing confidence in, and uncritical submission to the technological progress in medicine is understood as a defence and coping mechanism against the backdrop of the experience of life's fragility, suffering and the inevitability of death. Such uncritical acceptance of the technological imperative could lead to a harmful fallacy that cure is effected by prolonging life at all cost. What actually occurs, instead, is the prolongation of the dying process, increasing suffering for all parties involved. The historical development of the concept of medical futility is discussed, highlighting its applicability to the paradigmatic scenario of cardio-pulmonary resuscitation. Particular attention is given to ways in which the concept could endanger patient-autonomy by allowing physicians to make unilateral, paternalistic decisions. It is argued that the informative model of the patient-physician relationship, where the physician's role is to disclose information in order for the patient to indicate her preferences, ought to be replaced by a more adequate deliberative model, where both / AFRIKAANSE OPSOMMING: Hierdie tesis bespreek die waarde van mediese futiliteit as 'n maatstaf vir aksie in gevalle van neonatale 'einde-van-lewe' besluite. Die konsep word gekontekstualiseer binne die wêreldbeskouing van mediese vooruitgang, die onsekerheid van mediese prognostikering en die probleme wat geassosieer IS met regverdige hulpbrontoekenning; spesifiek binne die unieke Afrika-situasie. Dit word aangevoer dat die tradisionele mediese paradigma, met regverdiging vir voorkoming van siekte en dood ten alle koste, verouderd is. Sterftes in neonatale intensiewe sorgeenhede word toenemend toegeskryf aan 'einde-van-lewe' besluite Futiele behandeling sou dus beskou kon word as 'n vermorsing van skaars hulpbronne, wat teenstrydig sou wees met die beginsels nie-skadelikheid ('nonmaleficence') en regverdigheid. Die volgehoue vertroue in en onkritiese aanvaarding van aansprake op tegnologiese vooruitgang lil geneeskunde, kan beskou word as verdediging- en hanteringsmeganisme in die belewenis van lewenskwesbaarheid, lyding en die onafwendbaarheid van die dood. Sodanige onkritiese aanvaarding van die tegnologiese imperatief kan tot 'n onverantwoordbare denkfout, naamlik dat genesing plaasvind deur verlenging van lewe ten alle koste, lei. Wat hierteenoor eerder mag plaasvind, is 'n verlenging die sterwensproses en, gepaard daarmee, toenemende lyding van all betrokke partye. Die historiese ontwikkeling van die konsep van mediese futiliteit word bespreek met klem op die toepaslikheid daarvan op die paradigmatiese situasie van kardiopulmonêre resussitasie. Spesifieke aandag word gegee aan maniere waarop die konsep pasiënte se outonomie in gevaar stel, deur die betrokke medici die reg te gee tot eensydige, paternalistiese besluitneming. Die argument is dan dat die informatiewe model, waar die verhouding tussen die dokter en pasiënt gebasseer is op die beginsel dat die dokter inligting moet verskaf aan die pasiënt sodat die pasiënt 'n ingeligte besluit kan neem, vervang moet word met 'n meer toepaslike beraadslagende model, waar sowel die dokter as die pasiënt aktief deelneem aan interaktiewe beraadslaging oor 'n aksieplan. Albei partye word dan moreel verantwoordbaar. So 'n model van beraadslaging het die bykomende voordeel dat dit die beperkings van die deelnemers kan transendeer. Sodoende word 'n hoër-vlak oplossing - iets meer as 'n blote consensus - te weeg gebring. Die argument word ontwikkel dat mediese vooruitgang meelewing met die sterwendes en hul geliefdes mag verberg. Verder dui die literatuur daarop dat die kwaliteit van einde-van-lewe-sorg vir sowel die pasiënte as hul familie onaanvaarbaar is. Dit is binne hierdie konteks dat die konsep van mediese futiliteit kan dien as 'n maatstaf vir aksie. Medici kan nie verantwoordelikheid vir deelname aan beraadslaging rondom eindevan- lewe beluitneming vermy nie, en as sodanig vereis die situasie toenemende bewustheid van sowel die etiese dilemmas as 'n mediese opleidingsmodel waann kommunikasie, konflikhantering, omvattende geskiedenis-neming, met insluiting van die pasient se waardes en voorkeure, beklemtoon word. Die kapasiteit vir empatiese sorg moet weer eens beklemtoon word as 'n integrale deel van hierdie benadering. Ten slotte, hierdie tesis poog om die konsep van mediese futiliteit te toets en toe te pas op kliniese situasies.

Feminist and social historians have long been interested in that particularly female ability to become pregnant and bear children. A significant body of historiography has challenged the notion that pregnancy and childbirth considered to be the acceptable and 'appropriate' roles for women for most of the twentieth century in Australia - have always been welcomed, rewarding and always fulfilling events in women's lives. Several historians have also begun the process of enlarging our knowledge of the changing cultural attitudes towards bereavement in Australia and the eschewing of the public expression of sorrow following the two World Wars; a significant contribution to scholarship which underscores the changing attitudes towards perinatal loss. It is estimated that one in four women lose a pregnancy to miscarriage, and two in one hundred late pregnancies result in stillbirth in contemporary Australia. Miscarriage, stillbirth and neonatal death are today considered by psychologists and social workers, amongst others, as potentially significant events in many women's lives, yet have received little or passing attention in historical scholarship concerned with pregnancy and motherhood. As such, this study focuses on pregnancy loss: the meaning it has been given by various groups at different times in Australia's past, and how some Australian women have made sense of their own experience of miscarriage, stillbirth or neonatal death within particular social and historical contexts. Pregnancy loss has been understood in a range of ways by different groups over the past 100 years. At the beginning of the twentieth century, when alarm was mounting over the declining birth rate, pregnancy loss was termed 'foetal wastage' by eugenicists and medical practitioners, and was seen in abstract terms as the loss of necessary future Australian citizens. By the 1970s, however, with the advent of support groups such as SANDS (Stillbirth and Neonatal Death Support) miscarriage and stillbirth were increasingly seen as the devastating loss of an individual baby, while the mother was seen as someone in need of emotional and other support. With the advent of new prenatal screening technologies in the late twentieth century, there has been a return of the idea of maternal responsibility for producing a 'successful' outcome. This project seeks to critically examines the wide range of socially constructed meanings of pregnancy loss and interrogate the arguments of those groups, such as the medical profession, religious and support groups, participating in these constructions. It will build on existing histories of motherhood, childbirth and pregnancy in Australia and, therefore, also the history of Australian women.

A quantitative descriptive, retrospective and cross-sectional study was conducted. The purpose of the study was to identify and describe factors that contributed to high sickness and death rate of babies admitted in the Neonatal Unit at a tertiary institution in Limpopo Province. Data were collected from the patient’s records by administering an auditing tool. The tool included initial assessment on antenatal care, intra-partum and neonatal care. Analysis of data was performed by IBM Statistical Package for Social Sciences (SPSS) Statistics 22 computer software version. Frequency tables and pie graphs were used to present the data. The findings revealed that 42% of the mothers whose babies were admitted in the Neonatal Unit were in their childbearing period, 71% of the mothers started antenatal care at the second trimester and 75% babies were admitted within the first six hours of life. Respiratory distress, 77% and prematurity, 43% were the common conditions for admission in the Neonatal Unit. Spontaneous preterm and immaturity were the common causes of death. Recommendations are that education and training on record keeping to be done on continuous basis, to conduct quality improvement programmes and implement maternal and neonatal guidelines in the clinical area throughout. / Health Studies / M.A. (Health Studies)