All mothers and newborns deserve competent care and continuous support during the intrapartum period (Tinker et al., 2006:269). According to the Saving Mothers: Fifth Report on Confidential Enquiries into Maternal Deaths in South Africa, 2008-2010 (SA, 2011:4), the maternal mortality rate (MMR) is 176.22/100 000 live births (SA, 2011:4). The majority of maternal deaths are preventable and have many common preventable factors which are mostly related to the knowledge and skills of the healthcare providers and the challenges within the health care system (SA, 2011:5). The research was conducted in an attempt to make a meaningful contribution to the body of knowledge, specifically knowledge related to the experiences of women regarding the quality intrapartum care in a public hospital in Gauteng Province, and to make recommendations to enhance the quality of intrapartum care. A qualitative study design was used and data collected with the use of individual in-depth interviews. Purposive sampling was used to select participants who represent the target population. The sample used for the study included all women who had given birth within 24 hours before the interviews by normal vaginal delivery. A pilot study was conducted and the interview schedule was finalised. Sixteen individual in-depth interviews were done until data saturation had been achieved. Trustworthiness was ensured according to the principles of credibility, transferability, dependability and confirmability. A digital voice recorder was used to capture data and the data were transcribed verbatim. Field notes were written down for each interview. Data analysis was done by means of content analysis by the researcher and an independent co-coder. Themes and sub-themes were identified. The findings indicated that most of the women‟s experiences were positive regarding the quality of intrapartum care while a lesser percentage had had negative experiences. Identified areas of concern are staff attitudes, communication and staff shortages. Conclusions drawn are that women‟s experiences of quality of intrapartum care were that it is not of the highest standard. There is a need for provision of continuous emotional support during labour, improvement of staff attitudes and promotion of rooming-in, and a need not to be separated from their babies for long periods of time The research concluded with the researcher‟s recommendations for policy, nursing practice, nursing research and nursing education, for the enhancement and adherence of midwives to recommendations in improving the quality of intrapartum care in public hospitals. / MCur, North-West University, Potchefstroom Campus, 2014

All mothers and newborns deserve competent care and continuous support during the intrapartum period (Tinker et al., 2006:269). According to the Saving Mothers: Fifth Report on Confidential Enquiries into Maternal Deaths in South Africa, 2008-2010 (SA, 2011:4), the maternal mortality rate (MMR) is 176.22/100 000 live births (SA, 2011:4). The majority of maternal deaths are preventable and have many common preventable factors which are mostly related to the knowledge and skills of the healthcare providers and the challenges within the health care system (SA, 2011:5). The research was conducted in an attempt to make a meaningful contribution to the body of knowledge, specifically knowledge related to the experiences of women regarding the quality intrapartum care in a public hospital in Gauteng Province, and to make recommendations to enhance the quality of intrapartum care. A qualitative study design was used and data collected with the use of individual in-depth interviews. Purposive sampling was used to select participants who represent the target population. The sample used for the study included all women who had given birth within 24 hours before the interviews by normal vaginal delivery. A pilot study was conducted and the interview schedule was finalised. Sixteen individual in-depth interviews were done until data saturation had been achieved. Trustworthiness was ensured according to the principles of credibility, transferability, dependability and confirmability. A digital voice recorder was used to capture data and the data were transcribed verbatim. Field notes were written down for each interview. Data analysis was done by means of content analysis by the researcher and an independent co-coder. Themes and sub-themes were identified. The findings indicated that most of the women‟s experiences were positive regarding the quality of intrapartum care while a lesser percentage had had negative experiences. Identified areas of concern are staff attitudes, communication and staff shortages. Conclusions drawn are that women‟s experiences of quality of intrapartum care were that it is not of the highest standard. There is a need for provision of continuous emotional support during labour, improvement of staff attitudes and promotion of rooming-in, and a need not to be separated from their babies for long periods of time The research concluded with the researcher‟s recommendations for policy, nursing practice, nursing research and nursing education, for the enhancement and adherence of midwives to recommendations in improving the quality of intrapartum care in public hospitals. / MCur, North-West University, Potchefstroom Campus, 2014

Obesity is a steadily growing problem, and has both physiological and psychological consequences during pregnancy. Obese women may face discrimination which could shape their perceptions of maternity care. To date, few studies have studied the influence of body weight on patient satisfaction with care. The objectives of this study were: (1) to compare childbirth experiences and satisfaction with intrapartum care of normal weight (BMI between 18.5 and 24.9 kg/m2) and obese (BMI greater than or equal to 30.0 kg/m2) women and (2) to determine factors associated with satisfaction with intrapartum care. Guided by Barker’s (1997) pragmatic model of patient satisfaction, a descriptive comparative and correlational design was used to examine the relationship between childbirth experiences, weight discrimination, and satisfaction with intrapartum care among normal weight and obese women. Postpartum primiparous women (N = 138) in two Winnipeg hospitals completed a questionnaire package and had their chart reviewed (70 normal weight, 68 obese weight). Results: Using independent t-test, no significant differences in satisfaction with intrapartum care or childbirth experiences were found in the two weight groups. In the linear multiple regression model, perceived weight discrimination during labour and delivery was negatively associated (β = -5.78, p = 0.032), while professional support (β = 13.11, p < .001) and perceived control and safety (β = 3.25, p = 0.032) were positively associated with satisfaction with intrapartum care. Understanding factors that influence satisfaction with intrapartum care will assist healthcare providers and administrators to improve satisfaction in all women regardless of their weight. / May 2016

ABSTRACT Cephalopelvic disproportion (CPD) is a common and serious obstetric condition, especially in sub-Saharan Africa. Recognition relies on clinical observations, such as cervical dilatation, head descent, moulding, and size of fetus, all made in a trial of labour. No prospective studies have investigated intrapartum clinical observations and their predictive value for CPD. The objectives of this research were 1) to determine the association of intrapartum clinical findings, especially level of head and moulding, with the outcome of CPD, 2) to determine inter-observer agreement of these findings between clinicians, and 3) to compare intrapartum clinical palpation with symphysis-fundal height (SFH) measurement in the prediction of birth weight. A prospective cross-sectional comparative study was done in the Chris Hani Baragwanath labour ward, a large referral centre. The subjects were women at term, in the active phase of labour, with vertex presentations. The author, blinded to previous clinical or ultrasound findings, performed clinical assessments at the same time as the women’s attending clinicians. His observations were not divulged to the clinicians and he did not participate in obstetric management of the women. The primary outcome measures were CPD, defined as caesarean section for poor progress, and birth weight. Five hundred and eight women were examined, of whom 113 (22.2%) had CPD. Multivariate analysis identified short maternal stature, increased SFH, lesser cervical dilatation, long duration of labour, high degree of parieto-parietal moulding, and high degree of caput succedaneum as independent predictors for CPD. Fetal position and occipito-parietal moulding were not predictive, and level of head, by fifths and by station, was poorly predictive. Inter-observer agreement between the author and attending clinicians was moderate for cervical dilatation, engagement of the head in fifths, and caput succedaneum, and poor for engagement of the head by station. SFH measurement was a slightly better predictor of birth weight than clinical fetal weight estimation. The clinical observations that were shown to be predictive for CPD may be useful adjuncts in the management of a trial of labour. Inter-observer agreement of these findings is at best moderate. Measurement of SFH deserves more attention as an intrapartum predictor of birth weight.

Background: Adolescents are more likely to be dissatisfied with perinatal care than adults. Adolescents’ perspectives of their perinatal care experiences have been explored; however, there are few studies exploring adolescent-friendly inpatient care from nurses’ perspectives. Purpose: To explore adolescent-friendly care from the perspective of hospital-based adolescent-friendly perinatal nurses. Research Questions: (1) How and why do perinatal nurses in inpatient settings adapt their practice when caring for adolescents? (2) What are the individual nursing behaviours and organizational characteristics of adolescent-friendly care in inpatient perinatal settings, from the perspective of perinatal nurses? Methods: I report the qualitative component of a mixed methods study. Open-ended interviews were conducted with twenty-seven purposively-sampled expert nurses. Data were analyzed using Interpretive Description. Findings: Nurses described being mother-friendly to adolescents by being nonjudgmental, forming connections, individualizing care, and employing behavioural strategies that facilitate relationship-building. Implications: These findings will inform the development of interventions to facilitate connections between nurses and adolescent mothers.

Thesis submitted in fulfilment of the requirements for the degree Master of Technology in Information Technology in the Faculty of Informatics & Design at the Cape Peninsula University of Technology / Research on health informatics has seen a steady increase during this decade as the role of information technology in the health sector becomes pertinent. Findings of previous research in this domain have uncovered vast information needs of health workers, particularly in developing countries. However, there is a need to continue with multidisciplinary research in priority areas such as midwifery practice and in the environment of marginalised settings. This study explores the significance of the information needs and information-seeking behaviour or practice of midwives during the antenatal and intrapartum care within the environment of a midwifery unit. Additionally, the researcher obtained permission from Faculty of Informatics and Design – CPUT and Health department authority – Western Cape Government in South Africa, to conduct research in the Elsies River Midwifery Obstetric Unit (ERMOU). The research was carried out as case study in a Midwifery Obstetric Unit in the Western Cape, South Africa. The investigator conducted semi-structured interviews and observations to collect qualitative data of the antenatal and intrapartum care environment. The data was transcribed and analysed using thematic analysis and essomenic modelling. The findings comprehensively point to the importance of this research context. The study found that midwives acquired patients’ information from a handwritten Maternity Case Record (MCR) book and midwives’ colleagues, and often during handovers. In addition, midwives also communicate with each other during care activities in the ERMOU. It was apparent that the use of such communication practices is inadequate, and midwives did not always have sufficient information to make appropriate decisions in the ERMOU. All patient information, referral notes, and reporting is paper-based. In addition, essomenic models were used to depict the midwives’ work activities in the antenatal and intrapartum care environment in the Unit. Furthermore, essomenic models defined all the systematic processes that occur in the ERMOU which is described by midwives’ activities and work environment. To improve communication, future research is recommended to consider the importance of the continuity of the education of midwives. Further research will be on the implementation of nursing informatics and the electronic health record system in the Elsies River Midwifery Obstetric Unit.

Title: Psychosocial aspects of intrapartum and postpartum care Author: Mgr. Lea Takács Department: Department of Psychology Supervisor: PhDr. Simona Hoskovcová, Ph.D. Consultant: MUDr. PhDr. Pavel Čepický, CSc. Abstract Background: Satisfaction with perinatal care is largely a result of psychosocial aspects of the care provided. However, despite a considerable body of research, the concept of satisfaction with perinatal care is not sufficiently defined and understood, being often confused with other concepts, particularly with that of satisfaction with childbirth experience. The lack of knowledge concerns especially the psychosocial dimensions and determinants of the care, most importantly for different groups of women, and the level of importance of psychosocial factors for satisfaction compared to biomedical variables. Objective: The aim of the present dissertation is to contribute to the theory of satisfaction by investigating the psychosocial and biomedical factors that affect satisfaction with perinatal care and satisfaction with childbirth experience in different groups of women depending on the mode of delivery (vaginal delivery, emergency caesarean section or elective caesarean section). Method: Ordinal logistic regression was used to identify the key predictors of satisfaction. The data were...

The purpose of the research was to determine the underlying contributory factors in an obstetric unit at the district hospital in Mpumalanga province, South Africa, regarding neonatal deaths and to propose strategies for midwifery practice. Quantitative, nonexperimental, descriptive, exploratory and retrospective (ex-post facto) design was used to explore and describe the factors contributing to neonatal deaths. Data collection was done using an audit tool. The conclusions drawn from this study supported the assumptions that there are factors related to antenatal, intrapartum, postnatal and neonatal care that contribute to neonatal deaths, thus emphasizing the urgency of improving the care of pregnant mothers and their babies through effective implementation of programmes and protocols / Health Studies / M.A. (Health Studies)

The purpose of the research was to determine the underlying contributory factors in an obstetric unit at the district hospital in Mpumalanga province, South Africa, regarding neonatal deaths and to propose strategies for midwifery practice. Quantitative, nonexperimental, descriptive, exploratory and retrospective (ex-post facto) design was used to explore and describe the factors contributing to neonatal deaths. Data collection was done using an audit tool. The conclusions drawn from this study supported the assumptions that there are factors related to antenatal, intrapartum, postnatal and neonatal care that contribute to neonatal deaths, thus emphasizing the urgency of improving the care of pregnant mothers and their babies through effective implementation of programmes and protocols / Health Studies / M.A. (Health Studies)

The purpose of the study was to describe the knowledge, attitudes and practices of nurse-midwives related to obstetric care at Thaba-Tseka, Lesotho. A quantitative, descriptive, cross-sectional research design was used. Data were collected using structured questionnaire from 45 nurse-midwives. The findings revealed that nurse-midwives had mean knowledge score of 10.5(80.7%) out of a possible 13(Standard Deviation (SD) 1.31) on obstetric care issues. However, the majority of nurse-midwives (n=28, 62.2%) did not have knowledge on the steps of the active management of third stage of labour according to the WHO. The mean scores on practice were 34.5(86.2%) against a possible 40(SD 5.43) for antenatal care, 39.2(89%) against a possible of 44(SD 4.66) and 22.4(93.3%) against a possible of 24(SD 2.18) for postnatal care. The study revealed that nurse-midwives had positive attitudes towards obstetric care practices with mean score for attitudes was 23.4(86.7%) against a possible score of 27(SD 3.02) / Health Studies / M.A. (Public Health)