This research study explored and described a partogram as a clinical practice guideline for monitoring and managing women during labour at Vhembe District of Limpopo province. A qualitative, explorative, descriptive and contextual design was used in order to achieve the study objectives. Purposive sampling was carried out to select three hospitals in order to obtain comprehensive data from the district. The research study was conducted in three phases. Face-to-face semi-structured interviews were conducted with 17 midwives who were selected conveniently from the three hospitals. Document study was also conducted on 24 partograms that were conveniently selected from the three hospitals on the days that interviews were conducted, using a self-designed checklist. Tesch’s eight steps of qualitative data analysis were used to analyse the data, and simple, descriptive statistics using frequencies were used to analyse the data obtained from the document study. Four themes that emerged from the data are: benefits of implementing the partogram, challenges experienced, attitudes of staff and evaluation on how the guideline is being implemented in the wards, including giving feedback. These aspects were indicated as pivotal in the implementation of the guideline in monitoring a woman during labour. The findings on document study revealed gaps in recording, mostly on aspects that needed frequent observations and on aspects in which resources that needed to be used in monitoring were lacking. The strategies to improve the implementation of a guideline were developed based on the research findings, sent to one of the hospitals for review and comments were included in the discussions. It is recommended that in-service training on the implementation of the partogram be conducted regularly for midwives. Hospital management and supervisors need to provide support, enough staff and equipment in order to enable midwives to use the partogram / Health Studies / D. Litt. et Phil. (Health Studies)

People's inability to cope with the demands of modern life, has led to a significant increase in the incidence of anxiety being experienced by people from all walks of life. People are suffering from anxiety without knowing the root cause of it and it was found from the anxiety cases studied that its origin can in many cases be traced to the birth experience where specific negative suggestions were imprinted on the subconscious. In this study the influence of the birth experience as the underlying cause of anxiety and the effect of it on the formation of the self-concept and self-actualisation have been explored. The research shows that a subconscious origin exists in the development of anxiety. In the research for this study, Medical Hypnoanalysis, which is based on a process of diagnosis and therapy, was used as therapeutic method with several clients suffering from anxiety symptoms. In this research the perceptions formed in the subconscious during the birth experience were examined and related to the anxiety experienced during childhood and later life. The case studies, their diagnoses and the follow-up therapeutic sessions relating to the birth experience were investigated and discussed. Educational Psychologists show a specific interest in and a tendency to get involved with, or implement Medical Hypnoanalysis in therapy. It became obvious from this study that Medical Hypnoanalysis supplements the needs of the Educational Psychologist as a tool in therapy. In this study guide lines have been presented to the Educational Psychologist for the treatment of anxiety originating from the birth trauma by regressing the client back to this traumatic experience. Suggestions on how to conduct the birth regression sessions have also been presented and clarified. Through the case studies the identification and removal of the highly charged emotional and negative beliefs that were responsible for the anxiety symptom have been demonstrated. The case studies have furthermore demonstrated the successful utilisation of positive and healing suggestions to achieve the therapeutic goals. The results of this study show that Medical Hypnoanalysis can be used effectively in the treatment of the root causes of anxiety. / Psychology of Education / D. Ed. (Psychology of Education)

MPH / Department of Public Health / See the attached abstract below

The contribution of Emergency Obstetric Care (EmOC) in reducing maternal mortality in Ethiopia is very minimal as evidenced by poor provision and low utilization of EmOC. Client centred EmOC provision improves the provision and utilization of EmOC; leading to the treatment of the majority of obstetric complications which are the main causes of maternal mortality. This study describes clients’ views and perspectives concerning the quality of EmOC provision in Ethiopian public health facilities. An explorative and descriptive phenomenological qualitative study design was used in the study in order to explore and describe the lived experiences of clients with EmOC services. Key informant interviews with women who had direct obstetric complications and received EmOC at three public health facilities in Addis Ababa generated rich data on their lived experiences. Content analysis was used to analyze the data as it complies with the phenomenological data analysis and Atlas ti version 6.2 qualitative data analysis software was employed. The findings revealed that quality EmOC is a welcoming, life-saving timely care given in a clean environment with humility, respect, equal treatment and encouragement. It is care that is safe for the client, technically sound, responsive and meets clients’ needs and expectations. Accessibility of life saving care at all time and collaborative and coordinated care created good experiences for the clients. The causes of clients’ disappointment with the provision of EmOC were higher expectations from female providers, underestimation by providers, non responsive providers, and ethical misconduct by providers such as mocking, insulting, yelling, advantage taking providers, undelivered promises by providers, expectation with place of delivery, expectation with newborn care and a limited number of health workers attending delivery. Discrimination, high cost of care and asking client to buy drugs and supplies and referrals from centres, are some of the barriers on r the use of EmOC at public health facilities. The provision of EmOC is constrained by overloaded staffs, shortage of space to accommodate clients and inadequate number of beds. In conclusion, clients have expectations and experiences of provision of EmOC that influence their future decision to seek care. Finally, a client centred guideline for the provision of client centred EmOC provision was developed. / Health Studies / D. Litt. et Phil. (Health Studies)

Indiana University-Purdue University Indianapolis (IUPUI) / This thesis project aims to address the following question: How do women who were planning a vaginal birth with limited medical intervention experience an unplanned c-section? Specifically, this research project involved: completing in-depth interviews with 15 women who planned a vaginal birth with limited medical intervention but instead experienced an unplanned c-section between six months and two years ago; discovering and describing the nature of the birth the mothers originally envisioned for their child; exploring the women’s experiences with, and feelings about, the birth itself and how it might differ from what they envisioned; developing a better understanding of how these experiences and feelings affected the women during the first two years following the birth; describing any challenges they faced and how, if at all, they managed such challenges; and identifying strategies that could be used to improve the experience of women recovering from an unplanned c-section who envisioned a vaginal birth with limited medical intervention.