Thesis (M.S.)--University of Michigan, 1992.

M.Cur. / Women approach the experience of childbirth from their own frame of reference, expectations and the types of experiences which they encountered during their lifetime. Although much is done to prepare women for childbirth and motherhood, little information is obtained about the mother's experience of childbirth during the intra partum period, regardless of delivering naturally or with the administering of epidural anaesthesia. with this research it was endeavoured to gain more knowledge about the experiences of women during childbirth. The midwife can use this knowledge to have better insight in the needs of these women to ensure a better quality of patient care. A qualitative study was undertaken. The phenomenological method (the autobiographical method) was used, within the context of a private hospital on the West Rand. During March to April 1990 unstructured (non formative) interviews were conducted with 10 primigravidas that delivered vaginally. Five of the 10 women made use of epidural anaesthesia. A study of the literature was done to determine what the experts have already ascertained about this phenomenon. Themes were selected from the literature and the women's experiences were accordingly grouped. of this research, it appears that the who have delivered by means of epidural from those who delivered naturally. were identified where women had the same From the findings experiences of women anaesthesia, differ Universal experiences type of delivery. Recommendations were made on how the midwife can contribute to fulfil in the identified needs of the woman in labour.

Submitted in fulfilment of the requirements for the Degree in Masters of Technology in Nursing, Durban University of Technology, 2014. / Introduction High maternal, perinatal and under-five morbidity and mortality are some of the formidable development challenges in Africa. The World Health Organisation (WHO) estimates that worldwide, as many as 1500 women die every day due to complications related to pregnancy or childbirth (WHO 2010). The partograph or partogram, an inexpensive tool, was designed by WHO to be used by midwives for decision-making during labour. Many studies conducted in and out of Africa reflect sub-optimal use of the partograph. Aim of the study The aim of the study was to describe the utilisation of the partograph by registered midwives working in the maternity sections of public hospitals in the uMgungundlovu District in the province of KwaZulu-Natal. Methodology A quantitative descriptive cross-sectional study was used to describe the use of the partograph in the selected hospitals, and carried out in two phases. In phase one, 197 participants completed a questionnaire. In phase two, retrospective audits on 310 completed maternity records were done. The collected data was analysed using SPSS version 20 and presented in frequency tables, cross-tabulations and graphs. Results The results revealed that there were certain parameters that were given more focus when it came to correct and consistent recording, such as contractions (80.0%) and cervical dilatation (89%) whilst others were poorly done, such as the duration of labour (13.5%), pain relief (23.5%) and unrecorded partographs from the primary health care clinics and community health centres (80.8%).

Confirmatory factor analysis provided empirical support for the existence of the hypothesized constructs assessed by the CBSEI-C32. Doubly MANOVA indicated that the experimental group was significantly more likely than the control group to demonstrate higher self-efficacy for childbirth and lower perceived anxiety and pain in the early and middle phase of labour. The effects of the programe on anxiety and pain during labour differed according to different phase of labour. Independent samples t test also demonstrated a significantly higher level of coping behaviour performed by the experimental group as compared with the control group. (Abstract shortened by UMI.) / The aim of this study was to test the effectiveness of an educational intervention, based on Self-efficacy theory (Bandura, 1989); to promote women's self-efficacy for childbirth and their coping ability for reducing anxiety and pain during labour. The study consisted of two phases: the 1st phase was to establish the validity and reliability of the primary outcome measure of the phase 2 study: a short form of the Chinese version of the Childbirth Self-efficacy Inventory (CBSEI-C32). The confirmatory factor analysis (CFA) was used to establish the construct validity of the CBSEI-C32. In the 2nd phase, the focus was to test the effectiveness of educational intervention to promote women's self-efficacy for childbirth and their coping behaviour during labour. The researcher used an experimental design with random assignment of eligible participants into experimental (n = 54) or control (n = 62) group that completed one pre-test (baseline at 32--34 weeks of gestation) and three posttest surveys (post-intervention at 37 weeks of gestation and within 48 hours and 6 weeks after delivery). The experimental group received two 90-minute sessions of an educational program offered at 33--35 weeks of gestation based on Bandura's (1986) self-efficacy theory. The primary outcome measures were the two subscales of the CBSEI-C32: outcome expectancy (OE-16) and efficacy expectancy (EE-16). The secondary measures included psychological morbidity (GHQ12), pain and anxiety during labour (VAS) and performance of coping behaviour during labour (CCB). Physiological labour outcomes in terms of mode of delivery, length of labour, types of analgesia used, Apgar scores of newborn and neonatal admission were also extracted from the participants' medical record. / Ip Wan Yim. / "June 2005." / Source: Dissertation Abstracts International, Volume: 67-07, Section: B, page: 3717. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 159-191). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / School code: 1307.

Thesis (M.S.)--University of Michigan, 1994. / Spine title: CNM and MD outcomes for pain control in labor.

Thesis (M.S.)--University of Michigan, 1994. / Spine title: CNM and MD outcomes for pain control in labor.

Orientador: Jose Guilherme Cecatti / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-12T09:14:57Z (GMT). No. of bitstreams: 1 Guerra_GlauciaVirginiadeQueirozLins_D.pdf: 2929113 bytes, checksum: 54c7b830383d166f725dcf970e08b726 (MD5) Previous issue date: 2008 / Resumo: Objetivo: Avaliar a prevalência da indução médica e eletiva do trabalho de parto, métodos utilizados, índice de sucesso, fatores associados e resultados maternos e perinatais em oito países da América Latina. Método: Foi realizada a análise referente à indução do trabalho de parto no banco de dados da Pesquisa "2005 WHO global survey on maternal and perinatal health", referente a oito países aleatoriamente selecionados da América Latina. Obtiveram-se os dados individuais de todas as mulheres que tiveram seus partos em 120 instituições, no período do estudo. Avaliaram-se as indicações de indução por país, a taxa de sucesso por método, os fatores associados à indução e os resultados maternos e perinatais comparativamente aos partos iniciados espontaneamente (primeira abordagem). Após foi feita uma análise independente da indução eletiva comparada com o início espontâneo do trabalho de parto entre gestações de baixo risco, para avaliar os fatores associados a essa prática e seus resultados maternos e perinatais (segunda abordagem). Foram estimados os odds ratios (OR) para os possíveis fatores associados à indução e as razões de risco (RR) para os resultados maternos e perinatais, com seus respectivos intervalos de confiança (IC95%). Posteriormente, foram aplicados os modelos de regressão logística múltipla para o ajuste dos riscos estimados. Resultados: Do total de 97.095 partos do inquérito, 11.077 (11,4%) foram induzidos. Os hospitais públicos foram responsáveis por 74,2% das induções. A ruptura prematura das membranas (25,3%) e a indução eletiva (28,9%) foram as indicações mais freqüentes. A taxa de sucesso de parto vaginal foi de 70.4%, com 69.9% para a ocitocina e 74.8% para o misoprostol, os principais métodos isoladamente utilizados. O risco de indução do parto foi maior em mulheres com mais de 35 anos, com companheiro, nulíparas, sem cesárea no parto anterior, com rotura de membranas, hipertensão arterial, baixa altura uterina, diabetes, anemia grave, com menor número de consultas de pré-natal, pós-datismo, apresentação cefálica e naquelas que deram a luz em hospitais do seguro social. As complicações maternas mais associadas com a indução do parto foram a necessidade de uterotônicos no período pós-parto, laceração perineal, histerectomia, admissão em unidade de terapia intensiva, permanência hospitalar maior que 7 dias e maior necessidade de procedimentos analgésicos. Já os resultados perinatais desfavoráveis mais freqüentes foram Apgar menor que sete ao quinto minuto, ocorrência de muito baixo peso, admissão em UTI neonatal e início mais tardio da amamentação. Em relação à análise da indução eletiva entre gestantes de baixo risco, não foi encontrada diferença na taxa de cesariana e nos resultados perinatais, porém ocorreu maior necessidade do uso de uterotônico no pós-parto, risco cinco vezes maior de histerectomia pós-parto e maior necessidade de procedimentos de anestesia/analgesia. Conclusão: Na América Latina a taxa global de indução do trabalho de parto foi um pouco maior que 10%, enquanto a de indução eletiva entre gestantes de baixo risco foi de 4,9%. A taxa de sucesso para o parto vaginal foi elevada independentemente do método e da indicação da indução. Há, contudo, alguns riscos maternos e perinatais associados com essa prática, seja ela eletiva ou não / Abstract: Objective: To evaluate the prevalence of both medical and elective labor induction as well as employed methods, success rates, associated factors and maternal and perinatal outcomes in eight Latin American countries. Methods: it was performed an analysis on labor induction in the database of the "2005 WHO global survey on maternal and perinatal health" on deliveries occurring in eight randomly allocated Latin American countries. Data of all women who gave birth to children in the 120 included institutions during the period of the study were collected. The indications for labor induction according to the country, the success rate for each method, the factors associated with labor induction as well as maternal and perinatal outcomes were compared with deliveries with spontaneous onset of labour (Approach 1). A second independent analysis on elective induction compared with spontaneous onset of labor in low-risk pregnancies was performed in order to evaluate factors associated with elective labor induction and also maternal and perinatal outcomes (Approach 2). The odds ratios (OR) for possible factors associated with labor induction and the risk ratios (RR) for maternal and perinatal outcomes, with respective confidence interval (95%CI) for all types of labor induction and for elective induction were estimated. Additionally, multiple logistic regressions were applied to adjust the estimated risks. Results: Among the total 97,095 deliveries included in the survey, 11,077 (11.4%) underwent labor induction. Public hospitals accounted for 74.2% of them. Premature rupture of membranes (25.3%) and elective induction (28.9%) were the most frequent indications. The success rate in obtaining vaginal delivery was 70.4%. Oxitocin and misoprostol - the most employed methods - had success rates of 69.9% and 74.8%, respectively. Labor induction occurred more frequently in women older than 35 years, with a partner, nulipara, without cesarean section in the last pregnancy, ruptured membranes, hypertension, low fundal height, diabetes, severe anemia, vaginal bleeding, few prenatal visits, post term, cephalic presentation and those who gave birth in social security hospitals. The most frequent maternal complications associated with labor induction were need for uterotonic agents in postpartum period, perineal laceration, need for hysterectomy, and admission to intensive care unit, length of hospital stay above seven days and increased need of anesthetic/analgesic procedures. The most frequent adverse perinatal outcomes were low 5-minute Apgar score, very low birth-weight, admission to neonatal intensive care unit and delayed initiation of breastfeeding. Concerning elective induction in low-risk pregnancies there was no difference in cesarean section rate or perinatal outcome. However, there were increased needs for uterotonic agents in the postpartum period and for analgesic/anesthetic procedures, and a further than fivefold risk for postpartum hysterectomy. Conclusions: In Latin America, the overall labor induction rate was slightly more than 10%, while for elective indication among low risk pregnancies it was 4.9%. The vaginal delivery rate was high irrespective of the method or indication. However, there are some maternal and perinatal risks associated with this intervention, in spite of medically or electively indicated. / Doutorado / Tocoginecologia / Doutor em Tocoginecologia

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)

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)