A deductive, descriptive, quanitative study was undertaken at Nyangabgwe Hospital, Francistown, Botswana, situated in the north east of the country. Its focus was on the use of partogram by midwives. The population consisted of 395 obstetric records for the period of one month. A sample of 303 obstetrics records was drawn. Data were collected through auditing the bed letters of delivered mothers and interviews with and observation of midwives using the partogram in practice. The Statistical Package for Social Sciences (SPSS) program was used to analyse the data. The findings indicate that there are problems regarding, and factors that can have a negative influence on the use of the partogram by midwives. It is suggested that a supportive teaching programme for the midwives should be designed, that will support the system of supervision in the labour ward that already exists, in the use of the partogram throughout the labour process. / Health Studies / M.A. (Advanced Nursing Sciences)

A deductive, descriptive, quanitative study was undertaken at Nyangabgwe Hospital, Francistown, Botswana, situated in the north east of the country. Its focus was on the use of partogram by midwives. The population consisted of 395 obstetric records for the period of one month. A sample of 303 obstetrics records was drawn. Data were collected through auditing the bed letters of delivered mothers and interviews with and observation of midwives using the partogram in practice. The Statistical Package for Social Sciences (SPSS) program was used to analyse the data. The findings indicate that there are problems regarding, and factors that can have a negative influence on the use of the partogram by midwives. It is suggested that a supportive teaching programme for the midwives should be designed, that will support the system of supervision in the labour ward that already exists, in the use of the partogram throughout the labour process. / Health Studies / M.A. (Advanced Nursing Sciences)

This qualitative study was aimed at exploring midwives’ responses and attitudes towards women in labour, as well as their perception of the pain experienced during labour. A non-probability purposive sampling method was followed, and the data collection methods selected were in-depth individual interviews and focus-group interviews, with the aid of an interview guide for both methods, the researcher being the main data collecting instrument. More than one data collection method (triangulation) was used to ensure the trustworthiness of the study. Concerning the perception of midwives towards women experiencing labour pain, the study revealed that firstly, labour pain is unique to individual women, it is natural and bearable. Secondly, labour pain may be unbearable, and the women in labour need to be given medication for pain. Furthermore, certain behaviour was identified and viewed as unacceptable by participating midwives because it could put both the lives of the mother and the unborn baby at risk; these include: drinking herbal medicines during pregnancy and childbirth; extreme activities like jumping out of bed and rolling on the floor. These behaviours were sources of frustration to midwives. / Health Studies / M.A. (Health Studies)

Thesis (MCur)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: Background: Misoprostol, a prostaglandin E1 analogue with its uterotonic properties has entered as an integral part of management of the third stage of labour, helping to prevent postpartum haemorrhage (PPH). Objective: To assess evidence on the effectiveness of misoprostol compared to a placebo for the prevention and treatment of postpartum haemorrhage. Methods: Databases searched included; MEDLINE, Google Scholar and Cochrane Central Register of Controlled Trials (CENTRAL). Other sources were also searched. All articles were screened for methodological quality by two reviewers independently by standardized instrument. Data was entered in Review Manger 5.1 software for analysis. Results: Three Misoprostol studies were included (2346 participants), Oral (2 trials) and sublingual (1 trial). Misoprostol has shown not to be effective in reducing PPH (RR 0.65: 95% CI 0.40-1.06). Only one trial reported on need for blood transfusion (RR 0.14; 95% CI 0.02-1.15). Misoprostol use is associated with significant increases in shivering (RR 2.75; 95% CI 2.26-3.34) and pyrexia (RR 5.34; 95% CI 2.86-9.96) than with placebo. No maternal deaths were reported in included trials. Compared to placebo, misoprostol was coupled with less hysterectomies and additional used of uterotonics (RR 0.45; 95%CI 0.21-0.96) compared to placebo. Conclusion: Results of this review shows that the use of misoprostol in combination with some components of active management was not associated with any significant reduction in incidence of PPH. However oral administration showed a significant reduction in incidence of PPH. For its use for treatment of postpartum haemorrhage, there is a need for research focus in optimal dose and route of administration for a clinically significant effect and acceptable side effects. / AFRIKAANSE OPSOMMING: Agtergrond: Misoprostol, 'n prostaglandien E1 analoog met sy uterotonic eienskappe het ingeskryf as' n integrale deel van die bestuur van die derde stadium van kraam, help postpartum bloeding (PPH) te voorkom. Doelwit: Om bewyse oor die effektiwiteit van Misoprostol in vergelyking met 'n placebo vir die voorkoming en behandeling van postpartum bloeding te evalueer. Metodes: Databases gesoek ingesluit, Medline, CINHAL, Google Scholar en Cochrane Sentrale Register van gecontroleerde studies (Sentraal). Ander bronne is ook deursoek. Alle artikels is gekeur vir die metodologiese kwaliteit deur twee beoordelaars onafhanklik deur die gestandaardiseerde instrument. Data is opgeneem in Review Manger 5.1 sagteware vir ontleding. Hoof Resultate: Drie Misoprostol studies were ingesluit (2346 deelnemers). Mondeling (2 proe) en sublinguale (1 verhoor). Misoprostol het getoon nie doeltreffend te wees in die vermindering van PPH (RR 0,65: 95% CI 0,40-1,06). Slegs een verhoor berig oor die noodsaaklikheid vir 'n bloedoortapping (RR 0,14, 95% CI 0,02-1,15). Misoprostol gebruik word geassosieer met 'n aansienlike toename in bewing (RR 2,75, 95% CI 2,26- 3,34) en koors (RR 5,34, 95% CI 2,86-9,96) as met' n placebo. Geen moederlike sterftes is aangemeld in proewe. In vergelyking met placebo, was Misoprostol tesame met minder hysterectomies en addisionele gebruik van uterotonics (RR 0,45, 95% CI,21-,96) in vergelyking met placebo. Gevolgtrekking: Resultate van hierdie studie toon dat die gebruik van Misoprostol in kombinasie met 'n paar komponente van aktiewe bestuur is wat nie verband hou met' n beduidende afname in die voorkoms van PPH. Vir die gebruik vir die behandeling van postpartum bloeding, daar is 'n behoefte vir navorsing fokus in die optimale dosis en die roete van administrasie vir' n klinies beduidende uitwerking en aanvaarbare neweeffekte.

Thesis (MCur)--Stellenbosch University, 2003 / ENGLISH ABSTRACT: It appears that registered midwives prefer not to cut episiotomies which results in an increase in perineal tears. This may be the case as a result of current controversies regarding episiotomies, lack of suturing skills due to insufficient training and evaluation, or the fact that the necessity of an episiotomy are not recognised timeously. In light of this the incidence of perineal trauma during deliveries in public healthcare institutions in the Western Cape was evaluated from a nursing perspective. The midwife can playa significant role in the prevention of unnecessary perineal trauma by applying particular precautions in practice. Triangulation was used as the research method. Seven public healthcare institutions in the Western Cape were included in this study. Nurses completed 45 questionnaires while 33 deliveries and 25 cases of suturing of perineal wounds were evaluated according to a pre-compiled checklist. Semi-structured interviews were conducted with registered midwives and medical practitioners involved in the training of nursing students. According to findings it appears that nurses do not recognise the risk factors to be contributory causes of perineal tears. Furthermore, it appeared that 46% of registered midwives did not feel competent enough to suture perineal wounds. Disparities were identified pertaining to the training of student nurses as well as the continuous training and evaluation of registered midwives regarding the suturing of perineal wounds. It is recommended that a uniform policy should be formulated concerning guidelines for the cut and suturing of episiotomies and lacerations. Furthermore, a uniform classification system regarding perineal trauma should be formulated as well as a uniform system to evaluate the competency of midwives. / AFRIKAANSE OPSOMMING: Dit blyk dat geregistreerde vroedvroue nie graag 'n episiotomie knip nie, met 'n gevolglike toename in perineale skeure. Dit is moontlik as gevolg van die huidige kontroversie betreffende episiotomies, óf hegtingsvaardighede wat nie voldoende is nie te wyte aan gebrekkige opleiding en evaluering, óf die noodsaaklikheid van 'n episiotomie word nie betyds ingesien nie. In die lig hiervan is die voorkoms van perineale trauma tydens verlossings in openbare gesondheidsinstellings in die Wes- Kaap vanuit 'n verpleegkundige perspektief geëvalueer. Die vroedvrou kan 'n beduidende rol speel in die voorkoming van onnodige perineale trauma deur die toepassing van sekere maatreëls in haar praktykvoering. Triangulasie is as navorsingsmetode gebruik. Sewe openbare gesondheidsinstellings in die Wes-Kaap is in hierdie studie ingesluit. Vyf-en-veertig vraelyste is deur verpleegkundiges voltooi terwyl 33 bevallings en 25 hegtings van perineale wonde volgens 'n voorafopgestelde kontrolelys geëvalueer is. Semi-gestruktureerde onderhoude is gevoer met geregistreerde vroedvroue en geneeshere wat by die opleiding van verpleegstudente betrokke is. Volgens die bevindings blyk dit dat verpleegkundiges nie die risikofaktore as aanleidende oorsake van perineale skeure herken nie. Hulle verkies ook om nie episiotomies te knip nie en sal eerder 'n perineale skeur heg. Dit het verder geblyk dat 46% van die geregistreerde vroedvroue nie bevoeg gevoel het om perineale wonde te heg nie. Leemtes is geïdentifiseer ten opsigte van die opleiding van studentverpleegkundiges asook voortgesette opleiding en evaluering van geregistreerde vroedvroue ten opsigte van hegtingstegnieke. Aanbevelings sluit in dat 'n eenvormige beleid geformuleer moet word ten opsigte van die riglyne vir die knip en hegtings van episiotomies en skeure, 'n eenvorminge klassifikasiesisteem van perineale trauma asook 'n stelsel van evaluering van geregistreerde vroedvroue se bevoegdheid.

The purpose of this research was to test the predicted relationships among a component of nurse-midwifery care, psychosocial health outcomes and other maternal psychosocial variables. The theoretical framework for the research was the Intrapartum Care Level of the Nurse-Midwifery Practice Model, a middle range theory. Previous nurse-midwifery research had been based on theories and models not specific to nurse-midwifery practice. A nonexperimental, correlational design was used, with measures in the last trimester of pregnancy and the first month following birth. The psychosocial variables measured were prenatal care satisfaction, personable environment, positive presence, labor support, transcendence, labor satisfaction and enhanced self-concept. Purposive sampling was used at a birth center in a Southwestern city where women received nurse-midwifery care for pregnancy, labor and birth. The sample of 89 women consisted of 35 primiparas and 54 multiparas, with a mean age of 29 years; 46.1% gave birth at the birth center and 53.9% gave birth at a local hospital. The primary instruments for the research included the Prenatal Satisfaction Questionnaire, the Attitude Toward Issues in Choice of Childbirth Scale, the Positive Presence Index, the Labor and Birth Support Inventory, the Coping in Labor and Delivery Scale, the Labor and Delivery Satisfaction Questionnaire, and the Self-Confidence Scale of the Adjective Check List. The secondary instruments, used for the evaluation of construct validity, included the Positive Presence Index - Alternate Format, the Labor and Birth Coping Index, the Labor and Birth Satisfaction Index, and the Self-Concept Index - Alternate Format. Acceptable levels of reliability and validity were obtained for the instruments. The predicted relationships from the Model were tested with causal analysis using multiple regression and residual analysis. The empirical rather than the theoretical model was supported by the data. Prenatal care satisfaction, personable environment, positive presence and transcendence explained 66% of the variance in labor satisfaction, with an additional 2% explained variance with the addition of the situational variable of consultation. Positive presence had the greatest direct effect (B =.70) and also explained 5% of the variance in enhanced self-concept. The empirically significant relationships were clinically relevant.

The purpose of this study is to describe characteristics of childbirth pain communicative behaviors among laboring Thai women, determine mode of pain communication, and determine relationships among behaviors and parturients, age, parity, education, and occupation. This study employed an exploratory description design. Direct structural observation was used to collect data. The study was conducted at a general hospital in Bangkok, Thailand, with 32 subjects participating. The "Observation Checklist of Laboring Women's Behavior" was used to record the subjects' behaviors. Descriptive statistics, the t test, and Pearson product moment correlation were used to analyze data. Data analysis indicated that the subjects of this study communicated pain via nonverbal channels and in a quiet manner. The range of nonverbal behaviors ranked from the greatest to the least frequent occurrences and included tactual, facial, lips, body movements, eyes, and respiratory behaviors. The range of verbal reports ranked from the greatest to the lowest frequencies and included reports of sensation, self evaluation of tolerance of pain, asking for information, requesting help and comfort, and asking for permission. Reports of pain were the most predominant of all the verbal reports. There were no statistically significant differences between behaviors and age, parity, education, and occupation. Pain behaviors were more prevalent among primiparae. Subjects who were younger or had fewer years of education ask for more information relating to the childbirth process compared with their counterparts. The younger subjects tended to communicate their pain via verbal mode; the older subjects tended to communicate their pain through nonverbal channels. Information derived from this study contributed to clinical practice, research, and theoretical knowledge of nursing. The information will help nurses understand about pain communication among the Thai women. Findings also will serve as empirical data for future investigations and can be used as a basis for childbirth pain assessment. The findings of this study are not generalizable because subjects were not randomly selected and the sample size was small. Recommendations for future study include the use of larger sample sizes, refinement of the checklist, and the use of multiple methods to collect the data.

Thesis (M.Sc.)--University of the Witwatersrand, Faculty of Science,1976.

External cephalic version (ECV) involves turning a fetus in utero by manipulation through the maternal abdomen and the uterine wall. / Many clinicians and patients, however, still decline ECV in favour of Caesarean section. This could be due to the lack of experience of ECV, and fear of complications or pain during the version. / Summary. The force applied during ECV can be measured and analysed using a customized pair of gloves incorporating piezo-resistive pressure sensors and suitable analytical software. The degree of force required for a successful version is highly variable. Failure of version is not usually due to insufficient force. Uterine tone is the most important factor affecting the degree of force applied during a version attempt. The degree of force applied is associated with the changes in fetal cerebral blood flow after ECV, and the amount of pain perceived by the patients. (Abstract shortened by UMI.) / The lack of information in this area is primarily due to the lack of a suitable device that would allow measurements of the force applied without interfering with the ECV. A suitable device would therefore have to be sufficiently robust so that it could be worn on the hands, durable so that it could be used repeatedly, incorporate multiple individual sensors, each of which is capable of making dynamic and mutually independent measurements during the version procedure. / There is no report in the literature on quantification of the force applied during ECV. It is also unknown whether the degree of force applied is related to the version outcome. In particular, it is unclear whether a failed attempt is related to insufficient force, or whether an increase in force may help to achieve version after a failure. Furthermore, it is also not known if any patients' factors may influence how much force is applied through the operator's hands. Although the chance of successful version could be predicted by some clinical factors, whether these factors may also affect the degree of applied force is not known. / This thesis reports on the design and development of a suitable measuring device fulfilling the requirements described above. In addition, it will test a number of hypotheses relating to the degree of force applied during ECV and clinical feto-maternal parameters and outcomes, in a study cohort of 92 patients. / Leung Tak Yeung. / "April 2005." / Source: Dissertation Abstracts International, Volume: 67-07, Section: B, page: 3717. / Thesis (M.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 155-174). / 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.

Existing patient medical records are a rich data source with a potential to support clinical research. Fragmentation of data across disparate medical database inhibits the use of these existing datasets. Overcoming such disjointedness is possible through the use of a data warehouse. Once the data is cleansed, transformed, and stored within the data warehouse it is possible to turn attention to the exploration of the medical datasets. Exploratory and confirmatory Data Mining Tools are well suited to such activities. This thesis concerned with: demonstrating parallels between scientific method and CRISP-DM; extending CRISP-DM for use with medical datasets; and proposal of the supporting Intelligent Decision Support System framework. This research has been undertaken using a fetal-maternal case study. / Master of Science (Hons)