Background and objectives There has been a steady annual increase in the number of deliveries performed at Chris Hani Baragwanath Hospital in recent years. A 2004 audit found that approximately one third of deliveries conducted at the hospital were of women who had referred themselves and were low risk and as such did not require delivery at a specialist centre. A triage down-referral system back to midwife obstetric units was implemented in 2008 to address the problem of low-risk self-referrals at the hospital. This study was conducted after the establishment of the triage system to find out whether the establishment of the triage system had been accompanied by a decrease in the proportion of self-referred women presenting to Chris Hani Baragwanath Hospital in labour, and to assess delivery outcomes in these patients. Literature review The literature review was conducted using Pubmed and MDConsult using the key words self referral, triage, gatekeeper, low-risk pregnancy, maternity / labour and referral systems. Relevant references were accessed via the University of the Witwatersrand eJournal portal. Appropriate articles cited by other authors were also reviewed. Appropriate websites were also used and referenced. Methods This was a retrospective descriptive study which included all women presenting in labour to the hospital maternity admissions area. The study population was clinical case-files of all births that were admitted in labour from 1 May to 31 May 2010. A simple random sample of these files was drawn. Results One hundred and eighty two intra-partum admissions were sampled. Thirty-five (19%) of these women were self-referred. Seven out of the 35 (20%) required caesarean sections. Five more (14%) needed oxytocin augmentation of labour, and one more (3%) had a vacuum delivery. Twenty women (57%) did not develop any complications during labour and could have been delivered at their midwife obstetrics units. During the month of the study, the triage down-referral system attended to 171 women and down-referred 83 (49%). Conclusion The establishment of a triage down- referral system has been accompanied by a curtailment in the number of low-risk pregnancies presenting self-referred at the referral hospital labour ward, compared with the audit in 2004.

京都大学 / 新制・課程博士 / 博士(社会健康医学) / 甲第23384号 / 社医博第117号 / 新制||社医||11(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 佐藤 俊哉, 教授 滝田 順子, 教授 万代 昌紀 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

Background: In Oman, 33.3% of women attended late for publicly funded antenatal care in 2015 and 24% did not attend for the recommended 4-6 visits during their pregnancy. This low attendance suggests a need to explore attendance for antenatal care for low-risk pregnant women in Oman. Methodology: An exploratory qualitative design informed by constructivist grounded theory methodology was used in this research. Methods: In-depth semi-structured interviews were conducted with an initial purposive sample of nine pregnant women. The initial analysis enabled theoretical sampling of thirteen non-participant observations during women's appointments, interviews with ten care providers, and six women who booked late after 12 weeks of gestation. A constructivist grounded theory analytical framework of initial, focused and theoretical coding was followed to analyse all the data collected. Findings: The core category consists of five interrelated sub-categories: perceived benefits and value of antenatal care; timing of the first antenatal visit; woman-carer interactions during antenatal care; experiences with antenatal care delivery; and supplementary use of private healthcare. The integral categories explain the social processes and issues surrounding antenatal care. The emergent core category, Navigating antenatal care, reflects the views of the women and their care providers. The women were unhappy with the organisation and physical environment of care but attended their appointments to ensure optimal pregnancy outcome and to alleviate their fears of developing complications. Thus, they used both private and public healthcare and sourced online information in response to their feelings of obligation to protect their fetus. Conclusion: The women appeared disempowered and to lack control over the care they received. Thus, they accepted conditions such as long waiting times in an uncomfortable environment and the disrespect they encountered during their visits. There was a discrepancy between what the women expected and needed from their antenatal care and the actual care and information they received, which did not satisfy their needs. This could be due to a lack of woman-centred care and limited involvement in the plan of care. Thus, women sought further reassurance by accessing private clinics, using online information, and networking with others, which also resulted in a late booking for public antenatal care.

This descriptive quantitative survey attempted to identify reasons why pregnant women who have been screened as low-risk pregnancies failed to utilise MOUs for the delivery of their babies. The objective of the study was to investigate the factors determining the under-utilisation of Sharpville MOU in Emfuleni sub-district. The research population comprised all postnatal mothers residing in Sharpeville who delivered their babies at hospital and who were screened as low-risk pregnancies; the accessible convenience sample consisted of all postnatal mothers who attended Sharpeville Clinic for their six weeks follow-up postnatal care from 5 December 2005 till 6 January 2006 and who were willing to complete questionnaires. Data was collected by means of a structured questionnaire and analysed using the SPSS computer program. Major factors drawn from the study that influence their decision on place of delivery were nurses' attitudes, lack of doctors, transport, privacy and resources. / Health Studies / M.A. (Health Studies)

This descriptive quantitative survey attempted to identify reasons why pregnant women who have been screened as low-risk pregnancies failed to utilise MOUs for the delivery of their babies. The objective of the study was to investigate the factors determining the under-utilisation of Sharpville MOU in Emfuleni sub-district. The research population comprised all postnatal mothers residing in Sharpeville who delivered their babies at hospital and who were screened as low-risk pregnancies; the accessible convenience sample consisted of all postnatal mothers who attended Sharpeville Clinic for their six weeks follow-up postnatal care from 5 December 2005 till 6 January 2006 and who were willing to complete questionnaires. Data was collected by means of a structured questionnaire and analysed using the SPSS computer program. Major factors drawn from the study that influence their decision on place of delivery were nurses' attitudes, lack of doctors, transport, privacy and resources. / Health Studies / M.A. (Health Studies)