The practice of midwifery by those other than physicians is illegal in Canada and despite recommendations of nursing, medical and consumer groups, no trials evaluating the effectiveness of the nurse-midwife as a member of the modern obstetrical team have occurred here. To demonstrate a nurse-midwifery model, four nurse-midwives provided primary care to forty-seven childbearing women and their families over a twenty-two month period in a maternity teaching hospital. This clinic presented a unique opportunity for comparing the prenatal care provided by nurse-midwives with that of general practitioners who attended deliveries in the same setting. Utilizing a retrospective chart audit, case control study design, the nurse-midwife cases (NM cases) were each matched to two general practitioner controls (GP controls) through the use of the hospital's prenatal data base. The matching characteristics included low risk status, date of delivery, age, parity, gravidity, previous pregnancy losses and census tract income. Prenatal criteria that had been developed and tested in "The Burlington Randomized Clinical Trial of the Nurse Practitioner" for assessing the quality of care were reviewed and updated for this study. With these criteria two blinded abstractors audited the prenatal record forms of all the subjects and scored them as either "superior", "adequate" or "inadequate". Seventy-seven percent of the records of the NM cases received a "superior" score, where as 60% of the GP controls' records received an "inadequate" score [mathematical formula omitted] Overall, the general practitioners' records indicated more erratic care than those of the nurse-midwives. Although the physicians met most of the initial assessment criteria, they failed to meet the criteria that evaluated the ongoing routine assessment process by recording an inadequate number of prenatal visits (36%), or by omitting urine test results (38$) and blood pressure readings (21%). No differences were found in variables relating to labour and delivery with the exception of the incidence of episiotomies. The results indicate that nurse-midwives as part of an obstetrical team are able to provide safe prenatal care to a low risk population in a Canadian urban context, and that their records are thorough and more consistent than those of general practitioners. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Midwifery practice in Canada is anomalous in that, unlike other industrialized nations, a distinct legal status for nurse-midwives and community midwifery has yet to be established. Despite this constraint, community midwifery has survived the lack of institutional support for home births and legal prohibitions directed against it the manner of State regulation of midwives is a central issue in this study. It is shown that the State shapes the possibilities of midwifery in a contradictory manner, promoting midwifery on the one hand, and prosecuting and restricting midwifery practice on the other. A modified structuralist perspective on the State is developed with respect to midwifery. The Canadian State serves to limit possibilities for midwifery through various provincial enactments in quasi-criminal law, through the greater likelihood of criminal prosecution of midwives than physicians or nurses, and through funding of the established professions and hospitals. This thesis then, offers a critical examination of the anomalous occupational and legal status of Canadian midwives, using historical materials on the development of midwifery practice and cross-cultural data on the role of midwives in traditional cultures. It is argued that many of the reservations about community (lay) midwives are no longer applicable, and that the containment of nurse-midwives reflects an historical accommodation between the nursing and medical professions in Canada. This accommodation meets the need for highly-skilled obstetrical nurses or nurse-midwives within the tradition of physician dominance in health care. A major empirical focus of the study is a documentary analysis of birth records from community midwives, primarily in British Columbia and Ontario, between 1972 and 1986. Analysis of the data confirms that qualified community midwives, working under normal circumstances, manage births safely and with a minimum of interventions during labour and delivery, and during the prenatal and postpartum periods. Where comparisons with provincial and national populations are available, women attempting home birth under the care of a community midwife tend to have lower rates of forceps delivery, caesarean section, and episiotomy. These women are also likely to deliver their babies in positions other than the standard lithotomy position or prone position, and to have a lower incidence of perineal tears. Nevertheless, difficulties associated with the unregulated and often idiosyncratic situation of community midwives are underscored, particularly with regard to establishing guidelines for domiciliary midwifery. Data from the Low-Risk Clinic at Vancouver's Grace Hospital, together with reports on other nurse-midwifery programmmes, reinforce the claim that nurse-midwives can practice autonomously in providing prenatal care, assistance in labour and delivery, and postnatal care. The likelihood of realizing autonomous midwifery practice depends upon the particular agendas of the State, the structural interests of the professions, and the initiatives of midwives and health consumers who lobby for certification of safe alternatives in maternal and infant care. / Arts, Faculty of / Anthropology, Department of / Graduate

Background Pain during birth process is acknowledged for good progress of labour but severe, unbearable pain cause reduced effectiveness of contractions and lead to maternal exhaustion and fetal distress. Non pharmacological and pharmacological pain relief methods can be implemented to assist the women to cope with pain during labour. Non-pharmacological and pharmacological pain relief is available in the hospital, but it is not understood when and how labour pain is assessed and pain relief implemented. Research questions What is the current workplace culture relating to pain management during the first stage of labour? What alternative strategies can be implemented to address the current workplace culture relating to pain management during the first stage of labour? Research design and methods A qualitative design was followed. Convenience sampling was used and 18 observations on pain management during labour were done. Midwives taking care of women during labour took part in the research and their informed consent was obtained beforehand. Data was collected during unstructured observations of pain management during labour. Data was analysed by means of the creative hermeneutic data analysis method. Main findings Four themes were derived from the data: pain assessment, isolation, therapeutic environment and documentation. Based on these themes, strategies for improving pain management during labour were identified collaboratively. / Dissertation (MCur)--University of Pretoria, 2017. / Nursing Science / PhD / Unrestricted

MCur / Department of Advanced Nursing Science / Introduction: During the provision of care to preterm babies, midwives encounter many problems and challenges which may vary according to the gestational age of the women, condition of the foetus, availability of equipment and resources, and experience of the midwives. In addition, poor working conditions, feelings of insecurity, staff shortage, and lack of support from the management and having to deal with parents who do not comply with the hospital management plan for their babies; all contribute to the problems faced by midwives. The purpose of this study was to determine challenges encountered by midwives when providing care to preterm neonates at selected hospitals in the Mopani District of Limpopo Province, South Africa. Methods: Qualitative research in this study was conducted in a natural setting at the selected hospitals. The target population was the midwives who have been working in maternity wards for at least two years and were on duty during the period of data collection. Non-random purposive sampling was used to select the participants. Data were collected using unstructured interviews, which were tape recorded and transcribed. The six steps as described by Creswell were used for data analysis. Trustworthiness was ensured by using the model of Lincoln & Guba that included credibility, dependability, confirmability and transferability. Ethical principles, namely, permission to conduct the study, informed consent from participants, privacy, confidentiality, autonomy, anonymity and respect were observed. Results: When midwives provide care to preterm babies they often encounter multiple challenges which can be human or material resource related. In his study, midwives were found to perform their duties in the face of multiple challenges, including staff vi shortages, which resulted in exhaustion of the available midwives. Nursing a preterm baby is a challenge on its own as these babies are likely to develop clinical problems related to immaturity, e.g., hypoglycaemia, hypothermia, jaundice, sepsis and respiratory distress. Mothers may be traumatised and find it difficult to accept their babies as they are, this leads to lack of cooperation in the care of the neonate and it becomes a problem for the midwives who are directly providing such care. The aforementioned challenges are related to all the four major concepts of human caring as described by Jean Watson which are health, human being, nursing and environment. Recommendations: It is recommended that further research be conducted on the same topic, but in a different setting to generate more knowledge. Policy makers should work together with health care professionals who are directly involved in the care of preterm babies to improve the practice of the contents in the policies. / NRF

Over the past twelve years, Philadelphia has undergone an unparalleled large scale shift in the way maternity care is provided, accessed, and considered. Key aspects of the changes to the landscape of birth in Philadelphia include: the closure of the majority of hospital-based maternity units, the activities of local women's health non-governmental organizations (NGOs), and the new set of pregnancy care and birth choices that parents navigate. One of the most striking results of the restructuring of Philadelphia's maternity care system is a drastic reduction in the number of hospitals with maternity units. While the birth rate in Philadelphia has remained consistent around 22,000 per year, since 1997 two-thirds of the hospitals in Philadelphia have eliminated their maternity services. During this time, numerous local women's health-oriented NGOs worked to established themselves in Philadelphia. The aim of each NGO has been to respond to inadequacies in the provision of maternity services that develop as hospitals, the dominant resource for maternity care, withdraw from the maternity care business. With only six hospital maternity units remaining and a couple of local nonprofit organizations attempting to supplement the dearth of services, the current system within which parents and health care providers maneuver is both unstable and inadequate for meeting the maternity care needs of the community. In this research project, I explore the processes through which this new maternity care system is being established in Philadelphia with a particular focus on the influence of neoliberalism as an active force in the restructuring process. I examine the outcomes of this restructured system in terms of how lived experiences are influenced by the social, political, and economic reconfiguration of birth. The case of Philadelphia is of particular value as the City's maternity care system has undergone an accelerated restructuring that is unmatched in other areas of the US. While a similar trend in restructuring can now be found in other locations, these changes happened earlier and have continued in a more extreme manner in Philadelphia, marking Philadelphia as a possible canary in a coal mine. Understanding the outcomes of this large scale change in the system of care provides a basis for contending with similar trends elsewhere. My ethnographic work focuses on the experiences of particular individuals as they navigate Philadelphia's new system of maternity care. Within this restructured system of maternity care, the interests of parents and health care practitioners are increasingly devalued or disregarded, particularly for those whose philosophy of birth differs from dominant biomedical maternity care practices. Midwives, whose non-interventionalist methods of care starkly contrast with the biomedical model of care, and parents who wish to have a low-intervention or natural childbirth struggle to achieve their goals within the confines of Philadelphia's maternity care system. Similarly, individuals running local NGOs strain to intervene in the process of restructuring, and often face the dilemma of remaining true to their mission on one hand or preserving financial security by meeting the imperatives of funders on the other hand. Therefore, I have made the stories of midwives and parents seeking alternatives to biomedical care central to my analysis in addition to conducting in-depth fieldwork with three local women's health-oriented NGOs. This project adds to our understanding of how broad political and economic trends in health care translate into select cultural formations which inform the life choices of individuals. In times such as now, when national policy regarding the provision of health care is under scrutiny, it is essential to connect the dots between the circumstances of individuals and the structure of systems of health care. This research project fuses analyses of civil society institutions, the politics of reproduction, national ideology, and local political and economic agenda to present a complex and inclusive assessment of the landscape of birth in the uniquely positioned city of Philadelphia. / Anthropology

No description available.

Thesis (MPH.) -- University of Limpopo, 2014 / Legalising Termination of Pregnancy (TOP) in South Africa has given women the choice to decide to terminate an unwanted pregnancy. The implementation of the Choice on Termination of Pregnancy (CTOP) Act No. 92 of 1996 which was promulgated in 1997 engendered many challenges for the registered midwives performing TOP. A qualitative phenomenological study was conducted to explore and describe the experiences of registered midwives performing TOP at Polokwane / Mankweng Hospital Complex, which is one of the public hospitals in Limpopo Province. Registered midwives with 12 months or more experience in the TOP clinics participated in this study. Interviews were conducted with the participants. The audiotaped interviews and observational notes were transcribed and coded using Tesch’s qualitative and systematic approach of analysing textual data. The major themes that emerged from the data analysis include lack of resources, emotional and psychological trauma, lack of support, religious and cultural beliefs, blaming and coping mechanisms. Several sub-themes were identified that reflected the themes in greater detail. These were shortage of human and material resources, stress and frustration of midwives, rejection and labelling of midwives performing TOP, conscientious objection, cultural beliefs, lack of support by colleagues and management, failure by the community to use contraceptives, self-blaming, debriefing to assist registered midwives and self-acceptance. Guidelines based on contextualisation of these themes and sub-themes to improve identified challenges included retention of personnel through recognition and incentives, increase budgeting for essential equipment, planned debriefing sessions, promotion of positive attitudes by colleagues and intense training on reproductive health, including TOP.

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

Thesis (M.S.)--University of Michigan, 1993.

Thesis (M.S.)--University of Michigan, 1993.