Orientador: Antonieta Keiko Kakuda Shimo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-04T02:46:32Z (GMT). No. of bitstreams: 1 Santos_JaquelinedeOliveira_M.pdf: 12269134 bytes, checksum: f19f3baf04e8c61bc1009150e724b037 (MD5) Previous issue date: 2004 / Resumo: A episiotomia realizada há séculos constitui-se no procedimento operatório mais comum na obstetrícia moderna e um dos mais comuns na medicina em geral, apesar da ausência de evidências científicas que comprovem seus reais beneficio~. Foi realizado um estudo exploratório em um Hospital Escola, localizado no interior de Minas Gerais, com a fmalidade de compreender o significado da episiotomia para as mulheres que foram submetidas à intervenção durante o parto vaginal, identificar se elas percebem a episiotomia como urna intervenção inerente ao parto vaginal e, verificar se elas recebem alguma orientação em relação ao procedimento durante o processo de parturição. Os dados foram colhidos através do diário de campo, da observação participante e de entrevistas semi-estruturadas a puérperas que foram submetidas ao procedimento. Como instrumento de auxílio para as entrevistas foi utilizado um gravador, as informações assim obtidas foram transcritas fielmente.A análise de conteúdo temático foi a estratégia escolhida para analisar os dados obtidos que foram fundamentadas nos referenciais teóricos de gênero e poder. A partir da análise das informações emergiram três núcleos de sentido: A - Episiotomia: intervenção necessária e benéfica; B - Dor da episiotomia: um sofrimento necessário? CRelações de poder. Concluímos que apesar da episiotomia ser considerada uma intervenção dolorosa pela população estudada, ela é aceita como inerente ao parto vaginal. As parturientes durante seu período de internação foram pouco informadas sobre a intervenção, assim como não foi solicitado seu consentimento para a realização do procedimento. Essa informação serve de alerta para a maioria das instituições de saúde que prestam assistência ao parto e nascimento para que as mulheres tenham garantido seus direitos à informação e autonomia em seu próprio processo de parturição, tornando-a protagonista da fisiologia do nascimento / Abstract: The carried through episiotomy has centuries consists in general in the more common surgical procedure in moderri obstetrics and one ofmost common in the medicine, despite the absence of scientific evidences that prove its real benefits. A study in a Hospital School, located in the interior of Minas Gerais was carried through, with the purpose to understand the meaning of the episiotomy for the women who had been submitted to the intervention during the vaginal childbirth, to identify if they perceive the episiotomy as an inherent intervention to vaginal childbirth e, to verify if they receive some orientation in relation to the procedure during the process ITomchildbirth. The data OOdbeen harvested through the daily one of field, the participant comment and half-structuralized interviews women tOOtthey had been submitted to the procedure. As instrument of aid for the interviews a recorder was used, the thus gotten information OOdbeen transcribing faithful. The analysis ofthematic content was the chosen strategy to analyze the gotten data that OOd been based on the theoretical reference of sort and power. From the analysis of the information three nuclei of sensible OOdemerged: A - Episiotomy: necessary and beneficial intervention; B - Pain ofthe episiotomy: a necessary suffering? C -Relations ofbeing able. We conclude tOOtdespite the episiotomy being considered a painful intervention for the studied population, it is accepted as inherent to the vaginal childbirth. The women in labor during its period of intemment little OOdbeen informed on the intervention, as well as were not requested its assent for the accomplishment ofthe procedure. This information serves of alert for the majority of the health institutions tOOtgive to assistance to the childbirth and birth so that the women have guaranteed its rights to the information and autonomy in its proper process ofbirth, becoming it protagonist ofthe physiology ofthe birth. KEY WORDS: Episiotomy, rights ofthe woman, assistance to the birth / Mestrado / Enfermagem e Trabalho / Mestre em Enfermagem

An infant stimulation program developed for mothers from low income areas with children under the age of three years is described. The program was developed for use in a public health setting and involved close collaboration with personnel from a number of community service agencies. The program, which had a duration of eight weeks, involved a combination of group meetings and home visits. Outcome was assessed in terms of developmental quotients and estimates of the quality of the home environment. Three additional programs consisted of a waiting list control and programs in which each of the two intervention components, home visits and group meetings, were offered separately. Assessments were carried out prior to the programs, immediately following them and four months later. Pre-assessments established the equivalence of the four groups on both the dependent measures and socioeconomic indices, although the groups were found to differ on the measure of maternal intelligence obtained. Following intervention, the scores obtained on both dependent measures for the home visits plus group meetings program were found to be significantly greater than those obtained by the waiting list control clients. The effect of the home visits only program was indeterminate as the scores did not differ significantly from either the control group or the home visits plus group meetings program. Clients in the group meetings only program did not differ significantly from control group clients on either measure. Similar results were obtained at follow up assessments, with no evidence of any decline in scores following the end of intervention. Whereas the correlations observed between maternal intelligence and children's developmental quotients remained much the same over the three assessment periods, the correlations between the home environments and the children's developmental quotients increased, both concurrently and predictively, following intervention. These findings were interpreted as providing support for the hypothesis that the changes in the home environments resulting from the programs were indeed important ones in terms of the children's development. There was some evidence to suggest that the socioeconomic indices of age, education and income of mother were positively related to outcome, while, in addition, maternal intelligence was related to the maintenance of treatment effect at follow up. The correlation of socioeconomic status with outcome was consistent with the results of other infant stimulation programs but was not considered to reflect on the effectiveness of the program as all of the clients in the study were of low socioeconomic status. The implications of these results are discussed both in terms of the further development and implementation of the program described and in the context of research in the area of infant stimulation. / Arts, Faculty of / Psychology, Department of / Graduate

This thesis examines Irish and Jewish mothers' experience of maternity provision and infant care services in East London in the years 1870-1939. As newcomers these immigrants not only had to cope with poverty but also the barriers of language and different cultural customs. Leaving their family and kinship networks behind them, Irish and Jewish mothers had to find new sources of support when incapacitated through pregnancy or childbirth. Living in one of the poorest areas of London and unfamiliar with the local medical and welfare services, these immigrants might be expected to have suffered very poor health. On closer examination, however, Irish and Jewish immigrants appear to have had remarkably low rates of infant and maternal mortality. Despite the difficulties they faced as newcomers, Irish and Jewish mothers had certain advantages over the local population in East London. They were not only able to rely on the prolific and diverse services already present in East London, but could also call upon their own communal organisations. This provision offered a wide range of care and was a vital support to the newcomers. After examining the social and economic background to Irish and Jewish emigration and settlement the thesis examines what impact this had on their health patterns, particularly infant and maternal mortality. The following chapters explore what forms of support were available to married Irish and Jewish mothers through their own family and local neighbourhood and communal agencies. Chapter five concerns the unmarried mother and what provision was made specifically for her. The care offered by the host society to immigrant mothers and their infants is explored in chapters 6 to 8. Institutions covered by these chapters include voluntary hospitals, Poor Law infirmaries, and charitable organisations such as district nursing associations and medical missions. The thesis examines not only the services available to Irish and Jewish mothers, but also the attitudes of health professionals and philanthropists towards immigrants and how these affected the accessibility and acceptability of maternity and infant welfare services to Irish and East European Jewish mothers.

The study evaluates the effectiveness of a pregnancy intervention model (PIM) developed to improve first trimester prenatal care utilization in a population of 2,694 low-income Medicaid women. Engagement in prenatal care is critical before prenatal care can occur. Early initiation of prenatal care is important for low income pregnant women at risk for poor birth outcomes and the Medicaid managed care organizations that enroll them. Once identified and enrolled the health plan utilization medical management staff assessed these women for a myriad of high risk and socially detrimental behaviors in order to facilitate, in a sensitive manner, their access to drug treatment or any needed service. Interventions included a real time identification, reporting, incentive model using medical informatics to supplement existing clinical based assessment of high risk pregnant women and nursing care coordination that included outreach, enrollment assistance, support services, interagency coordination, home visits, transportation and medical home assignment. A difference was found in the utilization of first trimester prenatal care visits for all women who conceived after the intervention compared to those who conceived prior to the intervention date. A difference was also noted in the "no prenatal care" category due a decrease in the number of women who did not receive prenatal care. PIM appears to be a cost effective, simple solution to a real world problem. / Graduation date: 2005

Thesis (PhD)--Macquarie University, Division of Humanities, Department of Modern History, 2003. / Bibliography: p. 417-478. / Introduction: breeding and feeding -- The medical man: sex, science and society -- Confined: women and obstetrics 1880-1899 -- The kindest cut? The caesarean section as turning point -- Reproduction in decline -- Resisting reproduction: women, doctors and abortion -- From obstetrics to paediatrics: the rise of the child -- The breast was best: medicine and maternal breastfeeding -- The deadly bottle and the dangers of the wet nurse: the "artificial" feeding of infants -- Surveillance and the mother -- Mothers and medicine: paradigms of continuity and change. / The late nineteenth and early twentieth centuries saw profound changes in Australian attitudes towards maternity. Imbibed with discourses of pronatalism and eugenics, the production of infants became increasingly important to society and the state. Discourses proliferated on "breeding", and while it appeared maternity was exulted, the child, not the mother, was of ultimate interest. -- This thesis will examine the ways wider discourses of population impacted on childbearing, and very specifically the ways discussions of the nation impacted on medicine. Despite its apparent objectivity, medical science both absorbed and created pronatalism. Within medical ideology, where once the mother had been the point of interest, the primary focus of medical care, increasingly medical science focussed on the life of the infant, who was now all the more precious in the role of new life for the nation. -- While all childbirth and child-rearing advice was formed and mediated by such rhetoric, this thesis will examine certain key issues, including the rise of the caesarean section, the development of paediatrics and the turn to antenatal care. These turning points can be read as signifiers of attitudes towards women and the maternal body, and provide critical material for a reading of the complexities of representations of mothers in medical discourse. / Mode of access: World Wide Web. / 478 p

[Truncated abstract] The aims of the study were twofold; firstly, to describe the inequality in infant mortality in Indonesia namely, to look at the extent and magnitude of the problem in terms of the estimated number of infant deaths, the differentials in infant mortality rates, the probability of infant deaths across provinces, urban and rural areas, and across regions of Indonesia. Secondly, to examine the effect of family welfare status and maternal educational levels on the probability of infant deaths. The study design was that of a population-based multistage stratified survey of the 1997 Indonesian Demographic and Health Survey. Results of the study were obtained from a sample of 28,810 reproductive women aged 15 to 49 years who belonged to 34,255 households. A binary outcome variable was selected, namely, whether or not each of the live born infant(s) from the interviewed women was alive or dead prior to reaching one year of age. Of interest were the variables related to socio-economic status, measured by Family Welfare Status Index and maternal educational levels. The following risk factors were also investigated: current contraceptive methods; birth intervals; maternal age at first birth; marital duration; infants’ size perceived by the mothers; infants’ birth weight; marital status; prenatal care by health personnel; antenatal TT immunization; place of delivery; and religion. Geographical strata (province) and residence (urban and rural areas) were also considered. Both descriptive and multivariate analyses were undertaken. Descriptive analysis was aimed at obtaining non-biased estimates of the infant mortality rates at the appropriate levels of aggregation. Multivariate analysis involved a logistic regression model using the Generalized Estimating Equations (GEE) model-fitting technique. The procedure, a multilog-cumlogit , uses the Taylor Series Linearization methods to compute modelbased variance, and which adjusts for the complex sampling design. Results of descriptive analysis indicate that, indeed, there are inequalities in infant mortality across administrative divisions of the country, represented by provinces and regions, as well as across residential areas, namely urban and rural areas. Also, the results suggested that there is socio-economic inequality in infant mortality, as indicated by a dose-response effect across strata of family welfare and maternal educational levels, both individually and interactively. These inequalities varied by residence (urban and rural), provinces and regions (Java Bali, Outer Java Bali I and Outer Java Bali II). Furthermore, the probability of infant mortality was significantly greater among highrisk mothers, characterized by a number of risk factors used in the study

Thesis (M.Sc.) (Honours) -- University of Western Sydney, Macarthur, 1999. / A thesis presented to the University of Western Sydney, Macarthur, in partial fulfillment of the requirements for the degree of Master of Science (Honours), March, 1999. Bibliography : leaves 117-125.

Thesis(M. A. (Nursing)) -- University of Limpopo, 2021 / BACKGROUND The quality Kangaroo Mother Care (KMC) continues to be sub-standard as it is not managed properly, despite the maternal and neonatal services provided by the midwives during postpartum and neonatal period, as this can lead to increased neonatal mortality rate and maternal depression at selected hospitals of Limpopo Province, therefore the researcher is interested in developing strategies to enhance quality KMC at selected hospitals of Limpopo Province. KMC has been found to have physiological, behavioural, psychosocial and cognitive developmental benefits, and it enhances motherinfant bonding. The aim of the study was to develop strategies to enhance quality Kangaroo Mother Care in selected hospitals of Limpopo Province. RESEARCH METHOD A quantitative descriptive cross-sectional research method was used to collect numerical data with regard to the factors that hinders the quality Kangaroo Mother Care in selected hospitals of Limpopo Province. Population size was 77, Simple Random Probability Sampling was used in this study with the sample size of 65 midwives. Data were collected using self-administered questionnaires and analysed using Statistical Package for Social Sciences (SPSS) version 24. Quantitative analysis is the numerical representation and manipulation of observations for the purpose of describing and explaining the phenomenon reflected on observations (Babbie & Roberts, 2018). RESULTS The study revealed that the factors that hinders quality of Kangaroo Mother Care are lack of education and training to midwives regarding Kangaroo Mother Care, and other sources suggested that all categories of nurses should also be trained. The midwives are knowledgeable with regard to KMC, however, the problem remains the work overload when they have to monitor both the mother and neonate during feeding. It was further indicated that family members can also assist with regard to KMC. Strategies were developed, as optimal KMC environment, optimal KMC interventions, enhance optimal mother attitude to KMC crate gender sensitive environment. CONCLUSION The study concluded that the quality of KMC should be enhanced through both the promotion of education and training to all midwives, and involvement of families to assist in KMC at selected hospitals of Limpopo Province

In this dissertation I analyze patterns of maternal-infant health in developing contexts. My first chapter uses child hemoglobin as a bio-marker for maternal malnutrition in Senegal during the 2008 food price crisis. In early 2008, world rice prices skyrocketed, causing people around the world to plunge into poverty. Senegal, in particular, depends heavily on imported foodstuffs. I find that the crisis had a large, negative impact on child anemia in urban Senegal, most likely reflecting a deterioration of maternal nutrition caused by rising food prices. In the second and third chapters, we introduce a novel indicator of maternal-infant health: childhood sex ratios. Because infant females have lower rates of mortality than infant males, the sex ratio of the surviving population reflects the level of infant mortality. Childhood sex ratios are widely available from census data, meaning we can use them to shed new light on historical populations who lack traditional sources of data on infant mortality, like birth and death records. We apply this new method to the 19th-century US, where the lack of vital statistics has left uncertainty over even approximate levels of infant mortality. We find that the level of infant mortality in the pre-industrial US was much lower than previously thought, but that racial health disparities were much greater.

In Uganda, there are an estimated 200,000 women suffering from obstetric fistula, with 1,900 new cases expected annually. These figures, combined with a persistently high maternal mortality rate, have led to an international discourse that claims the solution to improving maternal health outcomes is facility-based delivery with a skilled birth attendant. In accord with this discourse, the Ugandan government criminalized traditional birth attendants in 2010. In this study, I examine the lived experience of traditional birth attendants and women who have suffered from an obstetric fistula in eastern Uganda. Using data collected from open-ended, semi-structured interviews, focus groups, and participant-observation, I describe the biocultural determinants of obstetric fistula. Based on findings, I argue that although emergency obstetric care is critical to prevent obstetric fistula in cases of obstructed labor, the criminalization of the locally constructed system of care, TBAs, serves as yet another layer of structural violence in the lives of rural, poor women. Results demonstrate how political-economic and cultural determinants of obstetric fistula are minimized in favor of a Western prescribed, bio-medical solution, which is heavily resource dependent. This solution is promoted through a political economy of hope fueled by the obstetric imaginary, or the enthusiastic belief in Western-style biomedical obstetric care’s ability to deliver positive health outcomes for women and infants regardless of local context and constraints. Recommendations include increased obstetric fistula treatment facilities with improved communication from medical staff, decriminalization of traditional birth attendants and renewed training programs, and engaging local populations in maternal health discourse to ensure culturally competent programs. / Graduation date: 2013