The aim of this study was to gain a better understanding of the effects and outcomes of Spiritual Healing in the context of women with breast cancer receiving long-term hormonal therapy. Background Spiritual Healing is widely available and used by many but is a neglected area of research. Whilst the exact mechanisms are not understood and healers make no claim to cure, evidence suggested that Spiritual Healing as a holistic complementary therapy could support women whose quality of life is negatively affected by breast cancer and its treatments. After initial surgical, radiological and/or chemical treatments, the majority of women are prescribed hormonal therapy for at least five years, giving rise to immediate and long-term symptoms that compromise their quality of life and force some to take respite from treatment. Spiritual Healing was thought to have the potential to improve quality of life and encourage continued compliance with potentially life-saving orthodox therapy. Method This qualitative study used Unitary Appreciative Inquiry to explore the fullness and richness of patients’ changing life patterns. An observational study of Spiritual Healing took place in a clinical research facility within a district general hospital, and was given by healers with a nationally recognised qualification. Twelve breast cancer patients, who reported at least one onerous treatment side-effect, self-referred to the study and were given ten Spiritual Healing sessions of approximately 40 minutes’ duration each. Data included direct observations noted by healers, patient’s daily logs, researcher’s field diary and one-to-one semi-structured interviews. Findings The effects of breast cancer and its treatments were long-lasting and permeated every aspect of these participants’ lives. The physical effect of cancer and its treatments restricted usual activities, leading to low morale and emotional distress. Patients’ narratives expressed loss and regret and for all patients fear was a constant companion. Observational data illustrated how the experience of Spiritual Healing reduced physical side-effects, including hot flushes, and afforded a sense of serenity and hope. Conclusions This study highlights the potential for Spiritual Healing as a complementary therapy to alleviate many of the distressing effects of breast cancer and its treatments, most notably during long-term hormonal therapy. These findings appear to justify further research to understand the potential value of Spiritual Healing as a complementary therapy to support orthodox medical care.

Childbirth is an emotional and physical experience, which may have permanent or longterm positive or negative consequences. Key predictive factors of traumatic and positive childbirth have been previously identified. Criticisms however have been levied towards the pre-dominantly quantitative-based, pathological focus of the literature. Few empirical studies have examined the positive nature of childbirth. Research has also focused on isolated aspects of the pre, intra and post-partum period, as opposed to women's global perceptions. The need to consult with women who have endured traumatic and non-traumatic childbirth and to identify the complex interplay of factors associated with these events has been highlighted in the literature. This research comprises an interpretive phenomenological study. By recruiting and interviewing women who had experienced a self-defined traumatic and positive birth, the research aimed to generate a deeper understanding of the meanings and lived experiences of diverse childbirth events. A further aim was to explore how women achieved a subsequent positive birth following a traumatic episode, as well as the impact of this experience on maternal wellbeing. Through purposive sampling methods, a total of fourteen women were engaged over two recruitment phases. In phase one an interview was held with ten women who had already experienced a self-defined traumatic and positive birth. In phase two, four vomen were recruited on a longitudinal basis; interviews were held after a traumatic (interview 1) and subsequent birth (interview 2). In addition, all women (across both phases) were also involved in a final interpretation meeting. Thirty-two interviews were held in total. Data were collected through in-depth interviews. Data analysis was undertaken through an interpretive framework based on Heideggerian and Gadamerian hermeneutics. The findings present the women's childbearing journey of tragedy and joy through seven interpretive themes. A theoretical framework has re-conceptualised the women's birth narratives as a hero's tale. This represents a heroic journey of adversity, trials, courage, determination and triumph. A unique psychosocial model has been synthesised by integrating aspects of the theories of Carl Jung (1968, 1989, 2006), Abraham Maslow (1962, 1970a&b) and Martin Heidegger (1962, 1976, 1977). This model has provided a holistic conceptual framework of women's childbirth experiences. The framework explores the psychosocial motivators and influences on women's childbirth experiences. It emphasises the importance of socio-contextual factors to determine a woman's growth potential during childbirth; as well as how growth-inhibiting (traumatic birth) and growth-enhancing (joyful birth) experiences are internalised by women. This model offers the basis through which a whole systems salutogenic orientation to maternity care can be achieved. Original insights into the transformative, cathartic and self-validating nature of a redemptive birth are also presented. The practical implications of these findings and suggestions for future research have been offered.

This study explores discourses around private three- and four-dimensional (3/4D) ultrasound scans in pregnancy, the experiences of women who have 3/4D scans and what impact these scans may have on pregnant women. A critical discourse analysis of scanning company websites was undertaken to explore the discourses, identities and genres set up on the websites. Longitudinal interviews exploring women’s experiences of 3/4D scans were analysed using interpretative phenomenological analysis. Case studies, using longitudinal questionnaire and interview data, were used to investigate the psychological impact of 3/4D scans on pregnant women. The critical discourse analysis revealed mixed discourses, identities and genres. While 3/4D scans are not overtly medical, they nevertheless contain medical aspects. They are promoted as enhancing bonding and reassurance. In the interview analysis, two superordinate themes emerged: ‘Getting to know the baby’ and ‘Experiences of pregnancy’. While the women’s physical and emotional experiences of pregnancy varied considerably, there were more convergences in the desire to ‘get to know’ the fetus and how women approached this. While routine and 3/4D scans played an important role, fetal movement also emerged as a significant factor. The case studies showed that the psychological impact was not consistent. Scans had no effect on fetal health locus of control, may have reduced anxiety about specific issues for some women and may have had a positive impact on some components of bonding for some women. It is not possible to state categorically that they reduce anxiety or increase bonding. The psychological impact of 3/4D scans appears to be individually mediated and depends on pregnancy experience and individual psychological differences, highlighting the significance of individual factors in both research and practice. Two opposing discourses portray 3/4D scans as either beneficial, by enhancing reassurance and bonding, or problematic, by undermining women’s embodied knowledge and experience and being potentially risky. This study suggests that neither of these two conflicting discourses are reflected in women’s experiences. The women in this study were not motivated primarily by bonding or reassurance when choosing 3/4D scans, but considered them a nice experience; on the other hand, the scans do not seem to have had a detrimental impact either. The interview analysis suggests that women acquire knowledge about the fetus through scans and fetal movement and combine these to make sense of the fetus. This study also provides evidence that the concept and measurement of bonding during pregnancy is problematic and that professional and academic perspectives are not necessarily reflected in women’s experiences.

This exploratory, descriptive research used a case study approach to analyse the role of the midwife in providing maternal and infant care in Australia. Midwives from the states of New South Wales, Victoria and Western Australia comprised the target population. These midwives were considered to be representative of the general midwifery population practising in the diverse settings of Australia.A triangulation of methods (Denzin, 1970) was used for data collection. This included observational field work, a questionnaire survey of a randomly selected sample of registered midwives (n=1754), and in-depth interviews (n=75), using a grounded theory approach (Glaser and Strauss, 1967; Strauss and Corbin, 1990).The questionnaire, in-depth interviews and observational field work addressed the practice of midwives:1. as documented in policies and procedures in practice settings.2. as defined by the Australian College of Midwives Incorporated in Standards for the Practice of Midwifery (1989), based on the International Confederation of Midwives' Definition of a Midwife (World Health Organisation, 1976).Data obtained through the survey questionnaire were analysed using descriptive analysis (Wilson, 1985) to portray a summarization of the entire data set. A thematic content analysis was used for the open-ended questions of the survey (Burnard, 1991). In an attempt to discover the 'how and why' questions associated with the study's survey findings, the constant comparative method of analysis of data from in-depth interviews was deemed appropriate (Glaser, 1978; Field and Morse, 1985; Chenitz and Swanson, 1986). This allowed a more abstract level of conceptualization that led to the development of a paradigm reflective of the midwives' practice domain (Strauss and Corbin, 1990).Lack of opportunities to practise throughout all stages of pregnancy and childbirth was identified as ++ / the major problem limiting the Australian midwives' practice domain. An explanatory process of Optimising Opportunities for Holistic Midwifery Practice emerged explaining midwives' actions and interactions throughout the four stages of optimising: revealing the image; influencing decision making; changing the paradigm; and expanding the profession.The findings of the study provide an analysis of Australian midwifery practice that considers factors facilitating and/or impeding the professional role and development of Australian midwives, and their ability to provide care that meets consumer needs.

This study draws on multiple modes of expression in texts that have been generated by my experience of midwifery development since I moved from England to Australia in early 1997. The Professional Doctorate in Midwifery at the University of Technology, Sydney (UTS) has enabled me to produce and study my work as a midwifery practitioner, researcher, educator, writer and activist and to engage in a process of scholarship that both informs and is generated by practice. This has allowed me to analyse the complex issues that I, and other midwives in Australia, face as we strategise to narrow the gap between our ideals and the realities of the professional and political constraints that challenge midwifery. The study analyses the rhetorical communications I have employed as both carriers of 'vision' and 'means of persuasion' and the deliberate strategies to make changes that I believe will benefit childbearing women. My portfolio challenges me and others, to explore how we are able to identify, enact, and convince others of the emancipatory potential of midwifery. Rhetorical innovations are therefore linked to the exposition of woman centred midwifery care; an overall goal being to enable situations in which women can experience the potential power that transforms lives, through their experiences of childbirth. In the process, I aim to produce new knowledge that will equip midwives to understand practice, policy and political situations and see new possibilities for responding and taking action. I have analysed and explained my work using a framework appropriated from rhetorical theory and drawing on a range of feminist perspectives. This involves identifying and critiquing the rhetorical innovations that I have used when trying to create possibilities and persuade others of the value of midwifery and the need to make changes happen in practice, education and regulation. My study analyses the rhetorical nature of my own work as presented in my portfolio in a range of carefully selected texts that I have authored during my candidature. These include journal and newsletter articles, conference papers, research activities, policy submissions, education and training materials, the development of midwifery standards, formal and informal communications, and other documents, all aimed in one way or another at the rhetorical strategy of stimulating interest and action. The portfolio texts that arise from this work form the empirical data that is studied. However, in varying ways these texts elicit understandings about the rhetoric and reality of Australian midwifery and the deliberate strategies that are employed by midwives to make changes that will benefit childbearing women. They therefore stand in their own right as contributions to the thesis with their own discursive and epistemological intent. The reflexive process employed in this thesis highlights comparisons between what is being positioned as the potential of midwifery with what is also presented as the reality played out in contemporary Australian maternity service provision and in midwifery education and regulation. The thesis weaves its way around the portfolio documents, attempting to bring to life and discuss the culture in which rhetorical innovations and intentional strategies are aimed at narrowing the gap between 'rhetoric and reality'.

Research Doctorate - Doctor of Philosophy (PhD) / Dr. Peter Chamberlen was a highly trained physician who specialised in midwifery at a time when midwifery had the potential to become a lucrative practice for men. Male midwives were considered inappropriate and unskilled for 'normal' births and were generally called when surgical procedures were necessary. Because the Chamberlen family had assisted in childbirth, including the children of royalty, for several generations Peter CHamberen virtually inherited his role as a royal midwife almost immediately after his graduation from medical school in 1619 and considered himself qualified for both difficult and normal births because of the training he received from his father. Because of his manicured heritage Peter Chamberlen also considered himself to have the necessary experience, training and skill to establish the first English state sponsored association of midwives that would have made London's independent midwives subject to his control. In 1634, after he had gained considerable experience as a reputable accoucheur, and establishing his reputation as a fellow of the Royal College of Physicians, Chamberlen petitioned the king for permission to institute the midwives association without consultation with the College or some influential midwives. Charles I, unwilling to promote the idea without support, suggested the matter should be taken up with the Archbishop of Canterbury and the Bishop of London, the official channels responsible for issuing midwifery licenses. Lacking the confidence to arbitrate on the matter, the ecclesiastic authorities sought advice from the Royal College of Physicians. Unfortunately for Chamberlen opposition arose from from the midwives, the Royal College of Physicians as well as the ecclesiastical authorities. This opposition was so intense that the proposed institute failed in its inception and Chamberlen was humiliated. Chamberlen retreated to the Netherlands but soon returned and continued to work in London as a male midwife. Henceforth he actively sought to clear his tarnished reputation. His life and contribution to 17th Century society form the basis of this thesis.

The selected publications presented here are concerned with the development of practice and knowledge in midwifery. The thesis underlying the publications is that the development of a positive personal relationship between women and their midwives is fundamental to effective and sensitive midwifery care. The methodology used is essentially different to the thesis written prospectively. This is because the publications presented arise from years of work informed by 'hands on' practice, development of policy, leading change and development, supported by research and communicated and disseminated through writing. The work presented therefore could be viewed as a long research project, with these activities forming an iterative process in thinking through and writing for publication, as well as continuing practice development and research. The extended essay serves to introduce the publications and show how they are linked through common themes developed over time. It also demonstrates the originality, importance and contribution of the publications. The publications presented may be viewed conceptually in a number of different ways however these are all related to the relationship between women and their midwives. The essay is presented in sections. The first is the Introduction to key concepts and theories. The second is The Midwife with Woman Relationship. This introduces publications that describe the nature and purpose of the relationship. The third section, Changing Practice: the New Midwifery is concerned with what the midwife does in the context of that relationship. Publications introduced in this section propose ways of working in the best interests of women and their families. The fourth section, Influencing Policy Nationally and internationally, is concerned with the creation of national policy that has supported the development of what I have called the New Midwifery. The fifth section, Transformative Change and Rediscovering Midwifery is concerned with developing the organisation and culture of care, that is its context, to enable midwives to work in the best interests of women and their families. The sixth section Developing Patterns of Practice that Enable Personal Relationships Between Women and Midwives: One-to-One Midwifery introduces publications concerned with the development and evaluation of new structures that facilitate continuity of care and thereby relationship.

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Preeclampsia is a complex, baffling and unpredictable syndrome. The condition affects the lives of approximately one in every twenty pregnant women. Most cases are mild but some are serious enough to threaten the life of mother and baby. Medical research has yet to identify a cause, and the search for a cure continues. Delivery remains the only method of resolving this dangerous complication of pregnancy and may need to be effected before the foetus has become mature enough to avoid the risks associated with preterm birth. Women's experience of preeclampsia has received little attention in midwifery and obstetric literature. This hermeneutic phenomenological study has been designed to answer the question "What is women's experience with preeclampsia before 34 weeks of gestation?" Eight women who had experienced severe preeclampsia were interviewed. Their narratives are analyzed to uncover the meaning of the lived experience of preeclampsia from diagnosis to postpartum recovery. Three data chapters reveal some of the ways that preeclampsia reveals itself as the disease progresses. The findings of this study indicate that there are many atypical presentations of preeclampsia and that sometimes early "showing" goes unrecognized. The woman may in fact feel better as the disease progresses. Late diagnosis leaves the woman and her family shocked and may compromise foetal and maternal safety. Having preeclampsia changes the reality of pregnancy and early parenting for a woman. Emotional consequences are significant and include an increased risk of post-traumatic stress disorder. The unpredictable manner in which preeclampsia first "shows itself" is analyzed in the first data chapter and the following two chapters explore the way in which a woman's life may be thrown out of control by diagnosis and management of the disease. Paradoxically, women with severe preeclampsia often lose continuity of care with their midwife at a time when they most need the support of a familiar and trusted professional. Provision of continuity creates a challenge for the midwife when the woman's care is taken over by secondary services. Innovative ideas to enhance the safety and holistic quality of care for women with preeclampsia are discussed.

The importance of the role of the midwife in providing safe, quality care for women has until recently, been underrated in Victoria, Australia. Acknowledgement of the need for midwife-led models of care in state maternity service policies provided opportunities for midwives to become recognised within the healthcare system and the wider community. This professional doctorate aims to examine the ways in which the role of the midwife and her practice has been impacted on by organisational renovations of midwifery care. It identifies the complexity of the factors that affect the midwife’s ability or choice to work in midwife-led models of care. Furthermore this doctorate highlights the need for ongoing debate into midwifery in Australia. Concepts related to midwifery practice are examined as they form the foundations for the research and policy components of the portfolio. This includes an exploration of midwifery philosophy, the antecedents to autonomous practice and the experience midwives have of midwife-led care. An examination of the concepts of continuity of care and woman-centred care provides a platform upon which to review models of midwifery care. This review highlights the development of an ongoing relationship as a source of satisfaction for midwives and women. The second part of the doctorate reviews policies that guide the provision of maternity services in Victoria. Analysis of these policies using Kingdon’s multiple streams framework identifies the problems, the political actors and the policy developed, establishing the context for organisational change in maternity care. The antecedents for successful integration of organisational change are explored through a review of change theory and leadership. A case study approach utilised for the research component of the doctorate provides insights into organisational change that occurred at two maternity sites in Victoria. The findings of the study suggest there was a dichotomy between those midwives desiring autonomous practice and wanting to work in midwife-led care and those wishing to remain in one specialised area. Recommendations stemming from these findings include the need for sufficient education and support during change, a review of terminology used to describe midwifery models of care and research into the use of integrated maternity units. Complexity science is examined in order to bring the different strands of the doctorate together, providing an explanation for the different outcomes that occur despite the implementation of similar models. The connective leadership model was suggested as the means to provide leadership that is inclusive of providing direction, mentoring new leaders and providing support and opportunities for midwives to become empowered to practice autonomously. Attention to the complexity of organisational change is vital to ensure the future of midwifery.