A key midwifery activity is the support of a woman in labour. Pain in labour has been extensively researched from the woman's perspective, but less has been explored in relation to the midwife and her approach to pain. The way in which the midwife works with a woman and her pain in labour is the focus of this qualitative study, using Heideggerian hermeneutic phenomenology. This philosophical approach seeks to uncover or illuminate aspects of the midwife's practice which are frequently taken for granted in their everydayness. Seven midwives, including both independent practitioners and hospital-employed, were interviewed. Their narratives were analysed to uncover the meaning of the way in which midwives work with women and their pain in labour. The findings of this thesis suggest that midwives work by interpreting the woman's pain. Before the pain begins, they 'leap ahead' to help them anticipate the pain and how they will confront it. During labour, midwives give pain meaning by translating its purpose in that context. They 'leap in' when required, sometimes using 'self as an intervention. Midwives interpret women's pain through their understanding of lived time. They know how the perception of time passing changes depending on the setting for labour or the amount of anxiety and pain the woman is experiencing. Midwives use time in their work. They break it down to help a woman focus on a single contraction rather than looking too far ahead toward the unknown. Time can be a midwife's friend when the arrival of the baby replaces the urgent need for pain relief. It can also be her enemy if her interpretation of a woman's pain differs from the woman's perception. The memory of pain may persist for the woman, after labour has finished, with a backlash for the midwife. Some midwives believe in the process of birth and the woman's ability to labour with such conviction that they gain a woman's complete trust. At her most vulnerable time, they encourage the woman to call upon inner reserves and be truly empowered by her experience.

This study is a longitudinal descriptive study conducted in eight villages of Banten province, Indonesia. The research describes the nutritional status of two groups of pregnant village women and investigates the implementation and impact of an intervention to improve nutrition in pregnancy. The intervention aimed to improve the effectiveness of village midwives and cadres by improving the nutrition of pregnant women, particularly iron deficiency, through the use of a community development approach. The thesis identifies the importance of good nutrition during pregnancy and some of the factors, which influence it in the context of this study. It examines the health promotion programs for improving iron intake and nutrition in developing countries and specifically examines the programs that are used in Indonesia. A small decrease in the rate of anaemia appears to have occurred due to these programs, but the anaemia rate remains high. There has been little systematic examination of the cultural and social factors that may influence nutrition in pregnant women in Indonesia and few studies, which have measured the nutritional status of pregnant women. The goals of the study are to: * Describe the social and cultural factors that influence nutrition, under nutrition and iron deficiency anaemia during pregnancy and to measure the nutritional status of rural women in Banten Province, Indonesia. * Improve the knowledge and skills of village midwives and cadres in using community development and effective communication to improve iron supplementation and nutrition. The conceptual framework for the study was derived from principles of health promotion, in particular the 'Proceed and Proceed' model (Green & Kreuter 1991). The study took place in eight villages in Banten province, Indonesia. Four of the villages received a community development intervention and four villages were used for comparison. The study was undertaken in three stages: Stage 1 - Baseline Quantitative and Qualitative Data Collection; Stage 2 - Intervention; and Stage 3 - Follow Up Evaluation. The intervention was guided by the results of Stage 1 and consisted of a two-day workshop aimed to improve their knowledge, communication skills of the midwives and cadres and their ability to use a community development approach to improving nutrition in the villages. Qualitative and quantitative methods were used in the research at Stage 1 and Stage 3. Ethnographic methods of interview, observation, field notes and survey were used to collect information about the cultural and social factors that influence nutrition and nutritional practices during pregnancy. The knowledge and practices of midwives and cadres were also explored. Thematic analysis was used to analyse the data. Forty pregnant women (20 from the intervention villages and 20 from the comparison villages) participated in the qualitative component of the research before the intervention (Stage 1). The follow up evaluation occurred 12 months later, and a different group of 35 pregnant women (20 from the intervention villages and 15 from the comparison villages) participated in the qualitative component of the research at Stage 3. The same eight midwives and 16 cadres participated in the qualitative research at Stage 1 and Stage 3. Quantitative data collected at Stage 1 and Stage 3 included socio demographic data, obstetric information and nutritional data (haemoglobin level, body mass index, and the weight gain of pregnant women). Data was collected from 210 women before the intervention and 189 women after the intervention. Some changes in the practices of midwives and cadres were apparent after the intervention with midwives building better rapport, communicating more effectively and providing more information and support to pregnant women. Cadres also talked more about nutrition in community meetings. Changes in the behaviour and approach of village midwives and cadres' in relation to nutrition education resulted in improved nutritional behaviour of pregnant women to some extent, but poverty and culture restricted the ability of pregnant women to access better food. The intervention did not effect the overall nutritional status of the pregnant women. Because of time and logistical constraints, the intervention was not able to influence the community's health in the medium term in the intervention villages. The results of this study showed that the comparison villages sometimes had better results than the intervention villages. A possible explanation is that the systematic evaluation of nutritional status may have increased the awareness and practice of the better-educated and more knowledgeable midwives who were located in the comparison villages. The comparison midwives had a better basic education in midwifery when compared to the intervention midwives. It appeared these better-educated workers responded positively to the research even without exposure to the intervention. The study showed that the position of the pregnant woman is low within the hierarchy of both the health care system and the power structures of the broader community. Husbands, mother-in-law, village midwives, cadres and village leaders all have more power to determine what pregnant women can and cannot eat and drink than women do themselves. However, some women tried to access better food after the intervention by subverting culture and the authority of husbands and mother-in-law and eating nutritious food in secret.

The challenge of ameliorating or preventing the health problems of Indigenous Australians living in remote areas is compounded by the profound professional, cultural, social and personal isolation of the health professionals who work there. This isolation has direct effects on the recruitment and retention of health professionals to remote communities, and their ability to work effectively in this unfamiliar environment. The overarching goal of this research was to strengthen the capacity of these professionals to improve the quality of remote area maternity services in Australia and the experiences and outcomes for birthing women and their families. This was achieved by investigating a process of engagement with a wide range of stakeholders and utilising contemporary communication technology through the Internet. A case study approach was undertaken using participatory action research (PAR) with the elements off rapid assessment, response and evaluation methods (RARE). The research explored, described and analysed the development of resources aimed at decreasing isolation and increasing communication in the remote setting. Identifying the barriers, facilitators and utility of an information technology intervention was an integral part of the investigation process. The first case study saw the development and evaluation of the Maternity Care in the Bush Web Based Resource Library, designed to decrease the isolation of practitioners from the educational resources and professional expertise available in current literature, guidelines and reports. The second case study targeted isolation from peers, with the development and evaluation of the Remote Links Online Community. This was designed to build partnerships between isolated practitioners, for the purpose of interactive peer support, information exchange and mentoring. The third and fourth case studies were guided by Aboriginal researchers and resulted in the development of the Birthing Business in the Bush Website, designed to decrease practitioners' isolation from cultural knowledge. An integrated component of this Website is the Primary Health Care Guide to Planning Local Maternity Services, designed to decrease the isolation of the health care practitioner from the community in which they are working. Issues related to conducting research in the Australian Indigenous setting have been explored, analysed and detailed. Each case study contributed new knowledge and learning about the challenges and contemporary contexts of remote area maternity service provision in Australia. The use of PAR, and, most particularly, how this can be used in Indigenous research to produce goals that extended beyond the individual researcher's goals, has been described. The current difficulties associated with computer mediated communication, as experienced by remote practitioners, have been highlighted. The research has identified areas of need within the workforce that, if addressed, could contribute to improved health services. Importantly, the research has documented, acknowledged, honoured and disseminated the voices of Aboriginal women, through the far reaching communication technology that is the Internet. Furthermore, the voices, concerns and conditions of remote maternity services providers were also documented and acknowledged. This workforce, often invisible and poorly valued, was assisted and supported to provide evidenced based, culturally appropriate maternity care, through the resources that were developed. To further progress the lessons taken from the research, recommendations have been developed and are listed in the Conclusion.

Many midwives continue to use Continuous Electronic Foetal Monitoring (CEFM) on low risk women in labour, despite overwhelming clinical evidence that it is unnecessary. The use of CEFM on low risk labouring women has been linked to rising rates of medical intervention during labour and birth with no improvement in long term neonatal outcomes. This study examined the decision-making processes of midwives who used CEFM on low risk labouring women. Whilst a number of previous studies have examined various aspects of CEFM, none specific to midwives’ decision-making and CEFM on low risk labouring women. This study contributes to the literature in this specific area. The theoretical origins of Symbolic Interactionism and Grounded Theory (GT) methods underpin this study. SI, a sociological theory that emphasises meaning in human interactions and behaviours is used in this study to focus on the behaviours and interactions of five midwives’when deciding to use CEFM on low risk labouring women. Primary data were collected by conducting unstructured interviews and systematic analysis was undertaken using GT methods to generate a substantive theory of: Midwives’ CEFM decision-making despite evidence based guidelines. The midwives made the decision that led to CEFM at two key points in the woman’s labour care. Firstly, during the initial assessment of the woman and foetus, some midwives decided to use a baseline CTG rather than intermittent auscultation (IA). Secondly, following initial assessment, the midwives made an individualised assessment and decided whether to use CEFM as the method to monitor the foetus during labour. Trust was identified as the core variable, having a profound effect on the midwives’ decision-making at these two points. Another significant factor that impacted on decision-making was staff workload. Recommendations relating to these findings promote that labouring women be central and intimately involved in decisions about foetal monitoring. Workplace reforms, such as the introduction of midwifery led models of care for women within a community setting are recommended to address professional trust and workload issues. Through the implementation of these recommendations it is expected that midwives will embrace the notion of woman centred care and that the unnecessary use of CEFM on low risk labouring women will be reduced.

This study used a qualitative research design incorporating principles of social constructionism, hermeneutic dialectic method, Neo-Socratic dialogue and philosophy for reporting the tacit and social knowledge constructions underlying particular ways of knowing that inform the experiential reality of love in the practice of nursing and midwifery. The philosophy of Emmanuel Levinas, that culminated in his magnum opus of the ‘metaphysics of otherness’, provided the theoretical underpinning for the interpretation of the experiences nurses and midwives believed were examples of love in their clinical practice in Australia, Singapore and Bhutan. What is love in nursing and midwifery? The answer is moral responsibility. The relational context has a nurse and midwife constantly exposed to patient situations that give rise to expressions of love as moral responsibility. It is a form of love that centres on the ability of our being, or at least the possibility of our being, to transcend its everyday form to a metaphysical state of being moral. It enables a nurse and midwife to transcend the isolation associated with their personal being as a self-project, to be ‘for’ the patient as a first priority. But while the ‘Goodness’ of the ‘Good’ assigns the nurse and midwife responsible and is expressed to their personal being in the form of the ‘urge to do’, ‘what to do’ in caring for the patient is a matter of living out the command to be responsible and will be different for each nurse and midwife. However, no matter the outcome, love as moral responsibility will always leave a nurse and midwife feeling there is still more to be done in being responsible.

This study aims to identify traditional medicines which people use in Babati District, Tanzania and to find out which direction the local use and knowledge of traditional medicine is taking in comparison with modern medicine (MM). It is a case study based both on primary and secondary sources. The primary information was gathered with the help of semi-structured interviews and shorter enquiries with people of all categories that use herbal remedies or visit bone fixers and with women that are supported by traditional midwifes. For simple health problems people use TM, for more complicated cases, they go to the hospital. A difference between Babati urban and rural inhabitants was noticed in the usage of traditional and modern medicine, but not between poor and rich people, opinions being slightly different. The Tanzanian government does not encourage the implementation of the TM in the modern medical system and as long as the young generation is not interested to learn the secrets of their parents‟ vocation, this knowledge is threatened by being forgotten. All the herbs used in TM will most likely find their way into the modern pharmacy; however because of the lack of documentation and statistics, it can take up to one hundred years. For this purpose, the gap between TM and MM has to narrow through a better collaboration between all the involved parts.

Thesis (Ph. D.)--Rutgers University, 2009. / "Graduate Program in History." Includes bibliographical references (p. 192-201).

Declining resources are a global phenomenon. One of the consequences has been the reorganization of health care provision in different countries. Doctor shortages and scarcity of resources particularly in developing countries like Cameroon have resulted in nurses providing frontline care to patients and taking on roles traditionally performed by doctors in developed economies, such as diagnosing and prescribing. However, little is known about the exact role of nurses, the process of providing care, how key stakeholders influence the nurse’s role and the consequences of this role of nurses on the various parties concerned in the context of Cameroon. An empirical study was conducted with (n= 42) key stakeholders; (government representatives, doctors, nursing managers, nurses and patients). Semi-structured taped-recorded interviews were carried out on a one-to-one basis to explore the perceptions of multiple key stakeholders of the role of nurses in diagnosing and prescribing. Interviews were transcribed and data analysed using framework analysis. Nurses are the first point of contact for patients in Cameroon in all health care settings and most have a far greater role in diagnosing and prescribing than their counterparts in developed economies. However their involvement was found to vary significantly depending on a number of factors, including: the organisational context, the type of facility (whether public / private or mission owned), individual nurse characteristics, doctors’ attitudes and practices, resources and experience of nursing managers, level of income and characteristics of patients. Most patients (including women) prefer to consult with doctors and in their absence, male nurses rather than female nurses. Some nurses, patients and doctors felt that a preoccupation with diagnosing and prescribing left nurses with little time for compassion and caring. In addition, the key stakeholders felt that some nurses were overstepping their professional boundaries, or had inadequate knowledge and were acting in a manner detrimental to patient care. Extended roles for nurses have the potential to enhance accessibility to care, to enhance the status and job satisfaction of nursing staff and maximise the use of scarce resources. Despite the benefits, there is growing concern that nurses do not have the advanced level of training and behaviour necessary to take on this expanded role and that some are neglecting the traditional caring side of their profession in pursuit of a more medical oriented disease-focused approach.

Thesis (MTech. degree in Nursing) / There is growing concern about lack of caring behaviour in midwifery clinical practice from all sectors of health. Internationally and locally, there is increased outcry about lack of care by midwives for childbearing women. The context of the study was midwifery settings where learners of the Adelaide Tambo School of Nursing Science were placed for work-integrated learning at state and private hospitals in Tshwane. The purpose was to explore caring in the clinical practice of midwifery from the perspective of learner midwives, midwifery educators and midwives.

The aim of the study was to discover, describe and analyze factors related to the perceived acceptance of male nurses in the practice of midwifery in the Seychelles as perceived by nurses, pregnant women and their partners. A descriptive study using the qualitative approach was used. Theoretical sampling was employed and thirty-four participants comprising nurses, pregnant women and their partners were interviewed using an interview guide. Probing was done throughout. The nurses, the pregnant women and their partners were interviewed both in focus groups and individually. Participants taking part in individual interview were different from those taking part in focus group interview. The focus groups were homogeneous comprising professional nurses and consumers of service (pregnant women and their husbands) respectively. The findings revealed multitude of factors associated with the perceived acceptance of males in the practice of midwifery. These were classified as positive, negative and ambivalent. The major positive themes were unconditional acceptance, conditional acceptance, and equitable treatment, by all three groups of informants while traditional belief was the major negative theme. Other positive themes by the nurses were change of attitudes over time, and males as caring professionals, while for pregnant women; it was viewed as prior acceptance of male obstetrician. Both the nurses and partners saw the intimate nature of midwifery as a negative factor while only the nurses identified fear of competition and religious belief. Lack of trust was another negative factor identified by the partners/husbands. Professionals and the husbands identified societal versus individual readiness as an ambivalent factor while the pregnant women and professionals saw conditional acceptance as an ambivalent factor. Recommendations made from this study have implications for nursing research, nursing practice, and nursing education. The study could also be helpful for decision makers at different levels in the health care system. / Thesis (M.Cur.)-University of Natal, Durban, 2001.