Organized medicine is a uniquely powerful political force in Canada, with physician colleges and associations exerting extensive influence over healthcare provision. Their influence has contributed to what social scientists describe as medical dominance, or the exceptional power of the medical profession within the healthcare system and wider society. However, Canadian medical organizations do not consistently defend this dominance; rather, they have occasionally lent support to policy changes that, on their face, would appear incompatible with traditional conceptions of medical power and authority. Typically, these instances are explained as a simple matter of strategic retreat: medicine conceding defeat on a particular issue in an effort to save face or conserve resources, without any change in underlying beliefs. This dissertation questions that assumption, asking if at times organized medicine’s support for threats to medical dominance is instead a function of more fundamental shifts in core policy beliefs. Through a series of interviews exploring how organized medicine responded to the re-emergence of midwifery and expansions of pharmacy scope in four provinces (Alberta, Ontario, Quebec and Nova Scotia), the analysis determines that, while medicine only supported expanded pharmacy scope out of strategic retreat, there are signs of more substantive shifts in belief with respect to midwifery. This suggests that the relationship between organized medicine and traditional medical dominance is more flexible and dynamic than has been assumed.

In this study, the childbearing women's perception of the role of a midwife in Australia was explored using a descriptive study. Data was gathered using a semi structured questionnaire.The findings revealed that childbearing women in Australia overwhelmingly believed a midwife is specifically trained and qualified to deliver babies normally and to care for a woman in labour.In addition, the belief was that a midwife is trained to provide a comprehensive range of maternity related tasks.The overriding themes which emerged identified the midwife as a source of advice, information, support, education, guidance, specific midwifery knowledge and being a liason person between the doctor and the pregnant woman.Limitation of the role of a midwife was believed to be due to the nursing based training of a midwife.The findings from this study revealed that childbearing women in Australia, United Kingdom and Singapore have similar perceptions of a midwife's role.Recommendations were made for further studies to investigate the reasons for a persistent lack of information regarding the role of a midwife and the type of information required by pregnant women. / Master of Nursing (Hons.)

The aims of this study were to describe the childbirth preferences of nulliparous women in early pregnancy and to develop a model of the predictors of those preferences. Participants were recruited with Facebook advertisements and data were collected from 344 women via online survey. Predictors were measured using the Utah Test for the Childbearing Year. Predictors of childbirth preferences (type of birth care provider, birth setting, mode of delivery, and use/avoidance of pain medication) were tested using structural equation modeling. Conventional content analysis was employed to analyze women’s reasons for selecting the type of provider and setting they expected for their delivery. Although the majority of respondents preferred physicians and hospital birth, the proportions of women who preferred midwifery care and planned home birth were higher than currently access those types of care in the U.S. More respondents preferred to use pain medication than to avoid it. Over 95% of respondents preferred vaginal delivery. Women who had an internal locus of control and perceived their childbearing role to be one of active participation were more likely than women who saw their role as a passive one to prefer midwifery care, home birth, vaginal delivery, and to avoid pain medication. Women who saw the provider’s role as dominant to their own were more likely to prefer physicians and hospital birth than those who viewed the provider’s role as a collaborative one. The more fearful/painful women expected birth to be, the more likely they were to prefer cesarean delivery.

Amning är viktig ur många aspekter. Om amningen inte fungerar kan det få känslomässiga konsekvenser för den nyblivna modern och anknytningen till barnet kan också påverkas negativt. Tiden för nyblivna mödrar att tillgodogöra sig amningskunskaper och -färdigheter på BB har minskat på senare år då vårdtiden har kortats. Syftet med denna litteraturstudie var att undersöka nyblivna mödrars upplevelse av amningsstöd på BB. Elva vetenskapliga artiklar granskades och bedömdes. Hur nyblivna mödrar upplevde amningsstödet på BB kunde urskiljas i fyra kategorier; Råd och information, Bemötande och praktisk hjälp, Individuell bekräftelse och Stress. När amningsstödet inte motsvarade mödrarnas önskemål, ledde det till känslor av osäkerhet och otillräcklighet. Fortsatt forskning är nödvändig för att ta reda på hur amningsstödet kan förbättras för nyblivna mödrar på BB. Det behövs ett nytt sätt att organisera och arbeta för att vården skall bli mer jämlik, där mödrarna i större utsträckning är delaktiga och ges eget ansvar. / Breastfeeding is important in many aspects. If breastfeeding does not work, it may have emotional consequences for the new mother and attachment to the child may also be adversely affected. The time for new mothers to benefit from breastfeeding knowledge and skills in the maternity ward has declined in recent years when the hospital stay has been shortened. The purpose of this study was to examine new mothers' experiences of breastfeeding support in the maternity ward. Eleven scientific papers were surveyed and evaluated. How new mothers experienced breastfeeding support in the maternity ward were evident in four categories: Advice and Information, Treatment and practical help, Independent confirmation and Stress. When breastfeeding support did not meet their mothers' wishes, it led to feelings of insecurity and inadequacy. Further research is needed to find out how breastfeeding support can be improved for new mothers in the maternity ward. We need a new way of organizing and working in healthcare to be more equal, where the mothers to a greater extent are involved and given responsibility.

Kvinnans kropp förändras i samband med graviditet och barnafödande. Detta kan leda till sexuell ohälsa första tiden som nybliven mamma. Det är viktigt att barnmorskor kan identifiera och våga diskutera de problemen som kan finnas för att kunna hjälpa kvinnan. Syftet med studien var att belysa faktorer som kan påverka kvinnors upplevelse av sitt sexualliv efter genomgången vaginal förlossning. Metoden är en litteraturstudie som har utförts med en kvalitativ ansats. Artiklarna hade både kvalitativa och kvantitativa ansatser vilket gav studien både djup och bredd. I resultatet framkom att kvinnor funderade över hur deras sexuella samliv påverkades efter vaginal förlossning. De kroppsliga förändringar kvinnan genomgick hade betydelse för hennes upplevelse av sitt sexualliv. Det sexuella samlivet påverkades i negativ riktning av trötthet. Smärta vid samlag hade oftast lagt sig efter tre till sex månader, medan nedsatt lust kunde hålla i sig upp till ett och ett halvt år. Dessa faktorer ledde till att frekvensen samlag minskade. Detta kunde bli ansträngande för den parrelationen kvinnorna levde i då behovet av sexuellt umgänge ofta var ojämnt mellan kvinna och man. Resultatet visade att barnmorskor endast berörde ämnet sexualitet genom att ge kvinnan recept på preventivmedel. Barnmorskor bör aktivt fråga kvinnan om besvär med sexuallivet för att underlätta rollen som nybliven mamma, kvinna och älskarinna.

Background. To give birth can be a stressful experience and women cope with thisstress in many different ways and have different personal outcomes. Self-efficacy orconfidence in ability to cope with labour can be considered as an important factoraffecting pregnant women’s motivation of normal childbirth and their interpretation ofthe childbirth event.The aim. The purpose of this study was to test the Chinese short form of theinstrument Childbirth self-efficacy instrument (CBSEI) in Tanzania, that measurepregnant women’s self-confidence and coping abilities during childbirth.Method. The Chinese short form of the CBSEI was used to pilot test the pregnantwomen’s confidence of childbirth to see if the questions were understood in theTanzanian culture. Besides this instrument socio-demographic data was collectedtogether with two open questions asking about attitudes and experiences of childbirth.The instrument was translated into Kiswahili. A sample of 60 pregnant women whowere visiting antenatal clinic (ANC) regularly were asked to participate and with helpfrom midwifes at two ANC places the questionnaires were filled out.Result. The result shows that the validity and reliability of the two subscales OE-16and EE-16 were established. The internal consistency reliability of the two subscaleswere high, suggesting that each of the subscale mean score provides a good overviewof self- reported belief in coping ability for childbirth.The results further show that the instrument, CBSEI in this pilot study is not able toidentify women who need extra support during childbirth.Conclusion. The reliability and validity of information presented in this pilot studysupport the use of the Chinese short form of the CBSEI as a research instrument in theTanzania culture. Further studies are recommended to get a wider understandingabout women’s coping abilities in a culture like Tanzania.

<p>This dissertation explores the simultaneous trends towards increasing and decreasing medical intervention in childbirth. Using the medicalization literature as a theoretical framework, I use a mixed-methods approach to explore how both the medical community and laypeople think about and plan for childbirth.</p><p>First, the midwifery and obstetrics literatures from the past 35 years are reviewed to provide a medical and scientific context for the trends seen in childbirth over this time period. Second, descriptive and logistic regression analyses of the Center for Disease Control's Natality dataset, a census of U.S. birth certificate data, provide a picture childbirth trends and an understanding of the relationship between maternal characteristics and medicalized and natural births. Third, 35 qualitative interviews were conducted with pregnant women, focusing on their plans for their children's birth. The interviews also address the factors that influence women's plans and choices for childbirth, thus providing a better understanding of the social factors that affect birth plans.</p><p>The key finding of this research is that most women would prefer to be able to have the "best of both worlds" - the ability to experience childbirth as a natural process for as long as is safe and comfortable, combined with immediate access to the medical skills and technology that can assist them and their babies in an emergency.</p><p>The quantitative analyses demonstrate that alternatives to a mainstream model of childbirth are on the rise, even while these alternatives continue to represent only a small fraction of births. The increase in midwifery use while rates of hospital births remain relatively consistent suggests that many midwife-attended births are taking place in hospitals. These data support the finding that women like the idea of a natural birth, but also want to have ready access to trained doctors, surgeons, and the best medical care available in case something goes wrong.</p><p>There can be no doubt that childbirth, on the whole, had become a highly medicalized process. However, despite the fact that women want childbirth to be recognized as a natural process, there is no true movement for the demedicalization of childbirth. That is, women are not suggesting that medical intervention be removed entirely from childbirth. Instead, there need to be more options available to women, thus enabling them to give birth in a way that is comfortable and respectful of their preferences and goals, while simultaneously maintaining ready access to additional intervention, should it be necessary.</p><p>Implications for future research in childbirth and other fields of study are discussed.</p> / Dissertation

<p>Kvinnans kropp förändras i samband med graviditet och barnafödande. Detta kan leda till sexuell ohälsa första tiden som nybliven mamma. Det är viktigt att barnmorskor kan identifiera och våga diskutera de problemen som kan finnas för att kunna hjälpa kvinnan. Syftet med studien var att belysa faktorer som kan påverka kvinnors upplevelse av sitt sexualliv efter genomgången vaginal förlossning. Metoden är en litteraturstudie som har utförts med en kvalitativ ansats. Artiklarna hade både kvalitativa och kvantitativa ansatser vilket gav studien både djup och bredd. I resultatet framkom att kvinnor funderade över hur deras sexuella samliv påverkades efter vaginal förlossning. De kroppsliga förändringar kvinnan genomgick hade betydelse för hennes upplevelse av sitt sexualliv. Det sexuella samlivet påverkades i negativ riktning av trötthet. Smärta vid samlag hade oftast lagt sig efter tre till sex månader, medan nedsatt lust kunde hålla i sig upp till ett och ett halvt år. Dessa faktorer ledde till att frekvensen samlag minskade. Detta kunde bli ansträngande för den parrelationen kvinnorna levde i då behovet av sexuellt umgänge ofta var ojämnt mellan kvinna och man. Resultatet visade att barnmorskor endast berörde ämnet sexualitet genom att ge kvinnan recept på preventivmedel. Barnmorskor bör aktivt fråga kvinnan om besvär med sexuallivet för att underlätta rollen som nybliven mamma, kvinna och älskarinna.</p>

In Bolivia, indigenous women's desires to give birth in an atmosphere of respect and cultural autonomy, as well as physicians' and politicians' attempts to mold the nation along racial lines, shaped the development of obstetric medicine. Based on oral histories of midwives, nurses and obstetricians, this study uses midwifery as a lens to examine the connections between nation-state formation and the development of obstetric medicine in Bolivia between 1900 and 1982. Putting midwives at the center of a study about nation-state formation reveals complexities that many male-centered studies miss: indigenous, mixed-race, and white Bolivian women played central roles in state projects and, through their embodiment of different forms of womanhood, influenced debates about Bolivian national identity. This study also engages groundbreaking feminist studies of the 1970s and '80s which showed that U.S. and European male physicians created obstetric medicine by pushing female midwives out of the practice. These physicians typically accused midwives of ineptitude and defined childbirth assistance as a scientific medical procedure that should not be practiced by women. While that pattern holds true in Bolivia to some extent, it does not explain the power dynamics that shaped childbirth assistance in Bolivia. Over the course of the twentieth century, Bolivian physician's desires to modernize childbirth assistance and childrearing practices intertwined with the efforts of Bolivia's elite to overcome what they considered the country's "Indian Problem."

The Birth Centre is a midwife-led, out-of-hospital facility for normal births in Winnipeg, Manitoba. Exploring women’s experiences of choosing the Birth Centre was the primary objective for this thesis. Through a feminist perspective and using interpretative phenomenological analysis (IPA), each participant’s idiographic description of the decision-making experience was analysed. A sample of seventeen women participated in in-depth interviews. Six themes emerged through the qualitative analysis: Exercising personal agency; Making the decision in the context of relationships; An expression of one’s ideology; Really thinking it through; Fitting into the eligibility criteria; and The psychology of the space. The findings suggest that a woman’s sense of safety is related to these themes. The women had a normal birth influence in their lives from personal relationships, past experiences, or personal values and beliefs. The study highlighted the importance of access to midwifery services in order to increase awareness and access to the Birth Centre.