Breech birth has become a rare phenomenon in England over the last two decades. 3-4% of all babies present bottom or feet first at full term (37-42 weeks gestation) and despite conflicting research about the safest mode of delivery for breech presentation, the vast majority of breech babies will be delivered by planned caesarean section. The small number of qualitative research studies suggest that the experience of breech has complex meanings for childbearing women. This research intended to explore these elements further and to better understand this experience within a social, cultural and gendered context.

This study explores the introduction of an approach called Pre-Therapy to staff working with people with dementia. Pre-Therapy contributes to the existing range of therapeutic approaches which aim to engage with the subjective experience of the world of people with dementia who have severe difficulty communicating. Pre-Therapy aims to facilitate engagement and create relationships with people who are traditionally seen as beyond contact or out of reach. The approach involves using contact reflections. The worker reflects back to the person their words, facial expressions, actions and surroundings. Until now, the application of Pre-Therapy to dementia care has not been explored in depth. An Action Research process examined the research question - What happens when staff learn and use Pre-Therapy contact reflections with people with dementia? The question involved three aspects: the response of people with dementia to contact work, the use of contact work by staff, and the learning process undergone by staff. Underpinned by values of inclusion, participation, democracy and collaboration, the study demonstrates joint inquiry and cyclical exploration. The research process involved self-participation, participation with health care staff and engagement with an expert community (The International Pre-Therapy Network). The entire research process spanned five years. Eleven staff in three residential settings participated as colearners for 18 months of the process. Located in the real world context, the study accommodated organisational flux, service instability and changes of personnel in a climate of modernization and reorganisation. Data were generated through observation, which included 14 hours of video recordings of interactions, and ongoing dialogue with health care staff and the expert community. The analytic process accompanied the research activity, using comparative analysis and Schatzman's Dimensional Analysis. Findings indicate that Pre-Therapy Contact Work has the potential to add to existing approaches in dementia care, facilitating greater self-expression of the experience of the subjective world of the person with dementia and promoting greater communication with workers. However, minor adaptations of the approach are indicated. Despite the apparent simplicity, contact work challenged staff. Barriers to learning and using contact work arose from intrapersonal, interpersonal and contextual factors. Factors which mediated the learning and use of contact work led to the emergence of a theoretical model of the emotional management of interactions. Resting on theories of constructed role identities, the model contains two contrasting positions: the emotional custodian and the emotional container. The thesis proposes that the model may be part of an underlying social process around maintaining emotional social order in interactions with people with dementia. In turn, this may help understand difficulties workers face when engaging in the emotional world of people with dementia and enacting values of being person-centred which are inherent in the policy and literature.

Podoconiosis is a neglected tropical skin disease caused by a fault in skin barrier function (SBF) combined with a genetic predisposition. Irritant minerals and pathogens entering breaches in plantar skin cause an inflammatory reaction and lower leg lymphoedema. This has a considerable negative impact on the quality of life and economic status of some of the poorest people in 20 countries. Podoconiosis is preventable and treatable but not curable. No previous pre/post controlled intervention studies on skin treatment for the disease have been published. The aim of this randomised control trial (RCT) was to evaluate the effectiveness of a low-cost evidence-based skin care intervention to improve the SBF in the legs/feet and enhance disease related quality of life. A pilot study (n=10) indicated that adding 2% glycerine to the existing skin management regime used in Ethiopia could have a positive effect on stratum corneum (SC) hydration levels and trans-epidermal water loss (TEWL). The study recruited participants from two Ethiopian clinics (n=193). The control group used the existing treatment regime: washing legs/feet with soap, soaking in 6 litres of water with disinfectant added and applying Vaseline®. The experimental group added a 2% dilution of glycerine to 1/6 of the amount of soaking water and 0.0045% less disinfectant. After 3 months the experimental intervention had a highly significant positive effect on TEWL (p = < 0.001) and SC hydration (p = < 0.002) compared to the control. The reduction in foot circumference was highly significant (p = < 0.001). There was no significant group difference in Dermatology Life Quality Index (p = 0.907). The study indicates the very positive effect on SBF of adding 2% glycerine and less disinfectant to the current treatment. This finding offers a significant contribution to the body of knowledge on the management of the disease. The addition of 2% glycerine to treatment regimens may also have positive effects on other skin diseases with compromised SBF.

No description available.

The specific aim of this thesis was to explore the culture, beliefs, values, customs and practices around the birth process within a free-standing midwifery-led birth centre (FSBC). It was done to shed light on the workings of this little known model of maternity service provision and to build on the small amount of qualitative research in this field to date. Using ethnography, I undertook participant observation within a FSBC in England over a nine month period. I interviewed thirty women who gave birth at the centre and fifteen members of staff who worked there. The birth centre rejected bureaucratic, institutional and hierarchical modes of management commonly seen in hospitals and was run more in accord with postmodern organisational attributes of devolved decision-making and teamworking. Leadership was transformational and decentred. The birth centre staff had powerful sense of identity and ownership of the facility, forged partly through a successful campaign to resist its closure over recent years. They had a strong commitment to creating an optimum birthing environment for normal birth to flourish, which may be explained by a vicarious 'nesting' instinct on behalf of women giving birth at the centre. The model of care contrasted with Fordist assembly-line birth in larger hospitals with the staff having time to 'wait on birth' and to 'be with women'. Their relationships with women were marked by equality and altruism. Their relationships with each other reflected communitarian values and a shared purpose that I theorized was an example of social capital. Childbirth for many women at the birth centre rejected the technocratic model, connecting more to birth's social origins. Finally, a defining characteristic of birth centre care appeared to be 'matrescence' wherein staff nurtured the 'becoming of a mother. The study provides an important insight into the values and benefits of small scale maternity care provision and the findings contrast sharply with much mainstream provision today based on large, obstetric-led hospitals.

No description available.

Despite improvements in health care services there are poor perinatal outcomes in the rural and remote regions of Morocco. A national plan was adopted as part of a WHO, UNICEF and UNFPA initiative to reduce maternal and neonatal deaths in underserviced regions. Strengthening the profession of midwifery was identified as a key component of the initiative. In 2008, a Moroccan framework for midwifery education, regulation and funding was established. There is evidence that funded midwifery care is not being accessed by women in rural regions. A scoping review was undertaken to examine the social barriers. The review was conducted using the Arksey and O’Malley’s 2005 framework for scoping reviews. The research stages included 1) identifying the research question; 2) identifying the relevant studies; 3) study selection; 4) charting the data; 5) collating, summarizing and reporting the results. The aim was to identify how the socio-cultural context can impede the uptake of midwifery care and thus impact maternal and neonatal outcomes. Language barriers, cultural differences and gender inequality were identified as key barriers that impact the acceptability of midwifery care in Morocco. / Thesis / Master of Science (MSc)

There is a lack of conceptual clarity regarding the drivers of midwives’ roles within health systems, which has contributed to the significant variability both within and across countries in whether, to what extent and how midwives are integrated in these systems. This dissertation incorporated a mix of methodological approaches to address this gap. First, a critical interpretive synthesis was used to develop a theoretical framework that identifies the different types of policy levers that would be required to enhance to roles of midwives within any given health system, and an exploratory network analysis was used to analyze relationships among the ‘health system arrangements’ part of the framework and to identify gaps in the literature. Second, a logistic regression was used to examine the correlates of birth-experience satisfaction – as a patient experience component of the health system ‘triple aim’ – among women receiving care from midwives, family physicians and/or obstetricians in Ontario’s health system. Third, an embedded single-case study design and Kingdon’s agenda setting and the 3i+E theoretical frameworks were used to qualitatively assess how and under what conditions the Ontario health system has assigned roles to midwives. The research chapters build on each other and make substantive, methodological and theoretical contributions. Specifically, insights gained from the theoretical framework informed variable selection and definition for the quantitative analysis and were tested in the embedded single-case study. Substantively, the dissertation provides a rich understanding of the roles of midwives in health systems through a mix of qualitative and quantitative research evidence, adding to the evidence base that policymakers can draw from when making decisions regarding midwifery care. v Methodologically, the dissertation introduces a novel combination of a critical interpretive synthesis and exploratory network analysis. Lastly, the dissertation advances the theoretical understanding of the roles of midwives within health systems through a new theoretical framework. / Thesis / Doctor of Philosophy (PhD) / Midwives who are educated and regulated according to international standards can play important roles in the provision of maternal and newborn care. Yet, there is significant variation within and across countries in whether, to what extent and how the profession has been integrated in most health systems. A lack of understanding regarding these roles likely contributes to this variation. This dissertation addresses gaps in understanding through: 1) a framework, which can be used as a tool by policymakers to identify policy levers that would be needed to enhance to roles of midwives within any given health system; 2) supportive quantitative evidence on birth-experience satisfaction among women in Ontario’s health system who received care from midwives; and 3) examining in two reform efforts why many women continue to experience unmet midwifery needs in Ontario’s health system even though the government is generally supportive of the profession.

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No / This article presents findings from my PhD study entitled Midwifery knowledge and the medical student experience. The research study sought to explore the question: 'What do medical students learn from midwives?' In the first part of this dual-phase project I conducted a Delphi study with an international panel of midwives to examine the concept of 'midwifery knowledge' (MacVane 2013a). Data from the Delphi survey were used to inform the second phase, which employed a longitudinal case study approach to explore medical students’ experiences of working with midwives during a specialist obstetric rotation. Thirteen medical students, who were recruited from a fourth-year cohort, participated in interviews at the start, middle and end of their specialist obstetric rotation. The students spent the majority of the rotation at their local teaching hospital (LTH), but also spent an interim two-week period at a variety of district general hospitals (DGH).