Grâce à des entretiens non directifs réalisés auprès de 16 sages-femmes et 16 obstétricien(ne)s, cette recherche tente de cerner l’impact que la mort périnatale a sur eux et sur leur travail, au-delà de celui qu’elle a sur les parents avec le deuil périnatal. Face à des progrès médicaux sans précédent, la société, les parents et les soignants eux-mêmes s’attendent peu à la survenue de la mort dans la naissance. Interruption médicale de grossesse ou mort périnatale inattendue confrontent cependant ces soignants à des épreuves au travail susceptibles d’avoir sur eux des répercussions majeures selon le contexte et l’âge de la grossesse. Elles donnent lieu à des déficits de la reconnaissance, qu’elle soit sociale, professionnelle ou personnelle. Leur restauration nécessite le recours actif à l’intersubjectivité engagée auprès des pairs comme auprès des parents afin que les soignants puissent continuer leur travail et y rester. / Through 32 open-ended interviews with midwives and obstetricians, this work attempts to identify, beyond parental mourning, the impact of perinatal death on childbirth professionals and their work. Unprecedented medical advances result in a relative absence of expectation of death in birth for the society, medical professionals and for the parents. Medically motivated induced termination or unexpected perinatal death, however, confronts caregivers at work with an ordeal which can have major repercussions depending on the context and the term of the pregnancy involved. These events cause deficits in social, professional and personal recognition in these caregivers. To be restored, symbolic processing is necessary for all concerned through the implication of subjectivity at work with peers and parents in order for these caregivers to be able to continue to work.

Summaries in English, Afrikaans and Tswana / The purpose of this study was to explore and develop understanding of nurses and midwives’ perceptions and attitudes towards the implementation of CPD, aiming to provide them with a platform to make recommendations to enhance the attendance of CPD.The study was conducted in a public regional hospital in Limpopo Province, South Africa. The purposive exploratory descriptive qualitative research method was used. Data was collected through Focus Group Discussions. Participants comprised of three focus group discussions. A semi-structured guide with open –ended questions was used and discussions were recorded with an audio recorder which were transcribed verbatim. Content analysis of the data was done. The study yielded themes, sub-themes and codes during analysis. Participants perceived CPD to have benefits to keep nurses updated with knowledge, skills and improvement of attitudes. It improves quality patient care. However, they identified staff shortage, time constraints and lack of internet connection as the major challenges. / Die doel van hierdie studie was om ‘n begrip van die houdings en persepsies teenoor die implementering van voortgesette professionele ontwikkeling (VPO) van verpleegkundiges en vroedvroue te verken, ten einde ‘n platform vir aanbevelings daar te stel om die bywoning van VPO te bevorder. Die studie was in 'n openbare streekshospitaal in die provinsie Limpopo, Suid-Afrika gedoen. ‘n Kwalitatiewe, doelgerigte, verkennende en beskrywende navorsingsmetode was gebruik om data is deur middel van drie fokusgroepbesprekings in te samel. ‘n Semi-gestruktureerde onderhoudegids met oop vrae was gebruik om klankopnames van gesprekke, verbatim te transkribeer. Data was ontleed deur middel van inhoudsanalise. Temas, subtemas en kodes is tydens die analise geïdentifiseer. Die deelnemers het VPO as voordelig beskou in terme van die opdatering van verpleegkundiges se kennis, vaardighede en houdings. Gehalte pasiëntsorg word sodoende verbeter. Hulle het egter personeeltekort, 'n gebrek aan tyd, en toegang tot die internet as ‘n struikelblok geïdentifiseer. / Maikaelelo a dipatlisiso tse (research), e ne e le go sekaseka le go tlhabolola kutlwisiso ya baoki le babelegisi ka ga tebo le maikutlo a bona mabapi le tshimololo ya go thlabolola dithuto bale tirong “CPD”. Maikaelelo e ne e le go ba neela tšhono ya go dira ditshwaelo go oketsa dipalo tse di tsenang dithuto tsa CPD. Dipatlisiso tse di diretswe kwa dipetleleng tsa kgaolo tsa botlhe, Porofenseng ya Limpopo mo Aforikaborwa. Go dirisitswe mokgwa wa dipatlisiso wa ‘purposive exploratory descriptive qualitative research’ mo di patlisisong tse. Dikitso di kgobokantswe go ya ka mokgwa wa lekgotla ‘Focus Group Discussion’. Batsayakarolo ba ne ba arogantswe ka ditlhopha tse tharo tsa ‘focus group discussions’. Kaedi e e rulagantsweng e e nang le dipotso tsa boitlhalosi- ka- botlalo e dirisitswe mme dipuisano tsa gatiswa ka rekhoto ya kgatiso-modumo morago tsa kwalwa fatshe ka mokgwa o di builweng. Tshekatsheko ya diteng tsa dikitso tse e dirilwe ka go latela mokgwa wa ‘content analysis’. Dipatlisiso tse dineetse molaetsa mogolo, melaetsanyana le melao ka nako ya ditshekatsheko. Batsayakarolo ba bone gothlabolola dithuto bale tirong ‘CPD’ go nale mosola mo tsweletsong ya go neela baoki kitso, bokgoni le tokafatso ya maitshwaro. E tokafaditse boleng ba tlhokomelo ya balwetse. Le fa go ntse jalo, ba supile fa tlhaelo ya baoki, dinako tsa go dira le go tlhoka kgokelelo ya enthanete e le dikgwetlho tse kgolo. / Health Studies / M.A. (Nursing Science)

<p>Ulla Isaksson (1916 – 2000) wrote many novels, often with a woman or several women as protagonists. In <em>Dit du icke vill</em> (“Where Thou Willst Not”) from 1956 she depicts a crisis of faith in a woman, which would not have been successful had she chosen a contemporary setting. She uses an adequate historical framework, the prosecution of witches in Sweden in the 17^th century, well documented in reliable sources. Her novel includes a message about oppression of women, manifest in patriarchal ambition to control ancient wisdom about healing and herbs and the denial of pre-Christian habits that include knowledge about female fertility, earlier exercised by midwives and wise women and men.</p><p>In “The Root of Evil” the novel is placed in a feminist tradition, where the author, like older writers like Fredrika Bremer, Ellen Key and Elin Wägner, pleads for “social mothering”.  A major difference is that, in her own life, Ulla Isaksson has experienced pregnancy, giving birth and breastfeeding which none of the pioneering Swedish feminist writers had. Emilia Fogelklou, pioneering theologian, wrote about witches as wise women, a study that influenced Ulla Isaksson. The witches are described as mirroring Hanna “the Good Mother”. Their fantasies about life at “Blåkulla” are similar to the everyday life at a wealthy farmstead. This kind of mirroring reminds of the theories of Gilbert and Gubar, who assume that female writers in the 19^th Century hid their revolt against patriarchy in mad women, like “The Madwoman in the Attic” in Jane Eyre. In the 1950s, golden age of the Swedish housewife, a female writer might well hide her anger at the circumscribed role model dedicated to women in a similar use of Anti-Women. The real witches clearly contrast the obedient protagonist, a true “Angel in the house”.</p><p>The villagers´ struggle to clear the ground from the ensnaring roots that hinder the male prosecution of witches imply a symbolic reading: this evil root is ancient matriarchal knowledge of childbearing and birth control. A theory on the original causes for the witch hunts in western Europe is introduced: the population sank in the 15^th century and one reason, beside plagues, starvation and warfare, was that women aware of how to prevent childbearing and giving birth to a lot of children were killed during the witch hunt. Churches and kings introduced the prosecution of witches and wise women, including midwives.</p>

Ulla Isaksson (1916 – 2000) wrote many novels, often with a woman or several women as protagonists. In Dit du icke vill (“Where Thou Willst Not”) from 1956 she depicts a crisis of faith in a woman, which would not have been successful had she chosen a contemporary setting. She uses an adequate historical framework, the prosecution of witches in Sweden in the 17th century, well documented in reliable sources. Her novel includes a message about oppression of women, manifest in patriarchal ambition to control ancient wisdom about healing and herbs and the denial of pre-Christian habits that include knowledge about female fertility, earlier exercised by midwives and wise women and men. In “The Root of Evil” the novel is placed in a feminist tradition, where the author, like older writers like Fredrika Bremer, Ellen Key and Elin Wägner, pleads for “social mothering”.  A major difference is that, in her own life, Ulla Isaksson has experienced pregnancy, giving birth and breastfeeding which none of the pioneering Swedish feminist writers had. Emilia Fogelklou, pioneering theologian, wrote about witches as wise women, a study that influenced Ulla Isaksson. The witches are described as mirroring Hanna “the Good Mother”. Their fantasies about life at “Blåkulla” are similar to the everyday life at a wealthy farmstead. This kind of mirroring reminds of the theories of Gilbert and Gubar, who assume that female writers in the 19th Century hid their revolt against patriarchy in mad women, like “The Madwoman in the Attic” in Jane Eyre. In the 1950s, golden age of the Swedish housewife, a female writer might well hide her anger at the circumscribed role model dedicated to women in a similar use of Anti-Women. The real witches clearly contrast the obedient protagonist, a true “Angel in the house”. The villagers´ struggle to clear the ground from the ensnaring roots that hinder the male prosecution of witches imply a symbolic reading: this evil root is ancient matriarchal knowledge of childbearing and birth control. A theory on the original causes for the witch hunts in western Europe is introduced: the population sank in the 15th century and one reason, beside plagues, starvation and warfare, was that women aware of how to prevent childbearing and giving birth to a lot of children were killed during the witch hunt. Churches and kings introduced the prosecution of witches and wise women, including midwives.

Dans le contexte actuel de crise des ressources humaines en Afrique sub-saharienne, il est important de comprendre comment les professionnels de santé vivent leur travail et comment cela les affecte. Cette étude longitudinale se focalise sur les sages-femmes du Sénégal en raison de leur rôle stratégique dans la réduction de la mortalité maternelle et infantile dans le pays. Une cohorte de 226 sages-femmes de 22 hôpitaux au Sénégal a participé à l’étude. Leur satisfaction au travail a été mesurée en 2007-8 avec un instrument multidimensionnel développé en Afrique de l’Ouest. Trois effets attendus : le « burnout, » l’intention de quitter et la mobilité professionnelle ont été mesurés deux ans plus tard. Des statistiques descriptives ont comparé celles qui ont quitté leur poste à celles qui sont restées, et une série de régressions multiples a modélisé les liens entre les facettes de la satisfaction au travail et les variables d’effet, en contrôlant pour les caractéristiques individuelles et institutionnelles. Les résultats ont montré un taux relativement faible de « turnover » sur 2 ans (18%), malgré une forte intention de quitter son poste (58.9%), surtout pour faire une nouvelle formation professionnelle. Les départs étaient majoritairement volontaires (92%) et entièrement intra-nationaux. Les sages-femmes se disaient le moins satisfaites avec leur rémunération et leur environnent de travail, et une forte proportion éprouvait des niveaux élevés d’épuisement émotionnel (80.0%) et de dépersonnalisation (57.8%). Toutefois, elles rapportaient être satisfaites de leur moral et de la stabilité de leur travail, et seulement 12% avaient des niveaux faibles d’accomplissement personnel. L’épuisement émotionnel était associé avec l’insatisfaction vis-à-vis de la rémunération et des tâches, la recherche active d’emplois était liée avec être insatisfaite de la stabilité du travail et avoir quitté son poste était associé avec une insatisfaction avec la formation continue. Cette étude montre que les sages-femmes semblent souffrir de « burnout », mais qu’elles se sentent toujours confiantes et accomplies au travail. Les résultats suggèrent que promouvoir la formation continue pourrait aider à retenir les sages-femmes dans leurs postes et dans la profession. / In the context of a health workforce crisis in sub-Saharan Africa, a better understanding of how health professionals are experiencing their work and how it is affecting them is needed. This longitudinal study focuses specifically on Senegalese midwives, given their strategic role in the promotion of mother and child health in the country. A cohort of 226 midwives from 22 hospitals across Senegal participated in the study. Their job satisfaction was measured in 2007-8 using a multifaceted instrument developed in West Africa. Three purported effects were measured two years later: burnout, intention to quit and turnover. Descriptive statistics compared the midwives who stayed and left their posts during the study period, and a series of exploratory regressions investigated the correlations between the 9 facets of job satisfaction and each effect variable, while controlling for individual and institutional characteristics. Relatively low turnover was found over 2 years (18%) despite high levels of intention to quit within a year (58.9%), particularly in pursuit of a new professional specialty. Departures were largely voluntary (92%) and entirely domestic. The midwives reported themselves least satisfied with their remuneration and work environment, and a large proportion experienced “high” levels of emotional exhaustion (80.0%) and depersonalization (57.8%). However, they were found to be satisfied with their morale and the stability of their work, and only 12.4% reported diminished personal accomplishment. Emotional exhaustion was related to being dissatisfied with remuneration and job tasks, actively searching for jobs was associated with dissatisfaction with job stability and voluntary quitting was associated with being unhappy with continuing education. This study shows that although midwives seem to be burned-out and unhappy with their working conditions, they retain a strong sense of confidence and accomplishment in their work. It also suggests that strategies to retain them in their positions and in the profession should emphasize continuing education.

As intensive care of preterm infants and high-risk infants has evolved, the practice of close physical contact between parents and their infants has been curtailed, with the separation of mothers and their infants more the norm than the exception (Browne, 2004). However, in the past two decades, the physiologic and socio-emotional benefits of close physical contact between parents and their high-risk infants has been revisited, with the practice of Kangaroo Mother Care (skin-to-skin contact) dramatically increasing in neonatal care units worldwide (Browne, 2004). Although research on Kangaroo Mother Care’s effects is plentiful, literature reveals gaps in the research pertaining to the experiences of midwives and nurses in its practice (Chia, 2006 & De Hollanda, 2008). As the role of midwives/nurses has been identified as crucial for Kangaroo Mother Care practice, this gap was recognised, and impelled this research study to be conducted in order to further extend the practice of KMC for its benefits to infants and their families. Due to current staff shortages and poorly resourced neonatal facilities in our local hospitals, local data on midwives’ experiences of Kangaroo Mother Care was perceived to be a vital first step in exploring these experiences. The purpose of this qualitative study was to explore the lived experiences of midwives regarding the Kangaroo Mother Care initiative at a selected tertiary level hospital in the Ethekwini District. Interpretive phenomenology informed this study design, data collection and analysis. As Kangaroo Mother Care is a complex phenomenon, an interpretive paradigm allowed the researcher to access the meaning of participants’ experiences as opposed to explaining their predicted behaviour. Purposive sampling was used by the researcher to select the eight midwives working in the tertiary hospital in the Ethekwini District. The midwives were selected from the neonatal unit during August 2011. Data was collected through a single in-depth interview with each participant in the neonatal unit. The interviews were recorded and later transcribed verbatim to facilitate analysis. Colaizzi’s method of data analysis and representation was utilised. Eleven themes emerged from the analysis of the data. Themes were aligned to the research objectives and included the participants’ experiences of conceptualisations, experiences, hindering and facilitating factors of Kangaroo Mother Care. Conceptualisations were aggregated into two themes pertaining to a physiological concept of KMC and an emotive concept of KMC. The physiological concept regarded the catalytic action of KMC as a promotive agent in health through its effect in increasing average weight gain. Furthermore, KMC was seen as a protective agent in reducing cross-infection and hypothermia. These findings aligned with findings from authors in the literature review. An emotive concept of KMC was revealed by the participants’ input regarding the effect of the skin-to-skin contact in facilitating maternal-infant attachment through bonding. This study finding is supported by current literature. Lived experiences emerged regarding the theme of KMC in maternal instinct and capability, which findings encompassed increased maternal confidence and competence with which several authors concurred. Factors considered as hindering KMC included five themes which emerged as maternal concerns, increased work-load, lack of training, management support and resource scarcity. Contrary to these, facilitators of KMC included the need for motivation and education as well as the provision of a comfortable environment conducive to the practice of Kangaroo Mother Care. A number of recommendations for nursing practice, nursing education, communities and research based on the findings from the study were made available to relevant stakeholders. If implemented effectively, these recommendations may assist in the continued and increasing practice of KMC; resulting in its beneficial effects changing infants’ and families’ lives. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2011.

The role of midwife has been an integral part of the culture of childbirth in Queensland throughout its history, but it is a role that has been modified and reshaped over time. This thesis explores the factors that underpinned a crucial aspect of that modification and reshaping. Specifically, the thesis examines the factors that contributed to the statutory regulation of midwives that began in 1912 and argues that it was that event that etched the development of midwifery practice for the remainder of the twentieth century. In 1859, when Queensland seceded from New South Wales, childbirth was very much a private event that took place predominantly in the home attended by a woman who acted as midwife. In the fifty-threeyears that followed, childbirth became a medical event that was the subject of scrutiny by the medical profession and the state. The thesis argues that, the year 1912 marks the point at which the practice of midwifery by midwives in Queensland began a transition from lay practice in the home to qualified status in the hospital. In 1912, through the combined efforts of the medical profession, senior nurses and the state, midwives in Queensland were brought under the jurisdiction of the Nurses' Registration Board as "midwifery nurses". The Nurses' Registration Board was established as part of the Health Act Amendment Act of 1911. The inclusion of midwives within a regulatory authority for nurses represented the beginning of the end of midwifery practice as a discrete occupational role and marked its redefinition as a nursing specialty. It was a redefinition that suited the three major stakeholders. The medical profession perceived lay midwives to be a disjointed and uncoordinated body of women whose practice contributed to needless loss of life in childbirth. Further, lay midwives inhibited the generalist medical practitioners' access to family practice. Trained nurses looked upon midwifery as an extension of nursing and one which offered them an area in which they might specialise in order to enhance their occupational status and career prospects. The state was keen to improve birth rates and to reduce infant mortality. It was prepared to accept that the regulation of midwives under the auspices of nursing was a reasonable and proper strategy and one that might assist it to meet its objectives. It was these separate, but complementary, agendas that prompted the medical profession and the state to debate the culture of childbirth, to examine the role of midwives within it, and to support the amalgamation of nursing and midwifery practice. This thesis argues that the medical profession was the most active and persistent protagonist in the moves to limit the scope of midwives and to claim midwifery practice as a medical specialty. Through a campaign to defame midwives and to reduce their credibility as birth attendants, the medical profession enlisted the help of senior nurses and the state in order to redefine midwifery practice as a nursing role and to cultivate the notion of the midwife as a subordinate to the medical practitioner. While this thesis contests the intervention of the medical profession in the reproductive lives of women and the occupational territory of midwives, it concedes that there was a need to initiate change. Drawing on evidence submitted at Inquests into deaths associated with childbirth, the thesis illuminates a childbirth culture that was characterised by anguish and suffering and it depicts the lay midwife as a further peril to an already hazardous event that helps to explain medical intervention in childbirth and, in part, to excuse it. The strategies developed by the medical profession and the state to bring about the occupational transition of midwives from lay to qualified were based upon a conceptual unity between the work of midwives and nurses. That conceptualisation was reinforced by a practical training schedule that deployed midwives within the institution of the lying-in hospital in order to receive the formal instruction that underpinned their entitlement to inclusion on the Register of Midwifery Nurses held by the Nurses' Registration Board. The structure that was put in place in Queensland in 1912 to control and monitor the practice of midwives was consistent with the policies of other Australian states at that time. It was an arrangement that gained acceptance and strength over time so that by the end of the twentieth century, throughout Australia, the practice of midwifery by midwives was, generally, consequent upon prior qualification as a Registered Nurse. In Queensland, in the opening years of the twenty-first century, the role of midwife remains tied to that of the nurse but the balance of power has shifted from the medical profession to the nursing profession. At this time, with the exception of a small number of midwives who have acquired their qualification in midwifery from an overseas country that recognises midwifery practice as a discipline independent of nursing, the vast majority of midwives practising in Queensland do so on the basis of their registration as a nurse. Methodology This thesis explores the factors that influenced the decision to regulate midwifery practice in Queensland in 1912 and the means by which that regulation was achieved. The historical approach underpins this research. The historical approach is an inductive process that is an appropriate method to employ for several reasons. First, it assists in identifying the origins of midwifery as a social role performed by women. Second, it presents a systematic way of analysing the evidence concerning the development of the midwifery role and the status of the midwife in society. Third, it highlights the political, social and economic influences which have impacted on midwifery in the past and which have had a bearing on subsequent midwifery practice in Queensland. Fourth, the historical approach exposes important chronological elements pertaining to the research question. Finally, it assists the exposure of themes in the sources that demonstrate the behaviour of key individuals and governing authorities and their connection to the transition of midwifery from lay to qualified. Consequently, through analysing the sources and collating the emerging evidence, a cogent account of interpretations of midwifery history in Queensland may be constructed. Data collection and analysis The data collection began with secondary source material in the formative stages of the research and this provided direction for the primary sources that were later accessed. The primary source material that is employed includes testimonies submitted at Inquests into maternal and neonatal deaths; parliamentary records; legislation, government gazettes, and medical journals. The data has been analysed through an inductive process and its presentation has combined exploration and narration to produce an accurate and plausible account. The story that unfolds is complex and confusing. Its primary focus lies in ascertaining why and how midwifery practice was regulated in Queensland. The thesis therefore explores the factors that influenced the decision to regulate midwifery practice in Queensland in 1912 and the means by which that regulation was achieved. Limitations of the study The limitations of the study relate to the documentary evidence and to the cultural group that form the basis of the study. It is acknowledged that historical accounts rely upon the integrity of the historian to select and interpret the data in a fair and plausible manner. In the case of this thesis, one of its limitations is that midwives did not speak for themselves but were, instead, spoken for by medical practitioners and parliamentarians. As a consequence, the coronial and magisterial testimonies that are employed constitute a limitation in that while they reveal the ways in which lay midwifery occurred, they relate only to those childbirth events that resulted in death. Thus, they may be said to represent the minority of cases involving the lay midwife rather than to offer a broader and perhaps more balanced picture. A second limitation is that the accounts are recorded by an official such as a member of the police or of the Coroner's Office and are sanctioned by the witness with a signature or, more often, a cross. It is therefore possible that the recorder has guided these accounts and that they are not the spontaneous evidence of the witness. Those witnesses and the culture they represent are drawn predominantly from non- Indigenous working class. Thus, a third limitation is that the principal ethnic group featured in this thesis has been women of European descent who were born in Queensland or other parts of Australia. This focus has originated from the data itself and has not been contrived. However, it does impose a restriction to the scope of the study.

The dissertation titled Symbols of exclusion from society in folk tradition concentrates on the interaction of symbols and folk tradition. It explores the way the phenomenon of love and death is traditionally viewed in the Czech country, namely during the Middle Ages and modern times. The main focus of this dissertation is on the social roles of women, although it also shows proof of social exclusion of a man as an executioner. To demonstrate the reasons behind excluding individuals on the outskirts of society, the author also gives short characteristics of the views on the issue of chastity, traditional expectations of fulfilling the female social roles - as virgins, wives and mothers. The author then gives examples of behavior which, in folk tradition, were looked upon as impure/virtueless.

Background Due to technological and medical advances, increasing numbers of pregnant and post natal women require higher levels of care, including maternity high dependency care (MHDC). Up to 5% of women in the UK will receive MHDC, although there are varying opinions as to the defining features and definition of this care. Furthermore, limited evidence suggests that the size and type of obstetric unit (OU) influences the way MHDC is provided. There is robust evidence indicating that healthcare professionals must be able to recognise when higher levels of care are required and escalate care appropriately. However, there is limited evidence examining the factors that influence a midwife to decide whether MHDC is provided or a woman’s care is escalated away from the OU to a specialist unit. Research Aims 1. To obtain a professional consensus regarding the defining features of and definition for MHDC in OUs remote from tertiary referral units. 2. To examine the factors that influence a midwife to provide MHDC or request the escalation of care (EoC) away from the OU. Methods An exploratory sequential mixed methods design was used: Delphi survey: A three-round modified Delphi survey of 193 obstetricians, anaesthetists, and midwives across seven OUs (annual birth rates 1500-4500) remote from a tertiary referral centre in Southern England. Round 1 (qualitative) involved completion of a self-report questionnaire. Rounds 2/3 (quantitative); respondents rated their level of agreement or disagreement against five point Likert items for a series of statements. First round data were analysed using qualitative description. The level of consensus for the combined percentage of strongly agree / agree statements was set at 80% for the second and third rounds Focus Groups: Focus groups with midwives across three OUs in Southern England (annual birth rates 1700, 4000 and 5000). Three scenarios in the form of video vignettes were used as triggers for the focus groups. Scenario 1; severe pre-eclampsia, physiologically unstable 2; major postpartum haemorrhage requiring invasive monitoring 3; recent admission with chest pain receiving facial oxygen and continuous ECG monitoring. Two focus groups were conducted in each of the OUs with band 6 / 7 midwives. Data were analysed using a qualitative framework approach. Findings Delphi survey: Response rates for the first, second and third rounds were 44% (n=85), 87% (n=74/85) and 90.5% (n= 67/74) respectively. Four themes were identified (conditions, vigilance, interventions, and service delivery). The respondents achieved consensus regarding the defining features of MHDC with the exceptions of post-operative care and post natal epidural anaesthesia. A definition for MHDC was agreed, although it reflected local variations in service delivery. MHDC was equated with level 2 care (ICS, 2009) although respondents from the three smallest OUs agreed it also comprised level 1 care. The smaller OUs were less likely to provide MHDC and had a more liberal policy of transferring women to intensive care. Midwives in the smaller OUs were more likely to escalate care to ICU than doctors. Focus Groups: Factors influencing midwives’ EoC decisions included local service delivery, patient specific / professional factors, and guidelines to a lesser extent. ‘Fixed’ factors the midwives had limited or no opportunity to change included the proximity of the labour ward to the ICU and the availability of specialist equipment. Midwives in the smallest OU did not have access to the facilities / equipment for MHDC provision and could not provide it. Midwives in the larger OUs provided MHDC but identified varying levels of competence and used ‘workarounds’ to facilitate care. A woman’s clinical complexity and potential for physiological deterioration were influential as to whether MHDC was assessed as appropriate. Midwifery staffing levels, skill mix and workload (variable factors) could also be influential. Differences of opinion were noted between midwives working in the same OUs and varying reliance was placed on clinical guidelines. Conclusion Whilst a consensus on the defining features of, and definition for MHDC has been obtained, the research corroborates previous evidence that local variations exist in MHDC provision. Given midwives from the larger OUs had variable opinions as to whether MHDC could be provided, there may be inequitable MHDC provision at a local level. Organisationally robust systems are required to promote safe, equitable MHDC care including MHDC education and training for midwives and precise EoC guidelines (so workarounds are minimised). The latter must take into consideration local service delivery and the ‘variable’ factors that influence midwives’ EoC decisions.

The purpose of this study was to evaluate care rendered to HIV positive women and their infants during the first six weeks of postpartum. Quantitative, descriptive, cross sectional and analytic study was conducted to investigate postnatal care services provided to HIV positive mothers. Data collection was done using structured questionnaires. 372 respondents participated in the study. Descriptive data analysis was used; Epi info version 3.5.2 software was used. The study highlighted that the quality of PNC was compromised, in all levels including the critical immediate postnatal care, 3-14 days and 6 weeks postnatal care services. All health facilities that were involved in the study had the basic resources to render quality postnatal care. Negative attitudes of staff and long waiting time (16.7%), were the most deterrents to postnatal care. / Health Studies / M.A. (Health Studies)