Thesis (M.Cur.) --University of Limpopo, 2011 / Introduction and aim: Globally it is of paramount importance that all pregnant women in labour are monitored by midwives utilizing a partograph so that a live baby is delivered. Midwives seemed not to utilize the partograph correctly when monitoring women in labour. The purpose of this study was to determine the utilization of the partograph by midwives in the labour wards of Lebowakgomo and Zebediela level 1 hospitals in the Capricorn District of the Limpopo Province, South Africa. The research question was, “What skills and knowledge do midwives have on the utilization of the partograph for monitoring pregnant women in labour”. The objectives of this study were to explore and describe the utilization of the partograph by midwives in Lebowakgomo and Zebediela level 1 hospitals in the Capricorn District of the Limpopo Province, and to develop guidelines that would assist midwives to effectively utilize the partograph hence provision of quality midwifery care. Research Design and method: The research design was qualitative, descriptive, explorative and contextual in nature. The population comprised all midwives registered with the South African Nursing Council and practicing as such in Lebowakgomo and Zebediela level 1 hospitals. A purposive sampling technique was used to select 15 participants. Data were collected using semi-structured in–depth interviews with a guide. The semi-structured in-depth interviews were conducted until data were saturated. Trustworthiness was ensured by credibility, dependability, transferability and confirmability. Ethical clearance to conduct the study was obtained from the University of Limpopo and from the Department Health and Social Development. The principles of informed consent, confidentiality and anonymity were observed during the study. Data were analyzed using the Tesch’s approach as described by Creswell (1994) cited in de Vos (2005:333). Conclusions: The following themes emerged during data analysis: monitoring of foetal status during intrapartum, monitoring of the progress of labour during intrapartum, monitoring of the maternal status during intrapartum, and shortage of staff in the labour wards. Guidelines which aimed at improving midwifery care were formulated.

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 Professional Doctorate in Midwifery explores the development of maternity services in New Zealand subsequent to legislative changes in 1990 enabling midwives to provide the same services as doctors and access the same funding for the provision of care for childbearing women. The papers in this portfolio describe and analyse challenges faced by New Zealand midwives in achieving their full potential as autonomous health professionals and the strategies they developed to survive within a healthcare environment that despite changes, remained medicalised. Throughout this portfolio, a theoretical framework based on complexity theory provides a lens for critique of the varying challenges to midwifery development and strategies to progress the profession. The seven papers that make up this portfolio were developed and written over a five-year period from 1999 to 2003. During this time I was involved in various activities supporting midwifery in New Zealand, including the establishment of a postgraduate midwifery programme and participation in the refocusing of both the New Zealand College of Midwives and the Midwifery and Maternity Provider Organisation. These activities took me to various parts of the country, enabling me to maintain contact with midwives from a variety of settings. The first paper sets the scene for the portfolio by exploring the socio-political context of contemporary midwifery in New Zealand. The second paper tracks the emergence of a theoretical framework out of Complexity theory and presents a set of principles, which guide the critique of midwifery services and professional development, explored in the subsequent papers. Part Three documents the development of a contextual scanning tool, used to analyse the organisation of maternity care by midwives in rural settings. Part Four presents the findings of the scan and strategies for consolidating the role of midwives as key providers of maternity services in rural localities. Part Five documents the development of a programme for optimising midwifery leadership within the health sector, while Part Six explores the risks and opportunities for midwives with the development of clinical governance strategies by District Health Boards. Part seven focuses on strategies to increase the potential for midwives to consolidate, maintain and further develop community-based maternity services throughout the country. This portfolio provides an organisational analysis of contemporary maternity services in New Zealand and presents a multifaceted approach to securing midwifery as a key health profession and midwives as the main provider of maternity services to women in this country. The findings of this collection of works, identified midwifery in New Zealand as precariously positioned within a rapidly changing health service environment. While appearing most vulnerable, midwifery within the rural and primary settings appeared to offer the most potential for innovative development in order to secure the place of midwives as the prime providers of health care for women in childbirth.

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.

The high infant mortality in Zambia is largely attributable to malnutrition. It is exacerbated by the inability of mothers to recognise threats to nutritional status and take corrective action. Advice in ‘Health Centres’ is often inaccessible to mothers. The Traditional Birth Attendants (TBAs) work with pregnant women in local communities, and the purpose of this study was to develop and implement an educationprogram in growth monitoring and nutrition for the TBAs and then to evaluate its effects. Twenty five TBAs from two peri-urban areas of Kitwe were enrolled in this pilot study and eighteen completed the program. The researcher developed and taught a program to the TBAs over ten days. A pretest was given before the teaching program to enable the researcher to obtain information about the knowledge and skills of the TBAs. Following the teaching program the TBAs were re-tested, with the same questionnaire. Focus groups were conducted to enable the TBA to provide information on the teaching materials and the education program. The TBAs then returned to their communities and put into practice the skills and knowledge they had learned for six months. Their practice was monitored by a trained Public Health Nurse. The researcher also surveyed 38 pregnant women about their knowledge of growth monitoring and nutrition before the TBAs went into the field to work with their local communities. The same questionnaire used with the pregnant women was administered to 38 new mothers with children aged 0 to 6 months to gain information of their knowledge and skills following the work of the TBAs. The program was evaluated by assessing the extent to which TBAs knowledge and skills were increased, the knowledge and understanding of a selection of their clients and the rates of malnutrition of infants in the area under study. The results from the research clearly indicated that the teaching program on growth monitoring and nutrition given to the selected group of TBAs had a positive effect on their knowledge and skills. It was found that the teaching developed their knowledge, practical skills, evaluative skills. That they were able to give infants’ mothers sound advice regarding their children’s nutrition was revealed by the mother’s increased knowledge and the decrease in numbers of malnourished children in the study areas at the conclusion of the research. The major outcomes from the study are: that Zambian TBAs can be taught to carry out an expanded role; field experience is a key factor in the teaching program; making advice available in local communities is important; and preliminary data on the Zambian experience were generated. Recommendations are: The pilot program should be expanded with continuing support from the Health Department. Similar educational programs should be introduced into other areas of Zambia with support from the Ministry of Health. That in administering a teaching program: Sufficient time must be allocated to practical work to allow poorly educated women to attain the basic skills needed to master the complex skills required to competently reduce faltering in their communities. The teaching materials to illustrate nutritional principles for feeding programs must be developed to suite locally available foods and conditions. Methods of teaching should suit the local area, for example, using what facilities are locally available. The timing of the teaching program should be suitable for the TBAs to attend. This may vary from area to area, for example it may be necessary to avoid times traditionally given to fetching water or working in the fields. For similar reasons, the venue for the teaching program should be suitable to the TBAs. The teachers should go into the TBAs’ community rather than causing disruption of the TBAs’ day by expecting them to go to the teacher. Data should be collected from a larger group of TBAs and clients to enable sophisticated statistical analysis to complement data from this pilot program. The TBAs should be given recognition for their work and achievement. This is something which they asked for. They do not ask for payment, rather acknowledgment through regular follow up and approbation.

This paper examines midwives and their practice in the criminal and notarial records from the later-medieval Provencal town of Manosque. This town counted amongst its 5,000 Jewish and Christian inhabitants a relatively high number of medical practitioners; these practitioners appeared frequently in the criminal court to offer testimony and to petition for professional protection. Although the apparent absence in Manosque of midwifery regulation like that present in northern France makes it more difficult to define midwives’ exact responsibilities, their appearance in court alongside other medical practitioners suggests that they possessed an acknowledged expertise of the reproductive female body. This paper situates midwives within the socio-medical milieu from which they are often separated in current historiography. A consideration of cases involving women’s reproductive bodies within the broader context of Manosquin medicine reveals that gender dictated the production and application of knowledge about this subject, but not on the grounds of biological essentialism. Rather, as cases of conception, abortion, and postmortem caeasarean sections reveal, the masculinized professionalism of later-medieval medicine granted male practitioners increasing authority in the realms of reproduction and pregnancy. Although this granted men access to “women’s secrets,” prevailing notions of feminine propriety prevented their theoretical knowledge from transforming into practical application to, or examination of, women’s “secret places.” This placed uncomplicated childbirth, and its attendants, on the margins of the medieval medical. It also made midwives indispensible not only to the women whom she attended in childbirth, but also to the institutions that sought to extend their authority over these concerns to which society otherwise denied them access. The cases from Manosque of adultery, illegitimate pregnancy, and virginity in which midwives appear reveal that the concept of feminine propriety simultaneously granted midwives’ authority over women’s physical reproductive bodies and rendered them instruments in the courts regulation of the female body. These cases, then, illustrate the court’s ability to legitimate and regulate through a symbiotic relationship between institution and society.

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

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 7 uppsatser.

Objective: To study midwives management, practice and reasoning regarding contraceptive counseling for women who are experiencing "mild" side effects of the pill Methods: Four focus groups, made up of three to five midwives per group, participated in focus group discussions. Qualitative design with the method “Think-Aloud” has been used to collect data and the material was analyzed using content analysis. Results: The study identified three categories, the first "How midwives practice regarding the side effects of the pill," shows that midwives have a systematic approach when meeting with women who are experiencing side effects of the pill. The next category "Using a holistic and professional approach for women" highlights that the midwives take women's side effects seriously and that midwives respect individual woman’s autonomy. Finally in the third category "Lack of evidence about side effects becomes a women's dilemma" here midwives describe varying ways of interpreting side effects as well as attitudes and socio-economic conditions in society that affect women's choice of contraception. Conclusion: The midwives express that side effects such as loss of libido, depression and weight gain are complex and often difficult to attribute solely to the pill. The midwives' work is characterized by a holistic approach. We see the benefits of sharing information in groups, therefor we suggest that midwives create mediums where they can learn from each other by sharing their valuable experience and knowledge.

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.