In this dissertation, I argue that the maternal body is a chief site of discursive political and cultural struggle over gender, family, and work in a neoliberal America. I consider contemporary discourses of maternity, an aggregate I call maternity culture, as cultural products and rhetorical expressions of the antagonistic arrangements in contemporary capitalism since the neoliberal turn. The complexities of maternity culture discourses can therefore be better understood when they are historicized alongside changing economic and political realities. Using materialist feminism as my primary methodology, I contend that maternity culture discourses express the ethics of neoliberalism including the privatization of social/political responsibility and self-actualization through entrepreneurialism and labor, while simultaneously justifying the intensification of maternal labor and the continued surveillance of women's bodies. I argue that maternity culture discourses are, therefore, rhetorics of reproduction and reproducing rhetorics. That is to say, they are a part of a larger set of discourses about the reproductive function that are themselves caught in the logics of capital that may result in the reproduction of unequal arrangements in material and symbolic life. In order to illuminate how maternity culture operates in neoliberal public life as a reproducing rhetoric, I provide a historical analysis of rhetorics of women's health, and analyze two case studies involving discourses surrounding breastfeeding and natural childbirth, major sites of struggle within maternity culture. / text

The labour pain experienced by 101 women giving birth in a Scottish hospital was assessed by the McGill Pain Questionnaire and Visual Analogue Scales during active first stage labour and post-natally. Labour pain was found to be on average severe, but not intensely negatively affective. Its intensity varied considerably and was related to parity and the duration of the first stage of labour reflecting underlying differences in levels of noxious stimulation. Other obstetric and pharmacological factors which might affect noxious stimulation were not significantly related to pain scores. Induction was related to higher,and complications of pregnancy, to lower levels of pain attributable to psychological modulation. The desirability of pregnancy, positive and accurate expectations of birth, ante-natal training and the welcomed presence of the husband at the birth were associated with significantly lower levels of labour pain, particularly of non-sensory pain. A few subjects had very minimal previous experience of pain. These subjects had the lowest levels of pain in childbirth, perhaps because they were relatively insensitive to noxious stimulation. Subjects whose previous experience of pain had been extensive had significantly lower levels of labour pain than subjects whose previous pain experience had been more limited. Subjects who had extensive experience of pain used a larger number of strategies to cope with that pain than subjects whose experience had been more moderate. They used more strategies during labour, a greater proportion of which they had used previously. The use of a number of strategies in labour, either in combination or in sequence was related to lower levels of labour pain but not to painless childbirth. So too was the use of strategies which had been previously utilised. The relationship between previous pain experience and levels of labour pain was mediated by the differential use of coping strategies.

Apesar dos esforços a favor da humanização do nascimento, sabemos que ainda se fazem presentes na prática uma série de procedimentos intervencionistas no trabalho de parto e parto que interferem nesse processo. Assim, a depender de como se dá o processo de parturição, este acarretará nas condições maternas e neonatais para o início do aleitamento materno, e como consequência, no processo da amamentação, uma vez que a mulher deve ser o elemento chave para esta prática. A prontidão do recém-nascido (RN) para mamar, depende do seu estado de consciência, sendo que pode apresentar-se mais sonolento em situações que envolvem o uso de anestésicos ou outras intervenções em suas mães durante o trabalho de parto. O objetivo do presente estudo é identificar a relação entre a prontidão do RN para sugar a mama materna na primeira mamada no alojamento conjunto e a condução do trabalho de parto, parto e nascimento. Trata-se de um estudo observacional, transversal, descritivo exploratório, realizado com 43 binômios, com RN de idade gestacional entre 37 e 41 semanas e 6 dias, Apgar >= 7 no 5º minuto, filhos de mães primíparas. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo, com protocolo (Nº1219/2010). As informações do processo de nascimento foram coletadas dos prontuários, e a partir das entrevistas às puérperas. A avaliação da prontidão dos RN para sugarem, foi feita por meio de filmagens dos neonatos desde o início ao término da primeira mamada no alojamento conjunto, sendo avaliados os estados de sono e vigília e mamada, com base no Formulário de Observação da mamada da OMS (1997). De acordo com o formulário os itens foram categorizados como \"sinais positivos\" e \"sinais negativos\", relacionados às condições favoráveis e às dificuldades na mamada. A análise foi fundamentada na estatística descritiva e na realização de testes estatísticos para análise comparativa entre as variáveis. Quanto aos resultados, em sala de parto, 17 (39,5%) neonatos foram colocados em contato pele imediato e apenas 4 (9,3%) sugaram o seio materno. Das 43 parturientes, 39 (90,7%) receberem analgesia, porém apenas 14 (32,6%) receberam a segunda analgesia (repique). No momento em que as mesmas receberam a primeira analgesia, a dilatação cervical variou entre 2 e 9 cm, sendo que 13 (33,3%) estavam com 5 cm. No repique, a dilatação cervical variou entre 4 e 10 cm, sendo que 6 (42,9%) estavam com 8 cm. O período mínimo de duração do trabalho de parto, foi de 25 minutos, e o tempo máximo, 11 horas. A menor duração do período expulsivo foi de 1 minuto e o tempo máximo, 59 minutos. Quanto aos dados referentes ao puerpério imediato, 36 (83,7%) mães referiram que estavam com sono logo após o parto e apenas 9 (20,9%) delas relataram estar sentindo algum tipo de dor e quanto ao cansaço, a maioria 41 (95,3%) referiu estar cansada. O período sem ingerir líquido variou de 33 minutos a 22h e 35 min e o período em jejum alimentar variou entre 2h 50 min e 21h 05 min. Em relação ao estado de sono e vigília no período que antecedeu a mamada, 18 (41,9%) dos recém nascidos estiveram no estado alerta quieto. Durante a mamada em 21(48,8%) dos neonatos, o estado sono ativo foi predominante. Na avaliação da mamada, os índices positivos se fizeram presentes nos diferentes domínios avaliados: 86,1% na sucção, 85,6% na postura corporal, 82,3% nas respostas do RN, 100% na anatomia da mama, no 78,4% tempo gasto na sucção durante a mamada. Quanto às associações entre as variáveis do trabalho de parto, parto e nascimento e as da mamada, obteve-se dados significativos entre a duração do período expulsivo e grupo sono e sonolento de estado de sono e vigília, com p=0,03. Embora as mães tivessem recebido intervenções durante o trabalho de parto e parto que pudessem interferir na qualidade da primeira mamada em alojamento conjunto, a maioria dos neonatos apresentou-se em estado de alerta, isto foi o suficiente para que eles apresentassem boa prontidão para mamar neste momento. O alojamento conjunto precoce, se mostrou uma prática favorável para a obtenção de sinais positivos na avaliação da primeira mamada à admissão de ambos. / Despite efforts to promote the humanization of birth, we know that still present in practice a number of interventional procedures during labor and childbirth that interfere with this process. So, depending on how is the parturition process, this will result in maternal and neonatal conditions for the initiation of breastfeeding, and as consequence, in the process of breastfeeding, since the woman should be the key element to this practice. The readiness of the newborn (NB) to nurse, depends on your state of consciousness, and may present more drowsy in situations involving the use of anesthetics or other interventions in their mothers during labor. The aim of this study is to identify the relationship between NB readiness to suck the maternal breast in the first feeding on the rooming in and conduct of labor, and birth. This is an observational, cross-sectional, descriptive and exploratory, conducted with 43 binomials, with NB in the gestational age between 37 and 41 weeks and 6 days, Apgar score >= 7 in the fifth minute, the children of first-time mothers. The project was approved by the Research Ethics Committee of the Nursing School of Ribeirão Preto, University of São Paulo, with protocol (No. 1219/2010). Information from the birth process was collected from medical records and from interviews with puerperal. The assessment of the NB readiness to suck, was made by filming the neonates from the beginning to the end of the first feeding in rooming in, evaluated the states of sleep and wakefulness and feeding, based on Observation of breastfeeding from WHO (1997). According to the form of the items were categorized as \"positive signals\" and \"negative signals\", related to the favorable conditions and difficulties in feeding. The analysis was based on descriptive statistics and statistical tests for comparative analysis between the variables. As for the results in the delivery room, 17 (39.5%) neonates were placed in immediate contact skin and only 4 (9,3%) sucked the breast. Of the 43 pregnant women, 39 (90.7%) received analgesia, but only 14 (32.6%) received the second analgesia (reinjection). At the moment in which they receive a first analgesia, cervical dilation varied between 2 and 9 cm, while 13 (33.3%) had 5 cm. In reinjection, cervical dilation varied between 4 and 10 cm, and 6 (42.9%) had 8 cm. The minimum duration of labor was 25 minutes and the maximum period 11 hours. The lowest delivery duration was 1 minute and the maximum time, 59 minutes. As for the data relating to postpartum, 36 (83.7%) mothers reported that they were sleepy soon after birth and only 9 (20.9%) of them reported to be feeling some sort of pain and tiredness, the most 41 (95.3%) reported being tired. The period without ingesting fluid ranged from 33 minutes to 22h and 35 min and fasting period varied between 50 min and 21h 2h 05 min. Regarding the state of sleep and wakefulness in the run-feeding, 18 (41.9%) of the infants were in quiet alert state. While feeding in 21 (48.8%) of the neonates, the active sleep state was predominant. In the assessment of breastfeeding, positive indices were present in different areas evaluated: 86.1% in sucking, 85.6% in body posture, 82.3% of infants\' responses, 100% in the anatomy of the breast, 78, 4% time spent sucking during breastfeeding. Regarding the associations between the variables of labor, and birth and breastfeeding, significant data was obtained from the delivery duration and sleep group and sleepy state of sleep and wakefulness, with p = 0.03. Although mothers had received interventions during labor and delivery that could interfere with the quality of the first feeding in rooming in, most neonates presented on alert, that was enough for them to present good readiness to nurse this time. The early rooming in practice proved favorable for obtaining positive signals in the evaluation of the first feed intake both.

Orientador: Ana Maria Segall Correa / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-11T19:09:49Z (GMT). No. of bitstreams: 1 Gouveia_CristianeMoretti_M.pdf: 2691354 bytes, checksum: c5ebcf4d90fe493f5689917c710d408c (MD5) Previous issue date: 2008 / Resumo: As intervenções durante o trabalho de parto e parto têm sido objeto de debates de órgãos nacionais e internacionais. No Brasil há mobilização, por meio dos gestores de suas políticas públicas, no sentido de diminuir o número de cesarianas, episiotomias e outras intervenções que se revelaram inadequadas quando utilizadas sem indicação clínica. O objetivo desta pesquisa é estudar a relação entre intervenções clínicas e cirúrgicas no trabalho de parto e parto e a saúde física e psicológica (transtornos mentais menores) das mulheres no puerpério imediato, mediato e tardio de um hospital público do interior do Estado de São Paulo. Trata-se de um estudo de caráter descritivo, com abordagem quantitativa, no qual foram entrevistadas 278 mulheres no puerpério imediato e mediato (em torno do 10o dia), com perguntas referentes ao seu estado físico e psicológico. No 40o dia pós parto foi possível entrevistar 130 mulheres com o objetivo de analisar possíveis intercorrências tardias. A análise estatística inicial foi exploratória, com descrição de freqüência dos eventos e testes bivariados para nível de significância de 95%. A análise da medida de efeito foi realizada através da prevalência para observar complicações no puerpério imediato e tardio de acordo com as categorias de cada variável. Os resultados mostraram índices de analgesia e parto fórcipe acima dos citados em literatura. O parto fórcipe se mostrou fator de risco para lacerações perineais mais severas e Rns com Apgar menor que 7 no 1º minuto. / Abstract: The interventions during labor and delivery have been subject of national and international agency debates. In Brazil, health policies has been implemented in order to reduce the rates of surgical delivery, episiotomies, and other birth procedures revealed as inadequate when used without clinical indication. The aim of this study is to identify the relationship between interventions during labor and delivery and, the physical and psychological women's condition in the puerperal period in a public hospital in the State of São Paulo. It's a quantitative descriptive study that depicts the assistance received in the labor and its association to the kind of delivery, the interventions performed, the occurrence of depression and complications to the mothers in their puerperium. A sample of 278 women have been interviewed about their physical and psychological state on the 10th day of their puerperium, and 130 out of these 278 on the 40th day. An analysis was undertaken for potential risky factors, with outcome variable being presence or absence of complications. Confidence intervals at 95% level were calculated for each variable. Prevalence was calculated to identify the relationship between delivery clinical and surgical procedures and woman's health during puerperium period. The results showed a prevalence of analgesia and instrumental delivery above the expected by the current literature. Forceps delivery was a risk factor for more severe perineal lacerations and for newborns with and Apgar index lower than 7 in the first minute of life. / Mestrado / Epidemiologia / Mestre em Saude da Criança e do Adolescente

M.Cur. / This dissertation studies the labour experiences of parents who received childbirth preparation. At the moment, the extended family is no longer prevalent, and the teachings mothers passed to daughters has decreased dramatically. As more medical interventions alter the labour process, couples need to be more aware of what to expect. The trend for first time parents is to attend some kind of formal antenatal preparation. How relevant is this preparation? A qualitative study design was utilised to allow for exploration and description of the experience of labour. An audio recording was done as well as the subjects filling in a questionnaire. A pilot study with one couple was completed initially. Mothers in the Northern Suburbs of Johannesburg were studied. They had given birth in private clinics in the area. The interviews were unstructured and conducted in English. The data once collected, was transcribed and analysed using cross case data analysis and classification according to common themes. Nursing for the Whole Person Theory was used as the paradigm and guide for analysis. The results are compared with the relevant literature which is presented in The results are displayed in various forms in the study and show a positive experience in women and men who attended antenatal preparation. Recommendations are made for the medical profession and presented in with the conclusions.

M.Cur. / The objective of this study explores and describes the experiences of first-time mothers regarding pain management during the first stage of labour. A qualitative approach involving phenomenology was used. Midwives were also interviewed to determine their assessment and management strategies in this regard in order to get a broader perspective on the focus of interest. The data collected from the mothers revealed three themes and they are: the care rendered, needs/wishes and beliefs/feelings of the mothers regarding the care given. These themes were further subdivided into small headings/categories as specified in the data and elaborated on. Eight categories of care strategies emerged from the data gathered from the midwives. Information from both the mothers and midwives were then extensively discussed and compared to the existing literature. Conclusions were drawn and recommendations formulated, in the form of guidelines, to assist midwives and other health-care professionals to improve their caring modalities in the management of patients with pain during the first stage of labour.

M.Cur. / Midwives are responsible to assess pain before treating it; then they should reassess the pain to evaluate the effectiveness of the interventions and plan future therapy. Accurate and objective measures of labour pain continue to be scarce and the discrepancy in labour pain perceptions between parturients and health-care providers remains challenging. Various pain measurement tools are currently in use measuring chronic and acute pain, but many problems were encountered applying these methods to the woman in labour. The charts were detailed and required too much time to complete. The aim of the study was to develop a multidimensional labour pain assessment instrument to assist clinicians and midwives with labour pain control. Objectives for developing a valid and reliable instrument to accurately measure labour pain included refinement of the labour pain assessment instrument developed from literature, testing of the refined instrument on patients during labour, compilation of a final instrument and development of guidelines on how to implement the labour pain assessment instrument in nursing practice. A descriptive and exploratory approach was used to describe, evaluate, observe, explore and assemble new knowledge on assessment and measurement of pain during the first stage of labour. Development of the instrument was addressed in the literature chapter. The research was conducted in three phases, combining qualitative and quantitative research. During phase one, the instrument was refined in two stages. Focus group interviews were conducted with members regarded as knowledgeable in the field of normal labour who evaluated the face and content validity of the instrument. The most senior people teaching Midwifery at all South African universities evaluated the face and content validity of the instrument with an open-ended questionnaire thereafter, using the Delphi technique. The analysis of the first Delphi round was compared to the focus group analysis. The instrument was altered and submitted to the Delphi experts in a second open-ended questionnaire to confirm the alterations. During phase two, the altered instrument was tested in private and provincial hospitals. Testing of the altered labour pain assessment instrument on patients in active labour yielded quantitative data. A statistician at the University of Johannesburg was consulted to assist with tabulation, frequencies and statistical tests needed. The midwives from the private and provincial hospitals also completed the second Delphi open-ended questionnaire. A Likert scale was included in the second Delphi instrument as midwives have less time available to complete questionnaires. The qualitative analysis of their responses was compared to those of the second Delphi round experts to avoid an inflated estimate of validity that might have been brought forth by the very small second Delphi round sample. The instrument was finally altered and, during phase three, guidelines were developed on how to implement the labour pain assessment instrument in nursing practice.The experts concluded the instrument as a simple tool that can measure and assist with labour pain control, assess the progress of labour and the patient’s condition, assist with training, guide inexperienced midwives in pain assessment and serve as a research tool. The labour pain assessment instrument can be a valuable tool in assisting clinicians and midwives with labour pain control during the first stage of labour and initiate standards for pain measurement. The challenge remains to convince institutions to improve pain control during labour and protect themselves from potential pain maltreatment litigation by using a valid and reliable pain measurement instrument.

Thesis (M.S.)--University of Michigan, 1994. / Spine title: CNM and MD outcomes for pain control in labor.

Thesis (M.S.)--University of Michigan, 1994. / Spine title: CNM and MD outcomes for pain control in labor.

A assistência ao parto em Centro de Parto Normal (CPN) mostra-se como uma tendência a ser incorporada por muitos serviços de assistência obstétrica no contexto brasileiro. Estudos com enfoque na experiência do cuidado, segundo a perspectiva da mulher, ainda são escassos. A presente pesquisa teve como objetivo descrever a experiência de mulheres que receberam assistência ao parto em um CPN. O estudo de abordagem qualitativa utilizou a análise da narrativa, como método de pesquisa. Este método é composto das fases de ler, analisar, transcrever, contar e ouvir a experiência; sua essência consiste no acesso à experiência primária, tal como representada pela pessoa que a vivencia. A análise dos depoimentos, foi desenvolvida de forma indutiva e interpretativa e resultou nas seguintes categorias descritivas da representação da experiência: a) O primeiro atendimento recebido no hospital; b) As experiências vividas no Centro de Parto Normal que foram relativas às orientações recebidas dos profissionais, as práticas de cuidado realizadas no trabalho de parto, os procedimentos executados pelos profissionais, a permanência do profissional no ambiente assistencial, o relacionamento interpessoal estabelecido pelos profissionais, a presença do acompanhante e as percepções em relação à sensação dolorosa; c) A estrutura física do hospital e d) Os conhecimentos e demandas por orientação expressos pelas mulheres. A categoria central A satisfação com a assistência recebida sintetiza a representação coletiva da experiência da assistência recebida no CPN. A experiência positiva relatada pelas mulheres confirma a premissa de que o local de assistência e as suas características influenciam a qualidade da assistência ao parto. Esta constatação fornece sustentação à política pública vigente no Brasil, que recomenda a implementação de CPNs em todo o território nacional. Cabe aos profissionais atuantes nesse contexto, o desenvolvimento da assistência ao parto, de acordo com as recomendações internacionais. / The healthcare rendered during childbirth in Birth Centers (BC) is seen as a trend to be incorporated by several services of obstetrical units in Brazil. Studies focusing on the experience of care according to the woman`s perspective are scarce. The objective of this research was to describe the experience of women who received healthcare during childbirth in a BC. This qualitative used descriptive analysis as a research method. The method consisted of steps to read, analyze, transcribe, relate and listen to experiences, its essence is the primary access to the experience, exactly as presented by the person who experienced it. Analysis of the interviews was developed in an inductive and interpretative manner and resulted in the following categories describing the representation about the experience: a) The first healthcare received in the hospital; b) Experiences in the Birth Center in accordance with guidelines received from the professionals, care practices performed during the childbirth, procedures executed by the professionals, permanence of the professional in the healthcare environment, interpersonal relationship established by the professionals, presence of a patient companion, and perceptions related to pain; c) The hospital physical structure; and d) The demands for knowledge and guidance expressed by women. The central category Satisfaction with the care received summarizes the collective representation of the healthcare received in the BC. The positive experience described by the women, confirms the premises that the healthcare unit and its characteristics do influence the quality of healthcare during childbirth. This finding provides support to current public policy in Brazil, which recommends the implementation of BC throughout the country. It is up to the professionals working in this context to develop childbirth care in accordance with international recommendations.