Background: Maternal perinatal mental health has been shown to be associated with adverse consequences for the mother and the child. However, studies considering the effect of DSM-IV anxiety disorders beyond maternal self-perceived distress during pregnancy and its timing are lacking. Aims: To examine the role of maternal anxiety disorders with an onset before birth and self-perceived distress during pregnancy for unfavourable maternal, obstetric, neonatal and childhood outcomes. Study design: DSM-IV mental disorders and self-perceived distress of 992 mothers as well as obstetric, neonatal and childhood outcomes of their offspring were assessed in a cohort sampled from the community using the Munich-Composite International Diagnostic Interview. Logistic regression analyses revealed associations (odds ratios) between maternal anxiety disorders and self-perceived distress during pregnancy with maternal depression after birth and a range of obstetric, neonatal and childhood psychopathological outcomes. Results: Lifetime maternal anxiety disorders were related to offspring anxiety disorders, but not to offspring externalizing disorders. Analyses focussing on maternal DSM-IV anxiety disorders before birth yielded associations with incident depression after birth. In addition, self-perceived distress during pregnancy was associated with maternal depression after birth, preterm delivery, caesarean section, separation anxiety disorder, ADHD, and conduct disorder in offspring. Conclusion: Findings confirm the transmission of anxiety disorders from mother to offspring. Apart from maternal anxiety, self-perceived distress during pregnancy also emerged as a putative risk factor for adverse outcomes. The finding that maternal anxiety disorders before birth yielded less consistent associations, suggests that self-perceived distress during pregnancy might be seen as a putative moderator/mediator in the familial transmission of anxiety.

De första timmarna efter födseln ska en rad åtgärder, viktiga för såväl kvinnan som det nyfödda barnet, utföras. Den nyblivna familjen lämnas ofta innan dessa åtgärder är slutförda.  Förbättringsarbetets syfte var att skapa bättre förutsättningar för god eftervård på förlossningsavdelningen under barnets första två–tre levnadstimmar. Studiens syfte var att efter förbättringsarbetet undersöka personalens erfarenheter av förbättringsarbetet och av att ostört arbeta klart med den omedelbara eftervården Förbättringsarbetet utfördes med hjälp av 5p, Nolans förbättringsmodell och sensemaking-aktiviteter. Studiens gruppintervjuer analyserades med kvalitativ innehållsanalys. Andelen kvinnor som fick ha ostörd personal kvar ökade. Kvinnornas upplevelser av den omedelbara eftervården förbättrades liksom medarbetarnas bedömning om rimlig arbetsbelastning. Andelen barn som ammat ökade. Den kvalitativa intervjustudien visade att arbetssättet upplevdes ha betydelse för patientsäkerhet och arbetstillfredsställelsen. Sensemaking-aktiviteterna hade skapat förståelse för syftet med förbättringsarbetet.  Att ostört arbeta vidare med den omedelbara eftervården gav ökat värde för kvinnan och för barnet.  Personalens arbetstillfredsställelse ökade. Det krävs arbete för att påminna om när anpassningar mellan kvalitet och effektivitet är nödvändiga. Sensemaking är verkningsfullt för att skapa förståelse för förändring men metoden är tidskrävande. / In the first hours after birth, a number of measures, important for both the woman and the newborn, must be performed. The new family is often left alone before these measures are completed.  The aim was to create better conditions for good postpartum care during the child's first 2-3 hours of life. The aim of the study was to examine the staff's experiences of the improvement work and of working undisturbed with the immediate postpartum care.  The improvement work was carried out with the help of 5p, Nolan's improvement model and sensemaking activities. The study's group interviews were analyzed with qualitative content analysis. The proportion of women who were allowed to keep undisturbed staff increased. The women's experiences of immediate postpartum care were improved, as was the employees' assessment of a reasonable workload. The proportion of children who breastfed increased. The interviews showed that the working method was perceived to be important for patient safety and job satisfaction. The sensemaking activities reminded of the importance of postpartum care.  Being able to work undisturbed with the immediate postpartum care increased value for both the woman and the newborn. It also improved job satisfaction for the staff. Efforts are needed to remind when adjustments between quality and efficiency are necessary. Sensemaking is effective in creating motivation for change, but the method is time-consuming.

No description available.

Background: During a woman's pregnant state, a diet that is adequate in nutrition is critical to the developing fetus, especially in the lower socioeconomic status population. The healthcare provider is charged with the acute fundamental awareness of this additional factor that can grossly impact pregnancy. Nutritional advice from the health care provider is one of many key points that contribute to the successful outcome of the pregnancy. Purpose: The purpose of this quality improvement project was to develop a standardized, evidence-based practice (EBP) protocol for the management of maternal nutrition, gestational weight gain, and physical activity for provider use at an LSE community clinic. Theoretical Framework: Theory of Planned Behavior Methods: After receiving institutional support for the implementation of the protocol presentation and instruction of the Maternal Nutrition Guideline, pre- and post-surveys were administered to eligible participants. A quantitative descriptive design was used for the project. Results: There were twenty-six respondents for both the pre-and post-survey. The data analysis revealed that two questions revealed the most significant increase between the pre-and post-survey occasions utilizing the Mann-Whitney test and related to physical activity during pregnancy and dietary intake. An independent sample t-test was performed to compare the two occasions. There was a tendency for an increase in the the total score between the pre-and post-surveys, but the difference did not reach statistical significance, which may be related to sample size (t24df = 1.782, p =0.087). Conclusion: A standardized, evidence-based nutritional guideline is a necessary tool to serve as a consistent resource and empower all health care providers to bring awareness and understanding to facilitate positive outcomes to the obstetric patient population for which they care.

La mortalité maternelle est considérée depuis quelques années comme un problème de santépublique au Sénégal ; ce qui a engendré pendant ces dernières décennies, un ensemble d’actionsparfois pertinentes, mais dont la mise en oeuvre est très souvent discutée, comme c’est le cas dansde nombreux pays africains.En 2010, le ratio de mortalité maternelle du pays est estimé à 392 décès maternels pour 100 000naissances vivantes selon le rapport de l’enquête démographique et de santé (EDS). Ce niveau resteélevé en dépit d’une hausse considérable du recours à l’assistance à l’accouchement.L’assistance médicale à l’accouchement qualifiée, définie comme « le processus par lequel unefemme reçoit des soins adéquats durant le travail, l’accouchement et le post-partum précoce », estapparue dans plusieurs études comme un déterminant-clé dans le processus de réduction de la mortalitématernelle.Deux conclusions principales sont obtenues à partir de nos analyses.D’une part, la très forte hausse du recours à l’assistance médicale à l’accouchement observée aucours de la première décennie des années 2000 a été sanctionnée par une baisse régulière, mais modérée,de la mortalité maternelle. D’autre part, cette faible baisse s’explique par une offred’assistance médicale à l’accouchement excessivement centrée sur des sages-femmes dont les qualificationssont hétérogènes et trop souvent limitées. Elle s’explique aussi par des infrastructures encoretrop peu adaptées à la gestion des urgences obstétricales.En effet, malgré tous les progrès accomplis dans ce domaine, il reste encore une marge importantepour poursuivre l’accès à un accouchement assisté. C’est en particulier le cas dans les campagnes,chez les femmes les plus jeunes, celles qui ont reçu une faible instruction et qui dépendent exagérémentde leurs conjoints. De ce fait, il serait intéressant de mener des politiques de sensibilisationdu côté des hommes.Au final, les enjeux futurs de l’assistance médicale à l’accouchement au Sénégal continuent à combinerdes problèmes d’offre et des problèmes de demande malgré les progrès accomplis dans cedomaine. / Maternal mortality is considered for several years as a public health problem in Senegal; which resultedin recent decades of a set of relevant actions sometimes, but the implementation is very oftendiscussed, as is the case in many African countries.In 2010, the maternal mortality ratio in the country is estimated at 392 maternal deaths per 100,000live births according to the report of the Demographic and Health Survey (DHS). This level remainshigh despite of a significant increase in the use of Delivery Assistance.The qualified medical assistance in childbirth, defined as "the process by which a woman receivesadequate medical care during labor, delivery and the early postpartum," has appeared in severalstudies as a key determinant in the maternal mortality reduction process.We can note two main conclusions from our analysis.First, the very strong increase in the use of medical assistance in delivery which has been observedin the first decade of the 2000s was sanctioned by a regular but moderate decline in maternal mortality.Then, this small decrease is due to a medical assistance in childbirth entirely performed bymidwives whose qualifications are heterogeneous and often limited. It is also explained by infrastructureswhich are not adapted to the management of obstetric emergencies.In fact, despite all the progress made in this field, there still are significant things to do before accessingto assisted delivery. This is particularly the case in rural areas, among younger women,those who received low education and who depend excessively on their husbands. Therefore, itwould be interesting to make aware of men on this issue.In the end, the future challenges of Assisted Reproduction Technology (ART) in Senegal continueto combine problems of supply and demand problems despite the progress made in this field.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23781号 / 医博第4827号 / 新制||医||1057(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 石見 拓, 教授 近藤 尚己, 教授 万代 昌紀 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

[pt] A recente emergência do termo violência obstétrica abarca uma grande carga de significados e possibilidades. Fruto da busca pela ruptura com as estruturas opressoras de poder impostas sobre os copos das mulheres em período gestacional no sistema de saúde, o termo é tão polêmico e impactante quanto a violência vivenciada por essas mulheres no mundo inteiro. Diante dos debates que a expressão suscita, este trabalho consiste na análise dos mecanismos de poder que perpetuam a violação de direitos das mulheres gestantes no sistema de saúde brasileiro, sob a perspectiva de Michel Foucault, e sua caracterização como violência de gênero, estruturante da sociedade capitalista ocidental. A partir da análise de tais mecanismos, considerando fatores como o racismo estrutural, classe e as disputas políticas que envolvem a atenção de saúde da mulher, bem como o arcabouço legal disponível, pretende-se traçar um panorama das possibilidades de prevenção e enfrentamento do problema no cenário brasileiro atual. / [en] The recently emerged term obstetric violence, is capable of great meaning and possibilities. Resulting from the struggle for rupture from oppressing structures of power imposed upon pregnant women s bodies in facility-based childbirth and other health services, this term is as polemic and powerful as the violence experienced by women all over the word. Considering the debates over this expression, the present research hopes to analyze the power dynamics that enable pregnant women s rights violation in Brazilian health-care system, using Michel Foucault s perspective, and a gender-based violence approach, that is built into the fabric of patriarchal capitalist society. Based on this analysis and considering facts such as structural racism, class and political disputes that surrounds women s healthcare attention, as well as the legal available support, it is hoped to provide an overview of possibilities for prevention and confrontation of the problem, in Brazilian current circumstances.

[pt] Partindo de relatos de parto de mulheres brasileiras circunscritas em diferentes realidades sociais, o presente trabalho, de cunho qualitativo e interpretativista tem como objetivo analisar a construção e os efeitos dos discursos hegemônicos (Foucault, 1988) em falas sobre experiências de gestação e parto. Observaremos em performances narrativas emergentes em dez entrevistas de pesquisa (offline e online), a construção da agentividade das narradoras em conexão com as relações corpo/afeto. Narrativas de mulheres de lugares socias diversos (diferentes raças, classes, sexualidades, faixas etárias, usuárias de organizações de saúde públicas e privadas) serão analisadas sob uma lente interseccional de gênero, raça e classe, focalizando como tais narrativas constroem inteligibilidades que regem a vida social e, assim, cerceiam corpos – o que induz à reflexão sobre a soberania do discurso médico hegemônico e seus impactos na experiência da maternidade. Nossa compreensão de gênero se pauta em feminismos matricêntricos – se propondo, assim, a dar centralidade a mulheres mães sob uma perspectiva interseccional. Sob a perspectiva interdisciplinar, indisciplinar e mestiça da Linguística Aplicada Contemporânea (Moita Lopes, 2006), alinhamo-nos à Análise de Narrativa por entendermos que, contando histórias, construímos a nós mesmos, nossa percepção de identidade, além de construirmos o mundo ao redor. A análise das narrativas examina a construção da avaliação – componente narrativo que imprime dramaticidade e razão de ser ao que se narra, contemplando a dimensão discursiva dos afetos. Dessa forma, foi possível observar, no âmbito das inter-relações entre cultura–discurso–corpo–afeto, como os atravessamentos discursivos deixam marcas: seja reprimindo, constrangendo e destituindo as mães da gestão de sua própria corporeidade; seja, por outro lado, instando autonomia e agentividade às mães em seus relatos. Assim, compreender os rastros discursivos pela via dos afetos possibilita ao analista interpretar, reelaborar e redimensionar a experiência vivida. / [en] The aim of this qualitative-interpretive study is to analyse the construction and effects of normative discourses) regarding pregnancy and birth by analysing labour narratives of Brazilian mothers located in distinct social contexts. In the narrative performances that emerge from three research interviews (conducted both on and offline), we observe how speakers build agency in relation to body/affect. The narratives of these women - from diverse social backgrounds (in terms of race, class, age, private/public health system users) - are analysed focusing on how these stories build intelligibility that governs social life and which can curtail bodies – leading us to reflect on the pervasiveness of medical discourse and its impacts on the experience of mothering and maternity. Our understanding of gender is based on matricentric feminisms and aims at furthering mothers visibility from an intersectional perspective. As part of an emerging tradition of undisciplined, Contemporary Applied Linguistics of Latin America, this study draws on Narrative Analysis, aiming at the further understanding of locally constructed identities and their relationship with the surrounding world. Our analysis examines the building of evaluation - a narrative component which heightens drama, conveying the story s very raison d être - as to consider the discursive dimension of affect. Our examination of the relationship between culture, discourse, body and affect, enables us to identify the way these insidious discourses leave their mark on mothers; either through reprimands, constraints and the erasure of control over their own corporeality or otherwise by prompting autonomy and agency. Medical discourse, as we observe, is a powerful institution which serves as underlying other major overwhelming discourses, such as the patriarchal and the racist. Thus, by building the bridges between the micro and macro dimensions it is possible to realise that what happens in social interactions reveals a lot from a complex broader scenario as much as the major institutions have a great impact on social life. The observation of the discursive scars left makes way to analyse, interpret, rework and reimagine the lived experience of labour.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Sverige har under en längre period utgjort de OECD-land med ett av de högsta antal förlossningsskador. Historiskt har förlossningsvården varit en sfär för kvinnor. Medicinvetenskapen intog emellertid en allt mer betydande roll under 1800-talet och läkarkåren utgjordes av män. Den gravida kvinnan blev en patologisk kropp. Följden har lett till att kvinnor föder i gynställning och bristningar är standard. Syftet med studien har utgjorts av att, genom Foucaults teori om biomakt undersöka hur en svensk, samhällelig och medicinsk normalisering av förlossningsskador kan förstås som en följd av medikalisering av kvinnlig sexualitet och reproduktion. Med ett konstruktivistiskt angreppssätt baserat på upplevelser och definitionsprocesser har kvinnors subjektiva erfarenheter av sina skador studerats genom strukturerade intervjuer. Resultatet skildrar en statlig inverkan i reproduktionsfrågor och dess disciplinerande kontrollorgan, inte minst inom mödra- och barnahälsovården. Känslor av skam, skuld, litenhet och förminskande är upplevelser bemötandet i vården orsakat. Samhället är aktiva i att upprätthålla realiteten för kvinnorna och förmedlas diskursivt, då kvinnan som gör anspråk på den egna kroppen kategoriseras som avvikande. Det saknas ett psykosocialt inriktat stöd i vårdkedjan. / For a long period of time Sweden has been an OECD-country with one of the highest quantity of obstetric injuries. Childbirth has mainly been a sphere for women historically. Medical science however took an increasingly significant role during the 19th century and the profession mainly contained men. The pregnant woman became a pathological body. The consequence has led to women giving birth in lithotomy position and obstetric trauma is standard. The aim of this study has been, through Foucaults theory of bio power, analyse how a Swedish, social and medical normalization of obstetric injuries can be understood as a result of medicalization of the female sexuality and reproductivity. With a constructivist approach, the subjective experiences of their obstetric injuries has been analysed via structured interviews with women. The result shows a public impact in questions regarding female reproductivity and sexuality from the institute administrators. Emotional states of shame, guilt, pity and diminishing occur by the encounter with the institutes. Societies maintain the reality for women and mediate it discursively, since women who claim their bodies as their own are abnormal. Psychosocial support lacks in the care chain.