This thesis traces and analyses the evolution of obstetrical and midwifery doctrine and use of episiotomy in the United States and United Kingdom. In the U.S., the routinization of episiotomy resulted from strenuous lobbying efforts of a small group of obstetrician/gynecologists between 1915 and 1935. These physicians claimed episiotomy prevented perineal lacerations, infant mortality and morbidity, and gynecological problems. In the U.K., the liberal use of episiotomy came about during the 1970s from pressure from obstetricians although no overt campaigning for the practice occurred. In both countries adoption of routine episiotomy was encouraged by social forces which involved changes occurring in the dominant belief system in obstetrics, maternity care practices, and the obstetrics and midwifery professions. Questioning of the practice by childbirth activists and others eventually led to declines in episiotomy. This was facilitated, particularly in Britain, by midwifery interest in resisting obstetrical control. Neither the adoption nor rejection of routine episiotomy was informed by scientific evidence. This study contributes to understanding the process of innovation in maternity care.

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Creating a safety culture is the focus in the current healthcare environment. An inhouse, around-the-clock laborist service delivery model has been associated with positive outcomes, but little is known about the laborist structure’s contribution to the labor-anddelivery working environment. The purpose of this descriptive correlational study was to explore the effects of physician service delivery model on safety culture, nurse-physician collaboration, and nurses’ job satisfaction. An additional purpose was to examine associations between nurses’ perceptions of safety culture, nurse-physician collaboration, and job satisfaction. Ray’s (1981, 1989) Theory of Bureaucratic Caring and Homan’s (1974) Social Exchange Theory guided this study. A survey consisting of demographic questions, the Collaborative Practice Scale (Weiss & Davis, 1985), the Hospital Survey on Patient Safety Culture (Agency for Healthcare Research and Quality, 2015; HSOPSC), and the McCloskey and Mueller Satisfaction Scale (McCloskey & Mueller, 1990) was distributed to registered nurses (RNs) nationwide. The results indicated that nurses in facilities using the around-the-clock model had higher perceptions of nursephysician collaboration, but not of safety culture or job satisfaction in relation to the physician service-delivery model. Significant moderate-to-strong correlations between nurses’ perceptions of patient safety and job satisfaction, and a weak correlation between bedside nurses’ perceptions of nurse-physician collaboration and job satisfaction were demonstrated. Additional significant correlations were found between the instrument subscales. Control/responsibility in the MMSS scale was positively associated with both management support for patient safety, supervisors’ and managers’ expectations and actions promoting patient safety, and overall perceptions of safety in the HSOPSC scale. Praise and recognition in the MMSS scale were positively associated with supervisor/manager expectations and actions promoting patient safety in the HSOPSC scale. Further appraisal is needed to understand the mechanism by which the laborist model affects patient care and work environment. Recommendations for future research include replicating the study with a larger sample sizes in specific groups based on the role and scheduled shift, conducting the study in a single system or location to mitigate the effects of other variables; and exploring physicians’ perspectives on the variables being studied. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2017. / FAU Electronic Theses and Dissertations Collection

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In this thesis, I examine the use of medical technology as the product of, among other things, value systems and individual and collective needs; technological use therefore is shown to be culturally influenced and subject to change according to historical and social context. / I describe and discuss the use of the Electronic Fetal Heart Rate Monitor (EFM)--a state of the art form of electronic information technology--in obstetrical care in a rural Canadian hospital and community. The central issue I examine is why this technology was obtained and repeatedly used despite local medical opinion and scientific evidence that it was ineffective as a tool to improve obstetrical outcome, and also had been shown to put pregnant women at considerable risk of unnecessary and potentially harmful interventions during birth. / I describe how EFM use appeared contradictory because medical understanding of EFM use was limited to what I define as "case centered" research; research limited to measuring the impact of the EFM on individual patient outcome. Case centered studies were not examinations either of the EFM itself, or of its associated technical regimens. Moreover, case centered studies were not used to relate the EFM to women's experiences during birth, hospital traditions, or community expectations. These latter relationships, which are ignored in case studies, form the focus of this research and explain why an EFM was used in this community.