The aim of this thesis has been to reconceptualize 'post natal depression' and challenge the 'clinical' and 'social science' models of explanation. It has focussed on a) whether 'post natal depression' is an objective phenomenon, and b) whether the experience of 'post natal depression' is the same for every women, and C) whether there are any common features of the experience of childbirth and early mothering which enable the construction of 'normal' experience. It begins by suggesting that the 'clinical' and 'social science' models are problematic in that they are based on ideological assumptions and not scientific evidence about what is 'normal' following childbirth. This is explored by examining the previous literature and by using a pre-validated measure of 'post natal depression' in the pilot work alongside semi-structured interviews. The literature demonstrates a history of weak conceptualization and associated poor methodology, with explicit and implicit assumptions about the psychology of women, childbirth and the motherhood role. This thesis therefore sets out to re-examine and re-define 'post natal depression' by analysing detailed accounts of pregnancy, childbirth and early motherhood within a framework suggested by Gidden's stratification model of knowledge and other frameworks which take human reflexiveness into account.. The research comprised a small-scale longitiudinal study in which 24 women were interviewed up to four times; during pregnancy, and one, three and six months after delivery. The data comprised indepth verbatim transcriptions (from tape recorded interviews) which were analyzed to consider the meaning of the experience of childbirth, depression and early mothering to the individual respondent, and also to review the common features of the experience in order to suggest a construction of what is 'normal' here. The conclusion identifies certain elements of experience which are likely to lead to 'depression' at various stages after childbirth. These are concerned with physical stress, initial ibsecurities and lack of effective support and loss of former identity. They are not co-terminus with the 'stressors' of the 'social science' model in that their effect is totally subject to the meaning attributed to the events by each woman within the context of her biography.

Caring for a new child is a significant, demanding, and time consuming role, often associated with increased stress. Postnatal depression is one possible outcome of increased stress and research has highlighted the importance of detecting depression in new mothers. However fatigue a correlate of depression, has only recently become a focus of research among health professionals. Understanding the nature of fatigue and its management within the postnatal period, the focus of this study, may reduce its impact on women’s lives. This longitudinal study explores changes in intensity, physical, mental and emotional dimensions of fatigue, factors associated with higher levels of fatigue, the impact of fatigue on women’s usual activities, and strategies for managing fatigue. Self-administered structured questionnaires gathered data form 504 women at 1, 6, 12 and 24 weeks after birth. Reliable and valid instruments were used to measure the relationship between the defined factors and the outcome of fatigue at the various time points. State anxiety was a consistently strong predictor of fatigue intensity across time and group. Women sought to manage their fatigue by using self-care practices and asking for help from family and friends. This research highlights two issues for health professionals – care of new mothers must include recognition that higher levels of state anxiety are associated with higher levels of postnatal fatigue: ongoing assessment of fatigue and the strategies used to manage it is essential beyond the early postnatal period / Doctor of Philosophy (PhD)

The post natal home visit care program is a maternal and newborn home visit care program, designed to address the needs of the childbearing families following delivery and early discharge, irrespective of the place of delivery. The study was undertaken to determine the factors influencing the implementation of the post natal home visit care program by nurses and to make suggestions to resolve the problem in an urban health district in Botswana. A descriptive exploratory study, using both quantitative and qualitative methods guided the process. Two methods were used to collect data, namely, the developed checklist and four focus group discussions. Twelve clinics were sampled and checklists were completed for the twelve clinics by the researcher. A total of twenty eight Registered Nurses and Registered/Enrolled Nurse Midwives were recruited from the participating twelve clinics through purposive sampling. This included nursing managers and senior nursing staff. The findings reflect the post natal home visit care program deficits. Protocols and logistics such as transport and staff for the program were not in place. Furthermore, the results also reflect various factors such as lack of motivation, lack of support from management and co-workers, distance and fear of stigmatisation as reasons for not implementing the post natal home visit care program. The participants felt that there was need to implement the program and attached merit to its importance. Finally, the participants made suggestions to overcome the deficit such as team work, commitment to work, academic development and improvement of management and supervision. In conclusion, failure to implement the program represents a health delivery deficit. There is need for improved management and supervision to balance the needs of Registered/Enrolled Nurse Midwives and the needs of the organization in order to attain better results. There is also a need for the provision of logistics needed for the post natal home visit care program such as transport and manpower. Finally, there is need for the coordination of the post natal home visit program by the District Health Team to aid implementation so as to provide the essential service. / Thesis (M.N.)-University of KwaZulu-Natal, 2006.

No description available.

published_or_final_version / Nursing Studies / Master / Master of Nursing

No description available.

No description available.

No description available.

published_or_final_version / abstract / toc / Clinical Psychology / Master / Master of Social Sciences

Background: Postnatal depression (PND) follows 10-15% of deliveries. Postnatal blues occur in the first postpartum week and are thought to have little significance. Studies report links between them, PND and premenstrual symptomatology but are methodologically flawed. Hypotheses: Women with severe blues are more likely to become depressed in the 6 months after delivery and more likely to experience premenstrual symptomatology when menstruation resumes. Subjects: First-time mothers who were literate, English speaking, had a singleton pregnancy, no current severe mental illness and whose fetus was healthy. Method: Written informed consent was obtained in late pregnancy. Baseline data include the Eysenck Personality Questionnaire, Edinburgh Postnatal Depression Scale (EPDS), sociodemographic and obstetric details. The Blues Questionnaire was completed on postpartum days 3 & 5. Obstetric data were recorded. Subjects (scores >/75^th centile on the Blues Questionnaire) and controls (\<25^th centile) were matched for age, marital status and social class. All participants completed monthly postal EPDS. When menstruation returned, daily Menstrual Distress Questionnaires and visual analogue scales for premenstrual symptoms were completed for 2 cycles. At 6 months all women with EPDS scores >/9 at any time postpartum were interviewed using the Schedule for Affective Disorder and Schizophrenia (Lifetime version). Research Diagnostic Criteria diagnoses were made for current or past psychiatric disorder. 1 in 5 women with EPDS scores <9 were interviewed to exclude false negatives. Results: Women with severe blues were 3.8 times more likely to become depressed and to have a major rather than minor illness. Their depressions began sooner after delivery and lasted longer than those with no blues. They were more likely to experience premenstrual symptoms. Discussion: Results support the idea that these conditions are variants of affective disorder, severe blues acting as a marker of affective vulnerability. Clinical applications of the results and areas for further research are explored.