M.Cur. / The primigravida's experience of childbirth is influenced by the knowledge and expectations she has of childbirth. Her expectations of childbirth are based on the information she got from the antenatal clinic, the nursing staff, her mother, friends and family. The purpose of this research was to determine the knowledge and expectations the primigravida has of childbirth. An exploratory, descriptive design was used within the context of an academic hospital in Johannesburg. The survey method was used. The method of research firstly consisted of a literature study of the primigravida's knowledge and expectations of childbirth. This was done in order to put the problem in perspective and also to serve as a theoretical framework for the study. Secondly, a structured questionnaire was used to make a survey of the primigravida's knowledge and expectations of childbirth. The test sample comprised all white primigravidas between the ages of 15 and 39 years with a pregnancy duration of 37 weeks and more who visited the antenatal clinic of an academic hospital in Johannesburg. Over a period of 11 weeks, from 15 october to 30 December 1989, 29 primigravidas participated in this research project. The questionnaires were completed with their visit to the antenatal clinic and then returned to the clinic staff. Descriptive statistics and frequency tables were used to interpret the results of the research. From this research it is clear that the respondents had insufficient knowledge of childbirth and the handling of pain during childbirth. This insufficient knowledge can mainly be attributed to the poor attendance of antenatal . preparation classes, inadequate professional counselling and the mother of the primigravida as the primary source of information on childbirth. The respondents, however, had realistic expectations· with regard to their handling of labour, as well as of the role of the midwife and the doctor.

Submitted in partial fulfillment of the requirements for the Degree in Masters of Technology in Chiropractic, Durban University of Technology, Durban, South Africa, 2017. / Introduction: Evidence suggests that pregnant women who lead sedentary lifestyles and have a poor knowledge of exercise during pregnancy are at risk of developing diseases like gestational diabetes, pre-eclampsia and low back pain along with many other chronic conditions. An exercise program during pregnancy has benefits for both the mother and the child. No studies have ascertained the knowledge and practices of exercise in pregnant women in South Africa, furthermore, there was a need to conduct research regarding exercise amongst South African pregnant women, particularly to determine whether any barriers to physical activity exist. Aim: To compare the knowledge and practices of pregnant women regarding exercise during pregnancy between a selected private practice and public clinic. Methodology: A quantitative, descriptive, cross sectional survey was used in this research study. The population consisted of pregnant women (n = 400) attending both public and private sector antenatal care in the Ethekwini municipal area of KwaZulu-Natal, South Africa. Public sector participants were drawn from the Addington Hospital public antenatal clinic and private sector participants were drawn from the gynaecological practice of Dr D Sankar. Purposive, stratified sampling was used. Following the signing of an informed consent form, data was collected by means of a self-administered questionnaire. A minimum sample size of 324 patients was calculated by the statistician. Descriptive statistics, such as frequencies and percentages were used to describe the demographic profile of respondents and their physical activities. Inferential statistics, including Chi-Square tests of association and student t-tests were used to determine differences in proportions and means respectively between the two categories of participants. Odds ratios (OR) were calculated to ascertain the measure of association between a risk factor and an outcome. Results: There were 198 (57.6%) participants from the private gynaecological practice and 146 (42.4%) from the public clinic at Addington Hospital. The mean age of the study population was 27.65 ± 5.3 years. Almost half of the study population were Indians (46.2%). Blacks made up the second largest proportion of the study population (39.2%). More than half of the study participants were involved in exercise during their pregnancy (57.1%). However, only 37% of the study population met the international criteria of physical activity, which is 30 minutes of moderate -intensity aerobic exercise, per day, for 5 days a week, during pregnancy as set out by the American College of Obstetrics and Gynecologists (2002). However, there was evidence of unstructured physical activity which increased the level of acceptable physical activity in the majority of participants 82.1%. Walking was the most common activity that the women engaged in from both the private sector (88.8%) and public clinic (89.3%). The average time spent on walking was more than 30 minutes a day. Household chores and climbing stairs also increased the levels of physical activity within the participants. Only a minority of participants (35.4%) stated that they were diagnosed with an adverse health condition, which prevented them from exercising. Some participants who did not exercise reported that fatigue was the reason for not being physically active (51.6%). Conclusion: Interventions need to be implemented to increase the knowledge of physical activity amongst pregnant women and the benefits that are associated with it. An attempt needs to be made by health practitioners to try and increase the level of physical activity among pregnant women, so that they may benefit from its effects. / M

There is a growing body of research aimed at understanding social support during pregnancy in South Africa. Pregnancy is constantly referred to as one of the challenging and stressful periods affecting women’s physical and psychological well-being. Various research studies on social support argue that social support is paramount at this stage. Research on social support indicates that having adequate and quality social support impacts on how pregnant women experience pregnancy. My interest in social support comes in the wake of absent fathers in South Africa and with the emerging trend of “new” fathers. Although there is a volume of research on social support, it tends to be realist. Using a social constructionist framework, I explore other ways of talking about social support in an attempt to expand the discourse around social support. I explore how pregnant women talk about social support during pregnancy from their intimate partners in the small rural municipality of Elundini, Eastern Cape, South Africa. Intimate partner support was limited to heterosexual partners regardless of their marital status. The sampling procedure followed a non-probability sampling method. Participants of the study were between 24 and 32 years old. Their gestational age ranged between five and eight months. Fourteen in-depth interviews using photo-elicitation were conducted with seven participants and were analysed using a social constructionist informed thematic analysis. The major theme that emerged from the analysis was partner involvement and absence during pregnancy. The analysis of results suggests that expectant father presence translates to social support. Participants constructed his presence as reassurance in the context of possible abandonment. Absence was constructed in different ways: participants constructed absence as unjust and unfair, absence and marriage, temporary absence in the form of cultural phenomenon of ukwaliswa/ukubukubazana, absence as normal but burdening to the pregnant women’s social network. Participants reported that social support from the expectant father affected pregnancy wantedness.

Thesis (M.Sc. (Nursing Science)) -- University of Limpopo, 2021 / Black South African women use herbal medicine during the intrapartum period. Research has proven that some herbal medicine may have a negative impact on both the mother and the fetus during labour and delivery. The aim of the study was to investigate the use of herbal medicine by pregnant women during the intrapartum period, at selected public hospitals in the Sekhukhune District, Limpopo, South Africa. The objectives of the study were to determine the use of herbal medicine by pregnant women during the intrapartum period and to develop a health education programme for communities around the Sekhukhune District, Limpopo, South Africa. Quantitative research method was used, and data were collected using selfdesigned questionnaire. Total of 192 respondents out of 370 population participated in the study. Simple random sampling was used. The questionnaire was piloted in a different setting to ensure reliability. Data were analysed using SPSS version 24. The outcome of the analysis was presented as frequencies and percentages in tables, pie charts and bar graphs. Ethical standards were adhered to throughout the study. One hundred and ninety-two (192) women were invited to participate in the study all of which were from surrounding areas. None of the women declined participation. A total of 192 post-partum women answered the questionnaires. Of the 192, 76% used herbal medicine during the intrapartum period. The mean age is 19 years. Mostly, those who are Sepedi speaking are dominant in the area (at 76%). Pregnant women commonly ingested herbal medicine to induce labour or during labour to accelerate delivery at 56%. The result highlighted that the prevalence of the use of herbal medicine during the intrapartum period was high among women in the Sekhukhune District. Therefore, healthcare professionals should have knowledge about herbal medicine used by pregnant women during the intrapartum period and educate them about the dangers and effects of the herbal medicines, both to the mother and the fetus.

The focus of the study was to evaluate the attitudes of midwives towards the implementation of the Choice on Termination of Pregnancy Act in the O.R. Tambo District hospitals in the Eastern Cape. There was no provision for termination of pregnancy (TOP) for unplanned pregnancy until 1994 when the Choice on Termination of Pregnancy (CTOP) Act was introduced. This act allowed any pregnant woman to request TOP when she wished for TOP. The midwives could voluntarily undergo training in TOP services and the designated institutions started offering TOP services, but stopped at a later stage. This resulted in overcrowding in health institutions which continued rendering TOP services. The researcher posed one question to be answered as: What are the attitudes of the midwives who are employed by health institutions in the O.R. Tambo District in the Eastern Cape Province towards the implementation of the Choice on Termination of Pregnancy Act? The aim of the study was to evaluate the attitude of midwives towards the implementation of the CTOP Act in the O.R. Tambo District hospitals. The objective of this study was to determine the attitudes of these midwives towards the implementation of these services in the O.R. Tambo District in the Eastern Cape Province. A quantitative descriptive design was used in this study. The population consisted of 150 midwives from two hospitals in the O.R. Tambo District. The sample consisted of 75 midwives; 30 midwives from Hospital 1 and 45 midwives from Hospital 2. Random systemic sampling was used in selecting the participants. Data were collected using a questionnaire developed by the researcher and approved by the supervisor and the University of Fort Hare Ethics Committee. In the study, using a sample of (n = 75), the attitude on the implementation of CTOP scale had high reliability of 0.81. Data were analysed with the help of a statistician using Statistix 8.1 software for Windows. Approval to conduct the study was obtained from the University of Fort Hare Ethics Committee, Eastern Cape Department of Health and Hospital 1 and Hospital 2 before the study was conducted. The dignity of the participants was maintained by explaining v the topic of the research study, the aim and objectives of the study, the method to be used for data collection and the significance of the study. The participants were allowed to ask questions and the name and telephone of the supervisor were provided in case they needed some clarity. Voluntary, written informed consent was obtained before the interviews were conducted. Privacy, anonymity and confidentiality were ensured and maintained through all the stages of the research process. The finding of this study was that the midwives employed by the health institutions in O. R. Tambo District Municipality displayed positive responses in the majority (n=11/61.1%) of 18 items in the questionnaire. Since the midwives in this study demonstrated a positive attitude towards TOP, it was recommended that the reason for stopping the TOP services in the concerned institutions should be investigated. The following are also recommended: Compulsory training of midwives should include aspects of reproductive epidemiology, in particular, the epidemiology of unsafe abortions. Training in TOP services should continue, so that there will be adequate number of midwives to provide the TOP services, and consideration of special remuneration for TOP providers. Employment of managers trained in TOP and voluntary training of managers working in TOP sections should be considered so that they may provide effective support to TOP providers. Formation of support centres for TOP providers at Provincial and National levels. Education of the community in prevention of unwanted pregnancies by means of contraceptives and indications for a need to provide TOP services, to prevent victimisation of the TOP providers. Availability of a toll free number for reporting victimisation of the TOP providers.

Thesis (M. A. (Clinical Psychology)) University of Limpopo, 2017 / The study investigated the prevalence of Obsessive-Compulsive Disorder (OCD) symptoms and their relationship with pregnancy-related anxiety, prenatal depression and clinical anger among African pregnant women. The sample consisted of 206 pregnant women attending their antenatal check-ups at the Mankweng, Nobody and Rethabile clinics, and Mankweng hospital in the Capricorn District, Limpopo Province. When correlational analysis was conducted, the patient characteristics of age, having undergone a medical check-up, and having previously delivered a live baby generally did not correlate with any of the main scales measuring OCD, namely, perinatal depression, pregnancy-related anxiety and clinical anger (p > 0.05). Findings from the study indicated that almost 81% of the pregnant women could be classified as obsessive-compulsive disordered, when using the Foa et al. (2002) cut-off score of 21. Furthermore, findings from the regression analyses indicated that higher age, the number of gestation weeks, having previously experienced pregnancy-related complications, perinatal depression, pregnancy-related anxiety and clinical anger were variably positive predictors of OCI-R measured OCD symptoms. The predictors are specific to each of the symptoms. It can be concluded from the study that there is a relationship between OCD symptoms and all the independent variables used. / National Research Foundation

PhD (Advanced Nursing Science) / Department of Advanced Nursing Science / See the attached abstract below

Thesis (M. (Nursing)) -- University of Limpopo, 2022 / Background Despite all the interventions that have been developed previously preterm labour remain to be the leading cause of perinatal morbidity and mortality worldwide. Preterm labour occurs before 37 weeks of gestation under two obstetric circumstances namely, ‗spontaneous preterm labour‘ and ‗indicated preterm labour‘. The aim of the study was to develop the strategies to enhance prevention of preterm labour in selected hospitals in Capricorn District, Limpopo Province. Research Method A sequential explanatory mixed method was adopted, the study was conducted in three phases, namely, quantitative study, qualitative study, and development of strategies. Self-developed questionnaires with 50 item questions each for mothers and registered midwives were administered. Both questionnaires were pre-tested prior to being administered to the respondents of the main study. The sample size of mothers was 77 mothers and 62 registered midwives. Data collected from the respondents were analysed using Statistical Package for Social Science (SPSS) version 25 with the help of the statistician. Tables, pie charts and bar graphs were drawn to present the results. The results of quantitative phase were utilized to formulate the Interview Guides that were used to explore the knowledge and practise of registered midwives and obstetricians regarding preterm labour. Interviews were conducted with 20 mothers, 6 registered midwives and 4 obstetricians until data saturation was reached. Data were analysed qualitatively using Tesch‘s Open-Coding method. v Quantitative Results The quantitative results for midwives revealed that about 60% of the mothers who had preterm labour were teenagers. Most of the respondents had ‗spontaneous preterm labour‘ and did not have any comorbidities while few had ‗indicated preterm labour‘ and were induced. All 62(100%) of the midwives showed that the facility does not offer an Outreach Programme on the prevention of preterm labour. Themes and Sub-Themes Results Themes and sub-themes were coded manually. Results that emerged from the integration and comparison of quantitative and qualitative results revealed that the mothers who went into preterm labour spontaneously had little information or no health education regarding preterm labour. Developed strategies The following strategies were developed based on the identified factors that might hinders the prevention of preterm labour and after exploring the knowledge and practice of midwives and obstetricians in the selected hospitals, Capricorn District, Limpopo Province. Strategies includes strengthening of BANC Plus, staff establishment, laboratory turnaround time, outreach programmes and improvement of counselling and support services. Recommendations of the Study The recommendation of the study is divided into three groups which includes recommendations for midwives at the PHC and hospital, recommendations for the obstetricians at the hospital and the recommendations for the Department of Health. The midwives to visit schools and community centres at least twice in a month to give information to the woman of childbearing age and reinforce health education on each Antenatal Care visit. The obstetricians to screen all mothers who are at risk of preterm labour for infections, follow up the results and treat the mothers accordingly. The Department of Health should hire enough staff so that quality care can be vi rendered to the pregnant woman at the PHC and hospital. The Department of Health should develop the electronic database, to register all mothers who have a history of preterm labour, so that when they are pregnant the database system will also help to identify them at the PHC, and they would then be referred to the hospital in time. If the developed strategies to enhance prevention of preterm labour may be adopted and adhered to by the midwives and obstetricians, these may help in reduction of high figures of preterm labour in the selected hospitals.

Thesis (MMed)-- Stellenbosch University, 2013. / ENGLISH ABSTRACT: The vast majority of new Human Immunodeficiency Virus (HIV) infections in infants and young children occur through mother-to-child-transmission (MTCT), either during pregnancy, labour or delivery or by breastfeeding. Without access to perinatal MTCT (PMTCT) programmes approximately 30% of all babies born annually will be infected with HIV. OBJECTIVES The aim was to implement and audit a quality improvement cycle at the Worcester Obstetric Unit, which comprises of Worcester Hospital, a regional hospital in the Western Cape Province and its level one midwife obstetric Unit (MOU), in order to improve the quality of the PMTCT programme. The intervention included the implementation of easy changes and tools in the Antenatal Clinic, Infectious Diseases Clinic and Labour ward. METHODS The files and antenatal records of all HIV positive patients and patients with an unknown HIV status, who delivered at the Worcester Obstetric Unit during January, February and March of 2010 and 2011, were reviewed. All HIV negative patients and patients that had stillbirths and miscarriages were excluded. The pre-interventional findings of 2010 were compared with the post-interventional findings of 2011. RESULTS At the Worcester Obstetric Unit, for the study time period, there were 907 deliveries in 2010, of which 102 (11.2%) patients were HIV positive and 4 (0.4%) had an unknown HIV status compared to 2011, with 865 deliveries of which 108(12.5%) patients were HIV positive and no patients had an unknown HIV status. Significantly more patients were diagnosed with HIV before they fell pregnant than during pregnancy in the 2011 group, when compared with the 2010 group. A CD4 count was done on 94% of patients who were newly diagnosed with HIV and those with an unknown CD4 count result in the 2010 group, compared to 92% in 2011. There was a significant improvement after the intervention in the time it took from when blood was drawn for a CD4 count until the result was followed up, the median time decreased from 34 to 8 days (p=0.000001). Significantly more patients qualified for highly active antiretroviral therapy (HAART) after the guidelines were changed and the CD4 cut off was increased to 350 cells/l (p=0.001). Prior the intervention 18 patients did not receive the correct management before delivery due to preventable reasons, compared to one at the MOU. After the intervention this decreased significantly to only one patient at Worcester Hospital and none at the MOU (p=0.000001). Before the intervention adherence to the PMTCT protocol at the MOU was significantly better than at the hospital (p=0.0005) and after the intervention there was no significant difference (p=1.0). CONCLUSION Although the audit and quality improvement cycle was performed at a single hospital, with specific changes geared towards their needs, the basic principles can be applied to any Unit in the country providing a PMTCT service. Educating staff, creating awareness and reminding staff of the basic principles of PMTCT, implementing small changes and streamlining processes and setting specific goals or timelines, can lead to significant improvements in care, which ultimately will lead to a decrease in PMTCT of HIV and HIV related maternal and infant morbidity and mortality. / AFRIKAANSE OPSOMMING: Die oorgrote meerderheid (>90%) van nuwe Menslike Immuniteitsgebreksvirus (MIV) infeksies in babas en jong kinders vind plaas deur middel van moeder-na-kind-oordrag, hetsy gedurende swangerskap, die kraamproses of borsvoeding. Sonder toegang tot perinatale voorkomingsprogramme (PMTCT) sal ongeveer 30% van alle babas jaarliks met MIV geïnfekteer word. DOELWITTE Die doel van die studie was om ‘n gehalteverbeteringsiklus by die Worcester Verloskunde Eenheid, wat bestaan uit Worcester Hospitaal, 'n streekshospitaal in die Wes-Kaapprovinsie en sy vlak een vroedvrou verlossingseenheid (VVE), te implementer en daarna te oudit, om sodoende die gehalte van die PMTCT-program te verbeter. Die intervensie het bestaan uit die implementering van eenvoudige veranderinge en prosesse in die voorgeboortekliniek, infeksiesiekte-kliniek en kraamsaal. METODES Die lêers en voorgeboorte rekords van alle MIV-positiewe pasiënte en pasiënte met 'n onbekende MIV-status, wat gedurende Januarie, Februarie en Maart van 2010 en 2011 verlos het by die Worcester Verloskunde Eenheid, is nagegaan. Alle MIV-negatiewe pasiënte en pasiënte met doodgebore babas en miskrame is uitgesluit. Die pre-intervensie bevindings van 2010 is vergelyk met die post-intervensie bevindings van 2011. RESULTATE By die Worcester Verloskunde Eenheid was daar 907 geboortes gedurende die studietydperk in 2010, waarvan 102 (11,2%) pasiënte MIV-positief was en 4 (0,4%) met ‘n onbekende MIV-status. In 2011 was daar 865 geboortes waarvan 108 (12,5%) pasiënte MIV-positief was en geen met 'n onbekende MIV-status. In die 2011-groep is beduidend meer pasiënte gediagnoseer met MIV voor as tydens swangerskap. In die 2010-groep is daar 'n CD4-telling gedoen vir 94% van nuut gediagnoseerde pasiënte en diegene met 'n onbekende CD4-telling, in vergelyking met 92% in 2011. Daar was 'n beduidende verbetering na die intervensie in die tyd wat dit geneem het vandat bloed getrek is vir 'n CD4-telling totdat die resultaat opgevolg is. Die mediane tyd het verminder vanaf 34 na 8 dae (p = 0.000001). Nadat die riglyne vir kwalifisering vir hoogs aktiewe antiretrovirale terapie (HAART) verander is na ‘n CD4 telling 350 selle/l het daar beduidend meer pasiënte gekwalifiseer vir HAART. By Worcester Hospitaal het 18 pasiënte voor die intervensie nie die korrekte behandeling intrapartum ontvang nie weens voorkombare redes, in vergelyking met slegs een pasiënt by die VVE. Na die intervensie was daar ‘n beduidende afname na slegs een pasiënt by Worcester Hospitaal en geen by die MOU (p = 0.000001). Voor die intervensie was die korrekte uitvoering van die PMTCT-protokol by die MOU beduidend beter as by die hospitaal (p = 0,0005) en na die intervensie was daar geen beduidende verskil (p = 1.0). GEVOLGTREKKING Alhoewel die oudit en gehalteverbeteringsiklus uitgevoer is by 'n enkele hospitaal, met spesifieke veranderinge gerig tot hul behoeftes, kan die basiese beginsels toegepas word in enige eenheid in die land wat ‘n PMTCT diens verskaf. Opvoeding van personeel en bewusmaking rakende die basiese beginsels van PMTCT, klein veranderinge en die vaartbelyning van prosesse by die voorgeboorte klinieke en die stel van spesifieke doelwitte of tydlyne, kan lei tot aansienlike verbeteringe in pasiënte sorg. Dit sal uiteindelik lei tot 'n afname in die MIV oordrag van moeder na kind, asook MIV-verwante morbiditeit en mortaliteit in moeders en kinders.

South Africa is a very violent society, where violence is often used as a social resource to maintain control and establish authority. Global and local research suggests that there is a high prevalence of intimate partner violence (IPV), a facet of this violence, although little research has been conducted into the effects of IPV during pregnancy in the South African non-governmental organisation (NGO) context. NGOs globally and in South Africa have attempted to address IPV and IPV during pregnancy by providing services that aim to assist (largely female) clients emotionally and logistically. In light of this phenomenon, this qualitative study presents data generated through the use of a lightly-structured narrative interview schedule. The interviews were conducted over three sessions with eight counsellors, all based at two NGOs in South Africa and experienced in counselling women who have suffered IPV and IPV during pregnancy. This study used Taylor and Littleton’s (2006) narrative-discursive analytical lens, infused with theoretical insights from Foucault about power, discourse and narrative in order to identify the discursive resources that shape the narratives that the counsellors shared in the interviews and how these translate into subject positions and (gendered) power relations of the men and women about whom they speak. Six discursive resources emerged from the narratives, namely a discourse of ‘traditional “African” culture’, ‘patriarchal masculinity’, ‘nurturing femininity’, ‘female victimhood’, ‘female survivorhood’ and ‘human rights’. These informed the three main narratives that emerged: narratives about IPV in general, IPV during pregnancy, and the counsellors’ narratives about their intervention strategies. Within these narratives (and the micro-narratives which comprised them), men were largely positioned as subscribing to violent patriarchal behaviour whilst women were mostly positioned as nurturing and victims of this violence. The counsellors also constructed women as largely ignorant of their options about IPV and IPV during pregnancy; they constructed these phenomena as problems that require intervention and identified a number of factors that indicate what successful IPV interventions should entail. In reflecting upon this analysis, this study also aimed to address the questions of what is achieved or gained by using these narratives and discursive resources, what the significance or consequences are of constructing and using these particular narratives and discourses and whether different narratives or discourses would have been possible. Recommendations for further research includes incorporating more sites as well as interviewing perpetrators and IPV survivors themselves, perhaps in their home language where relevant rather than English, to gain a broader and more faceted understanding of the dynamics surrounding IPV during pregnancy. A recommendation for practice in intervention against IPV during pregnancy is to introduce more holistic/systemic intervention strategies and working with communities to address this issue.