Thesis (Ph. D. 1981)--University of Utah, 1981. / Includes bibliographical references (leaves [156]-163).

Thesis (M.S.)--University of Wisconsin--Madison, 1980. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 63-65).

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M.Cur. / Please refer to full text to view abstract

A comparative study of two groups of primiparas was conducted in Vancouver, British Columbia (Canada), during the summer of 1976. The first group was comprised of those women who attended 50 per cent or more of a series of prenatal classes (the attenders), and was compared to a group of non-attenders, those who had not attended prenatal classes during their pregnancy. The objective of the study was to examine those factors which are expected to influence utilization of prenatal educational programs. The long-term objective was to generate data which could be used to improve these programs; and, consequently, also to improve the health of the mother and child. From a total sample of 154 primiparas drawn from the mothers having given birth to a live baby in April, May or June 1976, 127 were interviewed: 54 non-attenders and 73 attenders. The comparison of the groups of attenders and non-attenders showed the following results: 1) There were differences between the two groups in regard to basic socio-economic and demographic characteristics. In general, the non-attenders tended to be younger, less educated, poorer, new immigrants, and less fluent in English than the attenders. 2) When tested on a set of knowledge questions, the two groups showed differences in the areas of pregnancy, childbirth and child care knowledge. In general, the attenders responded correctly to more of the questions than did the non-attenders. However, on some questions, the differences were not very large and it would be interesting to re-examine these differences when confounding factors are controlled (e.g., English fluency). The comparison of behavioural health practices revealed the following: The non-attenders were less likely to smoke during pregnancy than were the attenders. - The two groups were fairly comparable in terms of a positive change in their nutrition habits during pregnancy. - As expected, more attenders than non-attenders used controlled breathing techniques during the delivery. Seventy-six per cent of the non-attenders either partially or totally breastfed their babies compared with 55 per cent of the attenders. When asked about their reasons for not attending prenatal classes, the non-attenders most frequently mentioned a lack of awareness of the existence of the classes and a general feeling that it was unnecessary to attend. Difficulty in speaking and understanding English was also a factor in non-utilization of classes. In regard to wife-husband relationships, husbands were given as a source of support by more attenders than non-attenders, although the difference was not statistically significant. It could be worthwhile to investigate this area more thoroughly to determine whether the presence of support from a husband/partner is a reason for attendance or occurs as a result of the attendance. The data on knowledge and behavioural health practices could raise questions concerning the effectiveness of the prenatal programs. However, this study has not been designed to evaluate these programs. Most of the factors studied regarding knowledge and health practices are known to be associated with socio-economic and cultural factors. An analysis of the true effect of the program should take these factors into consideration. In conclusion, this study has shown ways of increasing utilization of prenatal educational programs. Emphasis should be placed on the following: The target population - More effort and resources should be devoted to reach lower socio-economic groups, new immigrants, and those less fluent in the English language. The method - New communication and information dissemination techniques, as well as diversified teaching methods, should be developed (e.g., more courses should be taught in a language other than English). The content - Given the differences in knowledge levels and health practices, the content should be geared more to meet the needs of specific sub-groups in the population. Publicity - The study demonstrates the need for making better known the existence of the program as well as its present objectives. This study has raised a number of questions regarding both utilization of prenatal care and outcome measures relating to this care. Therefore, a larger and well designed study to investigate these questions more extensively is recommended. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Poor childbirth outcomes, and the disparities they highlight, continue to be of great concern in the United States. Birth doulas, professionals who provide support for pregnant people during the perinatal period, have been identified as a way to improve maternity outcomes while combating disparities in birth faced by marginalized groups of people. While existing research supports the positive benefits of doula care, limited research exists on the views and experiences of maternity care teams, specifically the relationship between obstetricians and doulas. This project aimed to explore the views, knowledge, and experiences of both obstetricians and birth doulas in New York City. The data for this study comprised a sample of all obstetricians attending births in Manhattan, New York City (response rate 125 of 220, 57%) and interviews with a purposive sample of 27 experienced birth doulas. The positive themes that emerged centered on the benefits a supportive doula could provide, specifically assistance to people wanting a natural childbirth and those lacking support. Negative themes included the comparatively high cost of a doula as well as unprofessional doula behavior, most notably interfering with medical recommendations and acting out of their scope of practice. Doulas reported that the obstetricians who do value their care are a “self-selecting” group, whereas those who do not tended to be controlling and unknowledgeable regarding the role of a doula. In addition to further exploration into the relationship between obstetricians and doulas, these findings indicate the need for more education in both groups, particularly if the goal is for a cooperative, integrated model of effective maternity care in which doula care is a component.

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The present studies were designed to investigate responsiveness of women to laboratory pain. The purpose of this investigation was manifold in that the effects of several different variables on pain perception were examined. First, the studies sought to determine whether the experience of menstrual pain, otherwise known as dysmenorrhea, had any relationship to the perception of laboratory induced pain, namely, cold pressor pain. Second, it was asked whether menstrual phase had any relationship either on its own, or in interacting with dysmenorrhea, to pain perception. Third, based on observations from the two previous studies, it was asked whether age and/or previous experience of childbirth pain had any influence on pain perception. The first study employed a within-subjects design of young university women in order to investigate the relationship of dysmenorrhea and menstrual cycle phase to pain threshold, tolerance, and subjective pain intensity ratings. The second study employed a between-subjects design of young university women as well, in order to replicate the menstrual phase effect obtained in the first study. The third study employed a between-subjects design of older women as it dealt with the relationships of age and/or the experience of childbirth pain to the same measures of pain perception. It also dealt with defining further characteristics of dysmenorrhea as occurring in an older group of women (over 30 yrs of age). Results from the first two studies indicated a significant increase in pain sensitivity, measured as pain threshold, from the follicular to the luteal phase of the cycle but no overall significant effects of dysmenorrhea on laboratory-induced pain. In the second study, there was a significant interaction between menstrual phase and dysmenorrhea with respect to subjective pain ratings. These results partially replicated previous findings in the literature while employing a clinically relevant method of pain induction. Results from the third study indicated that previous experience of childbirth pain, independent of age, is a significant factor in the perception of laboratory-induced pain. These latter results have never before been reported in the pain literature and thus deserve further investigation. Possible implications for an adaptation-levels model are discussed. / Thesis / Doctor of Philosophy (PhD)

Throughout the literature varying opinions exist concerning the health outcomes, service utilization and patient satisfaction as they relate to maternal and infant care given by physicians versus midwifery care. This study looks at the following question; what differences are there in health outcomes, service utilization, and patient satisfaction, between women who are cared for by either physicians or midwives and vaginally deliver a singleton healthy baby in hospital? This study employs a secondary analysis of data from the TOMIS II study. The TOMIS II data was collected from 250 women in each of five hospital sites in Ontario in 2002. The analysis showed that, except for the breastfeeding, all of the measures of maternal and infant health outcome did not statistically differ between physician-care and midwifery care. With respect to service utilization, the results indicated that family physician visits, length of stay, and utilization of the Healthy babies, Healthy Children (HBHC) resulted in statistically significant lower service utilization by mothers in the midwifery group, while the other measures were found not to be different. Patient satisfaction measures revealed that women receiving midwifery services were much more satisfied with their care than were women receiving physician-based services. Five conclusions were drawn from this study; midwifery care is a viable option for maternity care in Ontario for low-risk birth mothers; the utilization of midwives reduces the total amount of services being used in the health care system; women are more satisfied with their care when they have midwives participating in all parts of their care; health policy in Ontario should focus its efforts to expand midwifery to make it a viable option for maternal and infant care to all healthy women; health care policy should support publicly funded midwifery in each of the jurisdictions in Canada, as a cost-effective approach to care with comparable outcomes. / Thesis / Master of Social Work (MSW)

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2999-01-01