Background. To give birth can be a stressful experience and women cope with thisstress in many different ways and have different personal outcomes. Self-efficacy orconfidence in ability to cope with labour can be considered as an important factoraffecting pregnant women’s motivation of normal childbirth and their interpretation ofthe childbirth event.The aim. The purpose of this study was to test the Chinese short form of theinstrument Childbirth self-efficacy instrument (CBSEI) in Tanzania, that measurepregnant women’s self-confidence and coping abilities during childbirth.Method. The Chinese short form of the CBSEI was used to pilot test the pregnantwomen’s confidence of childbirth to see if the questions were understood in theTanzanian culture. Besides this instrument socio-demographic data was collectedtogether with two open questions asking about attitudes and experiences of childbirth.The instrument was translated into Kiswahili. A sample of 60 pregnant women whowere visiting antenatal clinic (ANC) regularly were asked to participate and with helpfrom midwifes at two ANC places the questionnaires were filled out.Result. The result shows that the validity and reliability of the two subscales OE-16and EE-16 were established. The internal consistency reliability of the two subscaleswere high, suggesting that each of the subscale mean score provides a good overviewof self- reported belief in coping ability for childbirth.The results further show that the instrument, CBSEI in this pilot study is not able toidentify women who need extra support during childbirth.Conclusion. The reliability and validity of information presented in this pilot studysupport the use of the Chinese short form of the CBSEI as a research instrument in theTanzania culture. Further studies are recommended to get a wider understandingabout women’s coping abilities in a culture like Tanzania.

<p>This dissertation explores the simultaneous trends towards increasing and decreasing medical intervention in childbirth. Using the medicalization literature as a theoretical framework, I use a mixed-methods approach to explore how both the medical community and laypeople think about and plan for childbirth.</p><p>First, the midwifery and obstetrics literatures from the past 35 years are reviewed to provide a medical and scientific context for the trends seen in childbirth over this time period. Second, descriptive and logistic regression analyses of the Center for Disease Control's Natality dataset, a census of U.S. birth certificate data, provide a picture childbirth trends and an understanding of the relationship between maternal characteristics and medicalized and natural births. Third, 35 qualitative interviews were conducted with pregnant women, focusing on their plans for their children's birth. The interviews also address the factors that influence women's plans and choices for childbirth, thus providing a better understanding of the social factors that affect birth plans.</p><p>The key finding of this research is that most women would prefer to be able to have the "best of both worlds" - the ability to experience childbirth as a natural process for as long as is safe and comfortable, combined with immediate access to the medical skills and technology that can assist them and their babies in an emergency.</p><p>The quantitative analyses demonstrate that alternatives to a mainstream model of childbirth are on the rise, even while these alternatives continue to represent only a small fraction of births. The increase in midwifery use while rates of hospital births remain relatively consistent suggests that many midwife-attended births are taking place in hospitals. These data support the finding that women like the idea of a natural birth, but also want to have ready access to trained doctors, surgeons, and the best medical care available in case something goes wrong.</p><p>There can be no doubt that childbirth, on the whole, had become a highly medicalized process. However, despite the fact that women want childbirth to be recognized as a natural process, there is no true movement for the demedicalization of childbirth. That is, women are not suggesting that medical intervention be removed entirely from childbirth. Instead, there need to be more options available to women, thus enabling them to give birth in a way that is comfortable and respectful of their preferences and goals, while simultaneously maintaining ready access to additional intervention, should it be necessary.</p><p>Implications for future research in childbirth and other fields of study are discussed.</p> / Dissertation

<p>The expectations of a successful outcome are great during childbirth. The overall objective of prenatal care and birth care is that midwives contribute in creating the most positive experience of pregnancy, child birth and infancy as possible. During the past 30 years there has been a significant increase in sectiofrequency both in Sweden and the rest of the Western world. More parents feel an overall insecurity when it comes to child labour. The purpose of this study was to describe how midwives experience the work of creating a sense of security and good nursing when meeting the expectant parents. A phenomenological approach was chosen with the use of eleven qualitative interviews that were analyzed with Giorgis' method of analysis. The result revealed three themes: organizational - professional conditions, the communicative ability and the reflective - emotional competence. Trusting your inner sensibility and intuition was something that characterized all the interviews and was the essence of the results. The way work was lead and organized, as well as the utilization of competence effected the midwives’ possibility of contributing to a sense of security and good care. When the communication was based on sensibility, midwives’ could create a good and trustful relationship with the expectant parents. The emotional involvement was an essential requirement for carrying out the work in a satisfying way. A question for the future is how inner knowledge based on practical experience can benefit new personnel and how the organization and education for healthcare givers can utilize the specialist knowledge of midwives with experience.</p> / <p>Förväntningarna i samband med barnafödande är stora på att en graviditet ska sluta lyckligt. Det övergripande målet inom mödrahälsovård och förlossningsvård är för barnmorskor att medverka till en så positiv upplevelse av graviditet, förlossning och spädbarnstid som möjligt. De sista trettio åren har sectiofrekvensen ökat betydligt både i Sverige och västvärlden. Fler föräldrapar upplever idag en allmän otrygghet i samband med barnafödande. Syftet med denna studie var att beskriva barnmorskors upplevelser av att förmedla trygghet och en god omvårdnad i mötet med det blivande föräldraparet. Fenomenologisk ansats valdes med elva kvalitativa intervjuer som analyserades enligt Giorgis analysmetod. Resultatet visade tre teman: Organisatoriska - professionella förutsättningar, den kommunikativa förmågan och den reflektiva - emotionella kompetensen. Att lita på sin inre känsla och intuition var en upplevelse som genomsyrade hela intervjumaterialet och blev resultatets essens. Hur arbetet leds och organiseras och hur kompetens tillvaratas påverkade i hög grad barnmorskors möjligheter att förmedla trygghet och en god omvårdnad. Genom att vara lyhörd i sitt sätt att kommunicera kunde en god och förtroendefull relation skapas mellan barnmorskor och det blivande föräldraparet. Det känslomässiga engagemanget var en nödvändig förutsättning för att utföra ett bra jobb. En fråga inför framtiden är på vilket sätt den erfarenhetsbaserade inre kunskapen kan komma ny personal tillgodo och hur omvårdnadsarbetets organisation och vårdutbildningar kan ta tillvara det expertmässiga kunnandet hos erfarna barnmorskor.</p>

Thesis (Ph. D.)--University of Washington, 2001. / Vita. Includes bibliographical references (leaves 252-263).

In this dissertation, I argue that the maternal body is a chief site of discursive political and cultural struggle over gender, family, and work in a neoliberal America. I consider contemporary discourses of maternity, an aggregate I call maternity culture, as cultural products and rhetorical expressions of the antagonistic arrangements in contemporary capitalism since the neoliberal turn. The complexities of maternity culture discourses can therefore be better understood when they are historicized alongside changing economic and political realities. Using materialist feminism as my primary methodology, I contend that maternity culture discourses express the ethics of neoliberalism including the privatization of social/political responsibility and self-actualization through entrepreneurialism and labor, while simultaneously justifying the intensification of maternal labor and the continued surveillance of women's bodies. I argue that maternity culture discourses are, therefore, rhetorics of reproduction and reproducing rhetorics. That is to say, they are a part of a larger set of discourses about the reproductive function that are themselves caught in the logics of capital that may result in the reproduction of unequal arrangements in material and symbolic life. In order to illuminate how maternity culture operates in neoliberal public life as a reproducing rhetoric, I provide a historical analysis of rhetorics of women's health, and analyze two case studies involving discourses surrounding breastfeeding and natural childbirth, major sites of struggle within maternity culture. / text

The purpose of this study is to determine the effect of childbirth preparation classes on self-efficacy in coping with labor pain in Thai primiparas. The nonprobability convenience sample consisted of sixty primiparas assigned to either a control or an experimental group (thirty in each group). In order to prevent crosscontamination, all control group data were collected before initiating enrollment of the experimental group. The control group participants received standard care and education. Participants in the experimental group attended three childbirth classes over three consecutive weeks. Data were collected at the beginning of week 1 to establish a baseline (pretest), at the end of the third class which is the end of the intervention (posttest), and at 24-48 hours after delivery (follow-up) using a demographic form, postnatal data form, and the Childbirth Self-efficacy Inventory. Overall, experimental group self-efficacy expectancy increased dramatically across three data points. In contrast, control group self-efficacy expectancy decreased dramatically across three data points. There was an interaction between time of selfefficacy expectancy measurement and group, F(1.33, 71.77) = 6.34, p < .05. Selfefficacy expectancy in the experimental group was significantly different than that of the control group, F(1, 54) = 14.66, p < .001. Outcome expectancy findings were different than self-efficacy expectancy results. Control group outcome expectancy decreased dramatically across three data points while the experimental group selfefficacy increased after the class and then decreased after the birth but was higher than baseline. There was an interaction between time of outcome expectancy measurement and group, F(1.72, 935.18) = 4.83, p < .05. Data at the follow-up or 24-48 hours after delivery revealed that only one woman from the control group received an analgesic during the birthing process. The groups did not differ in duration of labor and type of delivery. These findings indicate partial effect of childbirth preparation classes on self-efficacy in coping with labor pain. The relatively small effect size reflects the high degree of variability in issues surrounding a woman's experience of pain and measures related to self-efficacy in coping with labor pain. Additional research in this population is needed. / text

Background: Since the launch of the Safe Motherhood Initiative in 1987, the global community has called for reductions in maternal mortality in the developing world. However, reliable methods for assessing levels and trends in maternal deaths, particularly at a district level, are lacking. In increasingly-diverse countries like Indonesia, it is essential for national and local decision-makers to have timely figures to inform programmatic efforts. Aims: The aim of this PhD is to develop and pilot a community-based surveillance system (‘Surveillance by Key Informants’/SKI). The objective is a proof of principle of SKI’s reliability and feasibility, and to verify the potential for routine use at a district level in Indonesia. Methods: This PhD is comprised of two methodological studies, both designed and implemented in Serang and Pandeglang Districts of Banten Province, Indonesia, between 2004 and 2008. The Maternal Death from Informant/the Maternal Death Follow on Review (MADE-IN/MADE-FOR) method comprises retrospective, community-based surveillance of maternal deaths, involving two local informant networks. The experience from MADE-IN/MADE-FOR was used to create a prospective surveillance system (SKI), using the same networks but re-designed for routine use by district authorities. Results: MADE-IN/MADE-FOR found a high level both of maternal mortality (435 deaths per 100,000 live births) and of indirect causes (43%). The SKI findings show the considerable potential of this new approach. The two informant networks together captured about 91% of births and 92% of deaths. In general, the local stakeholders accepted SKI as a useful and realistic system for them to continuously capture local vital events. Conclusions: In a country like Indonesia where civil registration is lacking, SKI could be used to capture deaths and births in the immediate term, with MADE-IN/MADE-FOR used as a periodic census of all maternal deaths. Both approaches can provide the basis for more detailed follow-up of deaths, and so ultimately help to inform reductions in maternal mortality.

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