Thesis (Ph. D.)--University of Texas at Austin, 2008. / Vita. Includes bibliographical references.

Thesis supervisor: Susan C. Lawrence. Thesis supervisor: John Raeburn. Includes bibliographical references (p. 339-354).

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

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Objectives To determine obstetric, maternal and fetal variables that increase the risk of postnatal urinary and anal incontinence. To establish how anal and urinary incontinence impact on Quality of Life (QoL) with particular reference to sexual psychology. Finally, to ascertain the extent of disclosure of incontinence problems to partners and health professionals. Design A longitudinal, prospective, repeated measures, cohort study using five data sources. Data was collected in the last trimester of pregnancy, at 6 weeks postnatal, 6 months postnatal and finally at one year postnatal. Setting Wirral University Teaching Hospital NHS Foundation Trust. Participants Primiparous women with no pre-existing disease (N=516). Participants were recruited after a normal 20 week obstetric ultrasound scan. Results Stress incontinence was reported by 39.7% antenatally, 28.2% at 6 weeks postnatal, 31% at 6 months and 26.5% at one year postnatal. Urge incontinence was reported by 23.5% antenatally, 21.2% at 6 weeks, 21.4% at 6 months and 16.4% at one year postnatal. Anal incontinence at one year postnatal was reported by 9.39%. Those participants under the age of 20yrs had higher rates of postnatal urge incontinence (p<.001) possibly associated with increased rates of infection in this group. BMI>30 was associated with higher rates of antenatal stress incontinence but was not significant in the postnatal period. BMI<20 was associated with an increase in postnatal urge incontinence. Prolonged periods of time in labour without bladder emptying was associated with increased rates of both urinary incontinence (OR 2.36) and anal incontinence (p=.026). Forceps delivery was associated with postnatal stress incontinence (OR 2.41). Although caesarean section appeared protective against urinary incontinence initially, long-term data show a progressive increase in reported rates of urinary incontinence even after elective caesarean section. Elective caesarean section was protective for anal incontinence. Faecal incontinence was significantly higher (OR 3.26) in the group who had their labour induced (12.1%) compared to those who had a spontaneous labour (4.6%). Perineal trauma was not associated with anal incontinence. However, it was associated with urinary incontinence throughout the postnatal year with anal sphincter disruption having the highest rates of stress incontinence (p<.005). Birth weight, duration of labour, feeding method, epidural anaesthesia and smoking were not significant. Overall, urinary incontinence appears to be a regressive condition, although the impact on QoL is cumulative and seems to increase over time. Some participants had a progressive, deteriorating condition which appears to be associated with a higher BMI or >6 hours from bladder emptying to delivery of the baby. Urinary and anal incontinence had a detrimental effect on all QoL domains. Those reporting nocturnal enuresis, pain, intercourse incontinence and urge incontinence were effected the most. The greatest impact is on the emotion domain. Only 8.7% with urinary incontinence and 9.7% with anal incontinence discussed their symptoms with a health professional. Discussion with a partner was 32.8% and 21.4% respectively. The most common reasons for non-disclosure were embarrassment, fear of not being taken seriously and not wanting to waste the time of the health professional. Those participants who did disclose tended to have multiple symptoms. Pregnancy and childbirth appear to have a detrimental impact on sexual psychology, irrespective of continence status. Those who reported incontinence appear to have less sexual depression than the continent group suggesting the adoption of defense mechanisms to preserve the sexual Self. Conclusion Generally, urinary incontinence is a regressive condition. Risk factors for a progressive condition have been identified. Younger pregnant women appear to be more prone to infection which can sensitise the bladder and result in long term urinary incontinence. Prolonged periods of time in labour without voiding increases the risk of urinary and anal incontinence and is associated with a deterioration of symptoms over time. Whilst for all other modes of delivery the rate of UI decreased over time, in the elective CS group, the rate of UI increased steadily throughout the postnatal year. These findings support previous studies and suggest a degree of under-recognition or under-reporting of anal sphincter trauma leading to dysfunction. The impact of incontinence on quality of life domains shows clear evidence that the condition has a detrimental impact on many aspects of an individuals well being. Those women reporting intercourse incontinence had the greatest impact on QoL domains. Few women seek help for their condition and a number of personal and organisational factors have been highlighted which contribute to keeping incontinence both secret and taboo. It is clear that what incontinent women think is affecting the way they feel and ultimately their behaviour. Psychological defence mechanisms are employed to justify their inaction.

Introduction: About sixty million of home deliveries occur worldwide every year. The vast majority of them in Low and Middle Income Countries (LMIC) where most of all out of health facility deliveries are attended by relatives and traditional births attendants . Poor hygienic conditions, ignorance of clean birth practices and lack of skills to manage the complications when they occur, make home deliveries unsafe for the mothers and their new-borns. Thus, getting pregnant women to give birth at health facility is critical in the efforts to improve reproductive health outcomes in many LMIC.

Thesis advisor: Sharlene N. Hesse-Biber / Birth Visionaries: An Examination of Unassisted Childbirth By Lauren Ashley Brown Sharlene Nagy Hesse-Biber, Thesis Chair This exploratory study inquires into unassisted childbirth, the act of giving birth without the presence of any birth professional (doctor, midwife or doula). Unassisted birth is on the radical fringe of alternatives to the dominant techno-medical birth common in American hospitals today. My research questions are what are women's motivations for choosing unassisted childbirth and what is the lived experience of unassisted childbirth? I will answer these questions through nine in-depth interviews and a grounded theory data analysis. My approach comes from a focus on the everyday lived experience of women as problematic as well as insights from anthropology of birth and feminist postmodern sociology of knowledge. This study is relevant to public health policy on pregnancy and birth, to those working on questions of technology and culture, and to those concerned with how biosocial rituals shape embodied experience. My findings also contribute to research about power in contemporary society, specifically how the body can be a cite for social control and resistance. / Thesis (MA) — Boston College, 2009. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Sociology.