Obstetric trauma is a major cause of faecal incontinence in women resulting in considerable social disability. Until recently the development of faecal incontinence has been attributed largely to damage to the pelvic nerves. However the advent of anal endosonography has added a new dimension to our understanding of the pathophysiology of faecal incontinence. In this thesis, gross dissection and histological studies of 19 anorectal specimens was performed to demonstrate the normal anatomy. Simultaneous dissection and sonography of the anorectum (14 in vivo and 12 in vitro studies) has clarified the normal sonographic anatomy of the anal sphincters. Anal endosonography was performed in 114 healthy volunteers to demonstrate gender differences in anal sphincter anatomy. A prospective study of 12 patients undergoing secondary sphincter repair and 15 patients undergoing lateral internal anal sphincterotomy has validated the appearance of sonographic sphincter defects. A new technique of demonstrating the anal sphincters at rest using vaginal endosonography has been demonstrated in 20 women. A prospective study of 202 pregnant women using anal endosonography and neurophysiological tests has demonstrated that 35% of primigravidae (13% symptomatic) and 44% of multigravidae (23% symptomatic) develop occult anal sphincter defects during vaginal delivery. Although pudendal nerve damage can be identified in 16% of women 6 weeks after delivery, in the majority this recovers with time. Forceps delivery was identified as the single independent variable associated with sphincter damage although damage was also sustained in the absence of instrumental delivery. In a separate study of 50 women who sustained a recognized third degree tear 47% were found to be symptomatic despite a primary sphincter repair. In 85% of these women persistent anal sphincter defects were identified sonographically. In a further study of 43 women who had an instrumental delivery (17 vacuum and 26 forceps) anal sphincter defects were identified in 81% (38% symptomatic) of women who were delivered by forceps compared to 12% (21% symptomatic) delivered by the vacuum extractor. One hundred and fifty doctors and midwives were interviewed to assess their knowledge and training in perineal anatomy and repair. There was a clear deficiency in knowledge and inconsistencies in classification of third degree tears were apparent highlighting the need for more focused training in perineal anatomy and repair. / Thesis (Ph.D.)-University of Natal, 1994.

Fertility is one of the major tenets of demography. Its importance lies in the determination of fertility trends in a country, in a specific time period. These statistical inferences of fertility play an imperative role in population policy formation and planning. Thus the importance of the measurement of fertility remains undisputed. Due to the significance of fertility, its measurement and its profound impact on societies, acknowledging and addressing the quality of fertility data is of great importance. This research study was conceived in response to the above concern. This study aims at addressing and providing insight into birth history data irregularities and determining interventions of working with this issue in the context of South Africa. Through secondary analysis (i.e. descriptive exploratory and comparative analysis) the study sought to firstly establish a demographic profile of women associated with inconsistent and inaccurate reporting of their birth histories. Secondly the research attempted to ascertain a relationship between the socio-economic statuses of individuals and retrospective reporting. A third objective was to note the sex-selectiveness of reporting (i.e. were more girls or boys reported or misreported on in the retrospective birth histories). The study has established that older, married women with some educational attainment, of rural areas from either the middle and lower income categories tend to misreport more frequently than their converse counterparts. Furthermore, a plausible relationship between the socio-economic statuses of individuals was observed. In terms of the sex-selectiveness of reporting, in general, boys were reported on more consistently than girls. However in certain cases, it was found that rural and middle income women reported accurately on girl children born alive and dead girl children. Recommendations made with respect to improve the quality of fertility data for include the proper training of enumerators and data capturers, quality control during data collection, testing of questionnaires, dealing with social, cultural and language barriers and the reinforcement of publicity campaigns for censuses and surveys. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2010.

The present study investigated the effects of childhood abuse that occurred before the age of 18 on levels of marital satisfaction in older age. The study examined marital satisfaction in a group of Caucasian older married individuals with a mean age of 65.4 years who retrospectively endorsed a history of childhood physical, verbal and/or sexual abuse. Although previous studies examined the relationship of child maltreatment on young and middle-age adult relationship satisfaction, the study addressed a gap in the literature in that it examined the impact of child maltreatment on marital satisfaction in older age. Marital satisfaction in older age is particularly important to understand due to the health and psychological benefits derived from being in a satisfying marriage in older age (Booth & Johnson, 1994; Dush, Taylor, & Kroeger, 2008; Proulx, Helms, & Buehler, 2007), which is a time when health may become fragile. Furthermore, this study expands the current literature by explicating plausible mediators in the association between child maltreatment and late-life marital satisfaction. In particular, based on life course theory, the study examined specific life course risks (i.e., early marriage, early childbirth, and multiple divorces) and adult individual characteristics (i.e., avoidance coping and depression) as plausible mediators in the association between child abuse and later life marital satisfaction. The study examined men and women separately and investigated the effect of the severity of abuse on relationship functioning. The study used Structural Equation Modeling to analyze the data and tested all relationships between abuse, each mediator, and marital satisfaction. Results demonstrate that child maltreatment is negatively associated with late life marital satisfaction and that mid-life depression mediates that association for both men and women. Additionally, modification indices suggested that avoidance coping may influence late life marital satisfaction through a connection with depression and that coping by wishful thinking may be relatively more harmful for martial satisfaction than other forms of cognitive and behavioral avoidance coping. Findings suggest that treating depression in mid-life may be a feasible route to help individuals who have a history of early childhood abuse to have satisfying and protective relationships later in life.

The problem of the study was to develop valid and reliable evaluation tools for the American Red Cross course "Healthy Pregnancy, Healthy Baby." From a table of specification, a pool of 87 items was developed into two evaluation scales. A thirteen-member jury of experts composed of professionals in prenatal education was used to establish content validity. The jury of experts reviewed the scales twice. The first review, items were subject to both a quantitative and qualitative review. Items were then retained, revised, or eliminated. The jury of experts then reviewed the scales a second time, and items again were subjected to quantitative and qualitative analysis. The second review included the use of the Content-Validity Ratio. All items in the scales that were not statistically significant at p<. 05 were eliminated. The validated evaluation scales made up of 46 items from the 87 originally proposed items were then pilot tested. Fifty-two women were then asked to complete the two evaluation scales one week apart. Upon completion of the pilot study, items were subjected to statistical analysis using test-retest, Cronbach's alpha, and internal constancy. Those items with a low test-test scores and/or internal constancy were then eliminated. The retained knowledge questions were then revised as the questions were subjected to quantitative analysis. / Department of Physiology and Health Science

Bakgrund: Förlossningsupplevelser påverkar föräldrar psykologiskt, fysiskt, socialt och kulturellt. Föräldrarnas upplevelser av förlossningen har både omedelbara och långvariga effekter på deras hälsa och relation till varandra och sitt barn. Syfte: Syftet med studien var att belysa faktorer som kan bidra till negativa förlossningsupplevelser hos föräldrar. Metod: Datamaterialet bestod av ett frågeformulär som besvarats av 211 kvinnor som fött barn vid ett sjukhus i Norrland mellan åren 2006-2010 och som uppgivit en negativ förlossningsupplevelse på VAS-skala. Studien bygger på föräldrarnas svar på en öppen fråga "egna kommentarer" och "pappas kommentarer". Materialet har analyserats med kvalitativ innehållsanalys. Resultat: När kvinnornas svar hade analyserats framkom sex huvudkategorier. Huvudkategorierna var: "Bristande kommunikation och information", "Missnöje med personalens förhållningssätt", "Svårt att hantera smärtan", "Missnöje med förlossningen och förlossningssätt", "Oro och Rädsla" samt "Bristande närvaro och stöd". Diskussion: Faktorer som kunde bidra till negativa förlossningsupplevelser var om förlossningsförväntningarna inte motsvarade hur förlossningen faktiskt blev. Föräldrar som var rädda eller oroliga inför förlossningen fick i högre grad en negativ förlossningsupplevelse. Bristen på känslan av kontroll, där föräldrarna inte kände sig delaktiga eller hade kunnat påverka besluten under förlossningen ger oftare negativa förlossningsupplevelser. Förlossningens längd, förlossningssätt, interventioner och smärtupplevelser var viktiga komponenter hur förlossningsupplevelsen blev. Barnmorskans stöd, information och förhållningssätt till föräldrarna påverkade också förlossningsupplevelsen. / Background:Childbirth experiences affect parents psychologically, physically, socially and long-term effects on their health and their relationship to each other and their children. Purpose: Purpose of the study was to illuminate the factors that may contribute to adverse experiences of parents.Method: The data consisted of a questionnaire answered by 211 women who had a baby at a hospital in northern Sweden between the years 2006-2010 and who have provided a negative birth experience on the VAS scale. The study is based on parents responses to an open question "own comments" and "dad’s comments". Material was analyzed using qualitative content analysis.Results: When the women's responses were analyzed, revealed six major categories. Main categories were: "Lack of communication and information," " Dissatisfaction with staff attitude, " "Hard to manage pain," " Dissatisfaction with labor and mode of delivery," " Worry and fear" and "Lack of presence and support". Discussion:Factors that could contribute to negative birth experience was about childbirth expectations did not correspond to the birth actually became. Parents who were afraid or nervous about giving birth had a greater negative birth experience. Lack of sense of control, where the parents did not feel involved or had been able to influence decisions during labor gives more negative birth experiences. Redemption duration, mode of delivery, interventions and painful experiences were important components of the childbirth experience was. Midwife support, information and attitude to parents affected the birth experience.

The aim of this study was to develop and evaluate the effect of a prenatal hypnotherapeutic programme on the maintenance and promotion of postpartum psychological well-being of a group of first-time mother. Relevant literature on pregnancy, early motherhood and psychological well-being were explained in order to abstract important facets and perspectives to use as a background for the development and implementation of an intervention programme for the facilitation of psychological well-being of first-time mothers. Theoretical perspectives on, and practical applications of, clinical hypnosis were further analysed and used as foundation for the development of the hypnotherapeutic intervention. A hypnotherapeutic programme was developed, based on existing theoretical knowledge regarding pregnancy, childbirth and early motherhood, as well as clinical hypnosis, with specific emphasis on Ericksonian principles and ego state therapy techniques, enriched from the perspective of psychofortology. The empirical study consisted of a quantitative component and a qualitative component. In the quantitative component, a pretest-posttest-follow-up comparative design was implemented, with random assignment of participants to the experimental and control groups within the limits of practicalities. Both groups, each consisting of 23 women in their first pregnancy, completed the following questionnaires: (i) Perception of Labour and Delivery Scale (PLD), adapted from Padawer et al. (1988). Feelings about the baby and relationship with the baby (FRB), adapted from Wwllett and Parr (1997), Maternal Self- Confidence Scale (MSC), adapted from Ruble et al. (1990) and Maternal Self-Efficacy Scale (MSE) (Teti & Gelfand, 1991), to explore aspects of psychological well-being related to early motherhood; (ii) The Edinburgh Postnatal Depression Scale (EPDS) ofCox et al. (1987) and the General Health Questionnaire (GHQ) (Goldberg & Hillier, 1979), to investigate aspects of psychological well-being as evident by the absence of pathology; and (iii) the Satisfaction with Life Scale (SWLS) (Diener et al., 1985), the Affectometer 2 (AFM) (Kammann & Flett, 1983), the Sense of Coherence Scale (SOC) of Antonovsky (1979) and the Generalised Self-efficacy Scale (GSE), developed by Schwarrer, (1993), to measure general psychological well-being. The Stanford Hypnotic Clinical Scale (SHCS) (Morgan & Hilgard, 1978) was used for the experimental group to assess hypnotisabili. The qualitative component consisted of in-depth interviews and an analysis of written responses of mothers in the experimental group. They commented on their experience of the programme and its impact at two weeks and ten weeks postpartum. Results from the empirical study indicated that the experimental group showed significantly more symptoms of depression and symptomatology during the prenatal evaluation than the control group. Since the experimental group was possibly more vulnerable than the control group in a psychological sense, the effect of the intervention programme could not be deduced from a pure comparison of postnatal evaluation scores between the groups. Therefore, it was decided to explore the significance of differences within each of the experimental and control groups, as well as between the experimental and control group, using the mean difference scores between prenatal and postnatal evaluation on each variable. Results indicate that the hypnotherapeutic programme was effective in enhancing most aspects of psychological well-being within the experimental group. This strengthened sense of psychological well-being was evident both in the immediate postpartum period and at ten weeks postpartum. The control group showed a spontaneous increase in psychological well-being later in the postpartum period. The programme thus assisted mothers in the more vulnerable experimental group to experience a stronger sense of psychological well-being sooner after the baby's birth. The experimental and control groups were further compared on the mean differences in prenatal versus postnatal scores on measures of psychological well-being. The results suggest that the hypnotherapeutic intervention contributed to an enhanced sense of psychological well-being in mothers in the experimental group, in comparison to the control group, during the early postpartum period, as measured by variables related to motherhood, absence of pathology and general psychological well-being. At ten weeks postpartum, the differences between the experimental and control group were less obvious. However, a very important finding was that mothers in the experimental group continued to show a significant improvement in psychological well-being as indicated by the absence of pathology. Specifically, there was a continued decrease in depression and general symptoms of pathology. Findings from the quantitative study were supported by remarks by mothers in postpartum and follow-up interviews, as well as their written responses, as part of a qualitative exploration of their experience of the programme and its impact on them. The findings give compelling evidence that a hypnotherapeutic intervention, focusing on the enhancement of strengths and inner resources, could alleviate depression and psychological distress during the perinatal period, as well as prevent the exacerbation of symptoms. Findings from the current study indicate that the developed prenatal hypnotherapeutic programme was effective in enhancing the psychological well-being of mothers experiencing a first pregnancy. Recommendations for clinical practice and further research were made, based on the current research findings. The contribution of the current study lies in the fact that it is the first to explore pregnancy, childbirth and early motherhood from a salutogenidfortigenic perspective, and to utilise hypnosis to facilitate psychological well-being in this context. It contributed to scientific knowledge in the fields of developmental psychology, psychofortology and clinical hypnosis. / Thesis (Ph.D. (Psychology))--Potchefstroom University for Christian Higher Education, 2003.

This thesis is based on follow-up research from a project undertaken by my supervisor, Cecilia Benoit and colleagues (2007) entitled Social Determinants of Postpartum Depression: A Mixed-Methods Longitudinal Study (henceforth referred to as the “postpartum and health project study” -- PPHS). The PPHS examined the prevalence of postpartum depression amongst a diverse sample of mothers in Victoria, British Columbia. The main findings illustrate that the greater a woman’s satisfaction with maternity care, the lesser her likelihood of postpartum depression. The group of participants with the least satisfaction was those who were transferred from midwifery care to obstetrical care. This group also had a lower mean income than other care provider groups, such as those who retained their midwives, pointing to the connection between socio-economic status and quality of care. In search of dignified maternity care for all women, that is care that is respectful and autonomous, my research foregrounds the narratives of women who were transferred from a midwife to an obstetrician during their labour or birth (n=11). I examine the formal and informal support they receive, and interactions between health care practitioners and reasons for satisfaction or dissatisfaction with care. I also compare the experiences of women who were transferred from a midwife to an obstetrician with those who retained their midwife in the PPHS. My findings indicate that both sample groups’ satisfaction of care and well-being was due to feeling they had autonomy over the birthing process, adequate information from health care providers about medical and technological procedures, and support. The participants’ who were transferred, however, were less likely than the group who retained their midwife to experience the above elements of care. Participants who were transferred said they felt invaded by unnecessary procedures and technology, which contributed to a decreased level of autonomy. However, both sub-samples were affected by a lack of multi-disciplinary teamwork in the hospital setting. This had more of a negative impact on participants who were transferred from a midwife to an obstetrician.

Introduktion: 1,2 miljoner människor lever med HIV/AIDS i Etiopien, men med rätt åtgärder kan en gravid, HIV-positiv kvinna minska risken för att smitta sitt barn till under 5 %. Trots detta upplever en majoritet av HIV-positiva patienter stigma från sjukvårdspersonal som kan leda till en minskad livskvalitet. Vårdpersonalens förståelse av stigma och kunskap om HIV är nödvändig för att utveckla strategier för att minska denna stigmatisering. Syfte: Syftet med studien var att undersöka HIV-positiva kvinnors upplevelser av stigmatisering från vårdpersonal under graviditet och förlossning i Addis Ababa, Etiopien. Metod: En deskriptiv studie med kvalitativ ansats användes. Sju HIV-positiva kvinnor som har mottagit mödravård i Addis Ababa, Etiopien, deltog med hjälp av bekvämlighet urval. Travelbees omvårdnadteori och en kognitiv modell av AIDS-relaterad stigma användes som teoretisk ram. Strukturerade intervjufrågor användes och data analyserades med en kvalitativ innehållsanalys. Resultat: Studien har tre kategorier; Negativa reaktioner från vårdpersonal, Ingen känsla av stigma och Utbildning från vårdpersonal till kvinnorna. Majoriteten av deltagarna hade upplevt en händelse av HIV-relaterat stigma från vårdpersonal. Detta genom att bland annat känna sig annorlunda bemött på grund av sin diagnos eller genom att ha upplevt hur vårdpersonalen var överdrivet rädda för att bli smittade. Resultatet visar också att det finns vårdpersonal som utövar en vård utan stigmatisering samt att utbildning gavs till samtliga kvinnor från vårdpersonalen angående hur HIV smittas och dess medicinering. Slutsats: Stigmatisering från vårdpersonal förekommer bland HIV-positiva kvinnor. Sjuksköterskan har ett ansvar för att minska stigmatisering genom att utöva en omvårdnad där kvinnorna känner sig lika behandlad och respekterad. Förbättring behövs där vårdpersonal utvecklar sin förståelse av stigmatisering och av hur ett stigmatiserande beteende inom vården kan undvikas. / Introduction: 1.2 million people live with HIV/AIDS in Ethiopia, but with correct interventions a HIV positive pregnant woman can reduce the risk of infecting her baby to below 5 %. Nevertheless, a majority of HIV positive patients experience stigma from healthcare professionals, which can lead to a reduced life quality. Healthcare professionals’ understanding of stigma and knowledge about HIV is necessary in order to develop strategies to reduce this stigma. Purpose: The purpose of the study was to investigate HIV positive women's experience of stigma from healthcare professionals during pregnancy and childbirth in Addis Ababa, Ethiopia. Method: A descriptive study with a qualitative method was used. Seven HIV positive women who had received maternity care in Addis Ababa, Ethiopia participated and were chosen through a convenience sample. Structured interview questions were used and data were analyzed by using qualitative content analysis. Travelbeés theory of care and cognitive model of AIDS-related stigmatization were used as theoretical framework. Results: Three categories were identified in this study: Negative reactions from health care professionals, Non-presence of stigma and Education from healthcare professionals. The majority of the participants had experienced an event of HIV- related stigma from healthcare professionals. These HIV positive women felt as if they were treated differently because of their diagnosis and they experienced the professionals’ fear of becoming infected. However some of the HIV positive women who were interviewed felt they had also experienced situations where no stigmatization was shown by healthcare professionals. All the woman who were interviewed had received information about the HIV virus, how it´s spread and what medication is used as treatment. Conclusion: Stigma from healthcare professionals among HIV positive woman exists. Health care professionals have a responsibility to reduce stigma by providing care that gives women the sense of being equally treated and respected. Improvements are needed in the education of healthcare professionals so that they can develop an understanding of stigma as well as an understanding of how their own stigmatizing behavior can be reduced when caring for HIV positive women.

Denna studie syftar till att undersöka nyblivna föräldrars upplevelser rörande användandet av förlossningsbrev. Föräldrar intervjuade till denna studie valde att skriva eller inte skriva ett förlossningsbrev. Blivande föräldrar som valde att inte skriva ett förlossningsbrev gjorde detta på grund av att de ansåg att brevet skulle styra in dem i en specifik riktning, samt att det inte hjälper att försöka kontrollera något som är utom deras kontroll. Föräldrar som valde att skriva ett förlossningsbrev gjorde detta eftersom de hade specifika önskemål som frångick den norm som styr förlossningen. Även kvinnor som utryckt någon form av förlossningsrädsla valde att skriva ett förlossningsbrev. Under studiens gång har fokus även riktats mot att undersöka andra förberedelser inför förlossningen. Studiens resultat bygger på att förlossningsbrevet bidrar till att kvinnor ska få en mindre passiv roll i sin förlossning samt att partnern blir mer delaktig i förlossningsskedet. Förlossningsbrevet upprätthåller och bekräftar normen kring den ”normala” vaginala födseln, men bidrar även till att föräldrarna ska få styra och planera sin förlossning. Därför kan förlossningsbrevet ses som en användbar metod för föräldrar som vill förbereda och planera förlossningen, då de får en större delaktighet i förlossningsskedet. Förlossningsbrevet kan därför vara en användbar metod för blivande föräldrar som vill ha större kontroll och delaktighet under graviditet och förlossning. / This Bachelor Thesis discusses expectant parents' experiences regarding the use of a birth plan. Prospective parents who chose not to write a birth plan did so because they felt that the letter would steer them in a specific direction, and moreover, that trying to control something that is beyond their control won't help. Parents who chose to write a birth plan did so because they had specific requests that were not consistent with standard Swedish hospital practices. Those women who expressed any sort of fear of childbirth also chose to write a birth plan. During the study, the focus has also been aimed at exploring other preparations for childbirth. The essay's conclusion is that birth plans aid women in playing a less passive role during the birth process, as well as the partner becoming more involved in the birth. Birth plans maintain and reaffirm the norms surrounding "normal" vaginal birth, but also help parents to gain more control and plan childbirth on their own terms. A birth plan may therefore be a useful method for parents who want more control and involvement during both pregnancy and childbirth.

The establishment of effective relationships is fundamental to good nursing practice and the fulfillment of nurses’ moral responsibilities. While intrapartum nurses are uniquely placed to establish relationships that can directly influence the woman’s experience of childbirth, there has been limited investigation of the relationships, identities and values that underlie nurses’ varied approaches and responses to labouring women. The purpose of this study was to explore intrapartum nurses’ understanding of their moral responsibilities from a social-moral perspective, using Margaret Urban Walker’s “expressive-collaborative” model of morality. Interviews were conducted with fourteen registered nurses working in a birthing unit of a Canadian teaching hospital. Four themes were identified that captured nurses’ moral responsibilities, including: organizing and coordinating care, responding to the unpredictable, recognizing limits of responsibilities to others, and negotiating care with women and families. Nurses enacted their moral responsibilities to labouring women in a variety of ways depending on their personal and professional experience, the circumstances, the people involved and the context of care. A key factor influencing responses to women was the degree to which understandings and expectations related to birth were deemed to be reasonable and mutually agreed upon among nurses, physicians, women and their families. Nurses also described limits on their responsibilities to others. Their choice of response to circumstances in which practice was constrained departed from the idealized expectations and ‘expert’ practices often reflected in professional guidelines. While nurses were able to identify contextual influences that constrained their ability to maintain effective relationships with women, the influence of their own values on the care they provided was less apparent. This suggests a need to challenge normative assumptions related to care of women in childbirth, including the provision of choice and family centred care, in order to create environments that can support and sustain practices that build understanding, mutuality and trust between nurses and birthing woman. In addition, given the contested nature of childbirth and the lack of shared understandings of what constitutes ‘best’ care, there is a need to develop collaborative models of inter-professional maternity care that include the voices of women as a central component.