MPH / Department of Public Health / See the attached abstract below

Objective: To explore the longitudinal associations between prepartum fear of childbirth (FOC), birth experience, and postpartum mother-child-bonding, and the potential mediator role of the birth experience. Design: Women from the prospective cohort study DREAM completed questionnaires during pregnancy, 8 weeks, and 14 months after the birth. Participants: A community sample of n = 645 pregnant women from a large city in Eastern Germany participated in the study. Results: In a regression analysis, FOC predicted negative birth experience (β = 0.208, p < 0.001) which in turn predicted poorer mother-child-bonding both at 8 weeks (β = 0.312, p < 0.001) and 14 months postpartum (β = 0.200, p < 0.001). FOC also predicted mother-child-bonding at 14 months postpartum (β = 0.098, p < 0.05). Of note, this association was mediated by birth experience both at 8 weeks, indirect effect ab = 0.065, 95% CI [0.036, 0.098], and 14 months postpartum, indirect effect ab = 0.043, 95% CI [0.023, 0.067]. These effects remained stable even when adjusting for potential confounders. Key Conclusions: This study suggests that the association between FOC and mother-child-bonding is mediated by birth experience, pointing to the importance of a woman's positive subjective experience. Implications for Practice: Findings reveal two targets for peripartum interventions for women at risk for poor mother-child-bonding, namely the implementation of FOC screenings during pregnancy, and birth experience as mediating factor between FOC and mother-child-bonding. Focusing on the mother's subjective birth experience could aid to identify women at risk for impaired bonding who might need additional support.

Thesis (MA)--University of Stellenbosch, 2002 / ENGLISH ABSTRACT: This review examines the medical model's conceptualisation of postnatal depression (pND) from a feminist perspective. The arguments are fourfold: Firstly, it argues that the fundamental problem underlying the concept of PND is its conception as existing on a continuum with psychosis at the most severe end and maternity blues at the least severe end. The link with psychosis implies that it is potentially pathological requiring medical and psychiatric intervention. On the other hand its link with maternity blues gives scientific credence to continued research on emotional sequelae of reproduction that are below the psychiatric threshold of urgency. Secondly, the medical model's construction of PND implies that women are predisposed to mental illness because of their ability to bear children and thus pathologises normal experiences of childbirth. Thirdly, the medical model's preoccupation with classification and categorisation has become little more than an exercise in labeling that has removed women from their own experiences. Focusing on birth as an activity that is separate from the rest of pregnancy objectify women and ignores the socio-political context within which they give birth and care for their infants. Fourthly, it is argued that a different way of researching postpartum mood disorders is necessary to overcome a reductionistic and pathological model of childbirth. This is important if healthcare delivery hopes to provide adequate treatment for all women in the postnatal period. Especially in South Africa, where the dominant culture has for many years defined the experiences of the 'other', it is important to generate research that should include the 'voices' of the 'other' to prevent hegemonic practice from assuming an expert understanding of PND. This review does not deny the contributions from the medical establishment, but argues that a critique of its underlying assumptions is important to prevent women from being further marginalised by ignoring the socio-political context in which their lives are embedded. The implications for research within South Africa are also addressed. / AFRIKAANSE OPSOMMING: Hierdie oorsig ondersoek die mediese model se konseptualisering van postnatale depressie vanuit 'n feministiese perspektief. Die argument is vierledig: Eerstens blyk die konseptualisering van postnatale depressie, naamlik dat dit op 'n kontinuum bestaan, met psigose aan die mees disfunksionele kant en 'maternity blues' aan die minder ernstige kant, 'n fundamentele, onderliggende probleem te wees. Die verband met psigose impliseer dat postnatale depressie potensieel patologies is en mediese en psigiatriese insette benodig. Die verband met 'maternity blues' aan die ander kant, bied wetenskaplike begronding vir volgehoue navorsing op die gebied van emosionele aspekte van kindergeboorte wat nie van psigiatriese belang is nie. Tweedens impliseer die mediese model se konstruksie van postnatale depressie dat vroue 'n predisposisie tot geestessiektes het bloot deur die feit dat hulle die vermoë het om kinders voort te bring. Sodoende word patologiese kenmerke gekoppel aan normale ervarings van kindergeboorte. Derdens het die mediese model se beheptheid met klassifikasie en kategorisering verval in etikettering wat vroue van hul eie ervarings vervreem. Deur te fokus op geboorte as 'n aktiwiteit wat verwyder is van die res van swangerskap maak van vroue objekte wat verwyderd is van die sosio-politieke konteks waarbinne hulle geboorte skenk en sorg vir hul babas. Vierdens word dit beredeneer dat 'n nuwe benadering tot navorsing oor postpartum gemoedsteurings daar gestel behoort te word om 'n reduksionistiese en patologiese model van kindergeboorte te voorkom. Dit is belangrik as gesondheidsorgdienste hoop om toereikende behandeling te bied vir alle vroue in die postnatale periode. Veral in Suid-Afrika, waar 'n dominante kultuurgroep vir so lank die ervarings van ander omskryf het, is dit belangrik om navorsing voort te bring wat die 'stemme' van die 'ander' insluit om sodoende te verhoed dat die heersende praktykvoeringe van die dag 'n eensydige deskundige-verstaan van postnatale depressie voorveronderstel. Hierdie oorsig ontken nie die bydraes van die mediese model nie, maar beredeneer die feit dat 'n kritiese beskouing van die onderliggende aannames belangrik is om sodoende te verhoed dat vroue verder gemarginaliseer word deurdat die sosio-politieke konteks waarin hul lewens gegrond is, buite rekening gelaat word. Die implikasies vir navorsing binne 'n Suid-Afrikaanse konteks word dus ook ondersoek.

No description available.

Food historians have revealed that what constituted a working-class British woman's diet in the nineteenth century was quite different in calorific and nutritional content from what her family consumed. This work explores the nineteenth-century maternal diet and the effect this nutritional inequality had on the health of women and their infants. Divided into three sections, this dissertation deals with different aspects of nineteenth-century maternal nutrition. Section one explores the nineteenth-century medical understanding of diet, as well as the influences of class and traditional beliefs on eating habits, and how these factors determined the diet prescribed to mothers during pregnancy. Section two investigates the factors that perpetuated the unequal distribution and consumption of food within households. Factors explored include regional variations in working-class diet; gender associations with foods; economic changes in material wealth and expectations, and the pressures of respectability on female food denial. This section concludes that food refusal and unequal distribution were reinforced throughout the long nineteenth century because these behaviours appeared to have value, real or imagined, as long-term economic strategies. Food refusal maintained respectability, and helped women secure an economic support network. Mothers' self-denial seems to have secured the economic loyalties of children, making her the recipient of their income. The final section addresses how deprivation and dietary changes affected infant and maternal health, specifically examining how insufficient vitamin D and rickets influenced birth outcomes, and how the switch from a rural diet to an urban diet contributed to a rise in neural tube disorders in Wales. The analysis of childbirth data revealed a significant correlation between rickets and childbirth complications. The findings of this section also suggest that the dietary changes that followed migration and the change from an agricultural lifestyle to a market-integrated, industrial lifestyle for a majority of the Welsh population reduced women's intake of folic acid leaving their children susceptible to neural tube disorders.

This is an exploratory study of women’s childbearing decisions and outcomes in non-medically indicated cesarean section childbirths (CS). Focusing on the structure-agency dichotomy, the research is guided by Anthony Giddens’ theory of structuration used in the context of the medicalization framework in order to analyze elements of personal choice and medical jurisdiction in childbearing methods. Quantitative analysis of secondary data and a thematic content analysis of Internet forums are conducted in order to analyze women’s perceptions of autonomy and constraint in their childbearing decisions and outcomes. The findings suggest that the polarization between second- and third wave feminist critiques on medical intervention in childbirth, and between structure and agency, impede our understanding of the complex phenomenon. Applying structuration theory to the medicalization framework helps to work through this polarization, further lending support to third-way feminism.

This project employed a descriptive case study methodology guided by rational choice theory to examine the financial feasibility of marriage for low income women. By modeling the income and expenses of eight different low income family types in six states (Arizona, California, New York, Oklahoma, Virginia, and Wisconsin) this study illustrates the financial situation of various low income families. The family types under investigation include: a single parent family, a family receiving TANF, cohabiting couple with two wage earners, cohabiting couple with one wage earner, a married family with two wage earners, a married couple with one wage earner, a unmarried couple with an infant (unmarried fragile family), and a married couple with an infant (married fragile family). The income of each family type was calculated at two different wage levels (minimum and low wage for each state under investigation). Income included the welfare benefits and subsidies each of the family's is likely to receive (including child care subsidies and tax credits). The expenses of each family were calculated based on the size of the family and the cost of expenses such as housing and food expenditures. This study found that of the models presented here married families are not always financially better off when compared to single parent and cohabiting families. These findings demonstrate that if policy makers wish to support marriage among low income families they should first make marriage financially feasible for unmarried couples (particularly cohabiting couples) and create greater economic stability for couples that are already married. By providing consistent work supports (e.g. child care and health insurance), expanding programs that help low income families (such as the Earned Income Tax Credit), creating poverty measures that accurately reflect the real situation of low income families, and increasing the wages of low income workers, policy makers will create an environment where it is financially feasible for low income couples to marry and remain married.

The Healthy People 2010 Objectives for the population of the United States include the objective for women to sustain breastfeeding at a higher rate than they are currently.The American Academy of Pediatrics (AAP) now recommends that all infants be fed human milk for the first year of life instead of the previously recommended first six months of life. Breastfeeding initiation rates are rising, but breastfeeding duration rates continue to fall. It was hypothesized that the support system of the women may play a role in the duration of breastfeeding. The purpose of this research study was to investigate the support system and breastfeeding rates of mothers during the first six weeks after delivery and to determine if income level had an effect on these systems and rates. Mothers were interviewed during their hospitalization for childbirth regarding their perception of their support system currently in place. A questionnaire was administered regarding support from friends, family members, co-workers, and health care professionals and the responses were quantified. Mothers were contacted weekly to determine if breastfeeding was being sustained and who was the most supportive person to them. At the end of six weeks or when breastfeeding was discontinued, the mothers were interviewed a second time to determine if the support system had changed. The results of this study showed that income level affected the duration of breastfeeding and the mother's perception of her support system. Additionally, the results showed that the evaluation of the support system changed only slightly over time. The results showed preliminary ability of the study tool to predict breastfeeding at six weeks by income.This document was created using Microsoft Word 2003. The statistical package used for data analysis was JMP version 6.

In my work, I deal with motherhood from the perspective of mothers with severe visual impairment. I focused especially on parenthood planning, on the period of pregnancy, childbirth and stay in the maternity ward and on the care for the child from birth to the age of three. I was interested to find out, whether visually impaired mothers encounter prejudices on part of the well-sighted people, whether they were worried that they could give birth to a handicapped child, what are the difficulties that severely visually impaired mothers come across most often in the individual period of development of the child, if and how education of children is different from the perspective of visually impaired parents from the perspective of well-sighted parents and also whether the child growing up in a family with at least one visually impaired parent is deprived of something or whether, on the contrary, this family situation has any advantages for such child. The objective of my diploma thesis is to map out various aspects of life of visually impaired mothers with small children in the greatest detail, directly from the point of view of those women. I attempted to achieve this objective by means of a qualitative method research, in particular in the form of a structured interview with six visually impaired mothers.

La formation aux gestes en obstétrique réalisée directement auprès du patient pose des problèmes éthiques et médico-légaux. C'est pourquoi une grande partie de cette formation repose sur l'observation in-situ. Cette approche ne permet pas de prendre en charge l'ensemble des dimensions nécessaires à la formation telles que l'extraction instrumentale, l'acquisition d'un niveau de dextérité suffisant ou encore la capacité de prise de décision face à une situation à risque.Les systèmes d'entrainement par simulation consituent une réponse à ce problème de formation. Toutefois, les simulateurs haptiques actuels ne permettent qu'une évaluation qualitative du geste obstétrique et ne fournissent pas d'informations quantitatives sur les efforts subis par les différents organes pelviens. Ces informations quantitatives ne sont accessibles que par des simulation biomécaniques de la descente fœtale. Par contre, pour pouvoir être utilisées conjointement avec un simulateur haptique dans un but d'apprentissage, ces simulations doivent être interactives.Dans ce manuscrit, nous proposons tout d'abord un état de l'art des différents modèles biomécaniques existants permettant de modéliser les organes pelviens et la descente fœtale. Après avoir identifié la tête foetale comme la structure la plus susceptible de subir des dommages importants lors de l'accouchement, nous présentons un modèle de la tête foetale basé sur des éléments finis de coque CST-DKT que nous étendons avec un formulation co-rotationelle et une contrainte de volume permettant de prendre en compte la matière intra-crânienne. Une implémentation GPU de ce modèle est proposée pour permettre des simulations interactives. Ce modèle est validé sur une simulation de la pression intra-utérine subie par la tête fœtale lors de la deuxième phase de l'accouchement. Enfin, nous proposons une ébauche de modèle complet pour la simulation interactive de la descente fœtale. / The training to obstetrical gestures performed directly on the patient raise ethical and medico-legal problems. That is why most of the formation is based on in-situ observations. This approach can not handle all the necessary dimensions to the formation such as instrumental extraction, a good level of dexterity or the capacity to take decision in high risk situations.Simulation based training systems can address this formation problems. Neverteless, today's haptic simulators don't provide quantitative informations about the efforts undergone by pelvic organs. This informations are available only through biomechanical simulations of the foetal descent. To be used in conjunction with an haptic simulator, such simulations must be interactive.In this manuscript, first we propose a state of the art of the existing biomechanical models allowing to model the pelvic organs. After having identified the foetal head as the structure that can potentially undergo important damages during childbirth, we present a model of the foetal head based on shell finite elements CST-DKT that we extend to a co-rotationnal formulation and a volume constraint allowing to take in count the intra-cranial matter. A GPU implementation of this model is also porposed to allow interactive simulations. This model is validated on a simulation of intra-uterine pressure undergone by the foetal head during the second phase of childbirth. Finally, we propose a draft of a complete model intended to simulate interactively the feotal descent.