Thesis (M.S.)--University of Michigan, 1992.

Thesis (M.S.)--University of Michigan, 1964.

Thesis (M.S.)--University of Michigan, 1992.

Thesis (M.S.)--University of Michigan, 1964.

Thesis (Ph. D.)--University of Missouri-Columbia, 1998. / Typescript. Vita. Includes bibliographical references (leaves 103-110). Also available on the Internet.

Thesis (M.Sc.)--Memorial University of Newfoundland, 1987. / Typescript. Restricted until May 1988. Bibliography : leaves 145-155. Also available online.

Thesis (Ph. D.)--University of Missouri-Columbia, 1998. / Typescript. Vita. Includes bibliographical references (leaves 103-110). Also available on the Internet.

Over 18 million caesarean sections (CS) are performed around the world each year, with many being planned repeat CS which may lack absolute indications. Abdominal delivery on this scale demands an appreciation of the lasting impact, positive or negative, on the health of women and children. Maternal outcomes of planned CS birth have been extensively investigated, but knowledge of outcomes for offspring is largely limited to those occurring in the neonatal period. Avoiding labour and vaginal birth may protect offspring from birth injuries, but could also adversely affect their later health due to avoidance of physiological processes which aid immunity and gut function. Concern that CS may compromise offspring health has arisen from studies which demonstrate an increased risk of chronic health problems following CS compared with vaginal birth. However, the clinical implications of existing studies are unclear due to high risk of selection bias, confounding and lack of power. Studies which can overcome these issues are required. Studies focusing on offspring of women with a history of CS mean the risk of confounding by indication for CS is minimised, as the majority of repeat CS are planned due to maternal preference rather than medical indications. At present, it is not known whether perceived offspring health outcomes of mode of delivery drive women's birth choices after a previous CS, and if so, whether such beliefs reflect evidence-based information on offspring risks. The existing literature highlights a number of factors that may play a role in shaping these birth choices, but no studies have attempted to identify beliefs which independently predict birth preferences after a CS. Such a study has potential to identify key beliefs to target in future interventions designed to optimise women's birth choices. This project investigated both the health of offspring delivered by planned repeat CS and women's beliefs which predict their preferred mode of delivery after CS. Offspring health was investigated using a population-based cohort study. Pregnant women's beliefs about birth after CS were investigated using a synthesis of qualitative literature and a theory based interview and questionnaire study.

Epidural analgesia has increased in usage dramatically in the United States as a means of comfort for labor pain. Prior studies have connected epidural analgesia to an increase in cesarean birth rate, an increase in use of instrumentation, an increase in length of labor, episiotomy rate, and maternal fever. Epidural analgesia has produced additional costs to the patient and society. The purpose of this study is to examine the relationship between epidural analgesia during childbirth and childbirth outcomes. The data for this study were obtained from a retrospective patient record review of 200 systematically selected labor patients who delivered in 2002 at a midwestern hospital. The epidural analgesia rate was 72% at this facility in 2002, a significant increase from the previous 5 years. Using the Chi-square test of independence, 3 relationship was established between epidural analgesia and four of the variables examined. A statistically significant relationship was found to exist between epidural analgesia and cesarean birth rate, pitocin augmentation, and the first and second stages of labor with the total sample. The results of the study are important for healthcare providers who are relaying influential wellness information to childbearing women and their partners. The results indicate a need for further education for healthcare providers on alternative methods of pain relief for their patients during childbirth.

The purpose of this research was to test the predicted relationships among a component of nurse-midwifery care, psychosocial health outcomes and other maternal psychosocial variables. The theoretical framework for the research was the Intrapartum Care Level of the Nurse-Midwifery Practice Model, a middle range theory. Previous nurse-midwifery research had been based on theories and models not specific to nurse-midwifery practice. A nonexperimental, correlational design was used, with measures in the last trimester of pregnancy and the first month following birth. The psychosocial variables measured were prenatal care satisfaction, personable environment, positive presence, labor support, transcendence, labor satisfaction and enhanced self-concept. Purposive sampling was used at a birth center in a Southwestern city where women received nurse-midwifery care for pregnancy, labor and birth. The sample of 89 women consisted of 35 primiparas and 54 multiparas, with a mean age of 29 years; 46.1% gave birth at the birth center and 53.9% gave birth at a local hospital. The primary instruments for the research included the Prenatal Satisfaction Questionnaire, the Attitude Toward Issues in Choice of Childbirth Scale, the Positive Presence Index, the Labor and Birth Support Inventory, the Coping in Labor and Delivery Scale, the Labor and Delivery Satisfaction Questionnaire, and the Self-Confidence Scale of the Adjective Check List. The secondary instruments, used for the evaluation of construct validity, included the Positive Presence Index - Alternate Format, the Labor and Birth Coping Index, the Labor and Birth Satisfaction Index, and the Self-Concept Index - Alternate Format. Acceptable levels of reliability and validity were obtained for the instruments. The predicted relationships from the Model were tested with causal analysis using multiple regression and residual analysis. The empirical rather than the theoretical model was supported by the data. Prenatal care satisfaction, personable environment, positive presence and transcendence explained 66% of the variance in labor satisfaction, with an additional 2% explained variance with the addition of the situational variable of consultation. Positive presence had the greatest direct effect (B =.70) and also explained 5% of the variance in enhanced self-concept. The empirically significant relationships were clinically relevant.