Thesis submitted in fulfilment of the requirements for the degree Master of Technology in Information Technology in the Faculty of Informatics & Design at the Cape Peninsula University of Technology / Research on health informatics has seen a steady increase during this decade as the role of information technology in the health sector becomes pertinent. Findings of previous research in this domain have uncovered vast information needs of health workers, particularly in developing countries. However, there is a need to continue with multidisciplinary research in priority areas such as midwifery practice and in the environment of marginalised settings. This study explores the significance of the information needs and information-seeking behaviour or practice of midwives during the antenatal and intrapartum care within the environment of a midwifery unit. Additionally, the researcher obtained permission from Faculty of Informatics and Design – CPUT and Health department authority – Western Cape Government in South Africa, to conduct research in the Elsies River Midwifery Obstetric Unit (ERMOU). The research was carried out as case study in a Midwifery Obstetric Unit in the Western Cape, South Africa. The investigator conducted semi-structured interviews and observations to collect qualitative data of the antenatal and intrapartum care environment. The data was transcribed and analysed using thematic analysis and essomenic modelling. The findings comprehensively point to the importance of this research context. The study found that midwives acquired patients’ information from a handwritten Maternity Case Record (MCR) book and midwives’ colleagues, and often during handovers. In addition, midwives also communicate with each other during care activities in the ERMOU. It was apparent that the use of such communication practices is inadequate, and midwives did not always have sufficient information to make appropriate decisions in the ERMOU. All patient information, referral notes, and reporting is paper-based. In addition, essomenic models were used to depict the midwives’ work activities in the antenatal and intrapartum care environment in the Unit. Furthermore, essomenic models defined all the systematic processes that occur in the ERMOU which is described by midwives’ activities and work environment. To improve communication, future research is recommended to consider the importance of the continuity of the education of midwives. Further research will be on the implementation of nursing informatics and the electronic health record system in the Elsies River Midwifery Obstetric Unit.

Title: Psychosocial aspects of intrapartum and postpartum care Author: Mgr. Lea Takács Department: Department of Psychology Supervisor: PhDr. Simona Hoskovcová, Ph.D. Consultant: MUDr. PhDr. Pavel Čepický, CSc. Abstract Background: Satisfaction with perinatal care is largely a result of psychosocial aspects of the care provided. However, despite a considerable body of research, the concept of satisfaction with perinatal care is not sufficiently defined and understood, being often confused with other concepts, particularly with that of satisfaction with childbirth experience. The lack of knowledge concerns especially the psychosocial dimensions and determinants of the care, most importantly for different groups of women, and the level of importance of psychosocial factors for satisfaction compared to biomedical variables. Objective: The aim of the present dissertation is to contribute to the theory of satisfaction by investigating the psychosocial and biomedical factors that affect satisfaction with perinatal care and satisfaction with childbirth experience in different groups of women depending on the mode of delivery (vaginal delivery, emergency caesarean section or elective caesarean section). Method: Ordinal logistic regression was used to identify the key predictors of satisfaction. The data were...

Birth doulas offer continuous physical, emotional, and informational support before, during, and after birth. There is strong evidence of the maternal health benefits associated with continuous labour support. Nurses are the most common intrapartum care provider and navigate the overlapping labour support role with doulas. While there is evidence of mutual respect, conflicts can occur with negative consequences. This study aimed to explore collaborative practice between nurses and doulas from the perspective of intrapartum nurses in Ontario, Canada. Thorne's qualitative interpretive description (ID) methodology was used. Nurses experienced in working with doulas were recruited via email invitations and postings on a nursing online forum. Semi-structured 1:1 interviews were conducted with six nurses. Experience ranged from 4 to 35 years across nine hospitals. Interviews were recorded and transcribed verbatim. Data analysis was informed by the ID approach. Findings comprised two main themes, each with four sub-themes. First, participants described influences on nurses' readiness to collaborate with doulas. These influences include the culture clash between medicalized and natural birth, support from management and hospital policies and previous professional experiences. These led to the nurses' approach, "it's about the patient". Second, participants' responses reflected a continuum of nurse-doula collaboration, beginning with being open-minded, a necessity for getting on the patient's team, building trust and working together towards shared goals. These findings provide a framework for interventions to facilitate collaborative practice, including in-service training and enactment of appropriate institutional policies. Improved collaboration enhances both nurses' and doulas' practice while promoting better childbirth outcomes.

The purpose of the research was to determine the underlying contributory factors in an obstetric unit at the district hospital in Mpumalanga province, South Africa, regarding neonatal deaths and to propose strategies for midwifery practice. Quantitative, nonexperimental, descriptive, exploratory and retrospective (ex-post facto) design was used to explore and describe the factors contributing to neonatal deaths. Data collection was done using an audit tool. The conclusions drawn from this study supported the assumptions that there are factors related to antenatal, intrapartum, postnatal and neonatal care that contribute to neonatal deaths, thus emphasizing the urgency of improving the care of pregnant mothers and their babies through effective implementation of programmes and protocols / Health Studies / M.A. (Health Studies)

An emergency reaction is required in Africa because HIVIAIDS is a reality which may be regarded as a developing crisis and a catastrophe. Approximately a third of all women in the North-West Province are HIV positive. Because of their vulnerability against HIVIAIDS there arose a need for health service provision to the HIV positive woman to focus specifically on the reduction of the transmission of HIVIAIDS from mother to child. Mother to child transmission is the biggest cause of HIV infection among children. Almost all HIV positive children are infected during pregnancy, labour, childbirth or breastfeeding. Without the necessary preventative measures as many as 25-35% of the children of HIV positive mothers may be infected. The biggest percentage of infections, however, takes place during labour and the birth process. In first world countries the mother has access to choices and facilities to make an informed decision about antiretroviral therapy, as well as the method of birth. In the North-West Province not all these options and facilities are available, and therefore the knowledge and skills of midwives must be deployed to reduce vertical transmission of HIV during the intrapartum practice. It is important that midwives have the necessary knowledge about intrapartum practices and vertical transmission of HIV, in order to distinguish between risky and safe intrapartum practices. The purpose of this research was to determine whether midwives in the Southern region of the North-West Province have sufficient knowledge of intrapartum practices to reduce vertical transmission of HIV, as well as to determine the intrapartum practices in the Southern region of the North-West Province. The ultimate goals, then, were to determine how the national policy should be adapted and implemented in the Southern region of the North-West Province to reduce HIV transmission during intrapartum practices. A quantitive survey design was used. For the data collection a questionnaire and a control list were used. The questionnaire and the control list, which are adapted and based on literature, were submitted to research and subject specialists, after which they were adapted. Permission was obtained for this research from the Department of Health in the North-West Province, the ethics committee of the PU for CHE as well as each provincial hospital in the Southern region in the North-West Province to conduct the research. A purposeful availability sample of midwives working in the Southern region of the North-West Province was used and a random sample was used for auditing the obstetric records. A total of 31 midwives participated as respondents, and 401 obstetrical records were audited. Data analysis was performed by means of a frequency analysis, effect sizes and cross reference. Based on these findings it was concluded that the midwives do have basic knowledge regarding vertical transmission of HIV, but that this knowledge is not reflected in the intrapartum practice. There is uncertainty about certain aspects where the latest research about intrapartum practices are not implemented in practice. Recommendations were accordingly formulated for nursing education, research and practice. This research particularly focused on improving midwives' knowledge about intrapartum practices to reduce the vertical transmission of HIV, so that this knowledge may result in improved intrapartum practice. Recommendations are also made as to how the national policy may be adapted and implemented in the Southern region of the North-West Province. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2004.

An emergency reaction is required in Africa because HIVIAIDS is a reality which may be regarded as a developing crisis and a catastrophe. Approximately a third of all women in the North-West Province are HIV positive. Because of their vulnerability against HIVIAIDS there arose a need for health service provision to the HIV positive woman to focus specifically on the reduction of the transmission of HIVIAIDS from mother to child. Mother to child transmission is the biggest cause of HIV infection among children. Almost all HIV positive children are infected during pregnancy, labour, childbirth or breastfeeding. Without the necessary preventative measures as many as 25-35% of the children of HIV positive mothers may be infected. The biggest percentage of infections, however, takes place during labour and the birth process. In first world countries the mother has access to choices and facilities to make an informed decision about antiretroviral therapy, as well as the method of birth. In the North-West Province not all these options and facilities are available, and therefore the knowledge and skills of midwives must be deployed to reduce vertical transmission of HIV during the intrapartum practice. It is important that midwives have the necessary knowledge about intrapartum practices and vertical transmission of HIV, in order to distinguish between risky and safe intrapartum practices. The purpose of this research was to determine whether midwives in the Southern region of the North-West Province have sufficient knowledge of intrapartum practices to reduce vertical transmission of HIV, as well as to determine the intrapartum practices in the Southern region of the North-West Province. The ultimate goals, then, were to determine how the national policy should be adapted and implemented in the Southern region of the North-West Province to reduce HIV transmission during intrapartum practices. A quantitive survey design was used. For the data collection a questionnaire and a control list were used. The questionnaire and the control list, which are adapted and based on literature, were submitted to research and subject specialists, after which they were adapted. Permission was obtained for this research from the Department of Health in the North-West Province, the ethics committee of the PU for CHE as well as each provincial hospital in the Southern region in the North-West Province to conduct the research. A purposeful availability sample of midwives working in the Southern region of the North-West Province was used and a random sample was used for auditing the obstetric records. A total of 31 midwives participated as respondents, and 401 obstetrical records were audited. Data analysis was performed by means of a frequency analysis, effect sizes and cross reference. Based on these findings it was concluded that the midwives do have basic knowledge regarding vertical transmission of HIV, but that this knowledge is not reflected in the intrapartum practice. There is uncertainty about certain aspects where the latest research about intrapartum practices are not implemented in practice. Recommendations were accordingly formulated for nursing education, research and practice. This research particularly focused on improving midwives' knowledge about intrapartum practices to reduce the vertical transmission of HIV, so that this knowledge may result in improved intrapartum practice. Recommendations are also made as to how the national policy may be adapted and implemented in the Southern region of the North-West Province. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2004.

The purpose of the research was to determine the underlying contributory factors in an obstetric unit at the district hospital in Mpumalanga province, South Africa, regarding neonatal deaths and to propose strategies for midwifery practice. Quantitative, nonexperimental, descriptive, exploratory and retrospective (ex-post facto) design was used to explore and describe the factors contributing to neonatal deaths. Data collection was done using an audit tool. The conclusions drawn from this study supported the assumptions that there are factors related to antenatal, intrapartum, postnatal and neonatal care that contribute to neonatal deaths, thus emphasizing the urgency of improving the care of pregnant mothers and their babies through effective implementation of programmes and protocols / Health Studies / M.A. (Health Studies)

Dissertation submitted in fulfilment of the requirements for the degree Doctor of Technology: Informatics in the Faculty of Informatics and Design at the Cape Peninsula University of Technology / Background: Daily activities within a health care organization are mediated by information communication processes (ICP), which involve multiple health care professionals. During pregnancy, birth and motherhood a woman may encounter different professionals including midwives, doctors, laboratory personnel and others. Effective management requires critical information to be accurately communicated. If there is a breakdown in this communication patient safety is at risk for various reasons such as; inadequate critical information, misconception of information and uninformed decisions being made. Method: Multi method, multiple case study approach was used to explore and describe the complexities involved in the (ICP), during the management of the intrapartum period. During the study the expected ICP, the actual ICP, the challenges involved and the desired ICP were analysed. 24 In-depth interviews with skilled birth attendants were conducted, observer- as- participant role was utilized during the observation, fild notes, reflective diaries and document review methods were used to gather the data. Thematic analysis and activity analysis were applied to analyse the data. Findings: The findings illuminated that there are expectations of accessibility to care of the woman during pregnancy birth and the intrapartum, especially linked to referral processes. The actual ICP focused on documentation and communication of the information within and between organizations. Communication was marked by inadequate documentation and therefore errors in the information communicated. The desires for communication were illuminated by the need to change the current situation. Further a framework for effective information communication was developed: the FAAS framework for the effective management of the intrapartum period. Conclusion: In conclusion what is expected is not what is actually happening. The skilled birth attendants (SBAs) do not necessarily have the answers for change but the challenges were identified as desires for change. I urge that the framework will provide a basis for the evaluation of the effectiveness involved in the ICP for the effective management of the intrapartum period.

Introduktion: Antalet prehospitala förlossningar är få och därför kan det vara svårt för ambulanspersonal att upprätthålla tillräcklig kompetens inom området. Eftersom det händer sällan kan det väcka oro hos sjuksköterskor. Syfte: Syftet med studien var att beskriva sjuksköterskors erfarenheter av att vårda vid prehospital förlossning. Metod: En kvalitativ metod användes med semistrukturerade intervjuer som analyserades med hjälp av kvalitativ innehållsanalys med induktiv manifest ansats. Nio sjuksköterskor verksamma i norra Sverige inkluderades. Resultat: Resultatet presenteras i fem kategorier; Vikten av information och förberedelse, Stress och oro för komplikationer, En känsla av skräckblandad förtjusning, Stöd och samarbete minskar oron och Kunskap och erfarenhet ökar upplevelsen av trygghet. Resultatet visade att sjuksköterskor inom ambulanssjukvården känner en skräckblandad förtjusning när det kommer till att ta sig an uppgiften att bistå vid en förlossning prehospitalt. Det är en arbetsuppgift som skänker glädje i slutändan men vägen dit kan vara fylld av stress, oro och en upplevelse av brist på kunskap inom området. Slutsats: Förlossningar är ett uppdrag som sjuksköterskor inom ambulansen känner sig mindre förberedda på, det är en sällanhändelse och det gör att de inte kan tillägna sig den erfarenheten de önskar. Det finns ett behov av ökad kunskap och övning inom området.

This research study explored and described a partogram as a clinical practice guideline for monitoring and managing women during labour at Vhembe District of Limpopo province. A qualitative, explorative, descriptive and contextual design was used in order to achieve the study objectives. Purposive sampling was carried out to select three hospitals in order to obtain comprehensive data from the district. The research study was conducted in three phases. Face-to-face semi-structured interviews were conducted with 17 midwives who were selected conveniently from the three hospitals. Document study was also conducted on 24 partograms that were conveniently selected from the three hospitals on the days that interviews were conducted, using a self-designed checklist. Tesch’s eight steps of qualitative data analysis were used to analyse the data, and simple, descriptive statistics using frequencies were used to analyse the data obtained from the document study. Four themes that emerged from the data are: benefits of implementing the partogram, challenges experienced, attitudes of staff and evaluation on how the guideline is being implemented in the wards, including giving feedback. These aspects were indicated as pivotal in the implementation of the guideline in monitoring a woman during labour. The findings on document study revealed gaps in recording, mostly on aspects that needed frequent observations and on aspects in which resources that needed to be used in monitoring were lacking. The strategies to improve the implementation of a guideline were developed based on the research findings, sent to one of the hospitals for review and comments were included in the discussions. It is recommended that in-service training on the implementation of the partogram be conducted regularly for midwives. Hospital management and supervisors need to provide support, enough staff and equipment in order to enable midwives to use the partogram / Health Studies / D. Litt. et Phil. (Health Studies)