No description available.

Research on knowing in childbirth has largely been a quantitative process. The purpose of this study was to better understand the ways nine, first-time mothers learn about birth. A phenomenological approach using a feminist view was used to analyze two in-depth interviews and journals to understand first time expectant mothers' experiences of knowing in childbirth. The findings demonstrated a range of knowledge that contributed to issues of control, confidence, hope, and conflict. The participants also described an increased dependency on their mothers and a lack of intuition contiguous to the birth process. These findings contribute understanding as to how expectant mothers know birth, suggesting that their knowing does not diminish conflict surrounding and may even exacerbate it. Childbirth educators may want to include instruction on negotiating power differential in relationships encountered during childbirth, and to assess the expectant mother's view of birth and her expectations for birth. Schools of nursing should consider the inclusion of women-centered care curricula in schools of nursing at both the undergraduate and graduate levels. Clearly, the politics surrounding birthing remain in place and must be removed to provide a supportive environment for normal birth.

INTRODUCTION: Maternity services are a priority for all health care services but in most cases there have been serious challenges experienced through service performance. The National District Hospital (NDH)‟s key performance indicator is bed occupancy rate which showed an underutilization of this facility. The maternity services statistics, especially did not give a clear picture of the performance of the unit. Various studies have been conducted to identify management challenges in maternity units of district hospitals, but no formal study has been done to systematically document this problem at the National District Hospital (NDH), although there has been anecdotal evidence of problems in the performance of the unit. It was therefore important to investigate the functioning of the maternity unit of the NDH and identify problems that hinder it from functioning effectively. AIM: To evaluate the performance of maternity services in the maternity unit at the National District Hospital. METHODOLOGY: A cross sectional study design was used comprising of a retrospective record review. The setting of this study was the maternity unit at National District Hospital. Data was collected on various variables that are relevant to the performance of maternity services. ANALYSIS: The data collected was analyzed and revealed that the factors contributing to the poor performance of the maternity services were:  Poor record keeping, such as incomplete recording of partograms.  Non adherence to guidelines and protocols, such as poor management related to HIV and AIDS care and poor management of patients in the advanced labor phase.  Failure to make informed decision due to information mismanagement.  Poor supervision in the unit. No adherence to objectives of peer review meetings. RECOMMENDATION: The recommendations based on the findings are: - Establish patient centered maternity services - Train and retraining of health care providers in the maternity unit - Review existing strategies to improve quality of care in the maternity unit - Improve information management and functioning of the Maternal Morbidity Review meetings CONCLUSION: The recommendations given can be used to improve maternity services within district hospitals as well as provincial and national maternity services.

A research report submitted to the Faculty of Health Science, in partial fulfillment of the requirement for the award of a Master’s Degree in Nursing Sciences by the Witwatersrand University of Johannesburg, South Africa. / This study, entitled “Knowledge of and challenges of health workers managing maternity patients at PHC facilities of Yobe State, Nigeria,” had the following objectives:  To describe the socio-demographic characteristics of the health workers in the Primary health care (PHC) facilities in the state.  To determine the level of knowledge of the health workers regarding the management of maternity patients in Primary health care facilities in Yobe State.  To determine the challenges experienced by the health workers in the Primary health care facilities in the state. The study was primarily aimed at exploring the health workers level of knowledge, skills and competencies in the management of maternity patients and their contributions towards the control and reduction of maternal mortality in the state. METHODS: A cross sectional survey study in PHC clinics of six selected local government areas of the state, namely Gujba, Geidam, Fune, Fika, Nguru and Jakusko local government areas. A total of 221 health workers (n=221) were interviewed using structured questionnaires, whilst 46 facility managers (n=46) were given self-administered questionnaires while on duty, and data were collected concurrently from clinic records. The data were cleaned, entered in to Epi info statistical software, imported and analysed using STATA. Descriptive and inferential statistics were used to interpret the outcomes of the analysis. RESULTS: More than half of the respondents were female (65.61%) with an average age of 33 years (SD± 8.1). Categories of the health workers who participated in the study were SCHEW, JCHEW, SSCE, TBAS, EHA/EHO and others who were not trained in any form as health workers, but were found running the affairs of maternity patients. More than 80% of the clinics did not have functional ambulances and there was gross inadequacy of basic services in most of the clinics; only 14 out of 46 clinics had portable water supply and electricity. There was a large seasonal turnout of patients in the clinics but poor patronage by maternity clients. The health workers in the maternity unit were found to be deficient in the knowledge, skills and competencies to manage maternity patients. Protocols were not followed (68.78%), some significant information about ante-natal care was not given to v clients and maternity clients were not adequately informed of some of the danger signs of pregnancy. There was a poor standard of institutional deliveries and the majority of the Health Workers had no training on EOC or conducting a clean and safe delivery. CONCLUSION: Examining the background of the current health workers in the primary health care facilities, the attainment of MDG 5 by 2015 will not be a reality, unless urgent measures are put in place, including large recruitment and motivation midwives, and deployment of these midwives to the rural health clinics. There is a need for the existing health workers to be supported by government and enrolled in short course training in Colleges of Midwifery to acquire the much needed skills and competencies for the care of maternity patients.

A research report submitted to the Discipline of Psychology, Faculty of Humanities, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Masters in Clinical Psychology Johannesburg, South Africa December 2015 / Extensive literature emphasises that good quality maternal care is crucial for infants to develop secure attachments which positively shapes their future mental health. In a developing society such as South Africa where many mothers are raising children in contexts of multiple adversities, interventions which focus on improving the quality of maternal care are vital. Home visiting programmes are an effective way to support mother-baby dyads. In South Africa, it has been found that lay women from local communities trained to work as home visitors can make a significant difference to these mother-infant relationships. Ongoing supportive supervision has been found to be particularly important for lay home visitors. The evaluation and improvement of these intervention programmes is recommended. One aspect of programme evaluation is the investigation of the programme staff experiences. Currently, there is a dearth of research focusing on the experiences and supervision of lay community health care workers, internationally as well as in South Africa. The Ububele Mother Baby Home Visiting Project, run in the Alexandra Township in Johannesburg, is one such intervention and no evaluation of this intervention from the perspective of the staff has, as yet, been conducted. It was felt that research into the experiences of the home visitors and their supervisors would be beneficial in gaining clarity regarding which aspects of the project they perceive to have been effective and those that have been challenging, as well as to assist the team in developing their intervention further. The current research aimed to gain insight into these experiences and to gain an understanding of the main concerns. The form of data included 10 semi-structured in-depth interviews with the staff of the programme: the home visitors, the supervising psychologists and the director of the project. An interpretive thematic analysis was used to interpret the results. The findings indicated that the staff’s experience included a mixture of positive and challenging experiences. The staff all agreed on their passion for the project and their belief in the effectiveness of their work in improving the bonds between mothers and babies in the community. The challenges included working in a community faced with multiple adversities, as well working in a team divided by education level, race, culture and socioeconomic class. Suggestions for the Ububele Mother Baby Home Visiting Project team are also provided.

The objective of this study was to determine the clinical and epidemiological profile of women who died at the Caucaia Health Region from 2009 to 2014, through the epidemiological investigation of the pathway performed by these women to access, Death, and if there was an opinion of the Maternal Mortality Prevention Committee. This is a documental, descriptive and quantitative approach, with a population and a sample of 56 maternal deaths. Data were collected in the first half of 2016, using death certificates and M5 investigation forms found in the Information System on Mortality. The chosen variables were analyzed using SPSS 17.0 program and presented in absolute frequency and simple proportion. The research protocol was approved by the Ethics Committee of the Federal University of CearÃ, with opinion No. 1,403,777. It was found that the deaths occurred in women with a mean age 28.2 years (62.4%), mulattos (62.5%), single (57.1%), incomplete primary education (33.9%), housewives (48.2%). Obstetric data revealed bond to the Family Health Team (82.1%), prenatal consultations with more than 5 (51.8%), and only 25% directed to high-risk prenatal care. 80% delivery occurred in maternity, 48.2% caesarean section. The deaths occurred in hospital (76.8%), postpartum period (69.7%), the main causes of hypertension (16.1%) and infections (16.1%) and emboli (14.3 %), characterizing deaths from direct obstetric causes (58.3%) and preventable by appropriate action to prevent, control and attention to the causes of maternal death (73.2%). The Mortality Committee analyzed 87.5% of deaths. Despite the ease of access, there is poor quality of care. There is no guaranteed linking. The deaths could have been prevented through actions for the organization of the Maternal and Child Network with the expansion of resolutive and quality health services, the training of professionals for prenatal, childbirth and puerperium care, improvement of the recording of information, and strengthening the work of the municipal and regional Maternal, Child and Fetal Mortality Committees for the promotion of maternal and child health. / Este estudo teve por objetivo conhecer o perfil clÃnico-epidemiolÃgico das mulheres que foram a Ãbito materno na RegiÃo de SaÃde de Caucaia no perÃodo de 2009 a 2014, identificando por meio da investigaÃÃo epidemiolÃgica o trajeto realizado por essas mulheres, para acesso, atendimento, classificaÃÃo do Ãbito, e se houve parecer do Comità de PrevenÃÃo de Mortalidade Materna. Trata-se de um estudo do tipo epidemiolÃgico documental, descritivo e com abordagem quantitativa, com uma populaÃÃo e amostra de 56 Ãbitos maternos. Os dados foram coletados no primeiro semestre de 2016, utilizando as declaraÃÃes de Ãbito e fichas de investigaÃÃo M5 encontradas no Sistema de InformaÃÃo em Mortalidade. As variÃveis escolhidas foram analisadas pelo programa SPSS 17.0 e apresentadas em frequÃncia absoluta e proporÃÃo simples. A pesquisa foi submetida e aprovada no Comità de Ãtica em Pesquisa da Universidade Federal do CearÃ, com o parecer n 1.403.777. Identificou-se que os Ãbitos ocorreram em mulheres com idade mÃdia de 28,2 anos (62,4%), raÃa parda (62,5%), solteiras (57,1%), escolaridade baixa (33,9%) e donas de casa (48,2%). Os dados obstÃtricos revelaram vinculo à Equipe de SaÃde da FamÃlia (82,1%), prÃ-natal com mais de 5 consultas (51,8%), e apenas 25% encaminhadas ao prÃ-natal de alto risco. Em 80%; o parto ocorreu em maternidade, sendo 48,2% cesariana. As mortes ocorreram em hospital (76,8%), no perÃodo do puerpÃrio (69,7%), tendo como principais causas a hipertensÃo (16,1%), infecÃÃes (16,1%) e embolias (14,3%), caracterizando Ãbitos por causas obstÃtricas diretas (58,3%) e evitÃveis por adequada aÃÃo de prevenÃÃo, controle e atenÃÃo Ãs causas de morte materna (73,2%). O Comità de Mortalidade analisou 87,5% dos Ãbitos, apesar da facilidade no acesso, a qualidade da assistÃncia ruim. NÃo hà vinculaÃÃo garantida. As mortes poderiam ter sido evitadas mediante aÃÃes para a organizaÃÃo da Rede Materno-Infantil com ampliaÃÃo de serviÃos de saÃde resolutivos e de qualidade, capacitaÃÃo dos profissionais para os cuidados no prÃ-natal, parto e puerpÃrio, melhoria do registro das informaÃÃes, e fortalecimento do trabalho dos ComitÃs de Mortalidade Materna, Infantil e Fetal municipais e regional para a promoÃÃo da saÃde materna e infantil.

In western countries such as Australia, the U.S. and the U.K., the women’s prison population has increased exponentially over the past decade, far outstripping the rate of growth in male imprisonment. The majority of women in prison are the mothers of dependent children. Subsequently, increasing numbers of children are being separated from their mothers; many displaced from home and effectively left parentless. Despite a growing body of knowledge since the 1960s, and growing numbers of children affected, little is known about these children, particularly older children and adolescents. This study examines the impact of maternal imprisonment on 20 young people, aged between 10 and 18 years, whose mothers were incarcerated in the two women’s prisons in Victoria (Australia). Data was gathered directly from young people themselves, as well as from their mothers and a small cohort of professionals, after the mother’s release from prison. To answer the research question, the study sought retrospective and predominantly qualitative data on children’s lives before, during and after their mother’s imprisonment. The data was analysed in a variety of ways, initially through the development of case studies and then across cases using thematic content analysis, drawing on themes emerging from the data and a priori categories gleaned from earlier research. The study shows that maternal incarceration has a significant impact on the lives of adolescents, and that it is uncommon for children to have secure care arrangements in place at the time of their mother’s imprisonment. For children to be displaced from home is also common, although most maintain some contact with their mother over the course of her imprisonment. While the majority of children return home to live with their mother, this is largely influenced by the child’s pre-prison placement and their visiting patterns during the imprisonment. Interestingly, although many young people are not satisfied with their care arrangements, particularly those who are cared for by their fathers, and cope with difficulties by internalising them, most do not report persistent adverse effects. The study provides new and challenging ideas. It describes the important role played by care planning in children’s reaction to maternal incarceration; this has not previously been examined. The findings also illustrate the poor coping mechanisms employed by children and discuss the range of social factors which affect this coping. Finally, factors influential in actual family reunifications are described and examined; very few studies, and none in Australia, have previously sought this data. The study provides a description of family reunification pathways, and highlights the importance of pre-prison placement and children’s visiting. The study findings stress that the impact of a mother’s imprisonment begins before sentencing and continues beyond her release. Yet research to date has focused predominantly on the period of a mother’s imprisonment. Overall, the study finds that limited formal or informal attention is given by adults involved to children’s needs. They are little seen or acknowledged at any point during their mother’s contact with the adult criminal justice process. From her arrest, through sentencing, imprisonment and planning for release, they are not considered to be participants in the proceedings.

[No Abstract]

The effects of high maternal folate status on the offspring are unknown; however, early life exposure to environmental stimuli, including dietary factors, is thought to influence the risk of developing chronic disease. An animal study was performed to determine the effect of maternal folic acid supplementation during pregnancy and lactation on DNA methylation and global gene expression patterns in the offspring. Supplementation of the maternal diet with folic acid (5, 8, and 25 mg/kg diet) induced global DNA hypomethylation in the liver of juvenile and adult offspring, and altered the expression of the imprinted H19 gene and genes involved in lipid metabolism, coagulation, and iron transport and homeostasis. Our data suggest that intrauterine and early postnatal periods are susceptible to changes in DNA methylation and gene expression in response to high levels of folic acid, which may be associated with health status and disease later in life.

The effects of high maternal folate status on the offspring are unknown; however, early life exposure to environmental stimuli, including dietary factors, is thought to influence the risk of developing chronic disease. An animal study was performed to determine the effect of maternal folic acid supplementation during pregnancy and lactation on DNA methylation and global gene expression patterns in the offspring. Supplementation of the maternal diet with folic acid (5, 8, and 25 mg/kg diet) induced global DNA hypomethylation in the liver of juvenile and adult offspring, and altered the expression of the imprinted H19 gene and genes involved in lipid metabolism, coagulation, and iron transport and homeostasis. Our data suggest that intrauterine and early postnatal periods are susceptible to changes in DNA methylation and gene expression in response to high levels of folic acid, which may be associated with health status and disease later in life.