Masters Research - Master of Philosopy (MPhil) / For almost 20 years it has been known that the most common cause of preventable adverse events in hospital is communication problems between clinicians (1, 2). Within maternity services, ineffective communication has a strong relationship with adverse events for women and babies (3). Despite this knowledge, the ‘turf wars’ between some midwives and some doctors are a continuing concern. Although the link between poor communications and adverse events has been well known for a long time, no real change in how professions relate to each other has occurred. This dissertation describes a project that was designed to answer the research question: What factors affect interprofessional interaction in birthing units and how do these interactions impact on birthing outcomes? Midwives and doctors from 10 geographically diverse maternity units contributed to this qualitative research project. In-depth interviews were conducted. Analysis and theorizing was guided by feminist Interpretive Interactionism. New findings, about how health services can strengthen interprofessional collaboration in maternity services, are presented and explained. I argue that organisational factors are more important than the personalities of the individuals involved in the interactions because organisational factors frame, direct and limit what discourses and therefore behaviours, are possible. The dissertation ends with some procedural guidelines that show how administrators and clinical leaders can create and maintain collaborative work settings for public sector midwives and doctors.

Syfte: Att undersöka mammors behov av kunskapsmässigt, emotionellt och socialt stöd under barnets första år samt identifiera vilka stödgivande aktörer kvinnorna upplever är viktigast. Metod: Deskriptiv tvärsnittstudie. Sjuttio mammor som besökte någon av sex kommunala öppna förskolor i Uppsala läns landsting svarade på en enkät om deras behov av stöd. Resultat: Hälso- och sjukvården var den viktigaste aktören för många av mammorna som sökte informationsstöd. Studien visade att alla mammorna inte fått det kunskapsstöd de önskade. Socialt stöd och emotionellt stöd var viktigt för nästan alla mammor och många efterfrågade emotionellt stöd från hälso- och sjukvården. Mammornas behov var relaterat till deras ålder, och även i viss utsträckning utbildning och sysselsättning. Slutsats: Om BVC-sjuksköterskor och annan vårdpersonal som möter mammor med barn under ett år, ser till helheten i deras situation genom att erbjuda såväl kunskapsstöd som emotionellt stöd kan de bidra till att skapa långsiktigt nöjda och trygga mödrar. / Aim: To explore mother's needs in terms of knowledge, emotional and social support during the baby’s first year and to identify what support giving conductors the women feel important. Method: Descriptive cross-sectional study. Seventy mothers who visited one of six municipal open pre-schools in Uppsala County Council responded to a questionnaire about their support needs. Results: Health care was the main conductor for many of the mothers who sought information support. The study showed that not all mothers have got the knowledge support they wished. Social support and emotional support was important most mothers, and many sought emotional support from health care. Mothers' needs were related to their age, and also to some extent, education and employment. Conclusion: If child health nurses and other health care professionals, who encounter mothers with children under the age of one year, see the whole picture of their situation by offering both knowledge and emotional support, they can help create satisfied and secure mothers in the long term.

It’s not easy being a pregnant woman in rural British Columbia. With 10–20% annual attrition of family physicians in rural BC, and 17 rural hospitals having ceased maternity care services since 2000, many women lose the ability to deliver in their own community even if local hospitals exist. What are the causes and consequences? We investigated rural maternity care from the perspective of parturient women and care providers. Through a series of interviews and focus groups in 14 communities across BC, we learned about the current state of maternity care in rural BC and investigated how the reduction in maternity care services has impacted women’s lives, physician’s confidence, and community ethos.

First Nations women who live on reserves receive maternity care from a variety of government health care systems: Federal, provincial, and municipal. At first glance, this seems like an abundant amount of health care; however, the lack of coordination has led to poorer outcomes as demonstrated for example by the twofold IMR for First Nations on reserves compared to that of non-Aboriginal populations. To inform discussions and changes to health care policy and programming for maternity care for First Nations on reserves, my dissertation focuses on Health Canada’s evacuation policy within the province of Manitoba. It describes how First Nations women journey among these three health care systems in the provision of that care. This federal policy instructs federally employed nurses to arrange for the transfer of pregnant First Nations women who live on rural and remote reserves to an urban – and usually southern – location so that the women can receive labour and birthing services. Women are evacuated out of their home communities between 36 and 38 weeks gestational age and wait in the city, often alone, for labour to start. While there is a general understanding of how different elements of this federal policy work, there is no literature that describes its execution in detail nor in full. To address this critical knowledge gap, my dissertation consists of three stand-alone papers. For the first paper, “‘This Policy Sucks and It’s Stupid:’ Mapping Maternity Care for First Nations Women on Reserves in Manitoba,” I used intersectionality, institutional ethnography, and semi-structured interviews to produce a descriptive and visual map of the evacuation policy. Using intersectionality and a case study approach, the second paper, “Health Canada’s Evacuation Policy for Pregnant First Nations Women in Manitoba: Resignation, Resilience, and Resistance,” semi-structured interview data are analyzed through a thematic analysis to understand the experiences and perspectives of First Nations women, family, and community members. I argue for the development of a specific theoretical framework that makes explicit the specific legal and policy influences particular to First Nations women who live on reserves in the third paper, “The Legal Categorization of First Nations Women in Health: The Need for a First Nations Feminist Theory.” Taken as a whole, these three papers address some of the knowledge gaps related to maternity care services for First Nations women once they are evacuated. They also situate these gaps within the legal context of health care for First Nations women so that tangible improvements can be made.

No description available.

Magister Public Health - MPH / In recent years, the Chipata district has been making progress in promoting Respectful Maternity Care (RMC) implementation, with great emphasis on its underlying principles of ethics and psycho-sociocultural aspects as critical ingredients of care. RMC approach is individual-oriented and is based solely on the understanding of ethics and respect for human rights. Additionally, this approach utilizes evidence-based practices that recognize the needs and preferences of women and that of their newborns. Unfortunately, disrespectful and abusive care during childbirth has been found to discourage women from having their babies delivered by qualified health care workers, a practice that is essential in reducing maternal and neonatal mortalities. However, lacking are studies in the Chipata district that describe the prevalence of disrespectful and abusive maternity care.

The purpose of this thesis is to investigate how a public health crisis affects the pregnancy decisions and experiences of Canadians, how pregnancy history impacts these experiences, and whether the delivery of pregnancy care has been impacted or changed by the COVID-19 pandemic. This thesis surveyed women from across the country about their experiences during pregnancy with prenatal care and social support, as well as their birth experiences and perceptions of new motherhood during the pandemic. Interviews were conducted with perinatal care providers from Ontario about their personal experiences providing perinatal healthcare services, as well as their perceptions of their patients’ experiences. This thesis aims to identify prenatal, birth and postpartum experiences described by Canadians, and quality of perinatal health services during the COVID-19 pandemic.

In Ontario, supporting "a system of care that provides women and their families with equitable choice in birth environment and provider," (PCMCH & MOHLTC, 2017, p.33) has been identified as one of the central objectives of the Provincial Council for Maternal and Child Health's Low Risk Maternal Newborn Strategy. In theory, pregnant people in Ontario can choose to seek maternity care from a midwife, a family physician, or an obstetrician; however, in practice, pregnant people's choice of provider remains constrained. Extant literature suggests that in order to afford pregnant people the opportunity to exercise autonomous choice of provider, health systems must ensure that an acceptable range of provider options is available and accessible within the local organization of maternity care, that pregnant people are made aware of and knowledgeable about the available provider options, and that pregnant people have the ability and resources to navigate access to their provider of choice (Mackenzie, 2014; Sutherns, 2004). As a result, I designed this thesis to fill a gap in the evidence base to determine whether or not provincial policies had translated into the levels of access, awareness, and resourcing required to afford pregnant people the opportunity, ability and propensity to exercise autonomous choice of provider within the local maternity care system in Ontario's Champlain Region. I sought to elicit the structural conditions that would be necessary to equitably support pregnant people's access to and choice of a maternity care provider. In the pursuit of these objectives, I adopted an integrated knowledge translation approach (Bowen & Graham, 2013), using an explanatory sequential mixed methods design (Creswell, 2014), which encompassed two complementary stages: (1) quantitative geospatial mapping to assess pregnant people's access to the full range of maternity care providers across the Champlain Region; and (2) qualitative focus groups and individual interviews with parents, providers, and policy-makers to explore the individual, organizational, and system-level factors that are enabling or restricting access and autonomy. Using a systems approach to the investigation of this locally-identified issue, I demonstrate in this thesis that pregnant people within the Champlain Region have inequitable opportunities to exercise autonomous choice of maternity care provider due to (1) system and organizational-level factors that are creating imbalances in the supply, distribution and mix of maternity care provider options, and (2) pregnant people's differential access to the enabling information and resources required to exercise autonomous choice of provider and to navigate access to their services.

yes / This article considers the difficulties with using Gillon's model for health care ethics in the context of clinical practice. Everyday difficulties can arise when caring for people from different ethnic and cultural backgrounds, especially when they speak little or no English. A case is presented that establishes, owing to language and cultural barriers, that midwives may have difficulty in providing ethically appropriate care to women of Pakistani Muslim origin in the UK. The use of interpreters is discussed; however, there are limitations and counter arguments to their use. Training is identified as needed to prepare service providers and midwives for meeting the needs of a culturally diverse maternity population.

Over the past twelve years, Philadelphia has undergone an unparalleled large scale shift in the way maternity care is provided, accessed, and considered. Key aspects of the changes to the landscape of birth in Philadelphia include: the closure of the majority of hospital-based maternity units, the activities of local women's health non-governmental organizations (NGOs), and the new set of pregnancy care and birth choices that parents navigate. One of the most striking results of the restructuring of Philadelphia's maternity care system is a drastic reduction in the number of hospitals with maternity units. While the birth rate in Philadelphia has remained consistent around 22,000 per year, since 1997 two-thirds of the hospitals in Philadelphia have eliminated their maternity services. During this time, numerous local women's health-oriented NGOs worked to established themselves in Philadelphia. The aim of each NGO has been to respond to inadequacies in the provision of maternity services that develop as hospitals, the dominant resource for maternity care, withdraw from the maternity care business. With only six hospital maternity units remaining and a couple of local nonprofit organizations attempting to supplement the dearth of services, the current system within which parents and health care providers maneuver is both unstable and inadequate for meeting the maternity care needs of the community. In this research project, I explore the processes through which this new maternity care system is being established in Philadelphia with a particular focus on the influence of neoliberalism as an active force in the restructuring process. I examine the outcomes of this restructured system in terms of how lived experiences are influenced by the social, political, and economic reconfiguration of birth. The case of Philadelphia is of particular value as the City's maternity care system has undergone an accelerated restructuring that is unmatched in other areas of the US. While a similar trend in restructuring can now be found in other locations, these changes happened earlier and have continued in a more extreme manner in Philadelphia, marking Philadelphia as a possible canary in a coal mine. Understanding the outcomes of this large scale change in the system of care provides a basis for contending with similar trends elsewhere. My ethnographic work focuses on the experiences of particular individuals as they navigate Philadelphia's new system of maternity care. Within this restructured system of maternity care, the interests of parents and health care practitioners are increasingly devalued or disregarded, particularly for those whose philosophy of birth differs from dominant biomedical maternity care practices. Midwives, whose non-interventionalist methods of care starkly contrast with the biomedical model of care, and parents who wish to have a low-intervention or natural childbirth struggle to achieve their goals within the confines of Philadelphia's maternity care system. Similarly, individuals running local NGOs strain to intervene in the process of restructuring, and often face the dilemma of remaining true to their mission on one hand or preserving financial security by meeting the imperatives of funders on the other hand. Therefore, I have made the stories of midwives and parents seeking alternatives to biomedical care central to my analysis in addition to conducting in-depth fieldwork with three local women's health-oriented NGOs. This project adds to our understanding of how broad political and economic trends in health care translate into select cultural formations which inform the life choices of individuals. In times such as now, when national policy regarding the provision of health care is under scrutiny, it is essential to connect the dots between the circumstances of individuals and the structure of systems of health care. This research project fuses analyses of civil society institutions, the politics of reproduction, national ideology, and local political and economic agenda to present a complex and inclusive assessment of the landscape of birth in the uniquely positioned city of Philadelphia. / Anthropology