Cette recherche vise à donner une approche des troubles psychiques de la puerpéralité à partir de la psychanalyse d’orientation lacanienne. Ce travail se forge aussi comme une réponse aux idéaux de notre époque d’effacer toute la subjectivité des êtres parlants. Le pari de ce travail est donc d’élaborer une clinique prête à accueillir la subjectivité de chacune, tout en s’éloignant des théories valables pour toutes. Au-delà de la dialectique cause-effet et des conceptualisations des maladies puerpérales très définies et tranchées, on cherche à élucider les effets divers que l’événement de la maternité peut susciter et la façon dont chaque sujet peut renouer la déstabilisation provoqué par cet événement ; dès symptômes les plus anodins jusqu’aux déclenchements psychotiques les plus ravageants. Une telle orientation nous permet d’aborder ces diverses réponses à l’événement de la maternité d’une manière qui rend compte de l’unicité du sujet en question. / This investigation aims to provide a Lacanian approach to postpartum mental disorders. As such, our work responds to the dominant ideals of our epoch – that of erasing the unique subjectivity of each speaking being. The establishment of our clinical approach is based around a central wager, that of being able to welcome the subjectivity of everyone, all the while renouncing universal theories, which would be equally valid for all. Beyond the dialectic of cause-effect and conceptualizations of well defined and differentiated postpartum disorders, we seek to elucidate the diverse effects of the event of maternity; to elucidate the diverse ways in which each subject might come together again in the aftermath provoked by this event, from the most innocent symptoms to the most ravaging psychotic breaks. Such an orientation permits us to conceive of these diverse responses the event of maternity in a manner that takes into account the uniqueness of the subject in question.

À l'heure actuelle, les résultats périnataux en France demeurent parmi les moins satisfaisants en Europe malgré une très forte médicalisation. Les autorités de santé affirment reconnaître l'influence de la prise en charge et de l'accompagnement pendant la grossesse, l'accouchement et la période néonatale sur l'état de santé de la mère et de l'enfant mais l'offre de soins peine à s'élargir. Contrairement à ce que prévoient les lois concernant le libre choix du praticien en France, les parturientes ne sont pas à même de choisir le professionnel de santé qui les accompagnera lors de leur accouchement. De même, les sages-femmes, contrairement à ce qu'impose leur code de déontologie, ne sont pas en mesure de garantir à leurs patientes ni les conditions, ni le lieu de leur accouchement. De surcroît, peu d'entre elles exercent leur profession de façon autonome tout en pratiquant le plein exercice de leur fonction. En centrant cette recherche anthropologique sur l'expérience des femmes et des sages-femmes dans leurs relations autour de la naissance et de l'accouchement, l'objectif de cette étude qualitative est de faire la lumière sur les tenants et les aboutissants de l'uniformisation de l'offre de soins. Dans un premier temps sont abordés les différents types d'accompagnement proposés aux femmes aujourd'hui ainsi que la place qu'y occupent les sages-femmes. Dans un second temps, l'étude de l'accompagnement global permet l'examen de la prise en charge des patientes et de ses liens de causalité avec les relations interprofessionnelles. Ainsi sont révélés les impacts de cette pratique sur le soutien à la parentalité et la nécessité d'une diversification de l'offre de soins. / Currently, the perinatal results in France remain among the least satisfactory in Europe in spite of a very strong medicalization. However, health authorities acknowledge the influence of maternity care during pregnancy, childbirth and neonatal period on the state of health of the mother and the child but health services hardly increase. Contrary to what French law says on free choice of practitioner, parturient women cannot choose the health professional who will assist them during labor. Likewise, midwives cannot guarantee their patients the place and conditions of childbirth, contrary to their code of ethics. In addition, few of them have the opportunity to work in an independent way and at the same time fully practice their profession. By focusing this anthropological research on women's and midwives' experience in their relationships around childbirth, the aims of this qualitative study are to clarify the ins and outs of the standardization of health services. Initially, the various types of care provided to women today and the place granted to midwives are discussed. Secondly, possible causal links between interprofessional relations and maternity care are searched for through the study of comprehensive care. So are revealed the impacts of a close and trusting relationship in supporting parenthood and of a diversification of health services.

No description available.

The substandard care noted and reported on in midwifery practice at level one midwifery care institutions in South Africa raises a concern about the effectiveness of the assessment strategies used at nursing institutions in enhancing midwifery programme outcomes. The concern is mainly directed particularly at the performance of the newly qualified professional nurses as they are the ones that practise at level one institutions, had just gone through training and been found to be competent practitioners. The success of any training programme and specifically midwifery practice as in the content of this study is dependent on the effectiveness of the assessment techniques or strategies used; hence assessment is considered integral to monitoring the quality of the midwifery care programme. The current study used a quantitative research design to explore and describe the role of assessments in enhancing midwifery programme outcomes at a public nursing education institution in the Eastern Cape Province. Recommendations to enhance the role of assessments for the benefit of midwifery programme outcomes at a public nursing education institution that were made were guided by the findings of the study. Participants were non-randomly selected and were personally provided with a self-developed questionnaire to complete. 134 participants returned fully completed questionnaires while approximately 25% of the selected sample did not return theirs. Data was captured on an excel spread sheet and analysed using Cronbach’s alpha programme under the guidance of the statistician and supervisor. Findings of the study were that: • the participants perceived the role of assessments as positively enhancing the midwifery programme outcomes, • though they also agreed and strongly agreed that there were major factors that prevented enhancement of midwifery programme outcomes. Ethical considerations were autonomy, beneficence, justice and non-maleficence. The validity and reliability of the data- collection instrument was ensured. Furthermore, recommendations were made for nursing education, clinical practice and future research. The study was conducted during the period of July 2014 to January 2016.

Pregnancy challenges the health care system in a unique way in that it involves at least two individuals – the woman and the fetus. The death rates of both pregnant women (maternal mortality) and newborns (perinatal mortality) are often used to indicate the quality of care the health system is providing. In terms of maternal and perinatal outcomes South Africa scores poorly compared to other upper-middle income countries (Penn-Kekana & Blaauw, 2002:14). The high stillbirth rate compared to the neonatal death rate reflects poor quality of antenatal care. Maternal and perinatal mortality is recognised as a problem and as a priority for action in the Millennium Development Goals (Thieren & Beusenberg, 2005:11). The Saving Mothers (Pattinson, 2002: 37-135) and Saving Babies (Pattinson, 2004:4-35) reports describe the causes and avoidable factors of these deaths with recommendations on how to improve care. The quality of care during the antenatal period may impact on the health of the pregnant woman and the outcome of the pregnancy, in particular on the still birth rate. In primary health care services there are many factors which may impact on and influence the quality of antenatal care. For example with the implementation of the comprehensive primary health care services package (Department of Health, 2001a:21-35) changes at clinic level resulted in a large number of primary health care professional nurses having to provide antenatal care, who previously may only have worked with one aspect of the primary health care package such as minor ailments or childcare. Because skills of midwifery or antenatal care, had not been practiced by some of these professional nurses, perhaps since completion of basic training, their level of competence has declined, and they have not been exposed to new developments in the field of midwifery. The practice of primary health care nurses is also influenced by the impact of diseases not specifically related to pregnancy like HIV/AIDS and tuberculosis. The principles of quality antenatal care are known (Chalmers et al. 2001:203) but despite the knowledge about these principles the maternal and perinatal mortality remains high. The Basic Antenatal Care quality improvement package is designed to assist clinical management and decision making in antenatal care. The implementation of the BANC package may influence the quality of antenatal care positively, which in turn may impact on the outcome of pregnancy for the mother and her baby. The aim of this study was to evaluate the effectiveness of the Basic antenatal care (BANC) package to improve the quality of antenatal care at primary health care clinics.

In the first chapter of the diploma thesis I am concerned with the women employment and I define the term of special women working conditions. The second chapter describes the evolution of special women working conditions as well as the evolution of working hours and child labour. The next part of the diploma thesis summarizes international, european as well as czech sources of law that are connected with special women working conditions. The last chapter is devoted to the current legal regulations of special women working conditions that is compared to the previous legal regulations and there are the results of the checklist research in Chrudim region.

Although participation of Canadian women in the labour force has significantly increased in the past decade, and in turn the number of maternity leave claims, information is limited on actual employment behavior following maternity leave and the factors which influence this behavior. The purpose of this study was to examine the employment behavior following maternity leave for 313 women of varying occupations from a large metropolitan hospital in order to: isolate significant variables which influence this behavior, examine return rates and employment patterns for women who return to work, identify the major problems women experience upon their return to work, examine the experience of women with the current maternity leave legislation, obtain their opinions on whether flexible work policies encourage staff retention and finally, to develop a set of recommendations to assist organizations in achieving staff retention following maternity leave. Data respecting the positions of the women, their personal characteristics and their employment behavior following their leave were collected from personnel records. The dependent variables for the study were three distinct types of employment behavior: employees who terminated following their maternity leave, employees who terminated following their return to work and employees who remained employed at the hospital. There were nine independent variables which were tested as potential employment behavior influences namely level of education, age, organizational tenure, employment status, union/management affiliation, salary level, occupational level, number of previous maternity leaves and organizational division. The Chi Square test of Independence was run for six variables and the One Way Analysis of Variance for three variables. In-depth structured interviews were conducted with five women selected randomly from the sample in order to identify the major problems they encountered in returning to work as well as to obtain their opinions on the current maternity leave legislation. They were also questioned regarding the effectiveness of flexible work policies. Two of the variables tested were found to be significant employment behavior influences: type of union and organizational tenure. It was also found that the least flexible union had the highest termination rate. Although the majority of women returned to work and remained employed at the hospital, a high percentage transferred to part-time and casual employment. The interviews revealed that the major concerns women had were the need for more flexible work policies, an increase in part-time opportunities and child-care concerns including the need for on-site day care. All of the women interviewed felt that 18 weeks was an inadequate length of time for a maternity leave and some of the women wanted maternity benefits for their entire leave and not just 15 weeks. It was concluded from the results of the study that flexible work policies and organizational support systems encourage staff retention following maternity leave, it was recommended that in order for organizations to achieve staff retention following maternity leave that they must introduce flexible work policies and a specific staff retention plan. / Business, Sauder School of / Graduate

This phenomenological study was designed to explore the privacy needs of gynecological patients, as perceived by the clients during hospitalization, for the purpose of adding to knowledge and understanding of patients' privacy. Data were collected through sixteen in-depth interviews with eight recently hospitalized patients. The interviews were tape-recorded and transcribed verbatim for each participant. Data were analyzed using Giorgi's (1975) procedure. Analysis of participants' accounts revealed that privacy was important to participants' maintenance of their self-identity. Characteristics of privacy that participants identified as helping to maintain their self-identity included providing time alone for contemplation and helping to control interactions with others. Participants reported that privacy was important for their comfort during situations involving nursing care, basic needs and social interactions with others. Participants suggested that even though they reduced their expectations of privacy during the hospital stay, their privacy needs in hospital were at times still not met. Factors within the hospital setting that contributed or detracted from participants' hospital privacy included behavior of the nurses, doctors, roommates and the physical environment of the hospital. Participants indicated that nurses were the main factor in meeting privacy needs especially while caring for participants and participants' roommates. The findings of this study indicated that participants were willing to trade some privacy for health care. However, participants still valued privacy and considered it important during their hospital stay. There is a lack of research on privacy and acute care hospitalization. Recommendations for further nursing research, nursing practice, nursing education and nursing administration, based on the findings of this study, are presented in the final chapter of the study. / Applied Science, Faculty of / Nursing, School of / Graduate

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-06-15T15:07:24Z No. of bitstreams: 1 Cibelle Quaglio.pdf: 2331550 bytes, checksum: f2fb4ef2150b897753950372db1bf24d (MD5) / Made available in DSpace on 2018-06-15T15:07:24Z (GMT). No. of bitstreams: 1 Cibelle Quaglio.pdf: 2331550 bytes, checksum: f2fb4ef2150b897753950372db1bf24d (MD5) Previous issue date: 2018-03-20 / Ankyloglossia, also known as "tongue tie", is one of the several alterations that may occur in the oral cavities of newborns. This congenital abnormality limits tongue movements and can lead to difficulties in breastfeeding, swallowing, speech, as well as mandibular development. The incidence of alteration of the lingual brake in the population is of 0.2 to 12%. The great rate span is mainly due to scarcity of standardized protocols for the correct identification of ankyloglossia. Protocols are important for solving various problems in service delivery and management. Among the most common standardization methods, the Standard Operating Procedures (SOP), comprise detailed instructions for achieving uniformity in the execution of a library, in addition to being scientifically supported and adjusted whenever necessary. ELFABS (Lingual Frenulum Assessment with Baby Scores), better known as " Neonatal Tongue Screening Test" is a protocol that identifies whether the newborn has an alteration of the lingual frenulum. ELFABS was established as mandatory by the Ministry of Health (MH) in 2014 for all maternity hospitals in the country. This study checked validation of ELFABS in a maternity hospital of the city of São Paulo. Questionnaire was used with open and closed questions. The ELFABS, however, was not validated in studied institution. According to the evaluators the protocol is very extensive, complicated and unnecessary. This research suggests that protocols should be tested in a great number of locations before being mandatory tests. / Várias são as alterações encontradas nas cavidades orais dos recém-nascidos, dentre elas, as alterações do freio lingual ou anquiloglossia, também conhecida como “língua presa”. A anquiloglossia é uma anormalidade congênita que limita os movimentos da língua e pode acarretar dificuldades na amamentação, deglutição, fala e desenvolvimento mandibular. Na população há uma incidência de 0,2 a 12% de alterações no freio lingual, essa divergência de valores é dificultada pela escassez de protocolos padronizados para sua identificação. Protocolos são importantes instrumentos para o enfrentamento de diversos problemas na assistência e na gestão dos serviços. Um modo muito utilizado para se padronizar é feito por meio dos Procedimentos Operacionais Padrão (POPs) que são instruções detalhadas descritas para alcançar a uniformidade na execução de uma função específica, são apoiados em bases científicas e ajustados sempre que necessário. Esse estudo teve como objetivo checar a validação do Protocolo de avaliação do Frênulo da língua com Escores para Bebês (PAFLEB) em uma maternidade do município de São Paulo. O PAFLEB, mais conhecido como “Teste da Linguinha”, foi instituído como obrigatório pelo Ministério da Saúde (MS) em 2014, para todas as maternidades do país. Esse protocolo identifica se o recém-nascido apresenta a anquiloglossia. Foi utilizado questionário com questões abertas e fechadas. Não houve validação do teste da linguinha naquela instituição. De acordo com os avaliadores o protocolo é muito extenso, complicado e desnecessário. A sugestão desse estudo é que Protocolos sejam validados em maior número de locais possíveis antes de virarem leis.

Contexte et objectifs : Le taux d’activité des femmes a augmenté régulièrement depuis les années 1970 et les femmes sont de plus en plus souvent en emploi au moment où elles vont avoir une grossesse. Ce travail a pour principal objectif de décrire et comprendre les liens entre l’activité professionnelle et la grossesse. Tout d’abord, en comparant les taux d’activité professionnelle selon que les femmes sont enceintes ou appartiennent à la population féminine générale. Dans un second temps, en observant comment le groupe professionnel et le statut de l’emploi occupé influencent le moment de l’arrêt de travail pendant la grossesse. Enfin la troisième partie analyse l’impact de la position sociale, définie d’abord par le statut d’emploi des femmes et prenant en compte leur situation de couple et l’emploi du partenaire, sur la surveillance pendant la grossesse et les issues périnatales.Méthodes et population : Les données ont été extraites des Enquêtes Périnatales Nationales (ENP) en 1972, 1981, 1995, 1998, 2003, 2010 et 2016 et des données du recensement Une comparaison de l’activité professionnelle des femmes enceintes et de la population générale des femmes en France métropolitaine en fonction de l’âge et du niveau d’études, a été effectuée. Une modélisation de l’activité professionnelle pendant la grossesse en fonction des caractéristiques sociodémographiques, de la période entre 1972 et 2016 et de la génération de naissance, a été réalisée. Une analyse des femmes qui travaillaient pendant la grossesse en 2010 et en 2016 a été menée pour déterminer les moments de l’arrêt de l’activité professionnelle au cours de la grossesse, selon la situation médicale et la position sociale des femmes, en s’intéressant à l’arrêt précoce, avant 24 semaines d’aménorrhée (SA), et à l’arrêt tardif, après 36 SA révolues. Une analyse entre 1995 et 2016 a permis de décrire la surveillance prénatale et les issues périnatales en fonction du statut d'emploi des femmes et de leur partenaire pendant la grossesse.Résultats : Comme dans la population générale, le taux d’emploi des femmes enceintes a augmenté régulièrement entre 1972 et 2016, de 53 à 74 %. En 2016, 32 % des femmes qui travaillent pendant la grossesse se sont arrêtées avant 24 SA, et 2 % après 37 SA. Il existe des inégalités sociales autour des arrêts de l’activité professionnelle: les femmes ayant les situations sociales les plus défavorables s’arrêtent précocement pendant leur grossesse, alors que les femmes qui s’arrêtent tardivement ont des situations socioprofessionnelles plus favorisées, quelle que soit leur situation médicale. Entre 1995 et 2016, les différences selon la position sociale des femmes enceintes observées pour la surveillance prénatale et les issues périnatales se réduisent mais persistent.Conclusion : Les transformations majeures du rapport à l’emploi des femmes au cours des dernières décennies peuvent modifier les pratiques des soignants prenant en charge les femmes enceintes. La majorité des femmes enceintes sont des femmes en emploi rémunéré et la discussion de l’arrêt de l’activité professionnelle au cours de la grossesse doit s’évaluer au regard de la situation médicale mais aussi de la situation sociale et professionnelle. Une attention particulière doit être portée aux femmes plus défavorisées, soit au chômage ou sans activité professionnelle déclarée, soit ayant une situation précaire dans l’emploi, car ces femmes ont une initiation des soins plus tardive et des issues périnatales plus défavorables que les femmes qui travaillent avec une position sociale plus favorisée. / Background and objectives: The occupational activity rate of women is steadily increasing since the 1970s, and women are more and more often in employment when they are in childbearing age. The main purpose of this work is to describe and understand the links between occupational activity and pregnancy. First, by comparing employment rates according to whether women are pregnant or belong to the female general population. In a second step, by observing how their occupational group and status is linked to the timing of prenatal leave. Finally, the third part analyzes the impact of the social position, defined by the employment status of women and taking into account their couple status and the employment of the partner, on the antenatal care and perinatal outcomes.Methods and population: The data were extracted from the French National Perinatal Surveys of 1972, 1981, 1995, 1998, 2003, 2010 and 2016 and the Census. A comparison of the employment rate of pregnant women and the general population of women in continental France, by age and level of education, was carried out. A modelization of the employment rate of women during pregnancy was realized according to the socio-demographic characteristics, the survey period from 1972 to 2016, and the birth generation. An analysis of women working during pregnancy in 2010 and 2016 was conducted to determine the time of prenatal leave, according to the medical situation and the social position of women, focused on early leave, before 24 weeks of gestation (WG), and late leave, after 36 WG. For the period 1995 to 2016, prenatal care and perinatal outcomes were analyzed according to the employment status of women, taking into account their couple situation and partner’s employment.Results: As in the general population, rate of occupational activity of pregnant women shown a steadily increasing, between 1972 and 2016, from 53% to 74%. In 2016, 32% of women working during pregnancy leave their job before 24 WG, and 2% after 37 WG. Social inequalities exists around maternity leave: women with the most unfavorable social situations stop early, while self-employed women and those with more favorable social and occupational situations leave late, even after stratification for the medical situation. From 1995 to 2016, the differences in antenatal care and perinatal outcomes according to the social position of pregnant women are always observed despite a reduction.Conclusion: The major changes in the relationship to women's occupational activity in recent decades may change the practices of caregivers for pregnant women. A majority of pregnant women had a paid job and the date of prenatal leave should be discussed in relation to the medical situation but also considering the social and occupational status. Special attention should be given to the most disadvantaged women, either unemployed or without a legal job, or having a precarious occupational situation, since these women have a later initiation of care and more unfavorable perinatal outcomes.