Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

Introduction: Maternal and child care is one of the priority health issues that have been identified as requiring urgent attention in South Africa. Despite various efforts, South Africa has not seen improvements in maternal and perinatal outcomes. It is therefore essential that services and practices in hospitals rendering maternity care be reviewed and audited, so that current services can be improved and new services developed if necessary. In Schweizer-Reneke Hospital the clinical outcomes and clinical practices at the maternity unit have never been clearly described. The aim of the study was to describe the clinical outcomes and the associated clinical practices in the maternity unit of the hospital from 1 January 2009 to 31 December 2009. Methodology: The study setting was the maternity unit of Schweizer-Reneke District Hospital, a level 1 district hospital in a rural district of the North West Province. It comprised of a retrospective review of data from the District Health Information System and of the delivery records, specifically the partogram from 1 January 2009 to 31 December 2009. The study also examined records of Perinatal Problem Identification Programme and Mortality and Morbidity Review meetings. The study population included all the patients who delivered at the maternity unit during the study period. The measurement tools for data collection were data capture sheets on excel spreadsheets. The source of the data was the maternity register, maternity case records, Perinatal Problem Identification Programme records, District Health Information System and Unit Administration files (for records of meetings). The researcher personally captured the data. Results: Out of 699 deliveries conducted at the hospital 80.1% were normal deliveries, 16.3% caesarean sections and 3.6% vacuum-assisted deliveries. The record review revealed errors in the number of caesarean sections and vacuum-assisted deliveries on the DHIS. The perinatal mortality rate was calculated to be 56 per 1000 live births during the study period. Again the record review identified more perinatal deaths (41) than what was reported on the DHIS. No maternal deaths were recorded during the study period. A total of 295 records were analysed for completeness of the partogram. Out of the 295 partograms analysed none of them had data completed according to standard. The analysis of the completion of the partogram show that there is a significant association between recording of certain aspects of the partogram (risk factors, parity, age, fetal heart, contractions, cervical dilatation, problems and management plan) and mode of delivery whereas with other aspects there is no significant association. The aspects of the partogram that were completed according to standard by the perinatal outcome were poorly recorded, ranging from 0% to 54%. The association between mode of delivery and perinatal outcome was found to be statistically significant (p value 0.000). All of the fresh stillbirths and 90% of macerated stillbirths were born by normal vertex delivery. For the period under study one MMR meeting was conducted. Conclusion: The study found that there were poor clinical practices and outcomes in the maternity unit of Schweizer-Reneke Hospital. There are signs of poor information management as indicated by the discrepancies between data on hospital records and the DHIS. The reasons for this could not be established. Perinatal Problem Identification Problem and Mortality and Morbidity Review meetings were not conducted regularly and therefore could not be used to improve clinical practices and outcomes. Recommendations: Major steps need to be taken to improve clinical governance within the maternity unit of Schweizer-Reneke Hospital. Strategies to recruit and retain Professional Nurses need to be developed. The high percentage of macerated stillbirths needs to be investigated at district level and antenatal care needs to be improved. Studies focusing on the direct effect of inadequate recording on mortality and morbidity and the causes or reasons for inadequate completion of the partogram are necessary.

After the Second World War mothering became an object of social, political, medical and psychiatric investigation. These investigations would in turn serve as the bases for new campaigns around the practice, meaning and significance of maternity. This brought attention to mothers' emotional repertoires, and particularly their experiences of distress. In this thesis I interrogate the use of maternal distress, asking how and why maternal distress was made visible by professions, institutions and social movements in postwar Britain. To address this I investigate how maternal mental health was constituted both as an object of clinical interrogation and used as evidence of the need for reform. Social and medical studies were used to develop and circulate ideas about the causes and prevalence of distress, making possible a new series of interventions: the need for more information about users of the health care service, an enhanced interest in disorders at the milder end of the psychiatric 'spectrum', and raised expectations of health. I argue that the approaches of those studying maternal distress were shaped by their particular agendas. General practitioners, psychiatrists, activists in the Women's Liberation Movement, clinicians interested in child abuse and social scientists, sought to understand and explain mothers' emotions. These involvements were shaped by the foundation of the National Health Service in 1948 and the crystallization of support for alternative forms of care into self-help groups by 1979. The story of maternal distress is one of competing and complementary professional and political interests, set against the backdrop of increasing pessimism about the family. I argue that the figure of the distressed mother has exerted considerable influence in British society. As such, this research has important implications for our understanding of how mental distress developed into a mode of social and political critique across the late twentieth century.

In the context of population ageing and its consequences for future welfare state support, the issue of low fertility in Europe has become very topical over the past two decades. The role of policy and gender equality in explaining fertility behaviour has gained a prominent position in the literature and even today represents two streams that are believed to be important predictors of the current fertility outcomes in Europe. When building arguments regarding the policy effects on fertility behaviour, authors often implicitly assume that everyone living in a given country is entitled to support from particular statutory policy and/or that each individual is entitled to the same amount of support. However, although everyone of reproductive age is likely to make a decision about having children, the policy support does not mean the same thing for each one of them. Instead the set of rules on eligibility conditions clearly states who is entitled to welfare state support and how extensive this support is going to be. These rules consequently mediate the impact a child is going to have on an individual’s circumstances and therefore may influence the decision of whether or when to start a family and how big this family is going to be. The issue of within-country variation in the distribution of entitlements to policy support has been largely ignored in the comparative welfare state literature and has not been sufficiently acknowledged in fertility research. By focusing on the birth-related leave schemes in Europe, this thesis aims to address this gap. It does so by linking the individual-level survey data from EU-SILC with legislative rules from 27 European countries. Such an approach allows the identification of individuals that would be entitled to birth-related leave and compares how their socio-economic situation would change if they were to have a child. Apart from that the thesis is set into a wider context of contemporary fertility research that examines the role of gender issues in fertility behaviour. As such the thesis is particularly interested in the distribution of entitlements to birth-related leave between men and women and in the analyses pays special attention to the policy designs that strengthen traditional gender roles and whether they are associated with fertility behaviour.

A study of women's views of maternity services in the Northern Sydney Area Health Service was conducted as a result of the changing patterns of use of the Area's 7 obstetric hospitals. 340 primiparous women living in the Northern Sydney Area who had given birth in the previous six months were approached in Early Childhood Health Centres and asked to complete a survey exploring the factors influencing their choice of obstetric hospital, postnatal length of stay in hospital, and overall satisfaction with their choice of hospital. Of the 315 eligible women, 312 (99%) consented to participate and 297 (94%) completed the survey. Overall, reputation of the hospital and quality of nursing care were the most frequent reasons given for choice of hospital and there was some evidence that women selected different hospitals for distinct reasons. Women's postnatal length of stay ranged from less than 1 day to 11 days with an average of 5.3 days. Private patients stayed an average of 1 day longer than public patients, after adjusting for delivery type and pregnancy induced hypertension. There was little evidence that women in the Northern Sydney Area Health Service desire a shorter postnatal stay with the majority of women reporting they were satisfied with their length of stay. Overall, women displayed high levels of satisfaction with their choice of hospital; at least 90% of women attending all hospitals except one reported that they would choose the same hospital for the birth of another baby. This study provides valuable information, based on the experiences of the service users, to help guide the Northern Sydney Area Health Service in the provision of its maternity services to ensure they meet the changing needs of women and their families.

Thesis (D.N. Sc.)--Catholic University of America. / Typescript. eContent provider-neutral record in process. Description based on print version record. Bibliography: leaves 279-290.

Thesis--Columbia University. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 96-103).

With more than 50 percent of mothers in the workforce by their child’s first birthday, maternity leave’s influence on mothers’ well-being and the mother-infant interaction has implications for millions of employed mothers and their children. In this study, I used data from the National Institute for Child Health and Human Development Study of Early Child Care to examine the relations between variation in maternity leave benefit, length of leave, maternal well-being and mother-infant interaction within the context in which mothers make decisions to return to employment after childbirth. These associations depend on a number of important contextual factors including mothers’ subjective beliefs about the costs of employment, family structure and financial situation, mothers’ separation anxiety, and their commitment to work, all of which have important implications for both family and policy. The financial benefit that mothers use during leave varied positively with their socio-demographic characteristics. Paid leaves were related to shorter leaves and to fewer depressive symptoms, but had no direct relation with parenting stress or sensitivity. Mothers’ beliefs about the costs of employment, family structure and finances moderated the effects of paid leave. No direct association emerged between leave length and either maternal well-being or sensitivity, but interactions between leave length and both separation anxiety and work commitment indicated that long leaves are beneficial for only a sub-group of mothers. Results from this study indicate that individual differences are important in understanding the relations among leave type, leave length, maternal well-being and sensitivity. Consequently, effective maternity leave policy should be flexible to accommodate the varying needs of new mothers. / text

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