Case studies of five Dutch undergraduate students form the initial focus of this longitudinal study. An ethno-methodological approach was utilised to provide insight into how student nurses made sense of their social and personal reality and dealt with situations and challenges encountered during the four-year programme leading to registration as a degreenurse. The case studies are further examined within a meta-case study -this being the auto-ethnographic context of the researcher's role as a nurse, an educator and a researcher.The study highlights the interface between sociology and education, and between power and authority, discussing the student journey in terms of Parsonian and confluent educational frameworks. The research findings also highlight student awareness in dealing with the challenges of practice and indicate that students are proactive, and use preconceived strategies to negotiate their way through their placements successfully. Specifically a student, who dropped out of the programme, is the subject of a 'deviant' case study; her experience provides an interesting backdrop to the students who completed the programme. The researcher analyses and discusses the concept of 'deviance', questioning the appropriateness of this terminology. The study provides some insights into the original research questions regarding student motivation on entering nursing; the developmentof a 'caring philosophy, the internalisation of professional values and the ability to integrate theory and practice. In addition the richness of the researcher/student interaction adds an extra dimension to the existing body of knowledge. This narrative account invites the reader to follow the researcher's thoughts and decision-making whilst it simultaneously challenges the reader to confront their personalhistory and beliefs.

Thesis (MMidwif)--University of South Australia, 2001

Breastfeeding is an important public health initiative that has many benefits for mother and baby. Promoting and encouraging breastfeeding is an important role for all health professionals and particularly for midwives who have contact with women during their pregnancy and in the immediate postnatal period. Midwives have a crucial role in providing breastfeeding support and education during the postnatal period. However, little exists in the literature regarding the way midwifery students and graduates develop this role. This thesis investigates factors that impact on the development of breastfeeding support practice for newly graduated midwives. / PhD Doctorate

The selected publications presented here are concerned with the development of practice and knowledge in midwifery. The thesis underlying the publications is that the development of a positive personal relationship between women and their midwives is fundamental to effective and sensitive midwifery care. The methodology used is essentially different to the thesis written prospectively. This is because the publications presented arise from years of work informed by 'hands on' practice, development of policy, leading change and development, supported by research and communicated and disseminated through writing. The work presented therefore could be viewed as a long research project, with these activities forming an iterative process in thinking through and writing for publication, as well as continuing practice development and research. The extended essay serves to introduce the publications and show how they are linked through common themes developed over time. It also demonstrates the originality, importance and contribution of the publications. The publications presented may be viewed conceptually in a number of different ways however these are all related to the relationship between women and their midwives. The essay is presented in sections. The first is the Introduction to key concepts and theories. The second is The Midwife with Woman Relationship. This introduces publications that describe the nature and purpose of the relationship. The third section, Changing Practice: the New Midwifery is concerned with what the midwife does in the context of that relationship. Publications introduced in this section propose ways of working in the best interests of women and their families. The fourth section, Influencing Policy Nationally and internationally, is concerned with the creation of national policy that has supported the development of what I have called the New Midwifery. The fifth section, Transformative Change and Rediscovering Midwifery is concerned with developing the organisation and culture of care, that is its context, to enable midwives to work in the best interests of women and their families. The sixth section Developing Patterns of Practice that Enable Personal Relationships Between Women and Midwives: One-to-One Midwifery introduces publications concerned with the development and evaluation of new structures that facilitate continuity of care and thereby relationship.

This study draws on multiple modes of expression in texts that have been generated by my experience of midwifery development since I moved from England to Australia in early 1997. The Professional Doctorate in Midwifery at the University of Technology, Sydney (UTS) has enabled me to produce and study my work as a midwifery practitioner, researcher, educator, writer and activist and to engage in a process of scholarship that both informs and is generated by practice. This has allowed me to analyse the complex issues that I, and other midwives in Australia, face as we strategise to narrow the gap between our ideals and the realities of the professional and political constraints that challenge midwifery. The study analyses the rhetorical communications I have employed as both carriers of 'vision' and 'means of persuasion' and the deliberate strategies to make changes that I believe will benefit childbearing women. My portfolio challenges me and others, to explore how we are able to identify, enact, and convince others of the emancipatory potential of midwifery. Rhetorical innovations are therefore linked to the exposition of woman centred midwifery care; an overall goal being to enable situations in which women can experience the potential power that transforms lives, through their experiences of childbirth. In the process, I aim to produce new knowledge that will equip midwives to understand practice, policy and political situations and see new possibilities for responding and taking action. I have analysed and explained my work using a framework appropriated from rhetorical theory and drawing on a range of feminist perspectives. This involves identifying and critiquing the rhetorical innovations that I have used when trying to create possibilities and persuade others of the value of midwifery and the need to make changes happen in practice, education and regulation. My study analyses the rhetorical nature of my own work as presented in my portfolio in a range of carefully selected texts that I have authored during my candidature. These include journal and newsletter articles, conference papers, research activities, policy submissions, education and training materials, the development of midwifery standards, formal and informal communications, and other documents, all aimed in one way or another at the rhetorical strategy of stimulating interest and action. The portfolio texts that arise from this work form the empirical data that is studied. However, in varying ways these texts elicit understandings about the rhetoric and reality of Australian midwifery and the deliberate strategies that are employed by midwives to make changes that will benefit childbearing women. They therefore stand in their own right as contributions to the thesis with their own discursive and epistemological intent. The reflexive process employed in this thesis highlights comparisons between what is being positioned as the potential of midwifery with what is also presented as the reality played out in contemporary Australian maternity service provision and in midwifery education and regulation. The thesis weaves its way around the portfolio documents, attempting to bring to life and discuss the culture in which rhetorical innovations and intentional strategies are aimed at narrowing the gap between 'rhetoric and reality'.

The importance of the role of the midwife in providing safe, quality care for women has until recently, been underrated in Victoria, Australia. Acknowledgement of the need for midwife-led models of care in state maternity service policies provided opportunities for midwives to become recognised within the healthcare system and the wider community. This professional doctorate aims to examine the ways in which the role of the midwife and her practice has been impacted on by organisational renovations of midwifery care. It identifies the complexity of the factors that affect the midwife’s ability or choice to work in midwife-led models of care. Furthermore this doctorate highlights the need for ongoing debate into midwifery in Australia. Concepts related to midwifery practice are examined as they form the foundations for the research and policy components of the portfolio. This includes an exploration of midwifery philosophy, the antecedents to autonomous practice and the experience midwives have of midwife-led care. An examination of the concepts of continuity of care and woman-centred care provides a platform upon which to review models of midwifery care. This review highlights the development of an ongoing relationship as a source of satisfaction for midwives and women. The second part of the doctorate reviews policies that guide the provision of maternity services in Victoria. Analysis of these policies using Kingdon’s multiple streams framework identifies the problems, the political actors and the policy developed, establishing the context for organisational change in maternity care. The antecedents for successful integration of organisational change are explored through a review of change theory and leadership. A case study approach utilised for the research component of the doctorate provides insights into organisational change that occurred at two maternity sites in Victoria. The findings of the study suggest there was a dichotomy between those midwives desiring autonomous practice and wanting to work in midwife-led care and those wishing to remain in one specialised area. Recommendations stemming from these findings include the need for sufficient education and support during change, a review of terminology used to describe midwifery models of care and research into the use of integrated maternity units. Complexity science is examined in order to bring the different strands of the doctorate together, providing an explanation for the different outcomes that occur despite the implementation of similar models. The connective leadership model was suggested as the means to provide leadership that is inclusive of providing direction, mentoring new leaders and providing support and opportunities for midwives to become empowered to practice autonomously. Attention to the complexity of organisational change is vital to ensure the future of midwifery.

The importance of the role of the midwife in providing safe, quality care for women has until recently, been underrated in Victoria, Australia. Acknowledgement of the need for midwife-led models of care in state maternity service policies provided opportunities for midwives to become recognised within the healthcare system and the wider community. This professional doctorate aims to examine the ways in which the role of the midwife and her practice has been impacted on by organisational renovations of midwifery care. It identifies the complexity of the factors that affect the midwife’s ability or choice to work in midwife-led models of care. Furthermore this doctorate highlights the need for ongoing debate into midwifery in Australia. Concepts related to midwifery practice are examined as they form the foundations for the research and policy components of the portfolio. This includes an exploration of midwifery philosophy, the antecedents to autonomous practice and the experience midwives have of midwife-led care. An examination of the concepts of continuity of care and woman-centred care provides a platform upon which to review models of midwifery care. This review highlights the development of an ongoing relationship as a source of satisfaction for midwives and women. The second part of the doctorate reviews policies that guide the provision of maternity services in Victoria. Analysis of these policies using Kingdon’s multiple streams framework identifies the problems, the political actors and the policy developed, establishing the context for organisational change in maternity care. The antecedents for successful integration of organisational change are explored through a review of change theory and leadership. A case study approach utilised for the research component of the doctorate provides insights into organisational change that occurred at two maternity sites in Victoria. The findings of the study suggest there was a dichotomy between those midwives desiring autonomous practice and wanting to work in midwife-led care and those wishing to remain in one specialised area. Recommendations stemming from these findings include the need for sufficient education and support during change, a review of terminology used to describe midwifery models of care and research into the use of integrated maternity units. Complexity science is examined in order to bring the different strands of the doctorate together, providing an explanation for the different outcomes that occur despite the implementation of similar models. The connective leadership model was suggested as the means to provide leadership that is inclusive of providing direction, mentoring new leaders and providing support and opportunities for midwives to become empowered to practice autonomously. Attention to the complexity of organisational change is vital to ensure the future of midwifery.

Research Doctorate - Doctor of Philosophy (PhD) / Dr. Peter Chamberlen was a highly trained physician who specialised in midwifery at a time when midwifery had the potential to become a lucrative practice for men. Male midwives were considered inappropriate and unskilled for 'normal' births and were generally called when surgical procedures were necessary. Because the Chamberlen family had assisted in childbirth, including the children of royalty, for several generations Peter CHamberen virtually inherited his role as a royal midwife almost immediately after his graduation from medical school in 1619 and considered himself qualified for both difficult and normal births because of the training he received from his father. Because of his manicured heritage Peter Chamberlen also considered himself to have the necessary experience, training and skill to establish the first English state sponsored association of midwives that would have made London's independent midwives subject to his control. In 1634, after he had gained considerable experience as a reputable accoucheur, and establishing his reputation as a fellow of the Royal College of Physicians, Chamberlen petitioned the king for permission to institute the midwives association without consultation with the College or some influential midwives. Charles I, unwilling to promote the idea without support, suggested the matter should be taken up with the Archbishop of Canterbury and the Bishop of London, the official channels responsible for issuing midwifery licenses. Lacking the confidence to arbitrate on the matter, the ecclesiastic authorities sought advice from the Royal College of Physicians. Unfortunately for Chamberlen opposition arose from from the midwives, the Royal College of Physicians as well as the ecclesiastical authorities. This opposition was so intense that the proposed institute failed in its inception and Chamberlen was humiliated. Chamberlen retreated to the Netherlands but soon returned and continued to work in London as a male midwife. Henceforth he actively sought to clear his tarnished reputation. His life and contribution to 17th Century society form the basis of this thesis.

Preeclampsia is a complex, baffling and unpredictable syndrome. The condition affects the lives of approximately one in every twenty pregnant women. Most cases are mild but some are serious enough to threaten the life of mother and baby. Medical research has yet to identify a cause, and the search for a cure continues. Delivery remains the only method of resolving this dangerous complication of pregnancy and may need to be effected before the foetus has become mature enough to avoid the risks associated with preterm birth. Women's experience of preeclampsia has received little attention in midwifery and obstetric literature. This hermeneutic phenomenological study has been designed to answer the question "What is women's experience with preeclampsia before 34 weeks of gestation?" Eight women who had experienced severe preeclampsia were interviewed. Their narratives are analyzed to uncover the meaning of the lived experience of preeclampsia from diagnosis to postpartum recovery. Three data chapters reveal some of the ways that preeclampsia reveals itself as the disease progresses. The findings of this study indicate that there are many atypical presentations of preeclampsia and that sometimes early "showing" goes unrecognized. The woman may in fact feel better as the disease progresses. Late diagnosis leaves the woman and her family shocked and may compromise foetal and maternal safety. Having preeclampsia changes the reality of pregnancy and early parenting for a woman. Emotional consequences are significant and include an increased risk of post-traumatic stress disorder. The unpredictable manner in which preeclampsia first "shows itself" is analyzed in the first data chapter and the following two chapters explore the way in which a woman's life may be thrown out of control by diagnosis and management of the disease. Paradoxically, women with severe preeclampsia often lose continuity of care with their midwife at a time when they most need the support of a familiar and trusted professional. Provision of continuity creates a challenge for the midwife when the woman's care is taken over by secondary services. Innovative ideas to enhance the safety and holistic quality of care for women with preeclampsia are discussed.

Thesis (Ph.D.)--University of Technology, Sydney, 2003.