Dans les années 1780, une nouvelle politique française d’encadrement de la naissance choisit lasage-femme comme intermédiaire privilégié entre les attentes médico-administratives et lapopulation. Officialisé par la loi du 19 ventôse an XI sur l’exercice de la médecine, le métier desage-femme n’a plus dès lors qu’un point d’entrée possible et admis : la formation obstétricale.La thèse étudie le consentement des sages-femmes à leur mise en formation, sa chronologie et sesmodalités. Elle aborde la question de la part dans l’évolution de la profession et son renforcementau fil du siècle des dynamiques externes (État, administration, corps médical) et internes (sagesfemmeselles-mêmes). Ou comment les auxiliaires sans instruction de la naissance à la fin duXVIIIe siècle se muent en une profession médicale unifiée au début du XXe siècle.Au-delà, ce travail montre comment l’organisation administrative de la formation, les politiquesde recrutement et la forme des cours participent à la construction d’un nouvel agent sanitaire : lasage-femme qui se retrouve à assumer tour à tour les fonctions d’accoucheuse, de vaccinatrice, demédecin des pauvres ou encore de puéricultrice.En un siècle, les deux-tiers des départements français ont fondé un cours ou une écoled’accouchement. En un siècle, ce sont près de 45 000 sages-femmes qui ont été formées etdiplômées. Cette étude est celle de la construction d’une identité et d’une conscienceprofessionnelle permise par la formation obstétricale. / In the 1780s, the new French policy surrounding childbirth elected the midwife as theintermediary between the medical and administrative powers and the population. From themoment it was made official by the Law of Ventose 19, year XI on the practice of medicine, thesole gateway to midwifery has been obstetrical training.The thesis examines how midwives consented to this training, as well as the timeline of thisconsent and its modalities. It also examines how forces from without (government,administrative rules, physicians) as well as from within (the midwives themselves) created thedynamics allowing the profession to evolve and gain official status in the nineteenth-century—how from untrained birth assistants in the late eighteenth century, midwives turned into a unifiedmedical profession in the early twentieth century.Beyond, this study investigates how administrative guidelines, recruitment policies, trainingcontents and methods led to the creation of a new health worker: the midwife, in charge, byturns, of delivering babies, of performing smallpox vaccinations, of being a doctor to the poor,and of providing expert childcare.In the course of a single century, two-thirds of all French departments founded a midwiferytraining school. Over that century, nearly 45 000 midwives were trained and certified. This studydeals with the construction of a professional identity and a professional conscience, as a result ofobstetrical training.

D.Cur. / Since 1994, the government has engaged in extensive transformative processes that included the reviewing and restructuring of all relevant legislation, organisations, institutions and statutory bodies. These transformative demands resulted in the development and implementation of a new constitution and ensuing transformative legislation and policies. It is for this reason that the Department of Health, in attempting to transform the health system in South Africa, developed a strategy known as the Health Sector Strategic Framework, which sets out a 10-point plan. This plan states amongst others, that health professions and professional bodies develop Continuing Professional Development (CPD) systems/programmes. Over and above this other transformative developments in the education and labour frameworks, professional conduct hearings and national and international benchmarking influenced the need for a CPD system for nurses and midwives in South Africa. The problem statement is that there is no formalised and regulated CPD system for nurses and midwives in South Africa. The following research questions are relevant: • What is the international trend with regard to CPD for nurses and midwives? • What is the national trend with regard to CPD for healthcare professionals in South Africa? • What will a CPD system for nurses and midwives in South Africa comprise? • How will a CPD system for nurses and midwives in South Africa be implemented to ensure credibility? The overall aim of this study was to develop a CPD system for nurses and midwives in South Africa. To accomplish this overall aim the following objectives were formulated: • To explore and describe existing knowledge frameworks on Continuing Professional Development for nurses and midwives in selected countries, internationally and for health professionals in South Africa • To describe the draft CPD system for nurses and midwives in South Africa • To describe a final CPD system for nurses and midwives in South Africa. This study was conducted within the context of the South African professional, ethical and legal framework for Continuing Professional Development for nurses and midwives in South Africa. A descriptive, exploratory and contextual design was conducted. The description of a draft CPD system was based on the theoretical framework. The draft CPD system was developed from 9 June 2000 until May 2003 and exposed to critical reflection by the stakeholders of the SANC, the profession at large and the human resource directorates in each of the nine (9) provinces in South Africa. The researcher developed the final CPD system for nurses and midwives in South Africa. This final CPD system was exposed to critical reflection to confirm face and content validity, followed by a refinement of the CPD system. Emerging from this research and based on the feedback of the validators/appraisers, recommendations are made with reference to practice, nursing and midwifery education and research: The implementation of a formal, coordinated and regulated CPD system for nurses and midwives in South Africa is necessary as part of a quality promotion initiative and to meet the requirements of the transformative legislation especially pertaining to the labour and education legal framework.

O modelo de assistência ao parto o Brasil está fortemente relacionado à atuação do médico e a maioria dos partos é realizada em ambiente hospitalar: em 2004, 94% dos partos foram hospitalares e 43% dos nascimentos ocorreram por cesariana, uma atividade estritamente médica. Na rede privada de serviços de saúde do município de São Paulo, o percentual de cesarianas gira em torno de 84%. A partir do final da década de 1990, vêm sendo formuladas políticas públicas para promover mudanças nesse modelo. Algumas dessas proposições favorecem a inserção de enfermeiras obstétricas e obstetrizes (EO) na assistência ao parto, reconhecendo sua importância para promover o parto normal. Nesse contexto, a autonomia profissional da EO na atenção de baixo risco e o trabalho colaborativo na assistência ao parto são elementos fundamentais para uma atenção qualificada. Por sua vez, a atuação da EO na assistência ao parto é definida não exclusivamente pelas políticas de saúde oficiais, mas também pela organização da assistência praticada nas instituições. A forma como a EO atua na assistência ao parto e como vivencia a autonomia profissional e o trabalho colaborativo dependem do local de atuação, das regras e normas da instituição, da divisão técnica do trabalho e da relação hierárquica estabelecida na equipe obstétrica. O objetivo deste estudo foi descrever como a enfermeira obstétrica percebe sua inserção na equipe obstétrica e sua autonomia profissional na assistência à mulher durante o parto, em instituições de saúde privadas. Foi utilizada a metodologia qualitativa e o estudo foi realizado com EO que atuavam em instituições de saúde privadas da cidade de São Paulo, que atendem exclusivamente pacientes particulares ou usuários de seguros ou planos de saúde. Os dados foram coletados por meio de entrevista semi-estruturada, como uso do gravador. Foram incluídas 15 EO que atuavam no centro obstétrico de nove instituições de saúde privadas. A análise de conteúdo foi utilizada para sistematizar os dados qualitativos e a discussão foi realizada considerando os seguintes temas: Autonomia; Confiança e cumplicidade: principais facilitadores da autonomia; Outros aspectos facilitadores da autonomia; Dificuldades para a autonomia; Facilitadores do trabalho colaborativo; Barreiras para o trabalho colaborativo; Percepção da inserção da enfermeira obstétrica na equipe; Composição e coordenação da equipe de assistência ao parto; Reflexões sobre a atuação da enfermeira obstétrica nas instituições de saúde privadas. Identificamos que apesar do apoio legal e do reconhecimento dos órgãos oficiais e organizações internacionais da importância da EO assistência à mulher no parto, sua atuação nas instituições privadas do município de São Paulo é muito restrita e aquém das competências estabelecidas para esta profissional. As EO apontaram o não reconhecimento de suas atribuições pelos médicos obstetras como um dos principais fatores para a restrição de sua autonomia e para a falta de trabalho colaborativo no cuidado da parturiente / The model of healthcare during labor in Brazil is strongly associated to the physician care, and the majority of deliveries occur in hospitals: in 2004, 94% of the deliveries took place in hospitals and 43% of them were cesarian sections, something that implies medical care. In the private health system in the city of São Paulo, the incidence of cesarian section deliveries reaches around 84%. Since the end of the 1990-decade, some political initiatives have been trying to change this model. Some of the proposals favor the insertion of nurse-midwives in the assistance team, recognizing the importance of this professional in the promotion of normal delivery. In that context, the professional autonomy of the nurse-midwife and collaborative work in the delivery assistance are essential for a qualified care. However, the role of the nurse-midwife in the delivery assistance is defined not only by official guidelines, but also by the institutions\' policies. The way she can live professional autonomy and collaborative work depends on the type of hospital, its rules and norms, on the distribution of work among the team\'s members and on the hierarchical relationships. This study had the objective of describing the nurse-midwife\'s perception of her insertion in the assistance team and of her professional autonomy in private hospitals. This was a qualitative study, with nurse-midwives working in private institutions in São Paulo that assist members of health care insurance plans. Data were collected by means of semi-structured interviews, registered in a tape recorder, with 15 nurse-midwives who work in 9 private hospitals. Content analysis was used and the qualitative data collected was discussed based on the themes: autonomy, factors that facilitate autonomy or factors that make autonomy more difficult, facilitators of collaborative work and factors that make it more difficult, the composition and coordination of the delivery health care team and the perception of the nurse-midwife of her insertion in the team. We observed that, despite the legal support and the recognition of official and international organizations about the role of the nurse-midwife, her actual work in the private hospitals in São Paulo is restricted and are not in accordance with her competence and skills. The nurse-midwives pointed out that obstetricians do not recognize their responsibilities in the health care team, and this restricts her autonomy and plays against the collaborative work in the patient\'s benefit

Made available in DSpace on 2016-07-27T13:44:58Z (GMT). No. of bitstreams: 1 ADELMAR SANTOS DE ARAUJO.pdf: 3047939 bytes, checksum: 3973dd81a676351c3e63ffe80e395e03 (MD5) Previous issue date: 2015-06-16 / This doctoral thesis entitled "Knowledge of midwives: an archeology in the Alto Purus" is the result of a survey undertaken by the Research Field: Education, Society and the Graduate Program in Culture Education at the Catholic University of Goiás, PPGEPUC - GO. This research sought to investigate what knowledge of midwives of Alto Purus, in the municipality of Santa Rosa do Purus-AC, and the conditions of possibility of this knowledge. This is a theoretical nature of work mixed with the analysis of official and unofficial documents. Therefore, discussed the know from a path of reading between history and philosophy, aiming to understand the influences of French epistemology in Archaeology of Knowledge (its displacement) of Michel Foucault. It was used by public health agencies and education documents and oral reports of (the) river (the) from the Alto Purus region. He studied the issue of midwives with brief forays into the history of European and Brazilian midwives, to then make use of images (both iconographic and symbolic) of altopuruenses midwives. And when analyzing the conditions of possibility of knowledge of midwives in Alto Purus, if contacted that although being the knowledge of midwives altopuruenses something predominantly oral and empirical, mixed with extracts of modern medicine, it is an event of the knowledge order which does not fit the order of the scientific view, or the epistemological, and that, therefore, the concept of knowledge of midwives must be invented, if you like, reinvented. / A presente tese de doutoramento intitulada O saber das parteiras: uma arqueologia no Alto Purus é resultado de uma pesquisa empreendida junto à Linha de Pesquisa: Educação, Sociedade e Cultura do Programa de Pós-Graduação em Educação da Pontifícia Universidade Católica de Goiás, PPGE-PUC-G. Buscou-se nessa pesquisa investigar qual o saber das parteiras do Alto Purus, no município de Santa Rosa do Purus- AC, e quais as condições de possibilidade desse saber. Trata-se de um trabalho de cunho teórico mesclado à análise de documentos oficiais e não oficiais. Para tanto, discutiu-se o saber a partir de um percurso de leitura entre a história e a filosofia, objetivando compreender as influências da epistemologia francesa na arqueologia do saber (seu deslocamento) de Michel Foucault. Utilizou-se de documentos de órgãos públicos de saúde e educação bem como de relatos orais dos (as) ribeirinho (as) da região do Alto Purus. Estudou-se a questão das parteiras com breves incursões na história das parteiras europeias e brasileiras, para em seguida lançar mão de imagens (tanto iconográficas quanto simbólicas) das parteiras altopuruenses. E ao se analisar as condições de possibilidades do saber das parteiras no Alto Purus, contatou-se que embora sendo o saber das parteiras altopuruenses algo predominantemente oral e empírico, mesclado com extratos da medicina moderna, trata-se de um acontecimento da ordem dos saberes, que não se enquadra na ordem do olhar científico, nem do epistemológico, e, que, portanto, o conceito de saber das parteiras deve ser inventado, se quiser, reinventado.

Background: Indonesia is a republic in Southeast Asia, consisting of approximately 13 600 islands and is the home for 239 million inhabitants. The country was governed by a dictator but has since 1998 had democratic elections. The majority of the population, 88 percentages, are Muslims which makes the country the largest Muslim nation in the world. The structure of the health system in Indonesia is built on districts with sub-districts which are supported by sub-centres. Problem: The health care is improving and more women are attended by professional health care workers when giving birth, despite this child birth still is a common problem. Yet there is a lack of human resources which contributes to the problem. Since the children are the future of Indonesia it is important that the health development policy is adequate and that it has a great compliance in order for the children to stay healthy. Aim: The aim of the study was to describe nurses/midwives work with health promoting education to parents to prevent ill-health among children in the district of Yogyakarta, Indonesia. Method: The method that has been used for the seven interviews is a qualitative content analysis. The interviews were carried out in the Dr. Sardjito Central General Hospital in Yogyakarta and in Puskesmas NGAWEN, Gungng Kidul district, Yogyakarta Province and Puskesmas Mlati II, Sleman district which are placed in the rural areas of Yogyakarta. Result: The result shows that there is a constant work with increasing the knowledge level among nurses and health workers on grassroots level in the district of Yogyakarta, to prevent ill-health among the children. Regarding the health promoting education a crucial finding was made that revealed the most common reason why parents did not apply the health implications that they received, was related to culture and tradition. Positively, there is a great will among health workers and nurses to learn more and increase the health level among the children. Nurses and midwives in the hospital had to rely on their experience when educating the parents while the nurses and midwives working in the puskesmas used the Mother and Child health handbook as a guideline. Discussion: To increase the chance of implementation among the families the health promoting education has to include culture and socioeconomic factors. / Program: Sjuksköterskeutbildning

O modelo de assistência ao parto o Brasil está fortemente relacionado à atuação do médico e a maioria dos partos é realizada em ambiente hospitalar: em 2004, 94% dos partos foram hospitalares e 43% dos nascimentos ocorreram por cesariana, uma atividade estritamente médica. Na rede privada de serviços de saúde do município de São Paulo, o percentual de cesarianas gira em torno de 84%. A partir do final da década de 1990, vêm sendo formuladas políticas públicas para promover mudanças nesse modelo. Algumas dessas proposições favorecem a inserção de enfermeiras obstétricas e obstetrizes (EO) na assistência ao parto, reconhecendo sua importância para promover o parto normal. Nesse contexto, a autonomia profissional da EO na atenção de baixo risco e o trabalho colaborativo na assistência ao parto são elementos fundamentais para uma atenção qualificada. Por sua vez, a atuação da EO na assistência ao parto é definida não exclusivamente pelas políticas de saúde oficiais, mas também pela organização da assistência praticada nas instituições. A forma como a EO atua na assistência ao parto e como vivencia a autonomia profissional e o trabalho colaborativo dependem do local de atuação, das regras e normas da instituição, da divisão técnica do trabalho e da relação hierárquica estabelecida na equipe obstétrica. O objetivo deste estudo foi descrever como a enfermeira obstétrica percebe sua inserção na equipe obstétrica e sua autonomia profissional na assistência à mulher durante o parto, em instituições de saúde privadas. Foi utilizada a metodologia qualitativa e o estudo foi realizado com EO que atuavam em instituições de saúde privadas da cidade de São Paulo, que atendem exclusivamente pacientes particulares ou usuários de seguros ou planos de saúde. Os dados foram coletados por meio de entrevista semi-estruturada, como uso do gravador. Foram incluídas 15 EO que atuavam no centro obstétrico de nove instituições de saúde privadas. A análise de conteúdo foi utilizada para sistematizar os dados qualitativos e a discussão foi realizada considerando os seguintes temas: Autonomia; Confiança e cumplicidade: principais facilitadores da autonomia; Outros aspectos facilitadores da autonomia; Dificuldades para a autonomia; Facilitadores do trabalho colaborativo; Barreiras para o trabalho colaborativo; Percepção da inserção da enfermeira obstétrica na equipe; Composição e coordenação da equipe de assistência ao parto; Reflexões sobre a atuação da enfermeira obstétrica nas instituições de saúde privadas. Identificamos que apesar do apoio legal e do reconhecimento dos órgãos oficiais e organizações internacionais da importância da EO assistência à mulher no parto, sua atuação nas instituições privadas do município de São Paulo é muito restrita e aquém das competências estabelecidas para esta profissional. As EO apontaram o não reconhecimento de suas atribuições pelos médicos obstetras como um dos principais fatores para a restrição de sua autonomia e para a falta de trabalho colaborativo no cuidado da parturiente / The model of healthcare during labor in Brazil is strongly associated to the physician care, and the majority of deliveries occur in hospitals: in 2004, 94% of the deliveries took place in hospitals and 43% of them were cesarian sections, something that implies medical care. In the private health system in the city of São Paulo, the incidence of cesarian section deliveries reaches around 84%. Since the end of the 1990-decade, some political initiatives have been trying to change this model. Some of the proposals favor the insertion of nurse-midwives in the assistance team, recognizing the importance of this professional in the promotion of normal delivery. In that context, the professional autonomy of the nurse-midwife and collaborative work in the delivery assistance are essential for a qualified care. However, the role of the nurse-midwife in the delivery assistance is defined not only by official guidelines, but also by the institutions\' policies. The way she can live professional autonomy and collaborative work depends on the type of hospital, its rules and norms, on the distribution of work among the team\'s members and on the hierarchical relationships. This study had the objective of describing the nurse-midwife\'s perception of her insertion in the assistance team and of her professional autonomy in private hospitals. This was a qualitative study, with nurse-midwives working in private institutions in São Paulo that assist members of health care insurance plans. Data were collected by means of semi-structured interviews, registered in a tape recorder, with 15 nurse-midwives who work in 9 private hospitals. Content analysis was used and the qualitative data collected was discussed based on the themes: autonomy, factors that facilitate autonomy or factors that make autonomy more difficult, facilitators of collaborative work and factors that make it more difficult, the composition and coordination of the delivery health care team and the perception of the nurse-midwife of her insertion in the team. We observed that, despite the legal support and the recognition of official and international organizations about the role of the nurse-midwife, her actual work in the private hospitals in São Paulo is restricted and are not in accordance with her competence and skills. The nurse-midwives pointed out that obstetricians do not recognize their responsibilities in the health care team, and this restricts her autonomy and plays against the collaborative work in the patient\'s benefit

This study is an exploratory study, descriptive in nature and investigates the familiarity and practices of midwives and women with regard to complementary therapies during pregnancy and labour. The study was conducted in four major hospitals in Western Sydney, namely Nepean, Jamieson, Blue Mountains Anzac Memorial and Hawkesbury hospitals. The findings showed that in the main the midwives and women were familiar and made use of four therapies, ie. aromatherapy, massage, music and hydrotherapy. The midwives practiced without any significant training in these therapies. Hospital policies were almost non existant in relation to the practice of complementary therapies and nurses often felt frustrated at not being able to implement complementary therapies. The main issues that emerged from the study were the need for education for the midwives related to specific complementary therapies, hospital policies conducive to the practice of complementary therapies and research into the efficacy of the different complementary therapies. The women need further exposure to complementary therapies and education in the respective therapies if they are to feel empowered in dealing with the stress of their daily lives / Master of Nursing (Hons)

Introduction: In Western countries, about one pregnant woman in five experiences a considerable fear of childbirth (FOC). Consequently FOC is an important topic for midwives, being pregnant women’s main care givers. Also, although many aspects of FOC have been studied, almost no studies have into detail applied a theoretical frame of reference for studying pregnant women’s expectations for their upcoming labour and delivery. Therefore, the theory of self-efficacy, here regarding pregnant women’s belief in own capability to cope with labour and delivery, has been applied with the aim to better understand the phenomenon of FOC. Aim: The overall aims of the thesis were to describe midwives´ perceptions and views on FOC and to expand the current knowledge about expectations for the forthcoming birth in nulliparous women in the context of FOC. Method: Study I had a descriptive design. In total 21 midwives, distributed over four focus-groups, participated. Data were analysed by the phenomenographic approach. Studies II and III had cross sectional designs. Study II comprised 726 midwives, randomly selected from a national sample that completed a questionnaire that addressed the findings from Study I. Study III included 423 pregnant nulliparous women. FOC was measured using the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ), self-efficacy by the Childbirth Self-Efficacy Inventory (CBSEI). Study IV had a descriptive interpretative design. Seventeen women with severe FOC were conveniently selected from the sample of Study III and individually interviewed. Content analyses, both deductive and inductive, were performed. Method: Study I had a descriptive design. In total 21 midwives, distributed over four focus-groups, participated. Data were analysed by the phenomenographic approach. Studies II and III had cross sectional designs. Study II comprised 726 midwives, randomly selected from a national sample that completed a questionnaire that addressed the findings from Study I. Study III included 423 pregnant nulliparous women. FOC was measured using the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ), self-efficacy by the Childbirth Self-Efficacy Inventory (CBSEI). Study IV had a descriptive interpretative design. Seventeen women with severe FOC were conveniently selected from the sample of Study III and individually interviewed. Content analyses, both deductive and inductive, were performed. Conclusions: Swedish midwives regard severe FOC as a serious problem that influences pregnant women’s view on the forthcoming labour and delivery. Midwives at antenatal care clinics, compared to colleagues working at labour wards, experience a greater need for training in care of pregnant women with severe FOC. Self-efficacy is a useful construct and the self-efficacy theory an applicable way of thinking in analysing fear of childbirth. The self-efficacy concept might be appropriate in midwives’ care for women with severe FOC.

Många studier om föräldraskap är mest fokuserade på mammors upplevelser av graviditet och förlossning. Även om mammorna föder barnen och är i behov av mer vård än papporna, är det två personer som blir föräldrar. Pappor behöver också uppmärksamhet och kunskap för att bli bra föräldrar. Svenska barnmorskor och sjuksköterskor saknar ibland kunskap om mäns upplevelser av graviditet och förlossning. Syftet med denna studie är att belysa blivande/nyblivna pappors upplevelser av barnmorskors/sjuksköterskors bemötande. En litteraturstudie valdes för denna studie. 14 artiklar analyserades och de svarade på studiens syfte. I resultatet framkommer två teman, att bli bekräftad och att få ett stöd och att vara ett stöd, med tillhörande sex underteman. Pappor verkar vara de bortglömda föräldrarna. Många pappor känner att de är utelämnade och känner sig ofta oförberedda på själva förlossningen. Det framkommer även att de pappor som får extra förberedelser känner sig mer säkra under förlossningen och nyföddhetsperioden.

En el transcurso de los setenta y siete años que abarca la tesis, se investiga en torno a unas realidades socio-profesionales concretas que se generan a partir del estado de la cuestión historiográfica y de una preliminar cronología antepuesta al inicio del periodo de estudio. Contextualizado el estudio, se centra en las diversas normas legales que fueron normativizando la estructura social, profesional y de relación de esas actividades; en la conexión entre los manuales formativos y la praxis ocupacional-profesional; la determinación de los orígenes geográficos y sociales de los colectivos, así como su herencia profesional y el acceso de la mujer a las profesiones sanitarias; el asociacionismo profesional y sus publicaciones corporativas; los diversos ámbitos del ejercicio profesional liberal o dependiente y los relatos biográficos. El núcleo de esta tesis lo constituyen las personas, hombres y mujeres, a los que hay que considerar como los verdaderos protagonistas de la evolución histórica de esas tres profesiones sanitarias, es por ese motivo que se incluye el nomenclátor de los dos mil seiscientos cuarenta y cuatro personas que se titularon en Cataluña (1877-1932) / Certain social-professional realities were investigated during the seventy-seven years covered by this thesis that were generated from the state of the historiographic situation and of a preliminary chronology preceding the beginning of the period of the study. Contextualising the study, centred on the diverse legal rules which were normalising the social-professional structure and the relationship of these activities; in the connection between the formative manuals and the occupational-professional practise, the determination of the geographic and social origins of the groups, and its professional heritage and the access of women to sanitary professions; the professional associations and corporate publications; the various fields of professional, liberal or dependent practises and their biographic reports. The core of this thesis is constituted by the people, men and women, who must be considered as the true protagonists of the historical evolution of these three sanitary professions, it is for this reason that here is included, the catalogue of the names of the two thousand six hundred and forty-four people who graduated in Catalonia (1877-1932)