This study is a minor field study and is sponsored by Swedish Development Cooperation Agency. Nepal is one of the poorest countries in the world and struggles with continuing reducing the national maternity mortality rate in order to satisfy WHO millennium targets. In order to improve the maternal care in Nepal an understanding of midwives experiences is needed. This study aims to explore midwives experiences from working in the Nuwakot region in Nepal from a transcultural caring perspective. The study uses a qualitative methodological approach. Unstructured interviews were performed during April 2015 at health posts in remote mountain villages in the region of Nuwakot, Nepal. Seven midwives, two men and five women were involved. By analyzing the interviews with a qualitative content analysis several categories emerged. The result shows that midwives working in a rural area of Nepal today experience several challenges in their work based on cultural influences; challenging family hierarchy, dangerous home deliveries, villagers lack of education, patients arriving too late, patients distrust in medicine and lack of resources but happy to help. The conclusion is that in order for Nepal to keep improve their maternal care, midwives needs to develop an understanding of the patient and the family’s cultural beliefs. The result can be used to reflect on how the patient's cultural beliefs can affect the midwives when performing their work in a rural area of Nepal. It can also be used to develop the midwifery education in Nepal by improving midwives’ meeting with patients and their families with cultural needs.

The hospitalization of childbirth and maternal care in Sweden is from an international perspective quite unique. It was implemented already in the beginning of the 20th century and fully mainstreamed by the 1960’s. This essay examines the professional discussions of midwives and doctors as depicted in their union’s membership papers, during the hospitalization period. The hospitalization of childbirths presented a shift in responsibility and power from the midwives to the doctors, which has lead previous research to analyse this development as a clear conflict of professional interest. I will argue however that the professional frictions came later, as the midwife profession grew stronger as a collective, and were not so much present in the actual making. This essay investigates why, and touches upon class and gender divergences as explanatory factors. My findings are in part that the overtaking was more elaborate from the doctor’s point of view than the midwives. Through undermining the midwives professional competence, denying them necessary resources and advocating their superiority in the midwives internal debates, the doctor’s managed to steer the development of hospitalization and establish the hierarchy that followed. Today’s lively and sometimes infectious debate on the organization of childbirth and maternal care highlights the necessity for a deeper historical understanding and background to the indeed different positions midwives and doctors take in this regard.

No description available.

This paper examines midwives and their practice in the criminal and notarial records from the later-medieval Provencal town of Manosque. This town counted amongst its 5,000 Jewish and Christian inhabitants a relatively high number of medical practitioners; these practitioners appeared frequently in the criminal court to offer testimony and to petition for professional protection. Although the apparent absence in Manosque of midwifery regulation like that present in northern France makes it more difficult to define midwives’ exact responsibilities, their appearance in court alongside other medical practitioners suggests that they possessed an acknowledged expertise of the reproductive female body. This paper situates midwives within the socio-medical milieu from which they are often separated in current historiography. A consideration of cases involving women’s reproductive bodies within the broader context of Manosquin medicine reveals that gender dictated the production and application of knowledge about this subject, but not on the grounds of biological essentialism. Rather, as cases of conception, abortion, and postmortem caeasarean sections reveal, the masculinized professionalism of later-medieval medicine granted male practitioners increasing authority in the realms of reproduction and pregnancy. Although this granted men access to “women’s secrets,” prevailing notions of feminine propriety prevented their theoretical knowledge from transforming into practical application to, or examination of, women’s “secret places.” This placed uncomplicated childbirth, and its attendants, on the margins of the medieval medical. It also made midwives indispensible not only to the women whom she attended in childbirth, but also to the institutions that sought to extend their authority over these concerns to which society otherwise denied them access. The cases from Manosque of adultery, illegitimate pregnancy, and virginity in which midwives appear reveal that the concept of feminine propriety simultaneously granted midwives’ authority over women’s physical reproductive bodies and rendered them instruments in the courts regulation of the female body. These cases, then, illustrate the court’s ability to legitimate and regulate through a symbiotic relationship between institution and society.

This Professional Doctorate in Midwifery explores the development of maternity services in New Zealand subsequent to legislative changes in 1990 enabling midwives to provide the same services as doctors and access the same funding for the provision of care for childbearing women. The papers in this portfolio describe and analyse challenges faced by New Zealand midwives in achieving their full potential as autonomous health professionals and the strategies they developed to survive within a healthcare environment that despite changes, remained medicalised. Throughout this portfolio, a theoretical framework based on complexity theory provides a lens for critique of the varying challenges to midwifery development and strategies to progress the profession. The seven papers that make up this portfolio were developed and written over a five-year period from 1999 to 2003. During this time I was involved in various activities supporting midwifery in New Zealand, including the establishment of a postgraduate midwifery programme and participation in the refocusing of both the New Zealand College of Midwives and the Midwifery and Maternity Provider Organisation. These activities took me to various parts of the country, enabling me to maintain contact with midwives from a variety of settings. The first paper sets the scene for the portfolio by exploring the socio-political context of contemporary midwifery in New Zealand. The second paper tracks the emergence of a theoretical framework out of Complexity theory and presents a set of principles, which guide the critique of midwifery services and professional development, explored in the subsequent papers. Part Three documents the development of a contextual scanning tool, used to analyse the organisation of maternity care by midwives in rural settings. Part Four presents the findings of the scan and strategies for consolidating the role of midwives as key providers of maternity services in rural localities. Part Five documents the development of a programme for optimising midwifery leadership within the health sector, while Part Six explores the risks and opportunities for midwives with the development of clinical governance strategies by District Health Boards. Part seven focuses on strategies to increase the potential for midwives to consolidate, maintain and further develop community-based maternity services throughout the country. This portfolio provides an organisational analysis of contemporary maternity services in New Zealand and presents a multifaceted approach to securing midwifery as a key health profession and midwives as the main provider of maternity services to women in this country. The findings of this collection of works, identified midwifery in New Zealand as precariously positioned within a rapidly changing health service environment. While appearing most vulnerable, midwifery within the rural and primary settings appeared to offer the most potential for innovative development in order to secure the place of midwives as the prime providers of health care for women in childbirth.

The challenge of ameliorating or preventing the health problems of Indigenous Australians living in remote areas is compounded by the profound professional, cultural, social and personal isolation of the health professionals who work there. This isolation has direct effects on the recruitment and retention of health professionals to remote communities, and their ability to work effectively in this unfamiliar environment. The overarching goal of this research was to strengthen the capacity of these professionals to improve the quality of remote area maternity services in Australia and the experiences and outcomes for birthing women and their families. This was achieved by investigating a process of engagement with a wide range of stakeholders and utilising contemporary communication technology through the Internet. A case study approach was undertaken using participatory action research (PAR) with the elements off rapid assessment, response and evaluation methods (RARE). The research explored, described and analysed the development of resources aimed at decreasing isolation and increasing communication in the remote setting. Identifying the barriers, facilitators and utility of an information technology intervention was an integral part of the investigation process. The first case study saw the development and evaluation of the Maternity Care in the Bush Web Based Resource Library, designed to decrease the isolation of practitioners from the educational resources and professional expertise available in current literature, guidelines and reports. The second case study targeted isolation from peers, with the development and evaluation of the Remote Links Online Community. This was designed to build partnerships between isolated practitioners, for the purpose of interactive peer support, information exchange and mentoring. The third and fourth case studies were guided by Aboriginal researchers and resulted in the development of the Birthing Business in the Bush Website, designed to decrease practitioners' isolation from cultural knowledge. An integrated component of this Website is the Primary Health Care Guide to Planning Local Maternity Services, designed to decrease the isolation of the health care practitioner from the community in which they are working. Issues related to conducting research in the Australian Indigenous setting have been explored, analysed and detailed. Each case study contributed new knowledge and learning about the challenges and contemporary contexts of remote area maternity service provision in Australia. The use of PAR, and, most particularly, how this can be used in Indigenous research to produce goals that extended beyond the individual researcher's goals, has been described. The current difficulties associated with computer mediated communication, as experienced by remote practitioners, have been highlighted. The research has identified areas of need within the workforce that, if addressed, could contribute to improved health services. Importantly, the research has documented, acknowledged, honoured and disseminated the voices of Aboriginal women, through the far reaching communication technology that is the Internet. Furthermore, the voices, concerns and conditions of remote maternity services providers were also documented and acknowledged. This workforce, often invisible and poorly valued, was assisted and supported to provide evidenced based, culturally appropriate maternity care, through the resources that were developed. To further progress the lessons taken from the research, recommendations have been developed and are listed in the Conclusion.

A key midwifery activity is the support of a woman in labour. Pain in labour has been extensively researched from the woman's perspective, but less has been explored in relation to the midwife and her approach to pain. The way in which the midwife works with a woman and her pain in labour is the focus of this qualitative study, using Heideggerian hermeneutic phenomenology. This philosophical approach seeks to uncover or illuminate aspects of the midwife's practice which are frequently taken for granted in their everydayness. Seven midwives, including both independent practitioners and hospital-employed, were interviewed. Their narratives were analysed to uncover the meaning of the way in which midwives work with women and their pain in labour. The findings of this thesis suggest that midwives work by interpreting the woman's pain. Before the pain begins, they 'leap ahead' to help them anticipate the pain and how they will confront it. During labour, midwives give pain meaning by translating its purpose in that context. They 'leap in' when required, sometimes using 'self as an intervention. Midwives interpret women's pain through their understanding of lived time. They know how the perception of time passing changes depending on the setting for labour or the amount of anxiety and pain the woman is experiencing. Midwives use time in their work. They break it down to help a woman focus on a single contraction rather than looking too far ahead toward the unknown. Time can be a midwife's friend when the arrival of the baby replaces the urgent need for pain relief. It can also be her enemy if her interpretation of a woman's pain differs from the woman's perception. The memory of pain may persist for the woman, after labour has finished, with a backlash for the midwife. Some midwives believe in the process of birth and the woman's ability to labour with such conviction that they gain a woman's complete trust. At her most vulnerable time, they encourage the woman to call upon inner reserves and be truly empowered by her experience.

Thesis (Ph. D.)--University of Washington, 1995. / Vita. Includes bibliographical references (leaves [66]-70).

Thesis (M.S.)--University of Michigan, 1998. / Includes bibliographical references.

Thesis (M.A.)--Brigham Young University. Dept. of History. / includes bibliographical references (leaves [77]-82).