Thesis (M Nursing (Advanced Practice)) -- University of South Australia, 1994

No description available.

Thesis (Ph. D.)--New York University, School of Education. / Also on film.

Thesis (Ph. D.)--New York University, School of Education. / Also on film.

Thesis (Ph. D.)--UCLA, 2008. / Vita. Includes bibliographical references (leaves 387-400).

Thesis supervisor: Susan C. Lawrence. Thesis supervisor: John Raeburn. Includes bibliographical references (p. 339-354).

D.Cur. / Midwives are responsible to assess pain before treating it; then they should reassess the pain to evaluate the effectiveness of the interventions and plan future therapy. Accurate and objective measures of labour pain continue to be scarce and the discrepancy in labour pain perceptions between parturients and health-care providers remains challenging. Various pain measurement tools are currently in use measuring chronic and acute pain, but many problems were encountered applying these methods to the woman in labour. The charts were detailed and required too much time to complete. The aim of the study was to develop a multidimensional labour pain assessment instrument to assist clinicians and midwives with labour pain control. Objectives for developing a valid and reliable instrument to accurately measure labour pain included refinement of the labour pain assessment instrument developed from literature, testing of the refined instrument on patients during labour, compilation of a final instrument and development of guidelines on how to implement the labour pain assessment instrument in nursing practice. A descriptive and exploratory approach was used to describe, evaluate, observe, explore and assemble new knowledge on assessment and measurement of pain during the first stage of labour. Development of the instrument was addressed in the literature chapter. The research was conducted in three phases, combining qualitative and quantitative research.During phase one, the instrument was refined in two stages. Focus group interviews were conducted with members regarded as knowledgeable in the field of normal labour who evaluated the face and content validity of the instrument. The most senior people teaching Midwifery at all South African universities evaluated the face and content validity of the instrument with an open-ended questionnaire thereafter, using the Delphi technique. The analysis of the first Delphi round was compared to the focus group analysis. The instrument was altered and submitted to the Delphi experts in a second open-ended questionnaire to confirm the alterations.

Using the framework of the reformulated learned helplessness (RLH) model of depression, this study examined the nonachievement of self-expectations of primigravidas desiring natural childbirth in terms of their attributional style and the possible resulting depression. The RLH model predicts that individuals who have a depressive attributional style experience a sense of helplessness when faced with situations which seem difficult or out of their control and are more apt to fail and become depressed. Natural childbirth is an experience which has the potential of appearing out of control to women involved in the birth process. Using a before and after design, the study was based on a sample of forty-one married primiparas who had an uncomplicated pregnancy, attended Lamaze childbirth classes, and anticipated an uncomplicated, unmedicated vaginal delivery. Sixteen subjects stated they did not meet their self-expectations during childbirth and twenty-five stated they did meet their self-expectations. The hypothesis were tested using two matched groups of sixteen each. Data from all subjects were used for post hoc analysis of the hospital data.

Apesar dos esforços a favor da humanização do nascimento, sabemos que ainda se fazem presentes na prática uma série de procedimentos intervencionistas no trabalho de parto e parto que interferem nesse processo. Assim, a depender de como se dá o processo de parturição, este acarretará nas condições maternas e neonatais para o início do aleitamento materno, e como consequência, no processo da amamentação, uma vez que a mulher deve ser o elemento chave para esta prática. A prontidão do recém-nascido (RN) para mamar, depende do seu estado de consciência, sendo que pode apresentar-se mais sonolento em situações que envolvem o uso de anestésicos ou outras intervenções em suas mães durante o trabalho de parto. O objetivo do presente estudo é identificar a relação entre a prontidão do RN para sugar a mama materna na primeira mamada no alojamento conjunto e a condução do trabalho de parto, parto e nascimento. Trata-se de um estudo observacional, transversal, descritivo exploratório, realizado com 43 binômios, com RN de idade gestacional entre 37 e 41 semanas e 6 dias, Apgar >= 7 no 5º minuto, filhos de mães primíparas. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo, com protocolo (Nº1219/2010). As informações do processo de nascimento foram coletadas dos prontuários, e a partir das entrevistas às puérperas. A avaliação da prontidão dos RN para sugarem, foi feita por meio de filmagens dos neonatos desde o início ao término da primeira mamada no alojamento conjunto, sendo avaliados os estados de sono e vigília e mamada, com base no Formulário de Observação da mamada da OMS (1997). De acordo com o formulário os itens foram categorizados como \"sinais positivos\" e \"sinais negativos\", relacionados às condições favoráveis e às dificuldades na mamada. A análise foi fundamentada na estatística descritiva e na realização de testes estatísticos para análise comparativa entre as variáveis. Quanto aos resultados, em sala de parto, 17 (39,5%) neonatos foram colocados em contato pele imediato e apenas 4 (9,3%) sugaram o seio materno. Das 43 parturientes, 39 (90,7%) receberem analgesia, porém apenas 14 (32,6%) receberam a segunda analgesia (repique). No momento em que as mesmas receberam a primeira analgesia, a dilatação cervical variou entre 2 e 9 cm, sendo que 13 (33,3%) estavam com 5 cm. No repique, a dilatação cervical variou entre 4 e 10 cm, sendo que 6 (42,9%) estavam com 8 cm. O período mínimo de duração do trabalho de parto, foi de 25 minutos, e o tempo máximo, 11 horas. A menor duração do período expulsivo foi de 1 minuto e o tempo máximo, 59 minutos. Quanto aos dados referentes ao puerpério imediato, 36 (83,7%) mães referiram que estavam com sono logo após o parto e apenas 9 (20,9%) delas relataram estar sentindo algum tipo de dor e quanto ao cansaço, a maioria 41 (95,3%) referiu estar cansada. O período sem ingerir líquido variou de 33 minutos a 22h e 35 min e o período em jejum alimentar variou entre 2h 50 min e 21h 05 min. Em relação ao estado de sono e vigília no período que antecedeu a mamada, 18 (41,9%) dos recém nascidos estiveram no estado alerta quieto. Durante a mamada em 21(48,8%) dos neonatos, o estado sono ativo foi predominante. Na avaliação da mamada, os índices positivos se fizeram presentes nos diferentes domínios avaliados: 86,1% na sucção, 85,6% na postura corporal, 82,3% nas respostas do RN, 100% na anatomia da mama, no 78,4% tempo gasto na sucção durante a mamada. Quanto às associações entre as variáveis do trabalho de parto, parto e nascimento e as da mamada, obteve-se dados significativos entre a duração do período expulsivo e grupo sono e sonolento de estado de sono e vigília, com p=0,03. Embora as mães tivessem recebido intervenções durante o trabalho de parto e parto que pudessem interferir na qualidade da primeira mamada em alojamento conjunto, a maioria dos neonatos apresentou-se em estado de alerta, isto foi o suficiente para que eles apresentassem boa prontidão para mamar neste momento. O alojamento conjunto precoce, se mostrou uma prática favorável para a obtenção de sinais positivos na avaliação da primeira mamada à admissão de ambos. / Despite efforts to promote the humanization of birth, we know that still present in practice a number of interventional procedures during labor and childbirth that interfere with this process. So, depending on how is the parturition process, this will result in maternal and neonatal conditions for the initiation of breastfeeding, and as consequence, in the process of breastfeeding, since the woman should be the key element to this practice. The readiness of the newborn (NB) to nurse, depends on your state of consciousness, and may present more drowsy in situations involving the use of anesthetics or other interventions in their mothers during labor. The aim of this study is to identify the relationship between NB readiness to suck the maternal breast in the first feeding on the rooming in and conduct of labor, and birth. This is an observational, cross-sectional, descriptive and exploratory, conducted with 43 binomials, with NB in the gestational age between 37 and 41 weeks and 6 days, Apgar score >= 7 in the fifth minute, the children of first-time mothers. The project was approved by the Research Ethics Committee of the Nursing School of Ribeirão Preto, University of São Paulo, with protocol (No. 1219/2010). Information from the birth process was collected from medical records and from interviews with puerperal. The assessment of the NB readiness to suck, was made by filming the neonates from the beginning to the end of the first feeding in rooming in, evaluated the states of sleep and wakefulness and feeding, based on Observation of breastfeeding from WHO (1997). According to the form of the items were categorized as \"positive signals\" and \"negative signals\", related to the favorable conditions and difficulties in feeding. The analysis was based on descriptive statistics and statistical tests for comparative analysis between the variables. As for the results in the delivery room, 17 (39.5%) neonates were placed in immediate contact skin and only 4 (9,3%) sucked the breast. Of the 43 pregnant women, 39 (90.7%) received analgesia, but only 14 (32.6%) received the second analgesia (reinjection). At the moment in which they receive a first analgesia, cervical dilation varied between 2 and 9 cm, while 13 (33.3%) had 5 cm. In reinjection, cervical dilation varied between 4 and 10 cm, and 6 (42.9%) had 8 cm. The minimum duration of labor was 25 minutes and the maximum period 11 hours. The lowest delivery duration was 1 minute and the maximum time, 59 minutes. As for the data relating to postpartum, 36 (83.7%) mothers reported that they were sleepy soon after birth and only 9 (20.9%) of them reported to be feeling some sort of pain and tiredness, the most 41 (95.3%) reported being tired. The period without ingesting fluid ranged from 33 minutes to 22h and 35 min and fasting period varied between 50 min and 21h 2h 05 min. Regarding the state of sleep and wakefulness in the run-feeding, 18 (41.9%) of the infants were in quiet alert state. While feeding in 21 (48.8%) of the neonates, the active sleep state was predominant. In the assessment of breastfeeding, positive indices were present in different areas evaluated: 86.1% in sucking, 85.6% in body posture, 82.3% of infants\' responses, 100% in the anatomy of the breast, 78, 4% time spent sucking during breastfeeding. Regarding the associations between the variables of labor, and birth and breastfeeding, significant data was obtained from the delivery duration and sleep group and sleepy state of sleep and wakefulness, with p = 0.03. Although mothers had received interventions during labor and delivery that could interfere with the quality of the first feeding in rooming in, most neonates presented on alert, that was enough for them to present good readiness to nurse this time. The early rooming in practice proved favorable for obtaining positive signals in the evaluation of the first feed intake both.

The following thesis seeks to inquire whether the recent phenomenon of women seeking out and indeed actively engaging with a medicalised birth stems from a shift in not only perceptions of risk, but also how a shift in responsibility, choice and control has impacted on the birthing women of Australian society. The thesis examines sociology of risk employing the work of both Beck and Giddens, although an emphasis will be placed on the work of Ulrich Beck. The three major themes that underpin the work of Beck, namely his risk society thesis, reflexive modernization and individualization are employed to explore some of the issues that concern the relationship between risk and society, the ramifications of this form of society on its inhabitants and specifically in relation to its impact on those experiencing pregnancy and childbirth. The Risk Society as an explanatory framework was empirically tested by conducting 45 interviews with women who had recently given birth from three separate birthing environments: private birth mothers, birth centre and home birth mothers. The argument is put forward that whilst previous research into the area of childbirth is clearly important in shedding a critical light upon childbirth practices, it does nevertheless neglect some important current social changes. In this respect, the application of Beck and Giddens work to the area of sociology of reproduction captures more adequately the ideological shift which this thesis examines. It is argued, through the scrutinizing gaze of the public, that the pregnant woman is the least able to escape the consequences of risk society where changed notions of health and responsibility have created a cultural acceptance of medical intervention of childbirth. / Doctor of Philosophy (PhD)