La recherche se situe dans le champ de l’éducation pour la santé en périnatalité. Les sages-femmes en sont les acteurs privilégiés, notamment de la préparation à la naissance et à la parentalité (PNP) en période prénatale. Leur formation initiale se fait en alternance entre enseignements théoriques et stages. Elles assurent donc parfois une double mission : éducative auprès des femmes enceintes et formative auprès du stagiaire. Faisant l’hypothèse que les ancrages théoriques des pratiques éducatives et formatives des sages-femmes sont identiques, l’objectif de recherche est d’identifier ces ancrages en situation de PNP et d’encadrement d’un étudiant. La méthode de l’auto-confrontation simple et l’entretien de compréhension ont été utilisés. 14 sages-femmes volontaires ont participé à l’étude. Les données ont été traitées selon la méthode de l’analyse du contenu à partir d’une modélisation combinant des modèles d’éducation, d’apprentissage et de santé. Les principaux résultats valident l’hypothèse, avec cependant quelques exceptions. Les pratiques de transmission des recommandations et savoirs médicaux ou d’activité corporelle s’inscrivent majoritairement dans les combinatoires à la croisée des modèles béhavioristes, de l’éducation centrée sur l’instruction et de la santé biomédicale. Les modèles du développement du sujet ou de la santé biopsychosociale sont ponctuellement présents, alternant avec ceux qui sont prédominants. Les combinatoires basées sur le constructivisme et le modèle de santé du sujet autonome n’apparaissent qu’exceptionnellement. Les mêmes tendances sont retrouvées pour les modélisations éducation/apprentissage sous-jacentes aux pratiques formatives. / Our research lies in the field of perinatal health education in which midwives are key players, most notably for their roles in Childbirth and Parenting Education (CPE) during the prenatal period. Their initial training combines theoretical and vocational training immersion. They therefore are charged with fulfilling a dual mission: an educational one with pregnant women and a formative one with students. Based on the assumption that theoretical backgrounds of health education and of midwives’ training practices are identical, our objective is to identify and examine these models during the CPE and during the supervision of students. We resorted to the method of self-confrontation and to the method of the interview of understanding. To do so, we interviewed 14 volunteer midwives, who agreed to participate in the study, about their general skills. The data was collected and processed using the content analysis methodology based on a framework combining education, learning and health models.With a few exceptions, the main results largely validate our hypothesis: the practices of the transmission of medical knowledge and recommendations, as well as of physical activity, lie at the crossroads of the behaviorist models, of the education-centered instruction and of the biomedical health model. Models such as the development of the subject model and the bio psychosocial health model have been highlighted, along with other prevailing models. The combinatorial theories built upon constructivism and the health model of the autonomous subject have also been exposed, albeit very rarely. The same trends appear in the modeling of education/learning underlying training practices.

Les anomalies morphologiques sévères ou congénitales sont l'une des principales causes de morbidité et de mortalité infantile. Certaines de ces pathologies diagnostiquées en anténatal sont difficilement compatibles avec une survie postnatale. Il arrive que des femmes choisissent, malgré tout, de poursuivre la grossesse et les soins palliatifs périnatals apparaissent comme une des réponses à apporter. Ils constituent à l’échelle internationale un nouveau domaine de pratique clinique avec des dilemmes décisionnels. Il importe d’identifier les déterminants qui influencent les modes de résolutions de ces tensions éthiques. Notre travail explore les perceptions et les pratiques des professionnels susceptibles de faire sens à une demande de poursuite de grossesse en intégrant dans leur démarche l’incertitude inhérente à la période postnatale. Cette réflexion vise à questionner la normativité effective dans la pratique de l’interruption médicale de grossesse notamment, face aux dilemmes et divergences qui alimentent les prises de décisions et les pratiques professionnelles autour des soins palliatifs néonatals. Notre recherche s’articule autour de trois axes : premièrement, étude qualitative, des perceptions d’experts de la périnatalité vis-à-vis des pathologies fœtales létales et des soins palliatifs périnatals : représentations, opinions et pratiques professionnelles ; ensuite, enquête, à l’échelle nationale, de la démarche palliative périnatale à partir des perceptions et des pratiques professionnelles ; et en dernier lieu, approche éthique de la démarche palliative à partir du diagnostic d'anomalies fœtales létales et des pratiques professionnelles en médecine périnatale. / Severe or congenital morphologic anomalies are one of the main causes of infantile morbidity and mortality. Some of these antenatally diagnosed pathologies are difficult to get compatible with postnatal survival. In this context, some women choose to continue with pregnancy. Subsequently, perinatal palliative care seems to be a constructive answer to offer in such situations. It constitutes, at international level, a new clinical practice where decision dilemmas exist (prognostic uncertainty, prolonged survival, and attachment to the infant). It might be necessary to identify the factors that can affect the way of dealing with these ethical tensions. Without any national data, our work explores the perceptions and professional practices susceptible to influence parental request for continuing with pregnancy, despite the uncertainty corresponding to the postnatal condition of a newborn with lethal pathology. This thinking aims to question and debate the normativity that is to be effective especially in medical termination of pregnancy, confronting the dilemmas and divergences that affect decision taking and professional practice in neonatal palliative care.Our research revolves around three perspectives: Firstly, and at a local level, qualitative study of expertise perceptions of perinatality regarding lethal fetal pathologies and perinatal care: representations, opinions and professional practices; secondly,and at a national level, investigation of initiatives taken in perinatal care based on perceptions and professional practices; thirdly,ethical approach to the medical care as inspired by these lethal fetal pathologies and professional practices in perinatal medicine.

This study investigated the impact of a sensory-motor stimulation programme, namely the SEMOSTI Programme, on the gross motor proficiency of four-to-six-year-old children. A field experiment was conducted using a quasi-experimental comparison group pretest-posttest design as three teachers implemented the SEMOSTI Programme over a 30-week period. Data collection took place at two schools’ grade R classes in Gauteng province of South Africa. Due to a limited sample of 73 participants, the results are context-bound and specific to Afrikaans-speaking, white, grade R children and selected gross motor skills. Data was collected using subtests of the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2), a scale and measuring tape as well as several questionnaires. The variables, physical activity, body mass index (BMI), gender, age, and perinatal morbidity could possibly influence the results and were taken into account. Data was statistically analysed using the General Linear Model (GLM) procedure and Dunnett’s t-test analysis. Findings indicated that the SEMOSTI Programme had a significant impact on the dependent variable, gross motor proficiency. The SEMOSTI Programme positively impacted on all five motor skills tested (bilateral coordination, balance, running speed and agility, upper-limb coordination and strength), but only the impact on running speed and agility and strength were statistically significant. Findings from the questionnaires indicated that the teachers who presented the SEMOSTI Programme perceived it as user-friendly, well-structured and effective in choice of equipment and activities. They identified the timeframe for the evaluation of developmental milestones and the structure of the plan-of-action section as weaknesses. Findings suggest that the SEMOSTI Programme is promising in improving gross motor proficiency in four-to-six-year-old children. Through participation in the programme, the experimental group significantly improved total gross motor proficiency, running speed and agility, and strength. This study offers support for the future use of the SEMOSTI Programme as a stimulation programme in grade R after further development and validation. / Dissertation (MOccTher)--University of Pretoria, 2012. / Occupational Therapy / unrestricted

In Ontario, 1% of women who give birth have their newborn infant apprehended by child protection agencies (~200/year). Hospital-based perinatal nurses are in a unique position to support mothers. However, there is a lack of research examining mothers’ experiences of newborn infant apprehension. The purpose of this study was to explore mothers’ experiences with nurses and other providers when newborn infant apprehension occurs. Doka’s Disenfranchised Grief Framework was used as a lens to help guide the research questions, methods and analysis. Thorne’s Interpretive Descriptive approach was employed. Mothers who had experienced newborn infant apprehension in the last 10 years were recruited from an agency in Ontario. Nine individual, semi-structured interviews were conducted. When analyzing the data, the researchers identified patterns and themes from among the mothers’ varied experiences. The analysis resulted in four themes: Not good enough, I am a mother, I have rights, I live everyday like I’m grieving, and Hope in the face of adversity. The findings illuminated the imbalance of power that mothers face when experiencing newborn infant apprehension, where power and authority rest with health and social service providers. This research study will focus on the findings describing what mothers want - for nurses to be open-minded, non-judgmental, to teach mothers regarding cycles of violence, and to advocate for mothers’ rights. Ultimately, the mothers posited that nurses are well positioned to empower mothers, thereby giving them the opportunity to begin recovery. The findings indicate a need for nurses to provide safe, compassionate, competent, ethical care and inform how perinatal nurses can better support mothers experiencing newborn infant apprehension.

INTRODUCTION. The perinatal mortality rate is of concern worldwide. In South Africa at the time of the study, 2000, it was estimated to be of the order of 40/1000 live births. However in the setting in which this study took place, namely Tembisa, (Ekhuruleni, Gauteng, South Africa) it was said to be 50/1000 live births. One of the patient- related avoidable factors that has been found to be associated with perinatal and to a lesser extent maternal mortality, is either no, or late initiation of antenatal care. It has been found in an area which, is in many respects similar to Tembisa that 50% of women go the private general practitioner (PGP) for confirmation of pregnancy but, due of lack of funds, do not continue care with the private practitioner but, initiate care in the public sector and in a proportion of these women, this is at an advanced gestational age, making it difficult to prevent or intervene if there are problems in the pregnancy. As (PGP’s) are well placed in the district to render antenatal care, it was decided to perform a study looking at the effect of involving them in the antenatal care of women who presented to them for confirmation of pregnancy. METHODS Sixteen general practitioners agreed to be part of the study. The women who confirmed their pregnancy and who were going to deliver in Tembisa hospital were included in the study after giving written informed consent. They comprised the intervention group, the first antenatal visit was performed, the findings were recorded on the antenatal card which is used in the public sector and which was introduced to the private practitioner at 2 workshops held by the Department of Obstetrics and Gynaecology, University of Pretoria prior to the study. The woman was then to attend antenatal care with the private practitioner until delivery. The private general practitioners waived the costs normally associated with this care for the period of the study. The control group consisted of the women who confirmed their pregnancies in the public health care sector known as the public service health care workers group (PSHCWG). Data collection took place in the postnatal ward of Tembisa hospital over the period of 3 months. By means of systematic sampling, 100 cards from the PGPG and 100 cards from the PSHCWG were obtained. The 2 groups were compared with respect to gestational age at initiation of care and a modified version of the Quality Check for Antenatal Records Score (MQCARS), an audit score which, when applied to the antenatal card, gives a measure of the effectiveness of record keeping, and whether problems in the antenatal period are detected and appropriately managed. RESULTS. There was a statistically significant difference between the two groups in terms of gestational age at initiation of care [PGPG mean gestational age -19.96 (5.86), PSHCW 25.96(5.98,) p<0.0001]. The majority of women in the PGPG initiated care in the 2nd trimester (79%) while the majority of the women in the PSHCWG (53%) confirmed their pregnancies in the third trimester. Six per cent of PGPG confirmed their pregnancies in the first trimester compared to the PSHCWG (3%). The two groups differ significantly with respect to the total MQCARS with the PGPG group performing better [(8.16 (1.55) vs. 16.34(2.58), p<0.0001]. The associated sub- scores are statistically different [History score 5.99 (0.10) vs.7 (0.96), Examination score 9.59(1.29) vs.8.03 (1.85) Interpretation Score 2.55(0.50) vs.2.80 (0.49)]. CONCLUSION Despite the limitations of the study it is felt that if private general practitioners in Tembisa are involved in the antenatal care of those women who confirm their pregnancies with them, there is a reduction in the gestational age at initiation of care. There is a small difference between the two groups in record keeping, detection and management of problems. / Dissertation (MCur)--University of Pretoria, 2011. / Nursing Science / unrestricted

No description available.

SAMMANFATTNING Bakgrund Kvinnlig könsstympning (Female Genital Mutilation, FGM) är en uråldrig tradition med starka band till kulturell och etnisk identitet. Mer än 200 miljoner kvinnor och flickor beräknas vara könsstympade och årligen riskerar cirka 3,9 miljoner ytterligare flickor att utsättas. Andelen kvinnor från länder där FGM är vanligt förekommande och som föder barn i Sverige har ökat i och med ökad invandring från dessa länder. FGM är internationellt betraktat som en kränkning av de mänskliga rättigheterna samt ett brott mot kvinnor och barns rättigheter. Syfte Att jämföra förekomsten och risken för perinatala komplikationer hos kvinnor med en diagnos av FGM med kvinnor utan denna diagnos som fött barn i Sverige mellan åren 2007 - 2017. Metod En populationsbaserad kohortstudie. Resultat Det huvudsakliga resultatet i denna studie är att barn födda av kvinnor med en FGM diagnos har en signifikant ökad risk för låg Apgar, födas lätta för tiden (SGA), drabbas av kramper, perinatal död inklusive intrauterin fosterdöd samt att födas överburna. Slutsats FGM är förknippat med ett flertal allvarliga perinatala komplikationer. Störst risk kunde ses mellan FGM och att födas lätt för tiden, födas överburen och intrauterin fosterdöd. Dessa samband var robusta oavsett vilket land kvinnan är född. Det går att dra slutsatsen att kvinnor med en FGM-diagnos och deras nyfödda barn tillhör en riskgrupp. Det är av stor vikt att arbeta preventivt för att skydda dessa kvinnor och barns hälsa. / ABSTRACT Background Female Genital Mutilation (FGM) is an ancient tradition with strong ties to cultural and ethnic identity. More than 200 million women and girls are estimated to be exposed, and about 3.9 million more girls are at risk each year. The proportion of women from countries where female genital mutilation is common, and which gives birth to children in Sweden has increased with an increased immigration. Female genital mutilation is internationally considered as a violation of human rights and a violation of women's and children's rights. Aim To compare the incidence and risk of perinatal complications among women with a diagnosis of FGM with women without this diagnosis who has given birth to a child in Sweden during the years 2007 - 2017. Method A population-based cohort study. Results The main result of this study is that children born of women with an FGM-diagnosis have a significantly increased risk of low apgar scores, being born Small for Gestational Age, convulsions, perinatal death and prolonged pregnancy could be observed. Conclusion FGM is associated with a number of serious perinatal complications. The greatest risk was seen between female genital mutilation and being born Small for Gestational Age, prolonged pregnancy and intrauterine fetal death. These relationships were robust regardless of which country the woman was born. It can be concluded that women with an FGM diagnosis and their newborn children belong to a risk group. It is very important to work preventively to protect these women and children's health.

Depression is the leading cause of disability among women of reproductive age worldwide. Upwards of 1 in 5 women suffer from perinatal depression. This condition has deleterious effects on several birth outcomes, infant attachment, and children’s behavior/development. Maternal suicide causes 20% of postpartum deaths in depressed women. Although the vast majority of perinatal women are amenable to being screened for depression, screening alone does not improve treatment rates or patient outcomes. Obstetrics/Gynecology (Ob/Gyn) clinics need supports in place to adequately address depression in their patient populations. The primary goal of this thesis is to develop, refine, and pilot test a new low-cost and sustainable stepped care program for Ob/Gyn clinics that will improve perinatal women’s depression treatment rates and outcomes. We developed and beta tested the Rapid Access to Perinatal Psychiatric Care in Depression (RAPPID) Program, to create a comprehensive intervention that is proactive, multifaceted, and practical. RAPPID aims to improve perinatal depression treatment and treatment response rates through: (1) access to immediate resource provision/referrals and psychiatric telephone consultation for Ob/Gyn providers; (2) clinic-specific implementation of depression care, including training support and toolkits; and (3) proactive depression screening, assessment, and treatment in OB/Gyn clinics. RAPPID builds on a low-cost and widely disseminated population-based model for delivering psychiatric care in primary care settings. Formative data and feedback from key stakeholders also informed the development of RAPPID. Our formative and pilot work in real-world settings suggests RAPPID is feasible and has the potential to improve depression detection and treatment in Ob/Gyn settings. The next step will be to compare two active interventions, RAPPID vs. enhanced usual care (access to resource provision/referrals and psychiatric telephone consultation) in a cluster-randomized trial in which we will randomize 12 Ob/Gyn clinics to either RAPPID or enhanced usual care.

Bakgrund: Fadern kan vara ett stort stöd till kvinnan under såväl graviditet som förlossning. Under pågående covid-19-pandemi togs beslutet att fadern inte fick närvara fysiskt i samma utsträckning som tidigare. Att själv inte kunna välja nivå av involvering under denna period i livet kan påverka känslan av delaktighet hos fadern. Syfte: Att beskriva fäders upplevelser av delaktighet under den perinatala perioden under covid-19-pandemin. Metod: En kvalitativ studie med induktiv ansats gjordes med hjälp av intervjuer med åtta fäder. En kvalitativ innehållsanalys användes för att genomföra dataanalysen. Resultat: Resultatet omfattar tre huvudkategorier och sex underkategorier: Ej bemött ur ett familjeperspektiv; Ensamhet och oro och Bristfällig information; Fäders syn på sin roll; Prioriteringar och Ta eget ansvar; Acceptans av situationen; Förståelse och Andra former av delaktighet. Resultatet visar att flera fäder upplevde ensamhet, oro och bristande information från vårdpersonalens sida. Samtliga fäder hade en förståelse för de restriktioner som vidtagits till följd av pandemin men hade gärna blivit erbjudna att få delta vid de antenatala besöken via videolänk. De upplevde att de behövde ta eget ansvar och söka information själva för att kunna involvera sig. Fäderna graderade helhetskänslan av delaktighet under den perinatala perioden som god. Detta var till följd av att de fått närvara under förlossningen, vilket var viktigast för dem.  Slutsats: Barnmorskan bör ha i åtanke att arbeta för att involvera fäderna, främst i besöken på mödrahälsovården. Genom att involvera och stödja kan barnmorskan hjälpa fäderna att förbereda sig inför föräldraskapet Om fäderna känner sig förberedda kan de vara ett bra stöd för sin partner under den perinatala perioden. / Background: The father can be a great support to the woman during both pregnancy and childbirth. During the covid-19 pandemic the decision was made that the father was not allowed to be as physically present as before. Not being able to choose the level of involvement during this period of life can affect the fathers feeling of participation. Purpose: Describe fathers experiences of participation during the perinatal period during the covid-19 pandemic. Method: A qualitative study with inductive approach based on interviews with 8 different fathers. The data analysis was performed using a qualitative content analysis. Result: The result can be subdivided into three main categories and six subcategories: Not treated from a family perspective; Loneliness and Anxiety and Inadequate information; Fathers views on their role; Priorities and Take own responsibility; Acceptance of the situation; Understanding and Other forms of participation. The result shows that several fathers experienced loneliness, anxiety, and inadequate information from the care staff. All fathers showed understanding of the restrictions due to the pandemic but had wished to be offered participation via video link. They felt that they needed to take responsibility and seek information themselves to be involved. The fathers rated the overall feeling of participation during the perinatal period as good. This was because they were allowed to attend during the childbirth, which was the most important to them. Conclusion: The midwife must keep in mind to work to involve the fathers, especially at the visits to the maternal health care. By involving and supporting, the midwife can help the fathers prepare for parenthood. If the fathers feel prepared, they could be a good support for their partner during the perinatal period.

Background Up to 34% of perinatal individuals experience childbirth as traumatic. These individuals are at increased risk for developing depression, anxiety, and posttraumatic stress disorder (PTSD) after the traumatic event. The objective of this study was to elicit the perspectives of individuals with a traumatic birth experience on barriers and facilitators to receiving mental health support in the postpartum period after a traumatic delivery. Methods Individuals who delivered within the last three years and perceived their birth experience to be traumatic (n=32) completed an hour-long semi-structured phone interview. The interview included screening for PTSD, depression, and anxiety with validated instruments including the Posttraumatic Stress Disorder Checklist for DSM-V (PCL-5), the Patient Health Questionnaire depression scale (PHQ-8), and the Generalized Anxiety Disorder scale (GAD-7), respectively. Qualitative data was analyzed using a modified grounded theory characterizing participants’ barriers and recommendations for mental health support after traumatic births. Results Among participants, 34.4% screened positive for PTSD, 18.8% screened positive for major depressive disorder, and 34.4% screened positive for anxiety. Qualitative themes revealed multi-level barriers involving lack of communication, education, and resources which prevented obstetric professionals from recognizing and supporting patients’ mental health needs after a traumatic birth. Recommendations from participants included that 1) obstetric professionals should acknowledge trauma experienced by any individual after childbirth, 2) providers of multiple disciplines need to be integrated into postpartum care, and 3) mental health support is needed before the ambulatory postpartum visit. Conclusions There are multi-level barriers toward detecting and responding to individuals’ mental health needs after a traumatic birth. Obstetric professionals need to use a trauma-informed approach and proactively follow-up and assess mental health care in the postpartum period.