Dissertation (Ph.D.)--Auburn University, 2007. / Abstract. Includes bibliographic references (p.91-99).

Thesis (M.S.W.)--Smith College School for Social Work, Northampton, Mass., 2008. / Typescript. Includes bibliographical references (leaves 102-109).

Paper one is a metasynthesis of studies exploring mothers' experiences of recovery from postnatal mental illness. Four databases were systematically searched using key words and index terms to identify the qualitative literature exploring mothers' experiences of recovery from postnatal mental illness. Fourteen studies met the inclusion criteria and were critically appraised and synthesised. These papers reported the views of 395 women's experiences of recovery from postnatal mental illness. Five core themes emerged from the synthesis to describe four key processes that facilitate recovery. This experience begins with recognising the problem through crisis and relational distress. Women then go through the process of seeking help which consists of subthemes of accepting help and help to access help. The next process in the in the journey is achieving recovery which includes subthemes of sharing with others like me, coping strategies and noticing recovery. The final process of maintaining recovery consists of incorporating coping strategies into daily life; acquiring a different model of motherhood and processing the experience. The role of the family was interwoven through each stage of recovery. Recommendations were made for professionals who come into contact with this group of women and their families. The review highlighted gaps in the existing evidence and made recommendations for future research. The findings and limitations were discussed with reference to the existing literature. Paper two explored the role of the baby in 12 mothers' experiences of recovery from psychosis after childbirth. A thematic analysis of the data identified three core themes that described the role of the baby in the mothers' recovery. Findings revealed that the baby was central to women's recovery and could be experienced as both helpful and unhelpful. The baby interacted with the mother; increasing self efficacy and reducing emotional distress. The baby could act as a barrier to recovery by increasing the women's emotional distress and hindering access to help and self care. The findings recommended that women receive specialist treatment in mother and baby units where they can access interventions that support parent-infant interactions. The findings of the study add to the existing evidence base on recovery from psychosis after childbirth and highlighted areas for future research. Paper three is a critique of the research carried out in Papers one and two. This paper discussed the rationale for the research design in both papers. Approaches to data sampling and data analysis are reviewed with reference to researcher reflexivity. The search strategy and critical appraisal of techniques of the metasynthesis are also critiqued. Paper three closes with personal reflections and conclusions drawn from both papers.

Kvinnan upplever varierande känslor relaterat till ett akut kejsarsnitt. Upplevelsen av akut kejsarsnitt är individuell och varierar från person till person. Syftet var att ta reda på kvinnors psykologiska upplevelser av akut kejsarsnitt samt att undersöka vad sjuksköterskan kan göra ur ett omvårdnadsperspektiv under vårdtiden samt uppföljning efter hemkomst. En litteraturstudie genomfördes och tio vetenskapliga artiklar inkluderades från följande databaser: Pubmed, Scopus, Cinahl och Cochrane. Resultatet visade att det fanns både positiva och negativa känslor relaterade till akut kejsarsnitt samt olika erfarenheter relaterade till kontakten med vården. De vanligaste psykologiska upplevelserna som identifierades var stress, rädsla och att inte ha kontroll över situationen. Det fanns dock även kvinnor som upplevde akut kejsarsnitt som en positiv upplevelse och med tacksamhet mot att ha fött sitt barn via kejsarsnitt. En uppskattad del i vården var god kommunikation och bemötande mellan sjuksköterska och föderska under vårdtiden. Konsultation postpartum mellan sjuksköterska och föderska var en effektiv metod för att öka den positiva upplevelsen av akut kejsarsnitt då det öppnade möjligheter för kvinnan att få en förklaring över händelseförloppet, ventilera om uppkomna känslor samt kunna ställa frågor. Akut kejsarsnitt kan vara en oväntad, utelämnad och känslig situation för kvinnan och därför är det av största vikt att sjuksköterskan är medveten om att vårdtiden samt efterföljande vård har stor betydelse för kvinnan för att lindra efterföljande psykologiska konsekvenser. / Women experience different emotions towards emergency caesarean section. The experience of an emergency caesarean section is perceived individually. The main purpose of the thesis was to explore psychological experiences by women undergoing an emergency caesarean section and in what ways the nurse can support the woman during emergency caesarean section, as well as the time afterwards. The method used in the thesis was a literature study and ten articles from databases: Pubmed, Scopus, Cinahl and Cochrane were included. Main findings of the study were that there were both positive and negative emotions towards having to give birth by an emergency caesarean section. There were also different perceptions regarding the contact with caregivers such as midwives and nurses. The most commonly described psychological experiences of emergency caesarean section were stress, fear, and lack of control. However, there were also women who experienced relief, gratitude and overall a positive experience towards giving birth through caesarean section. Good communication by caregivers were described as essential by many women. Consultation postpartum with a midwife/nurse was appreciated amongst many women. It allowed women to talk through their individual experience of childbirth and ask questions regarding what had happened. In conclusion, emergency caesarean section can lead to both positive and negative emotions for women due to its unexpectancy and sudden turn of events, leaving many women feeling out of control. It is important that the midwife/nurse is aware of emotions women might feel during the procedure. Emergency caesarean section can be an unexpected and fragile situation for the woman and therefore it is important that caregivers are aware of the impact they have when it comes to the care that they provide at the hospital as well as the time afterwards to prevent psychological consequences for the woman.

The main aim of this thesis was to assess if early deprivation (ED) and glucocorticoid (GC) treatment exert long-term effects on the volume of the brain regions implicated in responses to stress, and if it associates with alterations in the distribution and structure of astroglia, which are known to support brain plasticity. This study also investigated the effects of prenatal dexamethasone (Dex) treatment on selected brain receptors, namely the oxytocin and 5-HT1A receptors, as they are implicated in the regulation of responses to stress. In addition, in vitro effects of Dex on neural stem cells were studied, in order to explore the drug effects on cell proliferation and differentiation, and on glial cell markers. Unbiased stereological estimation was employed to determine the regional brain volume, astroglial morphology and total cell count. Peripheral quantitative computed tomography (pQCT) technique was used to quantify total brain volume. Autoradiography technique was employed to visualise and analyse oxytocin and 5HT-1A serotonin receptor binding using selective radioactive ligands. The results of the present study demonstrate that both ED and prenatal Dex exposure leads to long-term effects on hippocampal remodelling with volume losses and impoverished astroglial morphology in the form of reduced primary process length. The observed deterioration in astroglial morphology adds further evidence that astrocytic changes contribute to hippocampal volume losses, a phenomenon that deserves more research in the context of effects of corticosteroid overload and stress-related pathologies. The present results also demonstrate that prenatal Dex induces long-term effects at the level of central neuroregulatory processes. Thus significant region- and sex-dependent reductions or increases in the oxytocin and 5-HT1A receptor binding were observed. The in vitro study has shown that Dex affects both proliferation and differentiation of GFAP positive NSCs with no toxic effects as such. Overall, both early postnatal or prenatal manipulations that increase levels of stress and/or glucocorticoids as the chemical mediators of stress, lead to a long-term maladaptive brain remodelling with losses in the hippocampal volume, impoverishment of hippocampal astroglial morphology and changes in the properties of central regulatory receptors in the brain areas involved in the reaction to stress.

No description available.

Abstract A longitudinal follow-up study of postnatal depression was performed in the years 1995-2000 in the University of Oulu. A volunteer, ramdomly selected group of 187 mothers from maternal wards of the University Hospital of Oulu were studied with different questionnaires in the first postpartum week. Depressive symptoms were re-assessed with Edinburgh Postnatal Depression Scale four months postpartum when paternal depression was evaluated with Beck Depression Inventory. 16.2% of the women were immediately after delivery screened as being depressed. Four months postpartum 13.0% of the mothers were depressed whereas 5.1 % of the fathers were having depressive symptoms. The cumulative incidence of maternal postnatal depression within the first four months was 22.2%. These mothers who immediately showed depressive symptoms were at a higher risk to be depressed later. Maternal age 30 years or less predicted postnatal depression. The occurrence of maternal postnatal depression varied slightly during different seasons; during dark time immediate depressive symptoms increased and the spring seemed to protect from later postnatal depression. Analgesia during vaginal delivery, e.g. nitrous oxide, epidural analgesia or paracervical blockade, protected from postnatal depression as well. Caesarean section, either elective or emergency, did not predict postpartum mental well-being. Scores from the GHQ and the EPDS were strongly interrelated. Seven (5%) fathers were depressed four moths postpartum. They all were men whose partners also scored high in the EPDS. Those mothers who were depressed interpreted infant facial signals differently, seeing less joy, disgust and anger, but more sadness in the infant facial pictures. Cultural variability was found in complex blended facial features of emotions, e.g. distress, in the Infant Facial Expression from Looking at Picture scale, although remarkable agreement was achieved and reinforced. In the videotaped early mother-infant interaction small, but essential, changes were observed at 10 months postpartum. Overall, mothers who had had persistent depressive symptoms showed less negative expressions and had less anger and anxiety in their interaction. Their children were slightly less impulsive and seemed to have less visual and communicative contact with their mothers. The dyad was characterised by short periods of uninvolvement between the mother and the infant; e.g. the moments of reciprocity were less frequent than in the non-depressed mothers. At 42 months postpartum, the children of the persistently depressed mothers scored lower on the Expressive language scale than the children of the mothers who were depressed in one measurement or never.

This thesis frames the transition into motherhood as a rite of passage; proposes a new model for the rite of passage into motherhood based on the four seasons; and highlights the importance of contextual and specific ritual actions or sequences to navigate the transition. Qualitative data from semi-structured interviews with ten western women, from a middle class, Christian background, who had all become mothers through childbirth, are examined under three main headings. Firstly, the women’s experiences of their transition are explored using rites of passage theory as a lens. Although significant differences emerge, particularly from a gender perspective, important themes within the women’s experiences are highlighted, including the nature of relationships; the importance of support; journaling; and the telling of birthing stories. The influences of contemporary cultural aspects such as the medicalization of childbirth and myths about motherhood are also taken into account. Secondly, the field of ritual studies is explored in order to provide a framework in which to situate the women’s ritualizing. Existing rituals associated with motherhood are analysed and gaps are identified in existing Christian liturgical resources for this area, specifically for ritual actions or sequences marking motherhood as a rite of passage, and for the expression of birthing stories. A working definition of ritualizing is also established and the research findings are divided according to time frame, exploring the women’s ritualizing before birth, around birth and after birth. Thirdly, spirituality in relation to childbirth and the transition into motherhood is explored and its place within healthcare and theological literature examined. Nicola Slee’s theory on women’s faith development is used to draw out some of the patterns that emerge from the interviewees’ experiences, and the sacramental nature of birthing is considered. The thesis concludes with a critique of implications and associated suggestions for those within a church or healthcare context with responsibility for the pastoral and spiritual care of women during their transition into motherhood.

M.Cur. / Few South African studies have been done with regard to private midwives and their clients. The practices of these midwives are overloaded, indicating a growing need for their services. An exploratory, contextual and descriptive study was undertaken to investigate some of the issues relating to the practice of the private midwife. This was done from the perspective ofthe women attending these practices. The aims of this study were to explore and describe how women experience the care they receive from their private midwives in Gauteng during antenatal visits, labour and postnatal contacts; to explore and describe the reasons for clients of private midwives in Gauteng to choose an independent midwife as birth attendant and to explore how these clients get to hear about their midwives. Eight women, attending a total of two different midwifery practices, were interviewed. The main categories that emerged from analysing the women's experience of private midwifery care were that the midwives were caring, family orientated, informative, knowledgeable, guiding and unintrusive. Time was both respected and given by the midwives. The midwives saw childbirth as a normal and natural process. The midwives empowered the women and left them in control oftheir childbirth. A mutual, intimate relationship was formed between the women and their midwives, which was based on trust and continuity of care. The women felt they were treated as unique individuals. One woman related some negative aspects ofthe care she received. A variety of reasons were given for choosing a private midwife as birth attendant. Some had specific wishes for their birth, such as a homebirth and knew that private midwives would grant them Other reasons included cost effectiveness, control over childbirth, one on one care, shorter waiting periods, longer consulting times and wanting an experienced birth attendant. Previous negative experience with staff at government hospitals and private gynaecologists; and hearing about positive experiences with private midwives also contributed to women opting for independent midwives. The women got to hear about their private midwives through their general practitioner, obstetrician, antenatal class instructor, friends, family members or health professional that delivered a previous baby. These research findings were supported by existing literature and recommendations were made to midwifery practice, education and research.

Magister Public Health - MPH / Background: Mother to child HIV transmission is a significant public health problem especially in Southern Africa. South Africa is the second highest burden country globally with 71 000 infants being HIV infected every year. The aim of this study was to identify and measure the influence of risk factors of late postnatal HIV transmission and/or mortality among infants born to HIV positive mothers. Study design: Historical cohort data collected during 2002 – 2004 from 3 purposively selected PMTCT sites in South Africa (namely: Rietvlei, Umlzai and Paarl) is used. These three sites are purposively selected to reflect different HIV prevalence, socioeconomic and geographical locations. A total sample size of 469 mother–infant pairs were followed for 36 weeks. Data Collection: Data were collected by trained field researchers and community health workers using semi-structured interviews including: infant feeding practices, infant and maternal mortality, disclosure of HIV status, basic knowledge of HIV/AIDS and MTCT and sociodemographic information. Dried blood spots were collected by heel prick in the baby at 3, 24 and 36 weeks, whilst in the mother finger prick was taken at 3 and 36 week visits. Data Analysis: Data from all questionnaires were coded, captured and cleaned. STATA version 10 is used to analyze and measure the independent influence of risk factors of HIV-free survival rate. Variables found having significant association in the bivariate analysis were analyzed using Cox-proportional hazard model. Result: Our study shows that early mixed feeding is a common practice in South Africa. Overall, 83% (as high as 90.26% in Rietvlei) of mothers were either mixed breast feeding or mixed formula feeding before the infant is at age 5 weeks. MBF at 7 weeks was associated with 3.5 fold increased risk of transmission and/or mortality as compared to EBF (p-value=0.22), while PBF had a 2 fold less hazard of transmission and mortality compared to MBF (p-value=0.1). In this study, failure to disclose, poor counselling and lack of close support by health facilities were major factors that contributed to inappropriate feeding choice and non-compliance to exclusive feeding. Poor counseling (below the average of expected level) had an associated 55% increased risk of transmission and/or mortality. A substantial proportion (70.61%) of women in our study didn’t disclose their status to anyone. Failure to disclose was associated with 44% of increased risk of transmission and mortality. The study also showed households who had shortage of food were at increased risk (adjusted hazard ratio 1.7) of HIV transmission and/or mortality of infants. Maternal and infant factors such as premature birth, maternal viral load, poor weight gain during pregnancy and low birth weight were significant influential factors of HIV-free survival rate. Conclusion: In general, this study has given us an idea that postnatal HIV-free survival is determined by the interrelated effect of multilevel co-factors. Therefore, comprehensive multi-sectorial approach is needed to address the MTCT and child mortality problem in South Africa. The health sector should take urgent action to improve the quality of counselling and health services given in health facilities. Government should give enough attention to reduce the bureaucratic hassles of receiving grant by HIV positive mothers.