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    Consumer satisfaction and maternity care: a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University
    (Massey University, 1993) Christensen, Tony Peter
    The present study investigated women's satisfaction with maternity care using a self-administered questionnaire. The purpose of the present study was twofold: first, to address a series of specific questions posed by the health provider and to provide feedback on the findings. Secondly, to examine the nature of consumer satisfaction with maternity care as a psychological construct from both a multidimensional and global perspective. The measure of global satisfaction was derived from items of the frequently used Consumer Satisfaction Questionnaire - 8, whilst, the discrete ( multidimensional) aspects of the questionnaire were derived from a pilot study, literature search and suggestions from the nursing personnel of the six maternity units assessed. Careful consideration was given to predispostional factors (e.g., life satisfaction) and the effects of demand characteristics, particularly reactivity, sampling error and response bias. Two hundred and forty-seven of the five hundred and thirty-eight women surveyed returned the questionnaire. The results showed high levels of global satisfaction with antenatal services, labour and delivery care, post-partum care and global satisfaction with maternity care in general. Multiple regression analysis showed satisfaction with maternity care to be a multidimensional construct with several discrete aspects of care significantly associated with the mother's global impression of each stage of their maternity care and their global satisfaction. The results also showed discrete aspects of the service with which mothers were especially dissatisfied. The methodological approach used in the present study and the statistical methods used to analyse the data were found to be especially useful in identifying areas in which the service could be improved, in addition to facilitating meaningful comparisons between similar facilities in the future.
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    Pregnancy outcomes in Nepal : an investigation of the relationships between socioeconomic factors, maternal factors and foetal and maternal outcomes in a Pokhara sample : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing at Massey University
    (Massey University, 1999) Poudel, Pratima
    Good maternal reproductive health is a prerequisite for the health of babies and families. Social, cultural, economic and health systems also affect the wellbeing and survival of women during pregnancy and childbirth. In Nepal, a developing country, women are discriminated against in terms of legal status, access to education, access to food, and access to relevant health care services (Tuladhar, 1996). Where women do not have access to such services, maternal, perinatal, and infant mortality rates are comparatively high (The Ministry of Health & UNICEF, 1996). There is a scarcity of research on the relationships between socioeconomic and maternal factors and pregnancy outcomes in the Nepalese context. The intention of the present study was to gain a greater understanding of factors affecting the health and behaviour of pregnant women in Nepal. Based on Mosley & Chen's (1984) and Maine's (1995) models of maternal and child survival, these factors were investigated to examine the relationships between socioeconomic and proximate determinants and pregnancy outcomes. Data were collected on a cross-sectional basis from 215 women who gave birth at Western Regional Hospital, Pokhara, Nepal. Analyses revealed that, antenatal care utilisation, and nutritional intake were related to socioeconomic determinants such as income, residence, parental qualifications, maternal occupation, ethnicity and religion. Furthermore, socioeconomic factors explained the greatest variance in birth weight, followed by general health behaviour and obstetric condition variables. The addition of reproductive health and behaviour variables did not add significantly to the explanation of variance in birth weight. Obstructed labour was studied in terms of length of labour, and the result revealed that, mode of delivery (normal or instrumental), gestational age, mother's age, and age at marriage were significantly related to the length of labour. Maternal mortality of 14.15 and perinatal mortality of 29 per 1000 live birth were reported during the study period of two months. Findings are discussed in relation to previous literature. Limitations of the study and implications for future research are also discussed. Findings suggest that, the maternal and child health care services in the Western Region of Nepal need improvement. Strategic development of health care services with cost-effective and quality health services through primary health care and the Safe Motherhood programme are found to be a necessity for this region.
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    Perinatal mental health policy : young women's mental health support during pregnancy : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Social Policy at Massey University
    (Massey University, 2008) Parsons, Jane Elizabeth
    A woman's reproductive period is when she is most likely to suffer mental ill-health with this risk increased for young women. Mental ill-health in the perinatal period is identified as common but with significant implications for the young women and her family (Dearman et al., 2007; Petrillo et al., 2005; Riecher-RÖssler & Steiner, 2005). From as early as a few weeks post conception, the foetal brain is found to be affected by maternal stress and mental ill-health. This continues to affect the infant postnatally and is exacerbated if maternal mental ill-health is not treated. Young women are more likely to experience impediments to their wellbeing in the perinatal period. Thus, introduction of suitable formal support perinatally can have a prophylactic effect on maternal and infant mental illness. Through feminist research methods, utilising semi-structured qualitative interviews, four pregnant women thirty years and under in the perinatal stage of pregnancy and four health professionals working in the field of maternal mental health explore with the researcher their experiences of mental health support and education during pregnancy. This research demonstrates how services are currently unable to appropriately meet the needs of young pregnant women due to lack of attention to gender and youth issues and the dominance of a medical model understanding that has allowed this negation through minimising holistic, contextual treatment. The gendered construction of health services and recent market principles in state provisions are evidenced by the compartmentalisation of services, lack of collaboration between these services, competition for resources, and rigidly defined roles of health professionals that present access barriers for young pregnant women. A need to enhance formal supports and create policy frameworks and practice guidelines to direct this support is identified alongside recommendations for increased service provision, education, and screening at the primary healthcare level.
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    The baby friendly hospital initiative : level of implementation in ten New Zealand hospitals : a thesis submitted in partial fulfilment of requirements for the degree of Master of Philosophy in Midwifery at Massey University
    (Massey University, 2000) Pownall, Beverly Margaret
    The potential benefits of breastfeeding are well documented. These include benefits for the infant which may extend into adult life, as well as benefits for the mother, the family, the economy, and the environment. Yet despite this, breastfeeding rates in New Zealand are not improving, and there is evidence of practices in New Zealand hospitals which have a negative influence on breastfeeding. One possible solution to this is to try to improve hospital policies and practices through implementation of the Global Baby Friendly Hospital Initiative (WHO/UNICEF, 1989). The purpose of this study was to ascertain the level of implementation of BFHI related policies and practices in New Zealand hospitals which provide maternity services. A descriptive survey utilizing face to face interviews of groups of 2-6 participants was undertaken in ten hospitals located in the North Island of New Zealand. Respondents included midwifery managers, lactation consultants, midwives, and nurses, familiar with their hospital's breastfeeding policy and practices. An adapted questionnaire and classification system developed by Kovach (1995) classified hospitals within four levels of implementation ranging from high, moderately high, partial, and low. Most of the hospitals were implementing six of the Ten Steps. The majority were not fully implementing Steps 1 and 2, and some hospitals had insufficient knowledge of current practices to be able to demonstrate implementation of Steps 3 and 5. The area identified as needing the greatest attention by hospitals is staff education on breastfeeding. Overall, five hospitals were classified as high implementers and five as moderately high, however no hospital was considered to be fully implementing BFHI. The study identified four main findings: a lack of consistent breastfeeding definitions and insufficient knowledge of exclusive breastfeeding rates; current difficulties in obtaining data, particularly about self-employed Lead Maternity Carer (LMC) practices; a lack of staff knowledge and misperceptions about the BFHI; and a gap between recommended evidence-based practices and reported breastfeeding practices in the surveyed hospitals.
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    Knowledge, early recognition and acceptance : the journey to recovery from postnatal depression : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing at Massey University
    (Massey University, 2006) Morton, Alice Mabel Ina
    The purpose of this qualitative study was to explore with women their experience of postnatal depression (PND), with a specific emphasis on what factors assisted and what factors hindered their recovery. Eight women who had suffered at some stage from PND took part in the study. Interviews were carried out using an in-depth interview technique with open-ended questions regarding their subjective experience, which were audio-taped and then transcribed. Using thematic analysis, the information obtained from the interviews was analysed and significant statements extracted. Patterns emerged and were clustered into three major themes: Knowledge, Early recognition and Acceptance. These three themes and the patterns within them were all closely entwined, each influencing the other and having a major effect on the woman's experience of PND and her recovery. Lack of knowledge was identified as a major hindrance to recovery, with women describing feelings of being in the dark, not knowing what was happening to them and feeling like a failure. This lack of knowledge was a barrier to seeking help, causing a delay in recognition and treatment which prolonged the illness and forced these women to suffer in silence. The opposite also applied where prior experience of PND enabled women to recognise the symptoms, seek help, receive treatment and recover more quickly. Postnatal depression is a common complication following childbirth. It can have devastating effects on the mother, the infant, the family and society. Recovery is not possible without knowledge about this condition, not only for the women themselves, but for society as a whole, including health professionals. Women in this study recognised that early recognition played a major role in their recovery, but also identified acceptance as a problem for themselves, health professionals and society, in delaying this process. As a result of this study, gaps within the New Zealand health service were identified, such as a lack of education about PND, parenting of a new baby and support services available in the community. Unrealistic expectations of mothers and the romantic media hype about childbirth and motherhood were also identified as an issue.
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    Staying involved "because the need seems so huge" : an exploration of the care processes used by midwives in their work with women living in areas of high deprivation : a grounded theory study : a thesis submitted in partial fulfilment of the requirements for the degree of Master of Arts in Midwifery, Massey University
    (Massey University, 2001) Griffiths, Christine
    It is estimated that 17-20 percent of New Zealand's population lives in relative poverty (National Health Committee, 1999; Waldegrave, King & Stuart, 1999). Poverty and ill health are closely related- 'with very few exceptions the financially worst off experience the highest rates of illness and premature death' (National Health Committee, 1998, p.8). Although much has been written about the impact of low socioeconomic status (SES) on pregnancy and birth outcomes, there is little written about the actual care midwives provide to childbearing women, especially to those living in socioeconomic deprivation. Grounded theory was the methodology used to explore the care provided by independent midwives to childbearing women, especially those of low SES. Through a process of theoretical sampling, independent midwives were interviewed about the care processes used in their work with women living in areas of high deprivation. Initial recruitment for the study was of midwives providing care to women living in thirteen selected meshblocks in a New Zealand city. Each of the meshblocks had been assigned a deprivation score based on the New Zealand Deprivation 1996 index showing them to be areas of high socioeconomic deprivation. Using the constant comparative method of data analysis, categories and properties were elicited which reflected the care processes used by midwives. These were used to develop a conceptual framework that fitted the collected data. The core category of 'Staying involved 'because the need seems so huge'' was the basic social process which emerged from the data. The midwives stayed involved throughout the woman's pregnancy and childbirth because the woman's need was so huge, to ensure an optimal pregnancy outcome for both the woman and her new baby. Four other categories were also identified; 'Forming relationships with the wary', 'Giving 'an awful lot of support'', 'Remaining close by' and 'Ensuring personal coping'. Details of the conceptual framework have relevance to the midwifery community, specifically to those midwives who work with women living in areas of high deprivation.
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    Autonomy, clinical freedom and responsibility : the paradoxes of providing intrapartum midwifery care in a small maternity unit as compared with a large obstetric hospital : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Midwifery at Massey University
    (Massey University, 2000) Hunter, Marion
    Small maternity units are an important historical feature within New Zealand. Over time many of these facilities have been closed and birth has increasingly occurred in large obstetric hospitals with the availability of technology and on-site specialists. A qualitative study using Van Manen's (1990) method of hermeneutic thematic analysis has been designed to answer the question: How is the provision of intrapartum care by independent midwives different in a small maternity unit, as compared with a large obstetric hospital? Ten independent midwives were interviewed, and data were analysed to uncover the meaning of the differences when providing intrapartum care in both small and large maternity settings. There are two data chapters that contain substantial extracts from the midwives' transcripts in order to illustrate the themes identified from the analysis of their narratives. 'Real midwifery' shows that independent midwives feel more autonomous and are able to let the labour 'be' when practising in the small maternity units. The midwives use their embodied knowledge and skills to support women to labour and birth without technological interference. In contrast, the midwives feel that employing technology such as fetal monitoring and epidurals at the large hospital, places the focus on the machines and the midwife does not use all of her skills. The second data chapter, called 'carrying the can', illustrates the additional responsibility that can at times be a worrying responsibility in the small maternity unit. When practising in the large obstetric hospital, specialist assistance is nearly always at hand and the midwives are considered to be practising in the safest place according to the dominant medical model. The paradox for midwives practising in small maternity units is that while these are a setting for natural birth, the midwives need foresight and confidence to avert or manage any problems that might arise. When midwives practise in the setting of small maternity units, they are more autonomous and have the clinical freedom to practise unshackled by technology. The art of midwifery might be lost if midwives continue to practise midwifery only in medicalised environments.
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    Well child care services in New Zealand : an investigation into the provision and receipt of well child care services in a Hawkes Bay sample : a thesis presented in partial fulfillment of the requirements for the degree of Master of Arts in Nursing at Massey University
    (Massey University, 1998) Tilah, Morag S W
    Maternal and child care in New Zealand has traditionally been given by a variety of providers from the private and public sector. The reorganisation of the health services has effected all forms of health delivery including maternal and well child care or well child care services. Contracting of services in a competitive environment has been an important feature of the reorganisation process. Ashton (1995) notes that the system of contracting has facilitated the introduction of new approaches to health from new provider groups, which are not necessarily based on primary health care principles. This has led to confusion for providers and consumers alike. In 1996 a new national schedule which described the services recommended for maternal and child care was introduced called WellChild/Tamariki Ora. A questionnaire based on this schedule was administered to a sample of 125 parents of children under five years of age in Hawkes Bay to investigate issues relating to the provision and receipt of well child care services. Descriptive data showed that the major providers of services in the present study were doctors. There were significant differences found in the number of services received across a number of demographic variables such that generally fewer services were received by the less educated, the unemployed, single parent families, and Maori and Pacific Island people. Perceptions about the helpfulness of services received were not related to ratings of the child's health. Parents who received a greater number of Family/Whanau support services rated their children's health more highly. Findings are discussed in relation to the previous literature and recommendations are presented with particular emphasis on the implications for nursing and the role of nurses in providing well child care services.
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    Being safe in childbirth : a hermeneutic interpretation of the narratives of women and practitioners : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy, School of Health Sciences, Massey University, New Zealand
    (Massey University, 1998) Smythe, Elizabeth
    This study uncovers the meaning of 'being safe' related to the experience of childbirth, from the perspectives of practitioners (midwives and doctors), and women. It is informed by the philosophies of Heidegger and Gadamer. Stories and thoughts of the participants are offered to uncover the taken-for-granted nature of the experience of 'being safe' and to expose possible meanings in a new way. The findings of this thesis are that 'being safe' dwells in vulnerability. There are possibilities of unsafely that are beyond human or technological control. There is however a distinctive spirit of practice that promotes safe care. It brings wisdom of learning and experience, alertness to the situation of 'now', and anticipation of problems that might arise. Relationships matter to the provision of safe care. Those that seek mutual understanding and that remain open and dialogical are more likely to anticipate concerns or find problems at their first showing. The setting in which practice is experienced impacts on safety, having the potential to erode or sabotage, to protect or enhance. Any questions asked in hindsight about the meaning of safety need to consider what possibilities, if any, existed for creating safe care, and what other factors influenced the situation to undermine the best intentions of those directly involved. The study concludes by drawing attention to four worldviews which bring conflicting meanings of 'being safe'. The findings of this study show, however, that in the experience of 'being human' there is a common understanding of what it means to be safe in childbirth that reaches beyond the boundaries of worldviews. Where there is a willingness between those involved to find the shared understanding of 'being safe' that overrides the conflicting worldviews, safety is more likely to be achieved. For practitioners, to be safe is a lifetime's struggle. For women, 'being safe' can never be assumed, or taken as a sure promise. 'Being safe' will always be complex, will always be vulnerable, will always be close to danger.