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    Safe motherhood : development and women's health in childbirth, Binh Dinh province, Viet Nam : a thesis submitted in partial fulfilment of the requirements for the degree of Master of Philosophy of Development Studies, Massey University, New Zealand
    (Massey University, 2006) Thompson, Tricia
    Safe Motherhood is one of the most important aspects of women's health, and is crucial to the development of a country. Women can only contribute to the economic, political, social and cultural development of their country if they are well and healthy. This thesis reviews the literature on poverty, health and development to examine factors which contribute to this major global issue. One of the eight United Nations Millennium Development Goals is to reduce maternal mortality by three quarters by the year 2015. Maternal mortality is the major cause of death among women of childbearing age in the developing world, with the World Health Organisation estimating that 600,000 women a year die as a result of pregnancy and childbirth (Levine et al., 2004; Thompson, 1999). Most of the deaths (99%) occur in developing countries and 80% of them are preventable, even in resource-poor countries (Lewis, 2003). The major direct cause of maternal mortality is haemorrhage at birth; if haemorrhage was reduced it would contribute significantly to reduction of maternal mortality (Wagstaff & Claeson, 2004). In this research project the author worked with the Binh Dinh Provincial Department of Health to develop a more complete picture of the problem of haemorrhage in one rural province of Viet Nam. Ethnic minority women are among the poorest and most disadvantaged in the community. In this research they were shown to receive the least amount of preventative antenatal health care, and to be at greatest risk of haemorrhage. The single greatest health factor shown to reduce maternal mortality is to have a skilled attendant at every birth who can prevent or detect problems early, and treat emergencies such as haemorrhage (Levine et al., 2004; World Bank, 2003; de Bernis et al., 2003; Kwast et al., 2003; Peters, 2000). In the second branch of the research, detailed observations were made of the technical skills of maternity staff to assess areas which could be improved through training programmes. These training programmes will enable the midwives to be better skilled and to provide safer care. Recommendations from the research include that the Department of Health invest in strengthening basic training, and ongoing postgraduate in-service education, in specific technical areas of monitoring and treating haemorrhage; that logistical support and supplies be improved so that all centres have the necessary equipment and medications to be able to prevent and treat haemorrhage; and that the Department of Health apply to the Ministry of Health for permission to teach their staff a specific haemorrhage prevention management approach called Active Management of the third stage of labour. Midwives in the province are eager for training and improved skills, and with the Department's support in these matters outlined above, they can achieve their desire of providing the best care they can to women in their communities. Improving the technical skills of midwives is one important aspect of addressing the problem of maternal mortality. However other underlying causes are complex and include poverty and the low status of women in society; these aspects will be more difficult to overcome. Safe Motherhood is a right; women in every country should be able to expect to survive the natural process of childbirth. It will take a multi-layered approach to overcome this complex problem and allow women to be safe in childbirth.
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    "Leave your dignity at the door" : technologies of power and the maternal body : a thesis presented in partial fulfilment of the requirement for the degree of Master of Science in Psychology at Massey University, Manawatū, New Zealand
    (Massey University, 2017) Quin, Laura Jean
    Women in Aotearoa New Zealand are immersed in multiple and contradictory discourses, and create meaning of their lived experiences from within them. Maternity and motherhood are life events and stages that are embedded in gendered social power relations, with the motherhood mandate positioning all women as potential mothers. A literature review highlighted how neoliberalism and biopower both enable and constrain the experience of maternity and mothering. This research aimed to tease apart some of the threads of power that produce sites of tension for women and the maternal body. Semi‐structured interviews were conducted with eleven women about their experiences of maternity and motherhood and a feminist post‐structuralist discourse analysis was used to understand how gendered social power relations enable and constrain women’s experiences. The analysis showed that the neoliberal political landscape impacted on women’s experiences, particularly where related to their everyday experience of maternity and mothering. The biomedical becomes the ordinary in an environment of uptake of interventions as the norm, and where a risk‐adverse maternity system positions every potential risk as absolute. The expectation on women to perform ‘good motherhood’ amongst the tensions of biomedical and natural discourses also constrains them to making morally correct choices in an environment where they have limited agency. This research sought to disrupt the status quo of producing women as docile bodies within biomedical power and neoliberalism, and to empower them to continue to resist.
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    Birth and breastfeeding events : the influence of birth on breastfeeding duration : an exploratory research study : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Midwifery, Massey University
    (Massey University, 2004) Hagan, Annette Elsie
    A retrospective exploratory methodology was used to examine the influence perinatal events had on breastfeeding duration measured at four months postpartum. A self-reporting questionnaire and examination of obstetric records provided the quantitative data for 68 normal vaginal birth women and 85 Caesarean section women. Nonparametric Pearson's Chi-square goodness of fit test was used to measure statistical significance. Almost 88% (87.6%) of the respondents were breastfeeding four months following birth. This was 86.8% of normal birth women and 88.2% of Caesarean section women. Sixty-four percent of infants were exclusively breastfeeding and 11% fully breastfeeding four months after birth. Prior breastfeeding was the only event or experience found to be significantly statistically associated with type of birth and breastfeeding duration. A marginally significant statistical relationship was found between type of Caesarean section and breastfeeding at four months postpartum. Highly significant statistical relationships were identified between type of birth and: time of first cuddle, concomitant skin-to-skin contact, time of first breastfeed, supplementary feeding in hospital, and receiving help in hospital. A significant statistical relationship was identified between type of birth and having a breastfeeding problem in hospital, and a marginally significant statistical relationship between type of birth and 'rooming in'. Other events that were expected and identified as highly significant statistically were: multiparity and having breastfed before, having a breastfeeding problem in hospital and receiving help, type of birth and time in hospital, and breastfeeding at four months postpartum and satisfaction. There was a marginally significant statistical relationship between breastfeeding at four months postpartum and type of caesarean section. This studies finding that there was no difference in breastfeeding rates at four months for either sub-sample of women warrants further exploration.
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    Childbirth in the Manawatu : women's perspectives : a thesis presented in fulfilment of the requirements for the degree of Master of Philosophy in Sociology at Massey University
    (Massey University, 1986) McSherry, Margaret Anne
    In most western countries the management of childbirth is surrounded by controversy and debate. New Zealand is no exception. Much of the debate centres round the role of medicine in the management of the healthy birth and the powerful influence exerted by the providers of maternity services over policy in this area. New Zealand research conducted on the management of childbirth, including consumer surveys, reflects the questions, methodologies and experience of the providers. Women's experiences of childbirth have not usually been considered legitimate data. This 'invisibility' of women in the research data has produced a body of knowledge about childbirth that is androcentric, reflecting male experience. Women, until recently, have been powerless to challenge this version of the reality of childbirth because they lacked access to medical knowledge and technology and because of the existence of an ideology of motherhood that imbued women with an expectation of self-sacrifice and nurturance impelling them to give priority to the perceived needs of the baby. The medical profession has been able to maintain control of the management of childbirth by requiring women's passivity and dependence 'for the sake of the baby'. In this way, medicine might, be said to act as an agent of social control of women, reproducing the unequal relations of gender by confirming women in their dependent roles of motherhood and domesticity. The pregnancy and birth experiences of 48 Manawatu women are explored in depth. The sample consisted of rural and urban women who, when pregnant, were expecting to have a normal labour and birth. Perinatal care was provided either by a specialist obstetric unit at the regional base hospital or by low technology, general practitioner (obstetric) units (GPU's) in the peripheral areas. Management of childbirth was found to be generally consistent with an obstetric or medical model of childbirth and similar in both high and low technology hospitals. Women's priorities for a quality service were more akin to a model of childbirth based on traditional midwifery. Women wanted a more 'holistic' form of maternity care; one that recognised and incorporated the socio-emotional dimensions of pregnancy and birth. Most women rejected the passive role expected of them in medical encounters and during the birth process. Women were likely to reject the association of childbirth with illness, preferring antenatal and perinatal services that were autonomous of general medical services. Few women, however, felt that the home could provide the ideal conditions for giving birth. The physical difficulty of labour and the level of medical intervention in the birth process were less likely to influence women's satisfaction with labour and birth that the quality of the emotional support women received from birth attendants and the level of the mothers' active participation in labour. Greater approval was found for the GPU as a place of birth, than for the specialist unit. Such findings challenge some of the current assumptions and directions of policy on maternity services in New Zealand.
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    Lead maternity carer midwives' construction of normal birth : a qualitative study : a thesis presented in fulfilment of the requirements for the degree of Master of Arts at Massey University
    (Massey University, 2002) Crabtree, Susan M
    Midwives provide maternity care for the majority of women in New Zealand and in 2000 midwives were the Lead Maternity Carer for seventy one percent of childbearing women. The aim of this research was to explore the assertion that continuity of midwifery care 'enhances and protects the normal process of childbirth' (New Zealand College of Midwives, 1993, p.7). I aimed to explore the meaning of 'normal birth' in Lead Maternity Care midwifery practice in the current New Zealand context and to understand the complex influences surrounding midwives' construction of normal birth. In order to explore the construction of 'normal birth' Lead Maternity Carer midwives were invited to participate in a small qualitative study. In-depth one to one interviews were used to collect data from nine Lead Maternity Carer midwives. Interviews were recorded, transcribed and analysed using thematic analysis. Using a qualitative approach allowed me to make thoughtful links with the literature and build upon what is already known about the construction of normal birth. Data analysis revealed that midwifery practice and women's birthing experiences occur in a contested context that remains firmly entrenched in a medically dominant model of care. There is an increasing normalisation of intervention and technology leading to ongoing medicalisation of the physiological processes of labour and birth. The midwives interviewed employed a number of strategies for promoting the normalcy of labour and birth including supporting women's choice to birth at home, and working with women in the hospital setting to birth without intervention. However, the medical model influenced the midwives' practice in a number of subtle ways and I argue that the medical model is the default mode: it is always there and is taken as the 'right' way to 'do' birth unless it is actively contended.
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    Childbearing in Timor-Leste : beliefs, practices and issues : a thesis presented in fulfilment of the requirements for the degree of Master of Philosophy in Development Studies, Massey University
    (Massey University, 2005) Thomas, Bronwyn
    Timor-Leste is country with a past, a past that reveals considerable strength and a will to achieve the right to be self determining. It is also a country that will need development assistance for many years to come. Lack of development by Portugal, the former colonial power, compounded by an illegal and destructive occupation by Indonesia it was a country largely devoid of infrastructure at the time of independence in 2002. The population of this small half island is diverse, ethnically and linguistically. The population is considered to be amongst the poorest in the world and women's health, particularly the high maternal mortality rates and the issue of domestic violence have been identified as key areas for development. Women's marginal status in Timorese society is due to traditional and patriarchal practices which enable males to exert control and power over women in many facets of daily life. One of the numerous results of this is that women have reduced access to valued resources including health, education and food. Children are greatly valued, but the high fertility and maternal mortality rates has led the government to identify reproductive health as a high priority. Childbirth is only one aspect of reproductive health but it has traditionally received greater attention. Utilising qualitative research a small group of rural women shared their experiences and practices of childbearing. One aspect the women identified was a lack of information as childbirth is a taboo subject until a woman becomes a mother. In view of this and the numerous priorities identified by Timorese government for future work, including the mainstreaming of gender health concerns I consider the research findings. Due to the need for cost effective and sustainable programmes I recommend Adolescent Sexual Reproductive Health (ASRH) as an area for future exploration and consideration. This is an area found to be commonly overlooked in development activities, but can have many positive outcomes. A broad ASRH programme could address not only the issues of poor information but also work toward challenging gender norms and values which are key influences on women's reproductive health and childbearing experiences. ASRH may be controversial, but some consider programmes can be implemented as early as ten years of age. As adolescents are the next generation of parents and the most receptive to change they are the ideal target group for the future health of this country.
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    Choices of care in the third stage of labour : a Foucauldian discourse analysis : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Health Science at Massey University
    (Massey University, 2004) Spenceley, Katherine
    For the majority of women, the culmination of pregnancy and birth is the arrival of the baby. The third stage of labour, or the birth of the whenua, is the completion of labour and the end of the pregnancy. This time of birth is largely disregarded but can be decisive in the postnatal health of the women. This study examines the third stage of labour focussing on the choices made by women regarding their care with particular reference to the information used by women and midwives to assist choice. The project places the birth of the whenua within the labour continuum, and within the context of the participant's life experience. The philosophy of Michel Foucault suggests that power and knowledge within discourse gives rise to truths and provides authority for statements and actions within the discourse. This project utilises Foucault's definition of discourse and is used to discern the varying discourses, and to locate possible dominant and emergent discourses, within the specific data collected and presented in the thesis.
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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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    Ergonomic design of a physiologic birth-support system : a research thesis for the fulfilment of the degree of Doctor of Philosophy
    (Massey University, 1996) Yap, Boi Leong
    The main theme of this study is centred on the design and evaluation of an Obstetric Body-Support System for upright childbirth that is physiologic and biomechanically efficient, besides improving the tasks of the birth attendant in the management of labour and promoting the safety and well-being of the mother and her baby. Current practices in obstetrics and consumers' expectations are not congruent. Childbirth - a physiological event is increasingly being managed as a pathological process under medical and surgical frameworks. Medicalisation has increased iatrogenic risks to both mothers and babies and is causing profound concerns. The last two decades have witnessed two major developments in maternity care moving in opposite directions - the growing dependence on obstetric technology and the increasing demand for natural birth and humanised maternity care. Consumers' demands are no longer based simply on the emotive needs for change. They are based on recent research evidence that is indicating that less technological interference in childbirth is better than more. The posture adopted by the mother during labour is considered to be the most important factor for the safe passage of the foetus through the birth canal. There is Biblical and historical evidence that the natural posture adopted by women during childbirth has always been in some form of the upright position - sitting, squatting, kneeling and standing. The supine position for delivery facilitates the management of labour, but it has no established benefit for the maternal mother and the foetus. Many physiological disadvantages that adversely affect maternal well-being and foetal oxygenation are associated with the supine position. In contrast, the upright posture for childbirth has been found to be more beneficial to the mother and foetus. The advantages of the upright posture for labour include: taking advantage of gravitational forces to promote foetal descent; preventing compression of the aorta, inferior vena cava and umbilical cord; increasing the size of the pelvic inlet; promoting more effective bearing-down effort and promoting more efficient contraction. In terms of psychological responses, labouring in the seated position has been found to promote active participation, control and emotional satisfaction. This study examined some of these issues from an ergonomic perspective for the design and evaluation of an Obstetric Body-Support System that is compatible with the physiology of childbirth and the management of labour in current hospital settings. Antenatal and postnatal user trials were conducted to evaluate the new Obstetric Body-Support System. Responses from birth attendants and childbearing women for the new System were both positive and encouraging, indicating acceptance, system compatibility and design viability. The changing trend in childbirth demands solutions that are difficult to find in traditional maternity care and practice. The answer is in natural birth - where the woman's enormous psychological, physiological and biomechanical capabilities are relied upon to give birth spontaneously - without technological intervention. Ergodesign - a new hybrid interdisciplinary technology was conceived to design and evaluate the Obstetric Body-Support System that supports and facilitates natural childbirth in the upright position. It is argued that the use of ergonomics and design as separate disciplines militates cohesive design thinking and the creative processes. Besides the symbiotic aspects of ergodesign, the truly interdisciplinary attributes become an effective and synergistic design tool, that is more powerful than conventional approaches of applying ergonomics and design as separate disciplines. The ergodesigner as a scientist, designer as well as a change-agent played a vital role in solving the intricate human-equipment-environmental problems in the management of labour and childbirth in hospital systems. The application of ergonomics to improve childbirth is a complex task, requiring full participation from childbearing women, midwives and obstetricians. They contributed significantly by enlightening the ergodesigner with an "insight" surrounding labour and childbirth, and were involved in the development of body-support concepts, appraisals of mock-ups and evaluations of the prototype Obstetric Body-Support System. A programme of further work is planned to evaluate the clinical aspects of the maternal woman and the baby before conclusion can be drawn on the safety of the new Obstetric Body-Support System.