Massey Documents by Type

Permanent URI for this communityhttps://mro.massey.ac.nz/handle/10179/294

Browse

Subject: search.filters.subject.Midwives

Search Results

Now showing 1 - 10 of 13
  • Thumbnail Image
    Item
    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.
  • Thumbnail Image
    Item
    Midwifery practice : authenticating the experience of childbirth : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing at Massey University
    (Massey University, 1988) Bassett-Smith, Joan L
    The purpose of this grounded theory study was to identify, describe and provide a conceptual explanation of the process of care offered by midwives and the effects of that care on women's experiences of childbirth in hospital. Ten couple participants and their attendant midwives provided the major source of data. The primary data collection methods used in this study were participant observation during each couple's experience of labour and birthing, antenatal, hospital and postnatal interviews with couples along with formal and informal interviews with midwives. Constant comparative analysis of data eventuated in the identification of a core category termed 'authenticating'. Authenticating, in the context of this study denotes a process that is engaged in by both midwives and birthing women in order to establish practice, and the experience of giving birth, as being individually genuine and valid. Authenticating is multifaceted and is seen to include the intertwined and simultaneously occurring phases of 'making sense', 'reframing', 'balancing' and 'mutually engaging'. The process of authenticating is proposed as a possible conceptual framework for midwifery practice. It identifies the unique contribution the midwife can make to a couple's experience of childbirth and serves in a conceptual way to unite the technical and interpersonal expertness of the midwife. The conceptual framework of authenticating legitimises 'being with' women in childbirth and facilitates a woman-centred approach to care with consequent implications for practice, education and research.
  • Thumbnail Image
    Item
    Living a divergent experience : the maternal perception of critical illness : a thesis presented in partial fulfillment of the degree of Master of Philosophy in Midwifery at Massey University
    (Massey University, 1997) Reid, Elizabeth Anne
    The aim of this grounded theory study was to describe and generate a conceptual explanation of the experience of maternal critical illness. Sixteen participants provided the data which was collected over nine months. The primary data collection methods used in this study were unstructured interviews, and participant observation. Data was also obtained from three published autobiographical accounts. Constant comparative analysis of the data eventuated in the identification of four linear stages, from the first symptoms of illness to a subsequent pregnancy, which were conceptual categories. These categories were named 'identifying a problem', 'being overwhelmed', absorbing' and 'getting on'. These conceptual categories were drawn together in the core category, a basic social process 'Living a divergent experience of childbearing'. The experience of childbearing for the women in this study diverged from the sociocultural expectations of childbearing in New Zealand and from their personal expectations. Their divergent experience of childbearing informed their continuing perception of childbearing as an illness which risked maternal life. These findings have implications for midwifery practice, education and research.
  • Thumbnail Image
    Item
    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.
  • Thumbnail Image
    Item
    Towards the professionalisation of New Zealand midwifery, 1840-1921 : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Midwifery at Massey University
    (Massey University, 1998) Cooper, Marion A
    This thesis examines the reasons behind the move to formalise New Zealand European midwifery care in 1904 and the impact this had on midwifery practice. 'The Midwives Act, 1904' concentrated on providing a training system for midwives, hence traditional midwives found their duties circumscribed by their lack of knowledge and training. While women were seen as the appropriate case managers for women during parturition, the Midwifery Act set in place regulations that required advanced knowledge and set standards of practice. The setting up of a nation-wide structure at St Helens Hospitals1 St Helens hospitals does not have an apostrophe. for the training of midwives reinforced the role of the trained midwife, who in some instances was also a trained nurse, and began the move towards the hospitalisation of maternity patients which came to fruition around 1938. The contention of this thesis is that the Midwifery Act contributed to the development of professional standards of midwifery practice leading to a more professionalised midwifery service in place of that which had, until 1904, been unstructured and informal. Through the inclusion of scientific developments into the syllabus of instruction the Midwifery Act gave formal direction to the training, examination and practices of midwives. Finally, it brought to the fore the trained midwife and single woman who replaced the traditional married midwife. The developments and changes in midwifery that occurred following the 1904 Midwifery Act had their beginnings well in advance of the Act. Maternal and infant mortality and morbidity rates had become a concern in England during the 1860s. As early as 1867 maternity lying-in hospitals were beginning to develop protective mechanisms to prevent infection. In New Zealand an unstructured midwifery service comprised mainly of traditional midwives developed from 1840. Stringent use of antisepsis and advanced, professional, midwifery knowledge did not influence these midwives' practices until 1904 when the Midwives Act was implemented leading to the demise of the traditional midwife.
  • Thumbnail Image
    Item
    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.
  • Thumbnail Image
    Item
    Midwives' use of unorthodox therapies : a feminist perspective : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Midwifery at Massey University
    (Massey University, 1996) Hotchin, Claire Lucille
    In New Zealand independent midwives are increasingly incorporating unorthodox therapies into their practice. This research studied the experience of metropolitan midwives using unorthodox therapies within the existing edically dominated maternity care system. It also explored the forces that facilitated and constrained midwives in their use of unorthodox therapies. Feminist case study method was used to research the experience of five independent midwives who had integrated unorthodox therapies and practices into their midwifery practice. Their individual stories are related in separate chapters. Semi-structured interviews were used to gather the data which was analysed using the feminist concepts of power and gender. Three key points emerged from the analysis. The midwives strongly believed that the way in which they used unorthodox therapies in their practice benefited and empowered women. Secondly, they had some concerns regarding knowledge of unorthodox therapies. Thirdly, the midwives who used unorthodox therapies felt professionally vulnerable within the bio-medical orthodoxy. Feminist theory was used to analyse the data and enabled the researcher to place midwives' use of unorthodox therapies within a broader socio-political context. It is hoped that this may stimulate midwives to examine their own use of unorthodox therapies as well as provide the impetus to initiate change within both the bio-medical orthodox maternity system and alternative heath movement.
  • Thumbnail Image
    Item
    Making decisions : focusing on my baby's well-being : a grounded theory study exploring the way that decisions were made in the midwife-woman relationship : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Midwifery at Massey University
    (Massey University, 1998) Calvert, Susan
    This thesis presents a study using a Grounded Theory methodology to explore the way that decisions were made in the midwife-woman relationship. The purpose of this study was to explore the woman's experience of the way that decisions were made, to gain an understanding of it and finally to present a description of the way such decisions were made when women utilised midwife-only care within the New Zealand maternity setting. Ten women were invited to participate. A diverse sample of women with different birth experiences and from different cultures was obtained. The sample was obtained using the tool of theoretical sampling which highlighted, through data analysis, the need for participants with different characteristics. All women who were interviewed were asked to describe their pregnancy and birth experience, their relationship with their midwife and the way they believed decisions were made during their pregnancy and birth experience. Data analysis was performed using the constant comparative method. Results showed that women acted in ways to ensure their baby's safety. Women initially acknowledged their pregnancy and as a result, they selected a maternity carer and participated in self education. To ensure their baby's well-being women undertook procedures and followed instructions from their midwife. Whilst they planned for their birth and made decisions that effected themselves and their unborn child, the primary goal behind these actions was their baby's health. The women trusted their midwives to endorse actions that would lead to a safe outcome. At times the women wanted midwives to make decisions for them. Choice, continuity and control are important to women but safety is vital.
  • Thumbnail Image
    Item
    Home sweet home birth : a qualitative study on the perceptions and experiences of home birth : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University
    (Massey University, 1994) Griffin, Helen Mary
    The management of pregnancy and childbirth, and the home as a location of birth, are all topics subject to considerable debate. Such debate often relies on emotive appeal rather than reference to relevant research. A series of three interviews were conducted with seven women planning home births. The most important reasons why women decided to have a home birth were the desire to have an established relationship with their midwife, wanting continuity of care from their midwife, wanting family involvement in the birth and wishing to retain control and avoid interventions. Postnatally, in most instances, high levels of satisfaction were expressed by women about the quantity and quality of information they received, the care they received from health professionals, their satisfaction with the birth experience and with their relationships with health professionals. Most women did not experience feelings of loss of control at the birth and the majority of women did not experience feelings of depression postnatally. Women's perceptions of pregnancy and childbirth were in accordance with the midwifery model of childbirth and it is proposed that women seeking home births hold a deeper and more encompassing belief in the tenets of the midwifery model in comparison to women who have hospital births. Findings are also in accordance with other research, both national and international.
  • Thumbnail Image
    Item
    Midwives : preparation and practice : a thesis presented in partial fulfilment of the requirements for a degree of Master of Arts in Nursing at Massey University
    (Massey University, 1990) Hedwig, Judith Anne
    The focus of this study is centred upon the perceptions, training and experiences of midwives. A sample of recently qualified midwives was externally selected and interviewed to provide data for a descriptive study. The initial results indicated the following needs for midwives: flexible training requirements, realisation of their prior nursing experiences, continuing professional educational needs, expansion of practical experiences to contribute to the development of a growing autonomous midwifery practice. A beginning model for midwifery practice which is offered to help clarify and integrate aspects of complex and varied issues was developed out of the midwives' perceptions of their education and employment experiences.