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Introduction: Perinatal death has a significant impact on the physical, emotional and mental health of women. This requires adequate bereavement care to limit the impact in the short and long term and on the quality of life. Women and families in sub-Saharan Africa and South Asian countries are most affected as they carry the highest burden of perinatal death. The experience of care and support in these countries has not been explored. Thus, there is a lack of understanding of the care and support received by women, and provided by healthcare professionals in South-Western Nigeria, one of the regions with the highest rate of perinatal death globally. Aim: The aims of this thesis were (i) to identify, synthesise and critically reinterpret the findings of existing literature on the care and support following perinatal death in high burden settings, and to reveal gaps and new understanding, (ii) to explore the lived-experience of women and families of care and support following perinatal death in South-Western Nigeria and (iii) to explore the lived experience of health care professionals who provide care and support following perinatal death in South-Western Nigeria. Methods: A metaethnographic metasynthesis was undertaken in synthesising and critically reinterpreting existing studies on womens care and support following perinatal death in high burden settings. Qualitative hermeneutic phenomenological studies using semi-structured interviews were conducted in exploring the lived experience of women, families and health care professionals of care and support following perinatal death. Results: Perinatal death is not appropriately acknowledged, thus care and support in high burden settings is inadequate. Women are not adequately supported whilst in hospital and receive no follow-up care from health care professionals in the community following discharge. Nurses endeavour to provide support as far as is possible within the hospital but this is determined by their practice as there is no recognised guideline for bereavement care following perinatal death in South-Western Nigeria. Thus, there is a lack of consistency in care and support. Nonetheless, nurses recognise the need for post-discharge follow-up and provide this within their own leisure time, outside of their role. Conclusion: Overall, bereavement care following perinatal death is limited in South-Western Nigeria; rather nurses provide care and support based on their own practice. There is a need for further research into and a development of sufficient bereavement care in Nigeria for women who experience perinatal death. In addition, the experience of other health care professionals and family members including partners of care and support also requires further research.

Background: Wireless fetal heart rate monitoring (telemetry) is increasingly being used by maternity units in the UK. Guidelines from the National Institute for Health and Care and Excellence recommend that telemetry is offered to any woman who needs continuous monitoring of the fetal heart in labour. There is no contemporary evidence on the use of telemetry in the UK. Aims: To gather in-depth knowledge about the experiences of women and midwives using telemetry to monitor the fetal heart in labour and to assess any impact that the use of telemetry may have on clinical outcomes, mobility in labour or control and satisfaction. Study design: A convergent parallel mixed methods design was chosen. Methods: Qualitative methods included in-depth interviews with 10 women, 2 partners, 12 midwives and one student midwife from two NHS Trusts in the Northwest of England. A constructivist grounded theory methodology was employed for this phase and used both purposive and theoretical sampling. All interviews were audio-recorded and transcribed verbatim. The quantitative phase recruited 161 women from both sites and compared clinical outcome and mobility data from 74 women who used telemetry during labour and 87 women who had conventional wired monitoring. Women also were asked to complete a questionnaire in the postnatal period on control and satisfaction during labour and birth. Questionnaire data was analysed from 128 women, 64 who used telemetry and 64 who had conventional wired monitoring. Both sets of data were integrated to give an overall broad understanding of telemetry use. Findings: The grounded theory core category was 'Telemetry: A Sense of Normality' and was described by three sub-categories. 'Being Free' described women being more mobile when using telemetry in labour and experiencing greater feelings of control, normality, and support. Telemetry also increased dignity for women as they were able to use the bathroom independently and with ease. 'Enabling and facilitating' described midwives facilitating the use of telemetry, encouraging mobility and using midwifery skills including caring for women in a birth pool. 'Culture and Change' described the different maternity unit cultures and how this impacted on the use of telemetry. Telemetry was viewed as increasing choice and equity for women with more complex pregnancies. Within the quantitative phase there was no difference in the aggregate scores for either the Perceived Control in Childbirth (PCCh) scale or the Satisfaction with Childbirth (SWCh) scale. Sub-group analysis found that women who used telemetry for the majority of the time the fetus was continuously monitored in labour scored a higher aggregate score for perceived control during labour (mean ± SD; 5.3 ±0.8 telemetry vs. 4.9 ± 0.9 wired, p = 0.047). Mobility data found that women using telemetry spent more time off the bed in labour and adopted more upright positions for birth. Conclusions: Both qualitative and quantitative findings confirmed that women were more mobile in labour when using telemetry to monitor the fetal heart and integrated findings also found that telemetry increased feelings of control in labour. The use of telemetry had a positive impact on women who required continuous monitoring in labour and engendered a sense of normality for both women and midwives. The use of telemetry contributes to humanising birth for women requiring more complex care in labour and birth.

Background: In Oman, 33.3% of women attended late for publicly funded antenatal care in 2015 and 24% did not attend for the recommended 4-6 visits during their pregnancy. This low attendance suggests a need to explore attendance for antenatal care for low-risk pregnant women in Oman. Methodology: An exploratory qualitative design informed by constructivist grounded theory methodology was used in this research. Methods: In-depth semi-structured interviews were conducted with an initial purposive sample of nine pregnant women. The initial analysis enabled theoretical sampling of thirteen non-participant observations during women's appointments, interviews with ten care providers, and six women who booked late after 12 weeks of gestation. A constructivist grounded theory analytical framework of initial, focused and theoretical coding was followed to analyse all the data collected. Findings: The core category consists of five interrelated sub-categories: perceived benefits and value of antenatal care; timing of the first antenatal visit; woman-carer interactions during antenatal care; experiences with antenatal care delivery; and supplementary use of private healthcare. The integral categories explain the social processes and issues surrounding antenatal care. The emergent core category, Navigating antenatal care, reflects the views of the women and their care providers. The women were unhappy with the organisation and physical environment of care but attended their appointments to ensure optimal pregnancy outcome and to alleviate their fears of developing complications. Thus, they used both private and public healthcare and sourced online information in response to their feelings of obligation to protect their fetus. Conclusion: The women appeared disempowered and to lack control over the care they received. Thus, they accepted conditions such as long waiting times in an uncomfortable environment and the disrespect they encountered during their visits. There was a discrepancy between what the women expected and needed from their antenatal care and the actual care and information they received, which did not satisfy their needs. This could be due to a lack of woman-centred care and limited involvement in the plan of care. Thus, women sought further reassurance by accessing private clinics, using online information, and networking with others, which also resulted in a late booking for public antenatal care.