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Background: The World Health Organization (WHO) acknowledges childbirth as a normal physiological process that does not require unnecessary interventions by maternity care providers. However, some maternity settings in Bahrain still continue to intervene during labour and childbirth while providing care to low-risk women. This approach contradicts the WHO's initiatives in implementing Evidence-Based Practices (EBP) of intrapartum care. Aim: to gain an understanding of intrapartum practices in Bahrain. Methods and methodology: A convergent parallel mixed-methods design was used in the study, conducted in two maternity units of governmental and University-affiliated hospitals in Bahrain. Quantitative data were collected by auditing retrospective birth records and a questionnaire on the intrapartum care of 228 postpartum women. Qualitative data were collected using purposive and theoretical sampling guided by grounded theory through 20 semi-structured interviews with maternity care providers and women and six non-participant observations of care providers' practices during labour. Descriptive and inferential statistical analyses were applied for quantitative data using IBM SPSS Statistics 23. Qualitative data were analysed by constant comparative analysis using Microsoft Word 2016. Findings: Integrated findings revealed that current intrapartum practices in the two maternity units in Bahrain contradicted the recommendations of EBP in certain aspects of intrapartum care. There was a routine use of continuous Electronic Fetal Monitoring (EFM) (93.4%), limited fluid intake during labour (77.2%), discouragement of mobility during labour (76.3%), routine vaginal examinations (65.8%) and lack of companionship presence at labour and birth (64.9%). Qualitative findings provided an in-depth understanding about the intrapartum practices in the two settings. The core category 'women as recipient of care' which includes three major categories 'experiencing childbirth', 'knowing the context of childbirth care' and 'moving toward EBP' emerged from qualitative data analysis. Qualitative findings explored the positive attitude of maternity care providers to some intrapartum practices such as the commitment to use the partograph, encouragement of skin-to-skin contact, provision of privacy and midwives' empathetic support. The integrated study findings contributed to the development of a theoretical model: 'Labouring women-from recipients to participants', drawing a path to move current intrapartum care in Bahrain toward women's active participation and involvement in care through adopting the recommendations of EBP. Conclusion: This study offers insights about how low-risk labouring women experience childbirth in maternity settings in Bahrain. Study findings suggest an urgent need to move intrapartum practices in Bahrain towards consistency with the WHO's recommendations for safe childbirth care. Maternity care providers should pay attention to the practices used routinely during labour. Policymakers need to consider the development of a unit policy that acts as a reference for midwives, updating the existing guidelines to align with Evidence based recommendations for care during 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.

'Reconceptualising the Birth Process in Eighteenth-Century England' employs a broad range of historical sources to construct a richly detailed account of childbirth. By examining women's life-writings, manuscript recipe books, medical texts, court records, collections of folklore, Anglican prayerbooks and material culture this thesis moves away from an historiographical focus on the delivery of the infant to explore the embodied experience of 'giving birth' in the eighteenth-century from the perspective of the labouring woman, her family and the friends and neighbours that visited her. Birth, it is argued, was a process of four distinct phases that lasted between four and six weeks in total. These phases - confinement, labour, delivery and lying-in - were flexible, highly adaptable and indispensable components of 'giving birth'. In exploring birth as a process, this thesis challenges the dominant historiography of the rapid professionalisation of childbirth during the eighteenth century by tracing high levels of continuity in community practices of childbirth management. By broadening the focus of research to include each phase of the birth process this thesis highlights the wide range of cultural, social and emotional behaviours that constituted the embodied experience of giving birth. In reconceptualising childbirth as a process, the thesis refocuses attention on the woman giving birth and the rich networks of friends, family and neighbours that were so crucial to the management of birth in eighteenth-century England.

Mother and Baby Units (MBUs) are recommended for the treatment of women requiring admission while pregnant or in the first year following childbirth. In this thesis, the experience of such an admission was explored. In the systematic review, the evidence relating to psychological outcomes from a MBU admission was synthesised and critically evaluated. This included outcomes relating to maternal mental health, the mother-child relationship and child development. Further aims focused on evaluating the quality of the available research, the efficacy of specific treatments and the utility of various assessment tools. A total of 23 papers met the inclusion criteria for this review. Overall the findings were highly positive, indicating a beneficial impact on maternal mental health and the mother-child relationship, and the absence of negative effects on child development. However these findings were limited by the relatively poor methodologies employed, with most studies including no comparison group nor any follow-up after discharge. There was insufficient evidence to explore the impact of specific interventions. It was possible however to make recommendations regarding the appropriateness of specific tools for both clinical and research purposes, as well as to identify further research priorities. The impact of one aspect of a MBU admission was explored in the empirical paper: the experience of compassion from nursing staff. Compassion is an increasingly discussed concept in the National Health Service (NHS) and is incorporated into the NHS Constitution, the values statements of various NHS Trusts and the code of ethics for nursing staff. Despite the differences between MBU admissions and admissions to general psychiatric inpatient units, no research had previously explored the experience of compassion by mothers admitted to a MBU. Repertory Grid interviews were completed with 15 mothers regarding their perceptions of both psychiatric and nursery nurses. The findings indicated the central role of compassion as well as its perceived impact on recovery. Additional valued characteristics in nursing staff included the ability to cope in stressful situations without becoming overwhelmed, and a willingness to be flexible in the application of rules and professional boundaries. The implications of these results for both nurses and managers are discussed, as well as future research directions. The final paper consists of a critical reflection of the research and the research process. This includes an evaluation of the decision making processes and discussion of the strengths and weaknesses of this research.

Indonesia has one of the highest rates of maternal mortality in Southeast Asia. Community participation has been known to reduce maternal mortality in some areas in Indonesia. However, in Aceh Province, the prevalence remains higher than the general Indonesian maternal mortality rate. The aim of this research was to gain an understanding of pregnancy and childbirth experiences from multiple perspectives, in relation to the use of maternal health services in Aceh, Indonesia. The conceptual framework was based on the importance of community engagement in improving maternal health. A qualitative study design with a grounded theory approach was utilised. This approach was chosen in order to gain an understanding of the social processes and ways in which experiences of pregnancy and childbirth are related to maternal death incidents. The process inherent in the method enabled the emergence of important theoretical concepts. A theoretical sampling strategy was employed. The data collection used multiple methods that involved a series of in-depth interviews, observations and focus group discussions with women, family members, a village leader and health professionals. The sample size was determined by data saturation (19 women, 15 family members, 7 health professionals, 3 kaders, 4 student midwives and 1 village leader participated). Ethical approval was gained and the research setting was in the two villages of Aceh Besar District, Aceh Province, Indonesia. Data were coded and analysed by following a constant comparison process. The emergent core category, entitled “maternal death: the elephant in the room” explains the views of the community about maternal death incidents in the research setting. The research findings highlighted that despite the maternal mortality rate still being high in the region, maternal death was not focused upon, as a problem within the community. The research findings revealed that maternal mortality was a hidden problem within the community, and was related to inadequate maternity practices in the village. The core category “maternal death: the elephant in the room” was found to consist of four interrelated categories. The categories of the value of midwifery in the community, desicion-making of maternity care, social control of the childbearing and distancing of maternal deaths; explain maternity practices in the community. Understanding of social processes related to maternal health can assist in informing strategies to improve the quality of maternal healthcare in Aceh Indonesia.

This thesis examines the complexities of delivering high quality pro-poor maternal child healthcare. The research recognises that good maternal child health (MCH) is a fundamental development imperative in which initiatives are not achieving targets. There is a chronic deficit of well trained healthcare workers and increasing reports of abuse being suffered by poor patients. The research suggests that current mechanistic results orientated approaches to healthcare should be foregone in favour of an appreciation of the fundamentally fluid and social nature of health and healthcare delivery. It is also suggested that whilst current literature focus on either a patient or a healthcare provider perspective, a complete picture of the healthcare transaction is generated by examining the relationship between the two. This research aims to unpack the realities of delivering high quality, pro-poor MCH in the chronically poor district of Kibaale, mid-western rural Uganda. Standing at a disjuncture between policy, conceptual theory and empirical research, this thesis presents the conceptual tool of ‘healthscapes’. It is suggested that healthscapes are an effective approach to read the hegemonic social values of power, gender and care operating in place. Taking a relational view of space and place, it is suggested that individuals plot routes to achieve health aims through a ‘terrain’ constructed by their health knowledge embedded in place. This constructs a knowledge base for individuals which can become authoritative, potentially enabling them to construct informal spaces of health within the formal setting. In the informal spaces, individuals can adapt their behaviour to overcome barriers to the healthcare transaction and ultimately achieve their health goals. By contemplating the healthcare transaction from both the health-seekers’ and the healthcare providers’ perspectives, the post-structural approach challenges conventional understandings of power in health. This nuanced social insight into health-systems could thus be used to inform policy. Based on 18 months of ethnographic fieldwork, the healthscape concept was used to unpack MCH transactions within Bunyoro as a whole, the Antenatal Clinic and the Maternity Ward. The research discovered that despite the prevailing negative perceptions of the government institution, over 60 women attended antenatal a week whilst only five delivered within the maternity ward. The research suggests that within the antenatal clinic, women were able to use their extensive place-based authoritative knowledge to construct informal spaces in which they could influence the healthcare transaction to achieve their antenatal aim. Due to cultural constructions of childbirth, if women presented at the maternity clinic it was ordinarily for emergency reasons. Their lack of experience and need for care meant they had little place-based authoritative knowledge to influence the healthcare transaction and were subjected to the biomedical gaze.

The aim of this study was to explore whether professional home postnatal care in n Northern Ireland (NI) and the Republic of Ireland (ROI) meets women's expectations and needs. s. This was the first study of Irish community postnatal services in a Border area. The study site was a hospital tmst located in Northem Ireland in a Border area that serves pregnant women from either side of the Border. In NI midwives care for all women for a period not less than 10 days and longer if necessary. In the ROI. a different model of care exists whereby the public health nurse visits less often initially but provides care for families with infants over a longer period up to and including the school years. Key findings were that some ROI mothers received the minimum of two visits by the public health nurse. ROI mothers valued home visits up to three months after the birth but wanted more visits in the early postoatal peiiod. More advice about maternal health was needed and more help with infant feeding was required.

Hyperemesis Gravidarum (HG) is a severe form of nausea and vomiting of pregnancy that is distressing, debilitating and potentially life threatening. This thesis presents qualitative, exploratory data of the experience of HG from the perspective of women with the condition and the health care professionals (hep's) caring for them. The study originated from difficulties identified by hep's managing HG in a hospital setting. The purpose of the study was to provide data to inform the development and improvement of services for women with HG.

The aim of this research study was to introduce and examine the effects of a change to a system of Patient Allocation in a ward of a Maternity hospital. The study examined in particular the relationship between the organisation of the delivery of nursing care and three organisational outcomes which, in the nursing literature are reputed to be improved when a system of patient Allocation is used. These organisational outcomes are; 1) patient Satisfaction with care 2) The Job Satisfaction of the nursing staff 3) The nurse-patient relationship A review and analysis of the literature suggested that methods of organising the delivery of nursing care - Task Allocation and Patient Allocation - tend to be seen as mutually exclusive 'ideal' types and that they tend to be associated with different paradigms of care. In this study descriptive, experimental and action approaches were used and the data was obtained from two areas of investigation. 1) An experimental study whereby one ward introduced the new method of delivering care. 2) A series of interviews with the nurses and midwives who had worked in the ward where the changes were introduced, and in other wards of the hospital. Questionnaires, interviews and non-participant observation were the main instruments used to collect the data. The data obtained in the study provided little evidence to support the reputed advantages of a system of Patient Allocation. Two explanations for the results were suggested. 1) The use of Task Allocation and patient Allocation as mutually exclusive 'ideal' types has led to the image being confused with the reality. 2) Change from a system of Task Allocation to patient Allocation should be seen as a process and not an event.