Objective To construct a substantive theory of postpartum fatigue. Design Grounded theory. Setting Participants were recruited in the hospital after delivery and interviewed in their homes. Participants Thirteen primiparae ( n = 5) and multiparae ( n = 8) women between 2 and 5 weeks postpartum from diverse ethnic, age, obstetric, and financial contexts were theoretically sampled. Results Persevering was the central human process around which the grounded theory emerged. The process of persevering was explained through the relationships of influencing factors, postpartum fatigue, coping techniques, self‐transcendence, and caregiving. Participants persevered in caregiving of infants and older children in spite of an overwhelming desire to rest and sleep using self‐identified coping techniques in combination with the belief that their children brought purpose and meaning to their lives. Conclusions The theory “Persevering Through Postpartum Fatigue” contributes a more complete understanding of the complex phenomenon of postpartum fatigue as it is expressed in the everyday lives of women during the postpartum period. The results may be used to develop and implement health‐promoting nursing interventions to reduce postpartum fatigue and its health‐related consequences.

/pdf/persevering-through-postpartum-fatigue-3o78cwkycz.pdf

Persevering Through Postpartum Fatigue

This thesis proposes a new philosophy of birth space design that values the diverse spatial practices and space-based experiences of childbearing women, across all types of birth venues and experiences of birth. The research aligns with the philosophy of woman-centred maternity care. It critically examines this as an intervention imposed on to a pre-existing medical system of care - a system which, in turn, influences the techno-rational basis of healthcare evidence-based architecture and the tendency for researchers to investigate the birth environment in quantifiable ways. The thesis proposes that birth space should be interrogated in a number of new qualitative ways: by user experience-based spatial design starting with the interiors of buildings; by examining women’s patterns of use of space over time, especially in relation to social interactions; and by interpreting space-based experiences within women’s birth stories. The literature review draws from a wide-range of literature: architectural, spatial, birth-environment, social theory, midwifery, obstetrics and policy documents. It critiques the naive readings of homely, control, safety and risk, and architecture understood as a techno-rational domain, in the extant research relating to birth spaces.

This thesis has an interpretative methodology that crosses disciplinary boundaries, and the definitions of architectural space and childbirth, that have previously limited knowledge of birth spaces. The nature of what is appropriate evidence for design, the spatial understanding afforded by using visual qualitative methods, semiotic meaning within policy documents, the nature of personal experiences of childbirth, and the application of a critical spatial methodology to birth spaces, all inform the selection of methods.

Representations of architecture are used to interpret the social and spatial meaning that architecture represents to birth space producers and users. Spatial practices for producing birth spaces are interpreted from the three policy design guidance documents commonly used in the context of maternity care in the UK; and the spatial practices of childbearing women are interpreted from the experiences of twenty-four women who took part in qualitative interviews. The transcripts, policy guidance documents and drawings were thematically-analysed and the visual data was also examined as semiotic materials. 

The findings demonstrate that birth spaces are prosumed and curated by women. Birth space is experienced as a socially-situated progression through time - and not contained within one room as current guidance implies. Women’s spatial experiences are embodied and influenced by prior experience and expectations of birth venues. Space is experienced in multiple ways (visually, via perceived affordances, and via movement) that are contingent on the venue. Experiences of waiting and of labour as a ‘physical journey’ are both spatially significant. Women want to use spatial strategies to self-manage the ebb and flow of companionship in labour. Women build personally-meaningful intergenerational stories from where birth took place.

The discussion chapter develops spatial insights into the design guidance and maternity policy goals (choice, control, continuity of carer and personalised care) from the interpretation of women’s experiences. The thesis creates a new critical understanding of the value of social architecture for improving midwifery practice and women’s birth experiences. Practical recommendations to be applied to existing maternity spaces are proposed. Existing spatial and social theory is applied to the new area of birth space, and its lacunae identified. The thesis concludes with a new situated spatial theory derived from women’s experiences of childbirth as inspiration for much needed further interdisciplinary research and design development in this area.

Towards a new architectural understanding of birth spaces grounded in women's experiences of giving birth

This dissertation reads the work of modernist poet H.D. (Hilda Doolittle, 1886-1961) through the lens of the maternal body, which was systematically repressed and concealed in the first half of the twentieth century despite the very public nature of women's reproductive issues in this period. H.D.'s era was one which saw the changing legal status of women, the medicalization of childbirth marked by its movement from the home to the hospital, the entry of women into the medical profession, the mainstream popularity of eugenics, the development of the psychoanalysis, and the rise of the technology of film. H.D.'s life and work provides a unique opportunity to bring together these major events of twentieth-century history with literary studies, not only because of H.D.'s connections to the Imagist movement, avant-garde cinema, and psychoanalysis, but also because of her personal experiences as a childbearing woman, a bisexual mother, and a patient of Freud. While her personal and social situation kept her on the fringes of modernist literary history throughout her lifetime, the variety of her pursuits positions her as a quintessential modernist figure. Through my sustained investigation of H.D., I argue that the childbearing woman, in all her functional physiological capacities, can be a central author figure. On the broadest level, my work interrogates the relationship between the medical and technological advances of the early twentieth century and the literature of the modernist period. By focusing primarily on H.D., I demonstrate how modernist literature grows out of an individual poet's continual personal contact with the changing technologies and medical institutions of her time. This interface between poet and culture is very much informed by H.D.'s social and biological status as a woman. Each of my chapters takes as its theme a particular possibility of female reproduction: stillbirth, birth, abortion, and pregnancy and lactation. I not only demonstrate how the socio-historical situation of the poet-aschildbearing-woman shapes the production of H.D.'s modernist writing but also I reveal how these themes exist as pervasive anxieties in modernist culture. Degree Type Dissertation Degree Name Doctor of Philosophy (PhD) Graduate Group English First Advisor Bob Perelman

/pdf/h-d-the-politics-and-poetics-of-the-maternal-body-1hr3r5wm98.pdf

H.D.: The politics and poetics of the maternal body

Women in the UK have access to NHS maternity services and most will attend hospital to give birth in the NHS. Much effort has been undertaken over several decades to improve childbirth and to enhance the experiences of those using NHS maternity services. However, while most women report positive experiences of maternity care, existing evidence suggests that women from ethnic minority groups in the UK have poorer pregnancy outcomes, experience poorer maternity care, are at higher risk of adverse perinatal outcomes and have significantly higher severe maternal morbidity than the resident white women (Puthussery, 2016; Henderson et al, 2013; Puthussery et al., 2010; Straus et al., 2009). Muslim women of child-bearing age make up a significant part of UK society, yet their health needs and their experiences of health services have not been extensively researched. The term ‘Muslim’ is often combined with ethnic group identity, rather than used to refer to people distinguished by beliefs, practices or affiliations. Muslim women commonly observe certain religious and cultural practices during their maternity journey and the little research there is in this area suggests that more could be done from a service provision perspective to support Muslim women through this, spiritually and culturally significant life event (McFadden et al., 2013; Alshawish et al., 2013). This study explores Muslim women’s perceived needs and the factors that influence their health seeking decisions during their transition to motherhood. Using a generic qualitative approach, seven English-speaking first time pregnant Muslim women and a Muslim mother who is second time pregnant but experiencing motherhood as a Muslim for the first time, were interviewed at different stages of their maternity journey (antenatal, post-labour and postnatal); five focus groups were conducted with Muslim mothers; and 12 semi-structured interviews were conducted with healthcare professionals. Thematic analysis of the transcripts revealed that Muslim women: 1) had a unique perspective on motherhood based on Islamic teaching; 2) sourced information from a number of sources, additional to midwives; 3) experienced difficulty expressing their religious requirements when preparing a birth plan; 4) assumed that healthcare professionals would have a negative view of Islam and Islamic birthing practices. While one-to-one interviews revealed that healthcare professionals: 1) varied in their perceptions of Muslim women; 2) had a general awareness of Muslim women’s Islamic practices but not specific to motherhood; 3) sourced cultural and religious information to enhance their understanding of women’s needs and their specific practices; 4) had some challenges when addressing women’s specific religious practices such as fasting; 5) would benefit from cultural/religious competency training that incorporates lived experience and group discussion. The implications for institutions, midwifery practice and further research are outlined. The study concludes that transcultural knowledge and specifically Muslim women’s worldview incorporated into healthcare professional training would enhance the competency and quality of healthcare services.

A qualitative study exploring British Muslim women’s experiences of motherhood while engaging with NHS maternity services

"It Seemed the Natural Thing To Do" A Heideggerian Study of Choice for Mothers Who Breastfeed

Becoming a Mother

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