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n Health SA Gesondheid - Women's experiences of a vaginal delivery conducted by a private midwife : research

Volume 10, Issue 3
  • ISSN : 1025-9848
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Abstract

During the last decade the process of childbirth has undergone many changes in South Africa. Most women currently give birth in the hospital under the supervision of a medical practitioner because they belong to a medical aid scheme which enables them to consult an obstetrician for their delivery. Due to this fact, a large number of deliveries take place in a hospital setting, be it private or provincial. Research undertaken in South Africa (Du Plessis, 1991:58) with regard to women's experience of childbirth in a hospital while under the care of a medical practitioner; found that they were dissatisfied with their birthing experience and felt disempowered. They felt a loss of control during the labour process, experienced a sense of abandonment and lack of involvement. Different modern approaches to childbirth have developed all over the world, essentially in response to the progressive medicalisation of birth with an increase in the number of home deliveries by a midwife (Robertson, 1988:2). In South Africa, there seems to be an increase in the demand by mothers for a less technological medicalised birthing experience. There is furthermore an increase in the number of women who are beginning to express a preference for deliveries with a private midwife. In South Africa the trend back towards delivering with a private midwife is relatively recent and the field of private practising (independent) midwives a growing one. Research pertaining to this topic has been carried out in the United States of America, the United Kingdom and the Netherlands which concluded that the mother's experience of the birthing process with a midwife was a superior one. The experiences of the mother who delivered with a private midwife is an area in South Africa where very little documented research has been carried out. Due to this fact minimal documented research is available. Statistics with regard to the number of babies delivered by private midwives are unknown and no register exists of the names and numbers of private midwives available. The purpose of this research study was to explore and describe the experiences of women related to their exposure of birthing with a private midwife. This allows recommendations to be made with regard to the practice of private midwifery in South Africa. The private midwives can use these guidelines to improve their practice and contribute to a better birthing experience. A qualitative, descriptive, explorative and contextual research design was utilised to conduct this research. The focus was to obtain information that would facilitate understanding of the women's experiences of labor while under the care of a private midwife in a midwife obstetric unit. A qualitative design was used where the phenomenological method was employed. Purposeful, convenient sampling was done where the researcher consciously selected certain subjects from a midwife obstetric unit in Gauteng. The collection and analysis of data involved exploring and describing the women's birthing experiences by means of analysis of naïve sketches collected prior to discharge; unstructured in-depth interviews and a focus group. These interviews were transcribed verbatim to add depth to the findings. Tesch's descriptive method was used to analyse data. Data were clustered into relevant themes. A thorough literature study was performed in order to try and describe the phenomena as seen by others. Books relating to the research topic, relevant research material and newspaper articles were utilised. Guidelines were discussed and formulated. Lincoln and Guba's measures to ensure trustworthiness were applied. Two main themes were extracted. They were that a therapeutic relationship developed with the midwife, but at the same time they had unrealistic expectations with regard to the birthing process. These two themes were further divided into subthemes which will be discussed with regards to the research findings and will be verified by means of a literature control. All information will be supported by direct quotes obtained from the data collected during the interviews. The researcher found that women who delivered with a private midwife found it to be a hugely positive experience. They felt that they were in control of their birth and the midwife remained unobtrusive, they felt safe and secure which enabled them to relax and enjoy the birthing process, they felt that they were not rushed because a therapeutic relationship had developed between the mother and midwife, and the midwife took time to concentrate on the mother as an individual. The bonding within the family unit was enhanced.

Kindergeboorte in Suid-Afrika het die afgelope dekade baie veranderinge ondergaan. Die meeste vroue skenk geboorte in die hospitaal onder die toesig van die geneesheer omdat hulle aan 'n mediese fonds behoort wat hulle in staat stel om 'n ginekoloog vir die bevalling te raadpleeg. Vanweë hiervan vind 'n groot aantal geboortes plaas in die hospitaal, ongeag of dit 'n privaat of provinsiale hospitaal is. Navorsing onderneem in Suid-Afrika (Du Plessis, 1991:58) met betrekking tot vroue se belewenis van kindergeboorte in 'n hospitaal onder toesig van die geneesheer het bevind dat hulle ontevrede was omdat hulle gevoel het dat hulle nie bemagtig was nie. Hulle het 'n gebrek aan beheer gedurende die geboorteproses beleef en verwerping asook 'n gebrek aan betrokkenheid ervaar. Verskeie moderne benaderings tot kindergeboorte het oor die wêreld ontwikkel in respons tot die toenemende medikalisering van geboorte, met 'n gevolglike toename in die aantal tuisbevallings onder toesig van die vroedvrou (Robertson, 1988:2). Dit wil voorkom of daar 'n toename in die aanvraag van moeders na 'n minder tegnologiese en gemedikaliseerde geboorte in Suid-Afrika is. Daar is verder ook 'n toename in die aantal vroue wat verkies dat hulle bevallings onder die toesig van 'n privaat vroedvrou plaasvind. 'n Betreklik nuwe neiging in Suid-Afrika is om weer soos in die verlede van die dienste van privaat vroedvroue gebruik te maak. Hierdie vroedvroue tree in 'n toesighoudende hoedanigheid tydens die geboorte op. Die dienste van privaat praktiserende (onafhanklike) vroedvroue word al hoe meer gebruik. Navorsing oor hierdie onderwerp is in die Verenigde State van Amerika, die Verenigde Koninkryk en Nederland uitgevoer. Daar is bevind dat die moeder die geboorte baie positief beleef indien sy geboorte geskenk het onder toesig van 'n vroedvrou. Daar het min navorsing in Suid-Afrika oor die belewing van hierdie tipe geboorte plaasgevind. Statistieke oor die aantal babas wat deur privaat vroedvroue verlos is, is onbekend en geen rekords bestaan waarin die name en getalle van privaat vroedvroue opgeteken is nie. Die doel van hierdie navorsing was om die belewenisse van vroue wat onder toesig van privaat vroedvroue gekraam het, te ondersoek en te beskryf. Aanbevelings om die privaat vroedvroue se praktykvoering te verbeter is gemaak om die geboortebelewenisse van vroue te verbeter. 'n Kwalitatiewe, beskrywende, ondersoekende en kontekstuele navorsingsontwerp wat die fenomenologiese metode ingesluit het is in hierdie navorsing gebruik. Die doel van hierdie navorsingstudie was om die belewenisse van vroue met betrekking tot die dienste van 'n vroedvrou tydens geboorte te eksploreer en te beskryf. Doelgerigte, gerieflikheidsteekproefneming is gedoen waartydens die navorser sekere subjekte van 'n vroedvrou-obstetriese-eenheid in Gauteng geselekteer het. Die insameling en analise van die data sluit in die beskrywing van vroue se geboortebelewenisse deur middel van 'n analise van naïewe sketse wat voor ontslag ingesamel is; ongestruktureerde in-diepte onderhoude en fokusgroepe. Die onderhoude en fokusgroepe is verbatim getranskribeer om diepte tot die bevindinge te verleen. Tesch se beskrywende metode is gebruik om die data te analiseer. Data is in relevante temas gegroepeer. 'n Deeglike literatuurstudie is uitgevoer om die verskynsel, soos deur ander persone gesien, te beskryf. Boeke oor die navorsingsonderwerp, relevant tot die tema en relevante navorsingsmateriaal en artikels is gebruik. Riglyne is bespreek en geformuleer. Lincoln en Guba se maatreëls om vertrouenswaardigheid te verseker is gebruik. Twee hooftemas is geïdentifiseer, naamlik dat 'n terapeutiese verhouding met die vroedvrou ontwikkel het en dat die vroue onrealistiese verwagtinge rondom die geboorteproses gekoester het. Hierdie twee temas is verder onderverdeel in sub-temas wat bespreek word in terme van die navorsingsbevindinge. Hierdie bevindinge is met 'n literatuurkontrole geverifieer. Alle inligting is ondersteun met direkte aanhalings wat gedurende die onderhoude verkry is. Die navorser het bevind dat die vroue wat onder toesig van 'n privaat vroedvrou gekraam het, 'n baie positiewe belewenis gehad het. Hulle het gevoel dat hulle in beheer van die geboorteproses was, dat die vroedvrou in die agtergrond gebly het en dat hulle veilig gevoel het. Dit het hulle in staat gestel om te onstpan en die geboorteproses te geniet. Hulle het geen gejaagdheid ervaar nie aangesien 'n terapeutiese verhouding tussen die moeder en die vroedvrou ontwikkel het. Die vroedvrou het op die vrou as 'n individu gefokus en het binding met die gesin as 'n eenheid bevorder.

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/content/health/10/3/EJC34971
2005-09-01
2017-05-23

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