Die keuse van babavoedingswyse binne die MIV/VIGS-epidemie : voorligtingsimplikasies

MCur (Verloskundige en Neonatologiese Verpleegkunde), North-West University, Potchefstroom CampusApproximately one third of the women who visit the antenatal clinics in the North West Province are HIV positive. These women need to decide on the most appropriate method of feeding for their babies. As early as 1985 it was proven that HIV transmission through breast milk could take place. Although total avoidance of breast-feeding entirely rules out the risk of HIV-transmission, it is not necessarily the best choice for all women. Other factors that make it dangerous for some women and their babies to avoid breast-feeding must also be taken into consideration. These factors are the risk of infection as a result of unhygienic circumstances, the mothers' fear that she, should she act contrary to the cultural norm of breast-feeding, can be identified as HIV positive and therefore be stigmatised, and the risk of the spill-over effect if also those mothers who cannot do it safely, feed their babies with a breast milk substitute. Because the risk of HIV transmission through breast milk depends on factors such as the virus load in the mother's blood and milk, and whether the mother's and baby's skin and mucus membrane are intact or not, a HIV positive mother who breast feeds, can make adjustments to limit the risk of HIV transmission. In order to be able to make an informed decision on the most appropriate baby-feeding method, pregnant women must be empowered. In her contact with midwives and pregnant women the researcher observed that health education regarding baby-feeding normally only incidentally mentions HIV and that it appears as if the midwives themselves are uncertain as how to address the problem. The aim of this study was to explore and describe the factors that should be taken into consideration by midwives in their health education of pregnant women on HIV and baby-feeding, the perceptions of midwives and pregnant women pertaining to these factors, as well as the level of knowledge of the midwives and pregnant women regarding HIV-transmission and baby-feeding. The final aim therefore is to compile guidelines from the findings for health education by midwives to pregnant women in order to empower them to make a choice pertaining to the most appropriate baby-feeding mode. A quantitative survey design was used. Two structured questionnaires were used to do data collection. The questionnaires that were based on the literature were laid before research and subject experts, after which it was adjusted before it was applied. First of all permission was obtained from the District Manager of the Department of Health. An all-inclusive sample of midwives who work in the antenatal clinics in the Potchefstroom district of the North West Province and an availability sample of pregnant women who visit these clinics were used. Trained field-workers assisted in collecting the data in the clinics. A total of 17 midwives and 93 pregnant women took part in the study after having giving their consent. Data analysis was done by means of frequency analysis and cross-references. On the basis of the findings the conclusion was made that, although the midwives have a basic knowledge of HIV and baby-feeding, specific knowledge-gaps and confusion regarding distinct themes do exist. The aspects that the midwives do not have sufficient knowledge of are those of recent tendencies and discoveries. On the aspects final clearance has not yet been reached in the literature and through research, confusion still exists. Furthermore it has been found that the knowledge the midwives do indeed have is not efficiently conveyed to the pregnant women. According to the perceptions of the midwives and the pregnant women, they aren't sufficiently empowered by the health education to be able to make an informed decision. Recommendations subsequently were formulated for the nursing education, research and practice. The study especially focused on efficient health education by midwives that will lead to empowering pregnant women to be able to make an informed choice regarding the most appropriate baby-feeding method. These guidelines are aspects such as updating the knowledge of the midwives, the creation of a positive climate in which the health education can be presented, as well as the method of conveyance of information and its contents.Master

Die keuse van babavoedingswyse binne die MIV/VIGS-epidemie : voorligtingsimplikasies

MCur (Verloskundige en Neonatologiese Verpleegkunde), North-West University, Potchefstroom CampusApproximately one third of the women who visit the antenatal clinics in the North West Province are HIV positive. These women need to decide on the most appropriate method of feeding for their babies. As early as 1985 it was proven that HIV transmission through breast milk could take place. Although total avoidance of breast-feeding entirely rules out the risk of HIV-transmission, it is not necessarily the best choice for all women. Other factors that make it dangerous for some women and their babies to avoid breast-feeding must also be taken into consideration. These factors are the risk of infection as a result of unhygienic circumstances, the mothers' fear that she, should she act contrary to the cultural norm of breast-feeding, can be identified as HIV positive and therefore be stigmatised, and the risk of the spill-over effect if also those mothers who cannot do it safely, feed their babies with a breast milk substitute. Because the risk of HIV transmission through breast milk depends on factors such as the virus load in the mother's blood and milk, and whether the mother's and baby's skin and mucus membrane are intact or not, a HIV positive mother who breast feeds, can make adjustments to limit the risk of HIV transmission. In order to be able to make an informed decision on the most appropriate baby-feeding method, pregnant women must be empowered. In her contact with midwives and pregnant women the researcher observed that health education regarding baby-feeding normally only incidentally mentions HIV and that it appears as if the midwives themselves are uncertain as how to address the problem. The aim of this study was to explore and describe the factors that should be taken into consideration by midwives in their health education of pregnant women on HIV and baby-feeding, the perceptions of midwives and pregnant women pertaining to these factors, as well as the level of knowledge of the midwives and pregnant women regarding HIV-transmission and baby-feeding. The final aim therefore is to compile guidelines from the findings for health education by midwives to pregnant women in order to empower them to make a choice pertaining to the most appropriate baby-feeding mode. A quantitative survey design was used. Two structured questionnaires were used to do data collection. The questionnaires that were based on the literature were laid before research and subject experts, after which it was adjusted before it was applied. First of all permission was obtained from the District Manager of the Department of Health. An all-inclusive sample of midwives who work in the antenatal clinics in the Potchefstroom district of the North West Province and an availability sample of pregnant women who visit these clinics were used. Trained field-workers assisted in collecting the data in the clinics. A total of 17 midwives and 93 pregnant women took part in the study after having giving their consent. Data analysis was done by means of frequency analysis and cross-references. On the basis of the findings the conclusion was made that, although the midwives have a basic knowledge of HIV and baby-feeding, specific knowledge-gaps and confusion regarding distinct themes do exist. The aspects that the midwives do not have sufficient knowledge of are those of recent tendencies and discoveries. On the aspects final clearance has not yet been reached in the literature and through research, confusion still exists. Furthermore it has been found that the knowledge the midwives do indeed have is not efficiently conveyed to the pregnant women. According to the perceptions of the midwives and the pregnant women, they aren't sufficiently empowered by the health education to be able to make an informed decision. Recommendations subsequently were formulated for the nursing education, research and practice. The study especially focused on efficient health education by midwives that will lead to empowering pregnant women to be able to make an informed choice regarding the most appropriate baby-feeding method. These guidelines are aspects such as updating the knowledge of the midwives, the creation of a positive climate in which the health education can be presented, as well as the method of conveyance of information and its contents.Master

Outcomes of births attended by private midwives in the Gauteng Province of South Africa: A retrospective cohort study

Midwives are important role players in providing women-centred care for low-risk pregnant women.South African women use either public or private health care services during pregnancy and birth. As the public sector is overburdened, women do not receive a high level of continuity of care there. The private sector is mainly obstetrician-led and intervention-driven. Private midwife-led care is available in South Africa, but is limited to the major cities. No evidence could be found about the outcomes of private midwife-led care in South Africa.The objective reported in this paper was to compare the outcomes of and interventions during births attended by private midwives in Gauteng with the latest Cochrane review on midwife-led care.A retrospective cohort design was used to audit the birth registers of private midwives in Gauteng, focusing on outcomes and interventions as in the most recent Cochrane review on midwife-led care.The maternal and neonatal outcomes of Gauteng midwives' patients were reassuring. Compared to women in the Cochrane review, significantly more Gauteng women had an intact perineum (53.4% vs 29%), fewer had interventions such as induction of labour (9.6% vs 19.3%), but more had caesarean sections (19.3% vs 13.3%). Overall foetal loss (0.3% vs 2.7%) and NICU admissions (4.3% vs 7.1%) occurred significantly less frequently in the Gauteng sample.The study's findings indicated that private midwife-led care in Gauteng compared well with that in the rest of the world in terms of outcomes and intervention rates

Women’s experiences of continuous support during childbirth: a meta-synthesis

Abstract Background Despite the known benefits of continuous support during childbirth, the practice is still not routinely implemented in all maternity settings and women’s views and experiences might not be considered. The purpose of the study was to integrate individual studies’ findings related to women’s experiences of continuous support during childbirth in order to expand the understanding of the phenomenon. The review question was: What were the views and experiences of women regarding continuous support during childbirth as reported in studies that adopted qualitative or mixed research methods (with a qualitative component) using semi-structured, in-depth or focus group interviews or case studies? Methods A detailed search was executed on electronic data bases: EBSCOhost: Medline, CINAHL, PsychINFO, SocINDEX, OAlster, Scopus, SciELO, Science Direct, PubMED and Google Scholar, using a predetermined search strategy. Reference lists of included studies were analysed to identify possible studies that were missing from electronic data bases. Pre-determined inclusion and exclusion criteria were applied during the selection of eligible sources. After critical appraisal, a total of 12 studies were included for data-extraction and meta-synthesis. Results Two themes were identified, namely the roles and attributes of the support persons and the type of support provided. Women’s perceptions about continuous support during childbirth were influenced by the characteristics and attributes of the support person as well as the types of supportive care rendered. Women preferred someone with whom they were familiar and comfortable. Conclusion Continuous support during childbirth was valued by most women. Their perceptions were influenced by the type of support person: a health professional or a lay support person. Health care institutions should include continuous support during childbirth in their policies and guidelines

Dissemination and Enrichment of Knowledge About Normal Birth to Bring About a Change to Society

The birth of a child is a pivotal time in the life of a mother, her family and society. The health and well-being of a mother and child at birth largely determines the future health and wellness of the entire family (World Health Organization (WHO), 2005). Normal birth has enormous benefits for mothers, neonates, families, and societies. The growing supportive evidence for the promotion of normal birth certainly relies on multidisciplinary collaborations to continue spreading knowledge about the advantages of normal birth and enhancing the understanding of how knowledge about normal birth can change society. Knowledge about normal birth varies among different groups of healthcare professionals, and it would be useful to identify how it is clinically translated to become accessible to other professionals and research teams, consumers, the public, significant decision- or policy makers, the industry, funding bodies, and volunteer health teams