Browsing by Author "Clow, Sheila"

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    Breastfeeding intentions and practices of women in Plateau State, Nigeria : a cross-sectional study of women attending antenatal clinics in selected hospitals
    (2014) Emmanuel, Andy; Clow, Sheila
    Breastfeeding exclusively for the first 6 months of a child’s life, and subsequently continuing to breastfeed until the child is 2 years old, potentially reduces maternal and child morbidity and mortality and has numerous benefits for mother and child. Infant feeding practices can change within a short period due to several modifiable factors. Underpinned by the Health Belief Model, this study attempted to identify the breastfeeding practices of women and the factors that influence these practices. The study also assessed mothers’ intentions to breastfeed the baby/infant following delivery of the current pregnancy.
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    The childbirth experiences of adolescent mothers in the Western Cape
    (2016) Füzy, Elizabeth; Clow, Sheila; Fouché, Nicola
    Objective: The objective of this study was to explore the lived childbirth experiences of middle adolescent mothers between 14 and 16 years of age. Methodology: A qualitative design was followed, using Husserl's phenomenological approach. Information was gathered by semi-structured conversations. Identified themes and sub-themes (Colaizzi's steps) were presented to participants for authentication during follow-up conversations. Study Setting: Two hospitals in the Cape Town Metropolitan area, Western Cape, South Africa. Participants: Six adolescent girls between the ages of 14 and 16 years of age who had normal vaginal births of healthy, term infants. Findings: An over-arching theme of preservation of personhood was identified. Themes and sub-themes were derived according to three Husserlian phenomenological concepts. Within these concepts three essential themes emerged from the conversations: i) essences: physically underdeveloped and emotionally unprepared for childbirth, ii) intentionality and consciousness: an unsettled state of mind during childbirth, and iii) life-world: feeling physically and emotionally overwhelmed by the experience. Conclusion: The participants highly valued the presence of a support person; they indicated that their mothers were their first choice. Friendly, helpful, respectful and non-judgmental care from nurses and midwives were associated with more positive birth experiences while humiliation, victimisation and rudeness were associated with negative birth experiences. Implications for adolescent-friendly practice: A condensed form of antenatal education is needed together with adolescent-friendly health care services to ensure better preparedness and experiences. Shared-decision making regarding certain aspects of childbirth is necessary. Continuous labour support is an important coping strategy and pain management is vital. Additional training is needed to address midwives' attitudes. Quality assessment tools are needed to address the mistreatment of maternity patients in health care facilities.
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    Development of Woman-Centred Midwife-led Model of Care through Participatory Methods for the Uasin Gishu County Hospital, Kenya
    (2020) Rotich, Everlyne Chepkemoi; Coetzee, Minette; Clow, Sheila
    Background: The concept woman-centred care is gaining currency in maternity care and is increasingly being used to guide provision of quality care. The midwifery philosophy supports woman-centred care and is associated with positive pregnancy and birth outcomes. Development of a woman-centred midwife-led model of care requires involvement of the users (women), service providers (midwives), and health administrators to ensure representativeness of the model. Purpose: The purpose of this study was to explore, through participatory methods, the views of women midwives and health service managers on current maternity care, and describe desired maternity care and develop a woman-centred maternity care model for Uasin Gishu County, Kenya. Methodology: Appreciative Inquiry 4-D cycle was used in the study. The Human Scale Development framework guided the study. Thirty two midwives, 85 women attending maternity and well-baby services at the facility, and four facility and three county health service managers participated in the study. Focus group discussions and interviews were carried out from May 2015 to April 2016 using the four phases of the Appreciative Inquiry cycle. Phase one “discovered” what best maternity care looks like, phase two “dreamt” what best maternity care would look like, phase three “designed” the model, and phase four “destiny” was used for development of implementation strategies. Data was analysed using thematic analysis augmented by thematic networks analysis and NVIVO 11 software. Ethical approval was obtained from the University of Cape Town and the Moi University and Moi Teaching and Referral Hospital Research Ethics Committees. Individual's participation was voluntary, informed consent was obtained and confidentiality maintained. There was no compensation for participation.
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    Enhancing the role of nurses in substance abuse intervention : a study of nurses and nursing lecturers in the Western Cape
    (2000) Sheard, Denise; Clow, Sheila; Flisher, Alan J
    Bibliography: leaves 134-158.
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    Infant feeding practices among women who gave birth at a baby friendly hospital in northern Malawi
    (2008) Kamwana, Mary Tinkhani; Clow, Sheila
    The aim of this study was to describe infant feeding practices (behaviours) and their determinants among mothers with children aged from birth to 1 year who had given birth at a designated baby friendly hospital in nothern Malawi.
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    The lived experience of migrating women spouses : a phenomenological study
    (2006) Lindhardt, Christina Louise; Clow, Sheila
    Migration has become more common as globalisation has required more and more people to be transferred to countries other than their own for short or long term placements. Numerous women experience migration due to their husbands being transferred, yet the literature does not reveal much about how women adapt to their new situation as migrating women. If there are implications of this phenomenon for health, little research has been done to describe this. The aim of this study was to explore the lived experiences of women who have migrated as expatriates. The study aimed to ascertain if there were health effects as a reult of migration and how these are understood and experienced.
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    Non-elective caesarean sections in the Khomas Region, Namibia: implications for midwifery practice
    (2014) Shikwambi, Hilma Inoukapo Taukondjele; Clow, Sheila; Fawcus, Susan R
    Women who undergo caesarean section (CS) are likely to have a repeat CS in a subsequent pregnancy, thus increasing the CS rate in the country, which is not ideal in a resource constrained setting. The occurrence of high maternal mortality among women who have nonelective CS is usually due to indications for prior CS such as fetal distress, obstructed labour and eclampsia. In developing countries, there is a high rate of maternal deaths associated with major operative complications. This study was a retrospective, descriptive quantitative, clinical audit. The purpose was to identify the reasons for non-elective CS in two hospitals namely, the Windhoek Central hospital and Intermediate Katutura hospital, and the implications for Midwifery clinical practice. The research question was: What are the indications and intrapartum care factors for non-elective CS in the two hospitals, and what are the implications for Midwifery practice? The population consisted of records of women who had given birth by CS between 1st January 2012 and 30th June 2012 in the two hospitals. All available records of women who had non-elective CS during the study period were reviewed. Data was collected with individual data collection sheets and analysed using Statistica 11 software. A total of 838 records were reviewed. The CS rate was 1264/5296 (23.9%), the rate of nonelective CSs was 912/5296 (17.2%), and the proportion of non-elective CS was 912/1264 (72.2%). A total of 171/838 (20.4%) women were HIV positive. Seventy per cent (634/838) women had a CS for the first time, of which 290/634 (45.7%) were multigravida. Records were grouped according to Robson’s classification, a mutually exclusive and totally inclusive classification of CS. The Robson group making the largest contribution was nulliparous women with a single cephalic pregnancy, at greater than or equal to 37 weeks gestation in spontaneous labour (group 1) with 213/838=25.4%. Problems with the progress of labour were the most common reason why women had non-elective CSs during the study period. The study findings highlighted a high number of primary CS in low risk women with poor assessment of maternal wellbeing and progress of labour. Limited documentation of Midwifery intervention and care was noted suggesting inadequate Midwifery care. Training is required to render evidence based care.
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    The experiences of expatriate mothers regarding pregnancy, childbirth and motherhood in the host city Cape Town, South Africa
    (University of Cape Town, 2020) Penduka, Annaloice; Clow, Sheila; Fouché, Nicola A
    The study explored the experiences of expatriate mothers' pregnancy, childbirth and motherhood in a host city. This included identifying how expatriate mothers access public healthcare, and adapt to motherhood in a host country in a subsequent pregnancy. These expatriate mothers had previously experienced childbirth in their country of origin. A descriptive qualitative approach was utilised as it describes individuals' lived experiences. Purposive sampling was chosen and I had an in-depth conversation with nine expatriate mothers. Thematic analysis was used to identify themes and sub-themes. Findings: The participants established that antenatal care was easily accessible. Mothers were confronted with a lack of respectful care in labour wards. They also had personal challenges. This all led to the development of the four themes. These are: expatriate mothers' need for support; organised antenatal healthcare; high cost of living; as well as labour and childbirth challenges in Cape Town (public healthcare). These revealed mothers need support to manage motherhood in a different setting. Further, the expatriate mothers rely on their husbands as their main support in the host city. Recommendations: An emphasis on teaching of respectful maternity care in midwifery is needed, the availability of more and highly skilled and caring midwives and the need for support groups for expatriate mothers.
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    The mixed experiences of pregnant women with physical disabilities in accessing and utilising antenatal care services in rural south-western Uganda
    (2023) Nuwagaba, Ponsiano Kabakyenga; Clow, Sheila; Lorenzo, Theresa
    Background: In low- and middle-income countries, several environmental barriers impede accessibility to antenatal care (ANC) services for women with disabilities, yet ANC is a critical entry point for pregnant women to receive quality maternity care services. These barriers are more pronounced in rural areas than urban areas in Uganda. Although the World Health Organisation recommends that ANC services should be designed and continually improved based on locally generated data to address access barriers, the experiences of rural pregnant women with physical disabilities are largely undocumented. Aim: This study aimed to investigate the experiences of pregnant women with physical disabilities in accessing and utilising ANC services and suggest strategies for improving the services in rural south-western Uganda. Objectives: The study sought to: - describe the accessibility of ANC services - explain the utilisation of ANC services - explore the relationship between women with physical disabilities and health care providers - explore how women with physical disabilities and midwives understand disability and the provision of ANC services in rural south-western Uganda Methods: An interpretive qualitative study using a multiple case study design was conducted. Twelve women with physical disabilities and six midwives from three health facilities in Sheema district in south-western Uganda, East Africa, were selected as study participants. Women were sampled using snowball sampling. Midwives and health facilities (health centre III, health centre IV and general hospital) were sampled using purposive sampling. Data was gathered through in-depth face-to-face interviews with the women and midwives, a focus group discussion with the women, and direct observation of the physical environment at the three health facilities, from November 2020 to January 2021. Data was transcribed, translated, and thematically analysed with support of NVivo software. Ethical approval was obtained from University of Cape Town and Uganda National Council of Science and Technology, including a Risk Management Plan for preventing the transmission of Covid-19. Findings: Four themes were generated: 1. ‘Optimising wellbeing' was shaped by exercising agency, accessing family and community support, and aligning policy and practice. 2. ‘Undermining wellbeing' involved ignorance and mental ill-health (including emotional and spiritual oppression), sociocultural prohibitions, and inaccessible transport and mobility systems. 3. ‘Unresponsive ANC policy to women's specific needs' included the integrated nature of ANC services, unresponsive ANC policy, and unaccommodating health facility designs. 4. ‘Improving quality of ANC services' related to women's mixed experiences, preparing midwives and other health workers through education, training, and mentoring, and enabling disability inclusion for fit-for-purpose ANC services. Conclusion: Despite a few enablers optimising their wellbeing, rural pregnant women with physical disabilities experience many barriers that negatively impact on their pregnancy experiences and pregnancy health care. Women's spirituality is integral to their wellbeing. Justice, equity, and respect for their human dignity need to be underscored in ANC policy, health system and infrastructure planning, and midwifery education, training, and practice. The establishment of accessible quality ANC services within under-served areas benefits all women. The spirit of Ubuntu, which may facilitate women's participation and functioning at the family, community, and health facility levels, cannot be overemphasised. Going forward: An integrated framework for disability inclusive family- and communityfocused ANC services for rural communities is proposed. This framework needs to be tested to determine its efficacy in other rural African settings. A further study to explore the effectiveness of maternity waiting homes from the perspective of women with physical disabilities and the community in the context of rural Ugandan setting is suggested.
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    "Why I stayed when others left": an appreciative inquiry of retention in the prevention of mother to child transmission of HIV in Takoradi Government Hospital, Ghana
    (2018) Abraham, Susanna Aba; Clow, Sheila
    Globally, great strides have been made in developing essential strategies and knowledge necessary to prevent vertical transmission of HIV. Retention in the Prevention of Mother to Child Transmission (PMTCT) programme is essential for the achievement of this aspiration. The study applied Mixed Method Sequential Explanatory Design to explore the factors that underscored the retention decisions of newly diagnosed HIV positive pregnant women. The study was set in the PMTCT programme in the Takoradi Government Hospital, Ghana, a lower middle income country. PMTCT records were retrospectively reviewed. Subsequently, the Appreciative Inquiry process using the 4Is terminology was applied to unearth the experiences and aspirations of mothers (n=12), midwives and Community health nurses (CHNs) (n=12) engaged in the programme. Ethical approval was granted by University of Cape Town Faculty of Health Sciences Human Ethics Research Committee and Ghana Health Service Ethics Review Committee. Retention rate at six weeks postpartum was 67.4%. Retention stories of women enrolled in the PMTCT programme reflected a life-enhancing experience in the face of a life-threatening diagnosis. Four themes were generated: Transitioning to the ‘new’ woman, Journeying with committed companions, Glimpses of triumph and Tying up the loose ends: A daring new path. The study highlighted development of hope in a seemingly hopeless situation, supportive network of family, healthcare professionals and religious leaders, and the commitment and companionship of the midwives and CHNs that culminated in the successes of the programme. ‘Healthy’ HIV-infected mothers and ‘exposed’ infants who tested negative to HIV at the end of the mother-infant pair’s journey in the PMTCT programme was evidence of the diligence of mothers, midwives and CHNs. A collaborative discussion resulted in the development of action plans to improve service delivery, enhance clients’ experiences and improve retention. The study recommends that PMTCT services should be structured to promote hope and empowerment for the clients through shared clients and healthcare professionals’ designed improvement programmes, instituting programmes that promote the emotional health of the health practitioners to sustain the programme, and promptly addressing health system challenges that contribute to disengagement.