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dissertation (3)


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Dissertation
Perspectives on maternity care in Belgium : a hermeneutic study.

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Dissertation
Caesarean section on maternal request in Flanders: understanding the determinants of women’s decision-making process

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Objective – To fully understand and address the phenomenon of caesarean section on maternal request, it is import to understand exactly how the decision is made. This study attempts to unravel determinants of the decision-making process from women’s point of view. Design – A descriptive phenomenological study was conducted using semi-structured face-to-face interviews. Setting – The study population consists of women with a preference for caesarean section on maternal request from Flanders, Belgium. Women were recruited through an online advertisement, both on social media network Facebook as well as on Belgian/Dutch online pregnancy forums. Participants – Purposive sample of ten women with a distinct preference for caesarean section on maternal request who are currently pregnant or gave birth in the last five years, were interviewed. Findings – A total of seven determinants were discovered, which can be divided into intrinsic and extrinsic determinants. Intrinsic determinants were beliefs, emotions, experiences and needs. Extrinsic determinants were supportive relationships, birth stories and social judgement. Intrinsic determinants dominated the women’s stories. Key conclusions – Decision making for caesarean section without medical indications as preferred mode of delivery contains both affective and cognitive elements. In particular fear, traumatic experiences and deviant risk perceptions are decisive for women’s decision-making process. Overall, the request for a caesarean section can be understood as wish for a positive birth experience. Implications for practice – There is a need for more adequate patient-physician communication and prenatal provision of information to all women and women with negative previous experiences in particular.

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Dissertation
Midwives' views on intramural implementation of Midwife Led Care in Flanders: a qualitative study
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Year: 2014 Publisher: Leuven : K.U. Leuven. Faculteit Geneeskunde

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Objective: to explore the views of midwives on intramural implementation of Midwife Led Care (MLC) in Flanders. Design: a qualitative, descriptive, phenomenological study based on the method of Giorgi using individual in-depth semi-structured interviews to gather data.Setting: Three non-university hospitals in two of the five provinces of Flanders, Belgium, were included in this study.Participants: 11 Flemish midwives working in the hospital were purposively sampled. Measurements and findings: According to the three sub-questions, different themes and subthemes were introduced by the participants. Knowledge of MLC among Flemish midwives was limited. MLC itself was viewed as the most important possible facilitator for intramural implementation of MLC. Obstetricians, education and funding were viewed as the most important possible impediments for intramural implementation of MLC.Key conclusions: The Flemish midwife who practices in hospital is not familiar with the MLC model, but is keen to implement a model which is woman centred and focuses more on the normality of childbirth with less unnecessary medical interventions. However, midwives are sceptical about the possibility for implementation of intramural implementation of MLC in Flanders.Implications for practice: Further research is needed to explore the feasibility of intramural MLC in Flanders.

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