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One young woman, who had just given birth to her first baby two months ago, shared her experience and described:. Our findings also revealed that the discussants had mixed perceptions and experiences regarding the responsible midwife during delivery. Some women agreed that the midwife had been helpful and supportive during the whole delivery period. A young woman with two children shared her positive experience and said:. On the other hand, other discussants shared negative experiences with midwives during labor. A mother of one child said:.

Most of the participating women had attended public postnatal clinics a week after giving birth to carry out certain tests, including lab tests, for their baby. Sometimes, I might even take him to more than one doctor to make sure he receives the correct diagnosis.

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They also reported not trusting the available postnatal care services. The women perceived postnatal care services in the public sector to be better than antenatal care services. They are better than what I received during my pregnancy. However, some women still preferred seeking private clinics for PNC services. They were willing to pay the extra costs, as they could then expect to receive superior care.

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Finally, discussants strongly believed that the lack of coordination between ANC, intrapartum care, and PNC services is one of the main factors which may negatively impact the health of women and newborns. The content analysis of the FGDs revealed that all of the discussant women acknowledged the importance of both ANC and PNC services in ensuring the health and safety of women during pregnancy and of newborns during and after delivery. Hence, they perceive maternal and child care services as being unimportant [ 34 , 37 , 38 ]. Several reasons for seeking antenatal care services were discussed by the participants.

These reasons included monitoring fetal development and detecting fetal anomalies, receiving comprehensive care and follow-up sessions, carrying out lab tests, receiving medications and multivitamins, and avoiding pregnancy complications such as gestational diabetes and preeclampsia. According to the WHO, ANC provides a platform for many important interventions and healthcare functions, including counseling for a healthy lifestyle, screening and diagnosis, and prevention of disease [ 8 ].

There is robust evidence that adopting timely and appropriate evidence-based ANC practices reduces maternal mortality and improves newborn health outcomes [ 8 , 12 , 39 , 40 , 41 ]. Empirical evidence from developing countries, including Jordan, has shed light on the influence of socio-economic, demographic, residential, and cultural factors on the utilization of maternal-fetal and child healthcare services.

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Educated women and women of high economic status are more likely to utilize ANC services than uneducated women or women of low economic status [ 42 , 43 , 44 , 45 ]. A positive correlation has been found between the percentage of Jordanian women who attend a minimum of seven ANC visits and household income. Meanwhile, insignificant differences in the use of ANC services have been found among Jordanian women from urban areas and women from rural areas [ 20 ]. As with regards to the utilization of PNC services, health status, mode of delivery, level of education, number of children, awareness of need, cost, and distance have been found to be the most common predictors [ 46 , 47 , 48 ].

Similarly, a positive correlation between maternal mortality and distance to hospital was observed [ 51 , 52 ]. However, no effect of distance to hospital was shown on indirect maternal or pregnancy-related mortality, suggesting a lack in the quality of care received [ 52 ]. There was some disagreement among the discussants on the difference in competency levels between healthcare workers in private facilities and those in public facilities.

However, many of the participating women stated that they preferred to seek ANC services in private sector clinics rather than public sector facilities for several reasons.

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Some of the reported reasons included longer consultation time, higher quality services, better interpersonal and communication skills of the healthcare providers, more advanced equipment and devices, constant availability of female doctors, and more flexible appointment times. These reasons discouraged many of the women from seeking public hospitals unless they were during the final month of pregnancy. Similarly, a qualitative study by Titaley et al. Other studies conducted in developing countries showed that private health facilities are preferred to public facilities due to several reasons, including more approachable and more helpful staff, easier access, well-equipped clinics with modern equipment and devices, and more professional healthcare providers who treat patients with respect and in a friendly manner.

The only negative issue found to be associated with private clinics was the high cost of services as compared to the free cost of public facilities [ 53 , 54 ].

Pregnancy calendar

The participating women perceived public hospital health services to be necessary only in the case of pregnancy-related complications, as they provide comprehensive care. Not all women can afford to give birth to their babies in private hospitals, and so many women choose to receive ANC at a private clinic but give birth in a public facility.

This can significantly impact the continuum of services and can increase the fragmentation in care. Medical insurance status and financial concerns were found to influence the utilization and continuity of maternal, neonatal, and child public care services [ 34 , 55 ]. The women reported seeking postnatal facilities only to receive contraceptives or in cases of serious health conditions. However, PNC is important as it is an opportunity to identify any complications after delivery and to provide preventive services.

Such services include the provision of family planning advice to avoid pregnancy soon after giving birth and improve the health and survival of both the mother and her child [ 10 , 56 , 57 ]. In line with the study findings, previous research has also found that, despite the perceived importance of postnatal care, these services usually target the newborn and pay little attention to the mother, unless there is a serious condition related to maternal complications [ 35 ].

Thus, more efforts need to be exerted to communicate the potential benefits of PNC more effectively.

Despite the importance of the postpartum period as a transitional time for the mother, the baby, and the whole family, it is, unfortunately, the most neglected period in terms of maternal care services [ 56 ]. According to the latest national survey — , Nonetheless, there is a lack of evidence on the utilization patterns and predictors of full PNC services in Jordan and other Arab countries.

In a systematic review by Jongh et al. This also implies sustained fragmentation of the continuum of maternal and child healthcare services [ 63 ]. There was a consensus among the participating women that, in the public sector, the quality of postnatal care is better than the quality of antenatal care. Despite this, the women preferred receiving post-delivery care in private clinics rather than in public settings.

Space limitations and staff shortages were among the perceived barriers to the provision of private and confidential maternal care in public sector facilities, as women usually have to sit together and take turns in receiving health services. This makes it difficult for a woman or her partner to discuss any personal concerns or vulnerable issues with the doctor without being overheard [ 64 ]. The women believed that discontinuity and poor quality of maternal and child care could lead to maternal mortality and perinatal death.

Bhutta et al. Another study which analyzed data from DHS surveys conducted in 20 countries in Africa found a large gap between the number of visits contacts and the interventions received by mothers and newborns during these visits content. This gap was seen as a proxy of the quality of care provided during antenatal, intrapartum, and postnatal periods in all of the 20 countries [ 65 ]. Continuity of healthcare is one of the main principles of healthcare systems and is considered as an effective health strategy to improve maternal and child health services [ 66 , 67 , 68 ].

Yet, it has not been adequately implemented and studied in LMIC [ 68 , 69 , 70 ]. Management continuity is critically important in managing chronic or complex clinical conditions that require multidisciplinary health providers [ 74 ]. Maternity care services in Jordan have proved to be fragmented, with poor communication between private and public healthcare providers. Furthermore, poor continuity between antenatal care settings and intrapartum and postpartum settings has been noted. In order to establish a maternal system of COC, several approaches and strategies have been implemented successfully in different countries.

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The midwife-led continuity MLC model is one of the promising strategies that could improve the utilization and quality of healthcare services for mothers and newborns [ 78 , 79 , 80 ]. In the MLC model, a known and trusted midwife, or small group of midwives, supports and helps the woman during pregnancy, delivery, and the postnatal period to enable a healthy pregnancy and childbirth and appropriate parenting practices [ 8 , 79 ].

However, in reorganizing existing maternal care services in order to implement the MLC model, ensuring the availability of competent, autonomous, skilled, and knowledgeable midwives is critical for the success of this model [ 80 ]. This leads us to emphasize the importance of enhancing inter-professional collaboration and the improving communication between all maternity care providers at different levels and in different settings [ 75 ]. The MLC approach has been implemented successfully in several countries around the world both developed and developing.

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In , Palestine implemented a new MLC model, and a recent study which evaluated this model showed that the number of antenatal and postnatal visits per woman have increased significantly. PNC visits for mothers and newborns, including home visits, have also increased substantially since the introduction of this new model. Some quality indicators related to facility-level outcomes have also improved, including increased continuity, better functioning referral to a higher level of care mechanisms, and increased postnatal home care visits [ 78 ].

Maternal quality of care encompasses many aspects other than the number and type of services provided. In , the WHO issued a new global guideline for the routine ANC, a guideline which emphasizes person-centered health and well-being based on a human rights approach [ 8 ]. This informs the development of an individualized approach which places the mother and her family at the center of care and aims to respond to their needs and preferences in a humane and holistic manner. A family- and woman-centered care system that keeps women and their families informed and actively involved in care and views them as participants as well as beneficiaries can encourage continuity of care and improve maternal care quality across health systems [ 80 , 82 , 83 , 84 ].

An integrated maternal health system with shared electronic medical records and mobile technology tools can also make a significant contribution to COC through the enhancement of coordination between different healthcare providers at different levels and the provision of tailored maternity services [ 85 , 86 ]. The introduction of new technology has proved to make mothers feel heard [ 87 ]. Several other models and strategies have been proposed and successfully implemented world-wide to improve the quality of maternal care. Still, every health system needs to choose a model that is best suited for its existing infrastructure, resources, and culture.

We cannot claim that there is a single or a group of models or approaches which can fit any country or health system to better meet the changing needs of women, children, and families [ 86 ]. For these reasons, inexpensive, non-traditional methods of maternal care are being proposed, such as giving each woman her own case notes. The development of innovative health promotion programs which aim to raise awareness among women and other community members about the protective role of postnatal care services is needed.

Recently, Shaban et al. This new model would best meet the needs of mothers, especially mothers who live in isolated areas and mothers who face financial and cultural barriers which prevent them from visiting maternal care facilities for PNC [ 89 ].

Pregnancy week by week- Fetal development Week 1 to 40 in mother's womb

Finally, developing the continuum of care for maternal and child health services will need effective interventions, policy support, public-health planning, strengthening of healthcare systems, and systematic efforts to overcome operational management challenges, especially human resources management [ 70 ].

The current study has several strengths. A total of 12 FGDs were conducted with women from different geographical locations in Jordan to reach a saturation of themes, thereby ensuring the quality and completeness of the findings. The focus groups were conducted in private meeting rooms in which the participating women felt safe and comfortable in sharing their experiences and views.