Interventions during the second stage of labour: an exploration of what may affect their use in Jeddah, Saudi Arabia
This thesis is an exploratory qualitative study using an ethnographic approach to explore the use of interventions during the second stage of labour among healthcare professionals and what may be influencing their use within two large government hospitals in Jeddah, Saudi Arabia. Data collection methods included participant observations of 19 labours and births and semi-structured interviews with 29 healthcare professionals comprising obstetricians [n=10], midwives [n=12], nurses [n=6] and nurse-midwife [n=1]. In addition, the hospital labour and delivery ward policies and guidelines from those hospitals were collected. Data collection took place over a two-month period in 2011 at King’s Hospital, and a two month period in 2012 at City Hospital (pseudonyms), after seeking ethical approval from City University and from each of the hospitals involved in the study. All participant observations, interviews, field notes (diary), and hospital documentation was recorded using a word processing package (Word 2010) and then transferred into qualitative data analysis software (QDAS) (Atlas.ti 7) which was used for organising and coding interviews transcripts, observations field notes and hospital policy documents. The findings from this PhD confirm that the influences on use of interventions during childbirth are complex. The findings revealed a number of rationalisations that professionals give for the many interventions used during labour and birth. Primary interventions used routinely included continuous Electronic Foetal Monitoring (EFM), bladder catheterisation, intravenous infusion, denial of companionship, episiotomy practice, lithotomy position, limitations on mobility and on duration of second stage of labour, directed pushing. Rates of instrumental delivery and Caesarean section were increasing. Thematic analysis of the data identified two core and inter-related explanatory themes in relation to the use of interventions observed during the second stage of labour in Jeddah: ways of seeing childbirth and power. The findings demonstrate the influence of a hierarchical system of control, the impact of the medical model, and the role of power in medical surveillance and fear culture on the use of interventions during the second stage of labour.
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