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Similar to trends in midwifery and obstetrics teaching.pptx
trends in midwifery and obstetrics teaching.pptx
- 2. TRENDS IN MIDWIFRYAND OBSTETRICS
- 3. MIDWIFERY :- • Midwiferyis the art and science of caring for women undergoing normal pregnancy labor and the period following childbirth .Midwifery is a health care profession which believes in providing care to childbearing woman during pregnancy. labor and birth not only this but even during the postpartum period OBSTETRICS :- It is the branch of medicine that deal with the care of women during pregnancy, childbirth and the reproductive period following delivery .
- 4. The maternal healthprogramme which is a component of reproductive and child health programme aims at reducing maternal mortality to less than 100 by the 2010. The major interventions include: 1. Essential obstetric care. 2. Emergency obstetric care. 3. 24 hrs. delivery services at PHCs/CHCs. 4. Referral transport. 5. Safe abortion services. 6. The Medical Termination of Pregnancy Act, 1971
- 6. Delivery at homeby an untrained woman in the second half of 20th century when parturition moved into the hospital setting. priority to the situation’s procedures and practices, relegating the personal needs of the mother and her newborn to second place. The mother and newborn remained isolated from the family for a week to 10 days
- 7. Nursing was separatedinto three subspecialties One nurse caring for the mother during labor and delivery, Handling postpartum mothers A third caring for the baby in the nursery.
- 8. Rooming in • By1940s, the 'rooming in' concept was advised. • Full-term infants were placed in a crib at their mothers' bedsides. • A reduction in neonatal infection from cross contamination, increased confidence and independence for the mother and greater breastfeeding success. • The infant show better weight gain and cried less. • Accepting full responsibility for the baby's care.
- 9. new mothers experiencethree psychological phases taking-in taking-hold letting-go New mothers are passive and dependent, requiring rest and supportive nursing care to promote bonding and attachment. With rooming in, the mother lacked that supportive care. • The mother is ready to learn mothering skills. • Lasts about 10 days. She establishes maternal role patterns and incorporates those changes into her personal and family life which was almost much neglected.
- 10. • In the1960s, the focus changed from the person giving care to the recipient of that care. • Terminology and obstetrical care became maternity care • The broadened scope includes both prenatal and postnatal care and promotes the health and well-being of the mother, the newborn and the entire family.
- 11. The World HealthOrganization (WHO) offers this definition of maternity care- "The object of maternity care is to ensure that every expectant and nursing mother maintains good health, learns the art of childcare, has a normal delivery and bears healthy children. Maternity care in the narrower sense consists of the care of the pregnant woman, her safe delivery, her postnatal examination and the care of her newly born infant, and the maintenance of lactation.
- 12. Trends IN MIDWIFERYAND OBSTETRICS
- 13. Increasing number ofworking women teenage pregnancies At both ends of the spectrum, increased risks of complications during pregnancy preterm delivery, low-birth-weight babies: maternal, fetal neonatal and postnatal mortality. Compounding the risks to themselves and the fetus of exposure to toxic chemicals, excessive noise and other workplace stress. ChangingPatterns of Childbirth and their Effects on Maternal-infant MortalityStatistics
- 14. Perinatal Risk Factors Theproblems of society are reflected in the risks to today's neonates. Acquired immunodeficiency syndrome (AIDS) in mothers and newborns and birth defects resulting from sexually transmitted diseases (STD). Low- birth-weight babies account for about 30%-40% of live births in developing countries. Preterm babies constitute two thirds of the low-birth-weight babies. Risk factors of low-birth- weight infants include the mother's medical history during past pregnancies, socio- economic status, education level and the presence or absence of prenatal care. STD can result in infant death or in a baby born with pneumonia, cerebral palsy, epilepsy. deafness, blindness or mental retardation.
- 15. Technological Advances Revolutionized thediagnosis and treatment Increasingly sophisticated computers necessary for nursing personnel to become thorough in the procedures and protocols discourage the 'hands-on care of the client Fetal monitoring has progressed from the use of the fetoscope to electronic fetal monitors 'Indirect' methods of EFM include ultra- sound, phonocardiography and abdominal fetal electrocardiography. 'Direct' (internal) fetal monitoring with a spiral electrode attached to the baby's scalp. Telemetry
- 18. • Experts predictthat in the coming years births that are even more normal would utilize 'hi tech' result of lowering perinatal mortality and morbidity. • Risk assessment and genetic counseling may begin well- before pregnancy. • Fetal assessment tools will become more sophisticated and new corrective techniques will become increasingly available including in utero surgical correction and medical management of defects, direct fetal blood transfusion and drug injection and genetic diagnosis. • The challenges for nurses will be enormous as they will have to provide humanistic, family-oriented care in a world of high technology.
- 19. •a) Fertility concern •b)Genetic counselling •c) Diagnostic testing
- 21. Decreased Lengthof HospitalStay Our grandmothers' endured a 'confinement' of 2 weeks following childbirth. By the time our mothers' had their babies, the average postpartum hospital stay had declined to 1 week. As health care becomes increasingly ambulatory-dominant, today's new mother is up and out of the hospital or health center in 2 or 3 days. Early discharge poses a challenge to the nurse, who must provide nursing interventions during a brief time frame and disseminate information, reinforce learning and affirm the mother's role in
- 22. Higher Patient Acuities •lack of knowledge about prenatal care • increasing number of women who have neglected their health during pregnancy. • Many have anaemia, hypertension, chronic diseases and STDs. Large numbers go into premature labour, delivering at risk low-birth-weight babies.
- 23. Lack of Facilitiesin the Rural Areas About 30% of all births in India are conducted by trained dais (birth attendants), who lack scientific education. This results in lack of detection of pre natal problems early enough for adequate management, lack of facilities to deal with childbirth complications and inadequate reporting of morbidity.
- 24. Changes in MaternalNewborn Nursing Social, economic, political and technological factors have contributed . The focus is now on childbirth as a familial process with less technical interference, greater humanism and a reaffirmation of the natural birth process. In addition, recognition of the importance of mother-baby bonding in the 1st hours and days of the new-born's life has led to the encouragement of maximal mother infant contact.
- 25. Family-centered Care • Thefamily centered approach assumes that family is the basic unit of society and should be viewed as a total unit with consideration given to each member. • The emphasis is on the delivery of professional health care that fosters family unity, while maintaining the physical safety of the childbearing unit-the mother, father and the infant. • The nurse attends, educates and counsels all age groups. • Integration and bonding take high priority and much anticipatory counselling is offered. • In family-centered care, the nursery and postpartum staffs are combined to form one mother-baby unit.
- 26. Labor, Delivery, Recoveryand Postpartum Care • Labour, delivery, recovery and postpartum care (LDRP) also called single room maternity care, was devised as a replacement for traditional maternity unit. • In it, the woman labors, delivers and recovers in the same room, in the same bed and in most cases, the baby remains with the mother during her stay. • The LDRP physical setup is generally circular with single birthing rooms surrounding a central area that contains all the equipment necessary for routine or emergency care. • From the time of mother's admission until her discharge, a primary care nurse is assigned to the family.
- 27. Mother-baby Couplet Care Coupletcare also known as dyad care is a system in which one- nurse cares for the postpartum mother and her newborn as single unit. It focuses and adapts to both the physical and psychosocial needs of the mother, the family and the neonate and fosters family unity. Nurses help both parents to assume responsibility for their baby's care and assess the family's adaptation and attachment. This system facilitates parental infant attachment, neonatal transition, lactation and involution, while supporting the taking-in and taking-hold phases of the postpartum period.
- 28. RESEARCH: The incorporation ofresearch finding into practice is essential to develop a science based practice . identify problem and read research literature to identify studies that address their clinical concerns . develop procedure and protocols based on published research . Health care providers need to support researchers in their works e.g. they can participate in research as data collectors.
- 29. Others Delayed umbilical cordclamping after birth Waiting anywhere from 30 seconds to a few minutes to clamp and cut the umbilical cord instead of immediately following delivery. By delaying cord clamping, baby will get additional blood from mom, which contains oxygen-carrying iron stores. Although this is something that many midwives and doctors have been doing for a long time, it isn't universally practiced. ACOG has recently recommended that in healthy infants, cord clamping should be delayed at least 30-60 seconds.
- 30. Laboring in water(WaterBirth) • Immersion in water can help decrease the need for an epidural or other pain medications in women with healthy, uncomplicated pregnancies. • However, once it's time to begin pushing it's best to get out of the tub because delivering baby in the water hasn't been well studied and there have been reports of serious complications. •
- 31. Cell-free DNA geneticscreening Cell-free DNA screening is the newest way to screen for genetic problems in the baby. This is a simple blood test that can detect pieces of the baby's DNA in mom's blood to determine if there may be a problem with the pregnancy.
- 32. Immediate postpartum IUDinsertion • . An IUD is one of the most reliable methods of birth control available. • In the past, you would need to return to the office a few weeks postpartum to get an IUD. • However now, immediately following birth, an IUD can be inserted, eliminating the need for an extra visit and an extra procedure.
- 33. Limiting interventions duringlow-risk labor Physicians have gotten a bad reputation for unnecessary interventions during labor and delivery. While there are definitely times that interventions are needed for a safe delivery, limiting unnecessary interventions can also be beneficial. • They are encouraging the use of doulas, changing positions during labor, intermittent monitoring and non-pharmacologic methods of pain control in conjunction with women's birth plans.
- 34. ROLE OF NURSEIN MIDWIFERY AND OBSTETRICAL CARE