Introduction of midwifery – This course is designed to understand the care of pregnant women and newborn: antenatal, intra-natal and postnatal; breast feeding, family planning, newborn care and ethical issues, The aim of the course is to acquire knowledge and develop competencies regarding midwifery, complicated labour and newborn care including family planning.
Introduction of midwifery
Definition of midwife
According to Bangladesh Nursing and Midwifery council (BNMC),”a midwife is a person who has successfully completed a midwifery education program that is duly recognized in the country where it is located and that is based on the international confederation of Midwives (ICM). Essential competencies for basic midwifery practice and the framework of ICM Global standards for midwifery education; who has acquired the requisite qualifications to be registered and legally Licensed to practice midwifery and use title “Midwife”; and who demonstrates competency in the practice of midwifery.
or
A midwife is a professional in midwifery, specializing in pregnancy, childbirth, postpartum, women’s sexual and reproductive health (including annual gynecological exams, family planning, menopausal care and others), and newborn care.
or
A midwife plays a critical role in the healthcare sector. They play the role of supporting a mother with a newborn child. The midwives assist with breastfeeding and taking care of the delicate child in this critical period. Effectively the midwife is a specialized nurse who has trained to care A for young children. The role of the midwife is most essential in the first six weeks of the child’s life. The midwife serves as a useful substitute on occasions when the mother needs some rest.
or
A midwife is a health care professional who provides an array of health care services for women including gynecological examinations,in contraceptive counseling, prescriptions, and labor and delivery care Providing expert care during labor and delivery, and after birth is a specialty that makes midwives unique.
Definition of nurse midwife:
A registered nurse with additional training as a midwife who is certified to deliver infants and provide prenatal and postpartum care, newborn care, and some routine care (as gynecological exams) of women
or
A nurse skilled in assisting women in the prenatal period and inchildbirth, especially at home or i n another nonhospital setting.
Definition of midwifery
Midwifery, as known as obstetrics, is a health science and health profession that deals with pregnancy, childbirth, and the postpartum period (including care of the newborn), besides sexual and reproductive health of women throughout their lives!
or
Midwifery refers “a person (typically a woman) trained to assist a woman during childbirth.
Concept of midwifery:
According to World Health Organization (WHO):
Midwifery encompasses care of women during pregnancy, labour, and the postpartum period, as well as care of the newborn. It includes measures aimed at preventing health problems in pregnancy, the detection of abnormal conditions, the procurement of medical assistance when necessary, and the execution of emergency measures in the absence of medical help.
Midwifery nursing:
Midwifery nursing is a nursing specialty which deals with variety of responsibilities including
➤ Attending births
➤ Performing gynecological exams
➤ Providing family planning services, prenatal care, and parent education
➤ Giving primary care, especially for reproductive health
Definition of obstetrics:
Obstetrics the branch of medical science concerned with childbirth and caring for and treating women in or in connection with childbirth.
Obstetrical nursing:
Obstetrical nursing, also called perinatal nursing, is a nursing specialty that works with patients who are attempting to become pregnant, are currently pregnant, or have recently delivered. Obstetrical nurses help provide prenatal care and testing, care of patients experiencing pregnancy complications, care during labor and delivery, and care of patients following delivery. Obstetrical nurses work closely with obstetricians, midwives, and nurse practitioners. They also provide supervision of patient care technicians and surgical technologists.
Obstetric nurse:
Obstetric Nurses care for women from puberty to menopause. They help women during pregnancy, labor and childbirth, as well as women with health issues with their reproductive system.
Obstetrical nurse:
Common duties for obstetrics nurses include:
➤ Preparing delivery rooms
➤ Prepping patients
➤ Sterilizing and preparing instruments
➤ Caring for babies immediately after birth
➤ Explaining after-birth care to new parents
Different types of midwife:
1. Certified Nurse-Midwife (CNM): a midwife trained and licensed in nursing and midwifery. Nurse-midwives must have at least a bachelor’s degree from an accredited
institution.
2. Certified Midwife (CM): an individual trained and certified in midwifery. Certified midwives must have at least a bachelor’s degree from an accredited institution.
3. Certified Professional Midwife (CPM): an individual who is trained in midwifery and meets standards of Midwives. Multiple educational backgrounds are recognized to become a CPM.
4. Direct-Entry Midwife (DEM): an independent individual trained in midwifery through various sources that may include apprenticeship, self-study, a midwifery school, or a college/university program.
5. Lay Midwife: an individual who is not certified or licensed as a midwife but has received) informal training through self-study or apprenticeship.
Qualities of nurse midwives:
There are a range of important skills and knowledge will need to pursue a career in midwifery
1. Good communication and observation.
2. Good listening skills are essential.
3. Be a problem solver
4. The ability to teach is important.
5. Excellent people skills.
6. Interest in the physical, psychological and process of pregnancy and birth.
7. Ability to answer questions and offer advice.
8. Happy to work as part of a team.
9. Dealing with emotionally charged situations
10. Values and behaviours.
In nursing, these values are defined by the 6Cs:
> Care
> Compassion
> Competence
> Communication
> Courage
> Commitment
Benefits of using a midwife:
1. Decreased risk of needing a cesarean.
2. Reduced rates of labor induction and augmentation
3. Reduced use of regional anesthesia.
4. Decreased infant mortality rates.
5. Decreased risk of preterm births
6. Decreased third and fourth degree perineal tear.
7. Lower costs for both clients and insurers
8. Increased chances of having a positive start to breastfeeding
9. Increased satisfaction with quality of care.
Midwifery functions/roles in maternity care:
1. Educator/teacher: They educates the community and families regarding maternal and newborn health: helps I changing the misconception and attitude of community in pregnancy, delivery and newborn care thereby helping to get rid off the harmful practices and superstition during childbirth
2. Service provider/practitioner: They render quality maternal and newborn services to women and their babies: family planning, STI prevention, pregnancy, delivery and postpartum care for the mothers and newborn; referral problems during pregnancies or
women with obstetric complications to the appropriate centre.
3. Trainee: They upgrades performance by evaluating one experience and achievement of set targets related to maternal and newborn services so that one can practice accountably and being able to train others.
4. Record keeper.
Roles and Responsibilities of a Midwives;
Various roles and responsibilities of a midwife have presented in the below
A. Care giver: Midwives provide high quality antenatal and postnatal care to maximize the women’s health during and after pregnancy, detect problems early and manage or refer for any complications.
B. Coordinator: Midwives coordinate care for all women. Coordinator ensures holistic, yoluntary and social services for pregnant women when when appropriate so that every women’s birth experience regardless of risk factor.
C. Leader: The role of leader is to plan, provide and review a women’s care, with her input and agreement, from the initial antenatal assessment through to the postnatal period. Midwife’s leadin leading role reduces admission on to hospital and results, in significantly less intervention during birth.
D. Communicator: As a communicator, the midwives understand that effectiveness of communication. It It helps to develop trust relationship with pregnant women and family members. The midwife has to communicate effectively with pregnant women and family members as well as others so that they can share their all problems.
E. Manager: Manager is a great role for midwife. Midwives manage all the circumstances where appropriate and can recognize and refer women to obstetricians and other specialists in a timely when necessary.
F. Educator: As an educator, midwives provide high quality, culturally sensitive health education in order to promote healthy, helpful family life and positive parenting
G. Counselor: Midwives provide information and counsel pregnant women on prenatal self-care including nutrition, hygiene, breastfeeding and danger sings in pregnancy
and childbirth.
H. Family planner: They also counsel people as a family planner. They provide all information about all kind of family planning methods and help couple to take decision.
I. Adviser: Midwives give advice on development of birth plan and promote the concept of birth preparedness. They also give advice during complicated situation so that it will help them to take decision.
J. Supervisor: Supervising and assisting mothers during antenatal period, monitoring the condition of the condition of the fetus and using their knowledge to identify early sings complication.
K. Record keeper: Record keeping is an integral part of midwifery practice. It helps making continuity of care easier and enabling identify problem in early stage.
(Or/another answer)
The responsibilities of the midwives have pointed out in the below:
1. Give the necessary supervision, care and advice to women during pregnancy, labor and the postpartum period.
2. Provide full antenatal care, including screening test in the hospital, community and the home.
3. Provide counseling and advice before and after screening and tests
4. Conduct deliveries on her own and care for the newborn infant.
5. Manage complications in in pregnancy and childbirth, in accordance with the principles of basic emergency obstetric care,
6. Identify high risk pregnancies and making referrals to doctors and other medical basic emergency obstetric care,
6. Identify high risk pregnancies and making referrals to doctors and other medical specialists.
7. Provide support and advice following events such as miscarriage, termination, stillbirth, neonatal abnormality and neonatal death.
8. Provide primary care to women of productive age, in accordance with the Basic Package
of health Services
9. Supervise the provision of primary health care within the community by female health workers.
10. Counsel and educate women, the family and the community, in relevant areas of health and provide a programme of parenthood preparation and a complete preparation for childbirth including advice on hygiene and nutrition.
11. Give support and advice on the daily care of the baby, including breastfeeding, bathing and making up feeds.
Duties During and After Birth
1. Midwives typically stay with their patients through as much of their labor as possible, offering emotional support as well as advice on how to progress through labor easier
2. They often promote movement during labor, such as walking and rocking on a medicine ball to help open the hips.
3. Depending on the midwife’s certification level and state laws, some can administer pain medication during labor and perform episiotomies when necessary.
4. Decreased risk of needing a caesarean and reduced rates of labor induction and augmentation .
5. Give the necessary supervision, care and advice to women during labor and the postpartum period.
6. Provide support and advice following events such as stillbirth, neonatal abnormality and neonatal death.
7. After assisting through delivery often at a birthing center or in the mom’s home, midwives typically teach the moms the basics of newborn care and breastfeeding.
8. Give support and advice on the daily care of the baby, including breastfeeding, bathing and making up feeds.
9. Maintain cleanliness and hygieney
10. Postpartum bleeding control in necessary.
11. Proper postpartum supervision.
12. They also continue offering emotional support through the postpartum time.
13. Provide counseling and advice.
There are five responsibilities of midwifery:
1. Maintain professional competence
2. Responsibility to keep records
3. Responsibility to family.
4. Responsibility to the profession and
5. Responsibility to society.
or
The responsibilities of the midwives in maternity care have pointed out in the below:
1. Give the necessary supervision, care and advice to women during pregnancy, labor and the postpartum period
2. Provide full antenatal care, including screening test in the hospital, community and the home.
3. Provide counseling and advice before and after screening and tests.
4. Conduct deliveries on her own and care for the newborn infant
5. Manage complications in pregnancy and childbirth, in accordance with the principles of basic emergency obstetric care,
6. Identify high risk pregnancies and making referrals to doctors and other medical specialists.
7. Provide support and advice following events such as miscarriage, termination, stillbirth, neonatal abnormality and neonatal death.
8. Provide primary care to women of productive age, in accordance with the Basic Package of health Services.
9. Supervise the provision of primary health care within the community by female health workers.
10. Counsel and educate women, the family and the community, in relevant areas of health and provide a programme of parenthood preparation and a complete preparation for childbirth including advice on hygiene and nutrition.
11. Give support and advice on the daily care of the baby, including breastfeeding, bathing and making up feeds
12. Provide all non-surgical methods of family planning, and counseling for/surgical methods.
13. Follow established health center policies, procedures and objectives; continuous quality improvement initiatives; safety, environmental, and infection prevention standards.
14. Decreased risk of needing a caesarean and reduced rates of labor induction and augmentation.
15. Help to decrease infant mortality rates and preterm birth and take all initiatives which are necessary in case of need and carry out where necessary immediate resuscitation.
16. Help to decrease maternal mortality rate and pregnancy ancy related sufferings.
Factors contributing to maternal and newborn health:
In maternity nursing, nurses need to understand factors contributing to maternal and newborn health. These include:
1. Physical sustenance of the family members to supply basic needs to mother and baby. e.
2. Economical support: parental attachment, pregnant women’s psychological wellbeing.
3. Economical status.
4. Family size: number of the children affects family interactions
5. Sibling order and gender
6: Culture.
Scope of practice of a midwife in Bangladesh:
Scope of practice refers to the job a midwife does: it describes her work, the nature of work, the boundaries of her clinical practice and the referral systems which support practice.
1. To manage normal pregnancy, labour, birth & post-partum period up to six weeks, including care of the newborn. During this timeithe midwife works independently with women & her family for responsible and accountable
2. The midwife has a special responsibility to make an impact on the maternal and newborn health indicators and to make motherhood safer for all women
3. The midwifes scope of practice will include, but is not limited to, skills in relation to complications such as midwifery management and referral of low birth weight & preterm babies, newborn resuscitation, manual removal of placenta, insertion of I/V cannulas and administration of emergency drugs
4. All midwives are teachers, their scope of practice to pass on their knowledge, information and skills for the promotion of health of women, family and community.
Why are Maternal, Infant, and Child Health Important?
Pregnancy can provide an opportunity to identify existing health risks in women and to prevent future health problems for women and their children. These health risks may include:
1. Hypertension and heart disease
2. Diabetes
3. Depression
4. Genetic conditions
5. Sexually transmitted diseases (STDs)
6. Tobacco use and alcohol abuse
7. Inadequate nutrition
8. Unhealthy weight
The risk of maternal and infant mortality and pregnancy-related complications can be reduced by increasing access to quality preconception (before pregnancy) and interconception (between pregnancies) care. Moreover, healthy birth outcomes and early: identification and treatment of health conditions among infants can prevent death or disability and enable children to reach their full potential.
Midwifery code of ethics and professional conducts:
The aim of the International Confederation of Midwives (ICM) is to improve the standard of care provided to women, babies and families throughout the world through the development, education, and appropriate utilization of the professional midwife. In keeping with its aim of women’s health and focus on the midwife, the ICM sets forth the following code to guide the education, practice and research of the midwife. This code acknowledges women as persons, seeks justice for all people and equity in access to health care, and is based on mútual relationships of respect, trust, and the dignity of all members of society.
Midwifery code of ethics:
1. Midwifery Relationships
a. Midwives develop a partnership with women in which both share relevant information that leads to informed decision-making, consent to a plan of care, and acceptance of responsibility for the outcomes of their choices
b. Midwives support the right of women/families to participate actively in decisions about their care.
c. Midwives empower women/families to speak for themselves on issues affecting the health of women and families within their culture/society.
d. Midwives, together with women, work with policy and funding agencies to define women’s needs for health services and to ensure that resources are fairly allocated considering priorities and availability.
e. Midwives support and sustain each other in their professional roles, and actively nurture their own and others’ sense of self-worth.
f. Midwives respectfully work with other health professionals, consulting and referring as necessary when the woman’s need for care exceeds the competencies of the midwife.
g. Midwives recognize the human interdependence within their field of practice and actively seek to resolve inherent conflicts.
h. Midwives have responsibilities to themselves as persons of moral worth, including duties of moral self-respect and the preservation of integrity.
2. Practice of Midwifery:
a. Midwives provide care for women and childbearing families with respect for cultural diversity while also working to eliminate harmful practices within those same cultures!
b. Midwives encourage realistic expectations of childbirth by women within their own society, with the minimum expectation that no women should be harmed by conception or childbearing.
c. Midwives use up-to-date, evidence-based professional knowledge to ensure safe birthing practices in all environments and cultures.
d. Midwives respond to the psychological, physical, emotional and spiritual needs of women seeking health care, whatever their circumstancestor
e. Midwives act as effective role models of health promotion for women throughout their life cycle, for families and for other health professionals,
f. Midwives actively seek personal, intellectual and professional growth throughout their midwifery career, integrating this growth into their practice.
3. The Professional Responsibilities of Midwives:
a. Midwives hold in confidence client information in order to protect the right to privacy, and use judgment in sharing this information except when mandated by law.
b. Midwives are responsible for their decisions and actions, and are accountable for the related outcomes in their care of women.
c. Midwives may refuse to participate in activities for which they hold deep moral opposition; however, the emphasis on individual conscience should not deprive women of essential health services.
d. Midwives understand the adverse consequences that ethical and human rights] violations have on the health of women and infants, and will work to eliminate these violations.
e. Midwives participate in the development and implementation of health policies that promote the health of all women and childbearing families.
4. Advancement of Midwifery Knowledge and Practice:
a. Midwives ensure that the advancement of midwifery knowledge is based on activities that protect the rights of women as persons.
b. Midwives develop and share midwifery knowledge through a variety of processes such as peer review and research
c. Midwives participate in the formal education of midwifery students and ongoing education of midwives.
[Ref-Adopted at Glasgow International Council meeting, 2008]
Other code:
A. Midwife and their clients:
1. Treat the client as an individual and with respect.
2. Demonstrate sympathetic and sensitive behaviour towards the client.
3. Maintain the confidentiality and the privacy of the clients at all times
4. Serve all clients equally regardless of religion, gender, age, race, nationality and economic class.
5. Act as the clients advocate in all matters relating to their care
6. Respect the legal right of the clients to be informed about their diagnosis.
B. Midwives and their profession:
1. Do not accept or request money or gifts of any kind from the clients or their. family or care givers.
2.Take responsibility to maintain and extend own professional knowledge through appropriate professional development and training
3. Do not misuse hospital or any property under one’s care or control
4. Do not knowingly engage in any activities which are likely to bring profession into discredit.
Purpose, aims/principles and structure of midwifery code of ethics
Principle 1: Respect for the dignity of the person
Principle 2: Professional responsibility and accountability
Principle 3: Quality of practice.
Principle 4: Trust and confidentiality
Principle 5: Collaboration with others.
Culture, values, beliefs, practice, economic status and taboos in Bangladesh influence on maternal and newborn:
1. During antenatal period:
➤ 50% of women do not receive any antenatal care
➤ If those who receive antenatal antenatal care, avail their first visit after 5 months of pregnancy
➤ Maximum family the issue of pregnancy is kept hidden from family members and community.
➤ No special attention is given to pregnant women regarding diet and rest as pregnancy is considered as natural process.
2. During intranatal period:
➤ There is no birth planning and emergency situation arise after the onset of labor pain.
➤ There is no role of women in decision making, all decisions are made by males.
➤ All deliveries are attempted at home without prior assessment.
➤ Unskilled birth attendant conducts the delivery.
➤ Patient are taken to hospital in late stage after obstetric emergency arise.
➤ Pregnant women and family members are not aware of universal infection prevention practices.
➤ The uterus is pushed downwards in each uterine contractions to deliver the fetus early.
➤ A tight tie is kept above the fundus of the uterus to prevent the fetus rise- up.
➤ The umbilical cord is cut with unsterile blade or scissor and ashes or cow-dung is put on it.
➤ Repeated vaginal examination is done during labour.
3. During postnatal period:
➤ People are not aware that postnatal mothers need extra care including diet and rest.
➤ Newborn is given pre-lacteal feed, water or milk other than the breast milk.
➤ Colostrum is not given to newborn. It is discard.
➤ Exclusive breast feeding is not practiced for the first five mothers.
Read More…