A SEMINAR ON ROLE AND SCOPE OF MIDWIFERY PRACTICES
SUBMITTED TO SUBMITTED BY MRS.JESMI JOHN MRS.LEKSHMI P SENIOR LECTURER YEAR MSC NURSING NURSING JOSCO COLLEGE COLLEGE OF NURSING COLLEGE OF NURSING
1 ST JOSCO
SUBMITTED ON – 06 /11/2013
INTRODUCTION The role of a midwife whether she practices in hospitals, health centers, or domiciliary conditions has been recognized as one of the most rewarded job. Her function carries great responsibilities and demands, specic knowledge and skills. They play a central role in health care delivery- promotion, prevention, treatment and rehabilitation, in areas of great health needs, especially in remote areas. The midwife may practice in any setting including the home, the community, hospitals, or in any other maternity services. n all settings the midwife remains responsible and accountable for the care she provides.
DEFINITIONS !ccording to "# membership $nternational confederation of midwives% and joint study group of maternity care and &H', the term midwife id dened as
“A !"#!$% !& ' (%)&*+ #,*- ,'!+ %%+ )%') '"!44%" 4* ' !"#!$%) %"5'4!*+' ()*)' " )%5*+!%" !+ 4,% 5*+4) !+ #,!5, !4 !& *5'4%" ,'& &55%&&$ 5*(%4%" 4,% ()%&5)!%" 5*)&% *$ &4"!%& !+ !"#!$%) '+" ,'& '57!)%" 4,% )%7!&!4% 7'!85'4!*+ 4* % )%!&4%)%" '+" *) %' !5%+&%" 4* ()'54!5% !"#!$%)9. RESPONSIBILITIES OF MID:I;ES
"are of women during pregnancy, childbirth, and postnatal period. (erve as a guardian of normal birth alert to possible complications. Treat complication due to miscarriage and unsafe abortion. )regnancy advices and health education. *ewborn care.
+ecognizing and addressing problems in the women and newborn before, during and after child birth. !ssist women to successfully breast feed. +efer women and new born to higher level of care.
ROLE OF MID:IFE IN HEALTH CARE *+( "*"!* •
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! nurse clinician is a registered nurse who has gotten the needed special training that enable him/her to be able to perform numerous of the duties of a physician. The nurse clinician uses advanced clinical nursing skills to assess, plan, implement and evaluate patient care for patient in a specialty area. "oordinate and handles administrative duties associated with clinical operations and patient scheduling. 0acilitates patient 1ow and patient education. +efers patient for further care or services. nsure the supply needed for the operations of clinic. #aintains re2uired documents and record.
"*"! *+( ()"!(T( "linical nurse specialists are advanced practice nurse who hold a master or doctorate degree in a specialized area of nursing practice. "linical nurse specialist provide direct patient care, serve as e3pert consultants for nursing sta4, and takes an active hand in improving health care delivery systems. &'#* H!TH *+( )+!"T'*+ &H*) focuses on the primary health care needs of women across the lifespan from adolescent through menopause and beyond, with an emphasis on reproductive gynecological health. she will be a specialist in the eld of women5s health addressing a range of women5s health issues ,including normal pregnancy, prenatal management, family planning, well women health care, uro-gynecology, aesthetic and menopause.
"+T06 *+( #6&0 "ertied nurse midwife are licensed health care practioner educated in the two disciplines of nursing and midwifery. They provide primary health care to women of childbearing age including prenatal care, labour and delivery care, care after birth, gynecological e3am, newborn care, assistance with family planning decisions, preconception care, menopause management and counseling in health maintenance and disease prevention. 0!#7 *+( "'*(T!*T #eet the health care needs of the family by providing health assessments, direct care, guidance, teaching or counseling as particular around family self care. The family nurse consultant typically works collaboratively with family primary care, )hysicians and other professional within the health care system. The family health care consultant may follow families in a variety of setting such as school, homework place or hospital depending upon the client needs. *+( "'*(T!*T •
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The nurse consultant will practice autonomously at an advanced level in the delivery of high 2uality, safe and e4ective care. The nurse consultant role blends a signicant proportion to direct, higher level clinical care with education, research, management and activities. The nurse in this role will focus on the delivery and maintenance of clinical e3cellence, provide an e3pert consultancy service to patient and colleague. )lan, implement and evaluate evidence based care, contribute to the development of services by taking an active role in generating and disseminating knowledge across the organization. They undertake research in a specialist area that focuses on improving outcomes and e3periences for patient and families. 0acilitate and provide education and training to sta4 and students.
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*urse researchers are scientists who study various aspects of health illness and health care.
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8y designing and implementing scientic studies, they look forward to improve health, health care services and health care outcomes. *urse researcher identies research 2uestion, design and conduct scientic studies, collect and analyze data and report their ndings. #any nurse researchers teach in academic or clinical setting and often write article and research report for nursing, medical and other professional journal and publications.
*+( 6"!T'*!(T *urse educationalist is a person who is a specialist in the theory and method of nursing education.
SCOPE OF MID:I;ES IN HEALTH CARE AND THE COMMUNITY The
midwife works in partnership with women, on her own professional responsibility, to give women the necessary support, care and advice during pregnancy, labour and the postpartum period to facilitate birth and to provide care for the new born. The midwife has an important role in health and wellness promotion and education for the women, her family and the community. The midwifery practices involve informing and preparing the women and her family for pregnancy, birth, breast feeding and parenthood and include certain aspect of women5s health, family planning and infant well being. The midwives play an important role in providing essential health care and emergency health care.
E&&%+4!' *&4%4)!5' 5')%< ntends to provide the basic maternity services to all pregnant women through
arly registration of pregnancy $within 9:-9; weeks% )rovision of minimum three antenatal checkups by !*# or medical o
)rovision of safe delivery at home or in the institution. )rovision of three postnatal checkups to monitor the postnatal recovery and to detect complication. t is more relevant for !ssam, 8ihar, +ajasthan, 'rissa, ttar )radesh and #adhya )radesh as most of the deliveries in these states are conducted at home in unclean environment causing high maternal morbidity and mortalility rate.
E%)%+5 *&4%4)!5 5')% "omplications associated with pregnancy are not always predictable= hence emergency obstetric care is an important intervention to prevent maternal mortality and morbidity. #ain emphasis is on > major problems which cause maternal mortality- hemorrhage, sepsis, unsafe abortion, hypertensive disorder and obstructed labour ? which can be treated at a well sta4ed, well e2uipped health facility. There are mainly three levels on emergency obstetric care-primary, secondary and tertiary
Primary level "are would be provided in the community, birth center public maternal unit and private hospitals or in combination. .g. &omen would receive all her antenatal care in the community, labour and child birth would be in hospitals. Secondary level )rovide additional care during the antenatal, labour and birth and postnatal period for women and babies who e3perience complications and who have clinical needs for referral or transfer Tertiary level These services provide multidisciplinary specialist team for women and babies with comple3 and or rare feto-maternal needs who re2uire access to specialist services. These services provide multidisciplinary specialist team for women and babies with comple3 and or rare feto-maternal needs
!ccording to &.H.' the emergency obstetric care is provided by giving emphasis on three main aspects
The care provided at health center, large or small, include capabilities for
Obstetric frst aid
!dministration of antibiotics, o3ytocin and anticonvulsant.
Basic emergency obstetrical care !long with obstetrical rst aid
#anual removal of placenta +emoval of retained products following miscarriage or abortion !ssisted vaginal delivery, preferably with vacuum e3tractor *ewborn care
Comprehensive emergency obstetric care This include all the basic function given above plus, The
cesarean section (afe blood transfusion "are of sick and low birth weight newborns including resuscitation 0amily planning services
Three phases are included
) h a s e The nurse midwife plays an important part in all areas of women5s health care. The scope of midwife can be e3plained through their role in the following eld namely= 9. :. @. A.
!dolescent girl care )reconception care #aternal care *ewborn care
ADOLESCENT GIRL CARE Barious services/program/yojana are developed aiming at improving the nutritional and health status of adolescent girls and promoting self development, awareness of health, hygiene, nutrition, family welfare and management. t is well recognized that these program when provided could signicantly improve the health and nutritional status of women and children and promote the decision making capabilities of women. The midwife should be aware of these yojana and some of them include
Sabala yojana t is also known as +ajiv Candhi scheme of empowerment of adolescent girls. The proposal intend to empower adolescent girls of age group 99 ? 9D years with spotlight on educating girls, development in their dietary and health, and upgrading diverse skill like home talent, life skill and vocational
talents. t targets outtting girls on family benet, health sanitation and information and direction on current public facilities along with targeting girls who are out of schools.
Kishori sakti yojana t is for addressing the needs of self development, nutrition and health status, literacy and numerical skills, vocational skills etc of adolescent girls.
Swawlamban yojana !t (wawlamban yojana scheme, funded by department of women and child development of +ajasthan state government, they train @E women and adolescent girl in readymade garment skills within : months, from #onday to 0riday two hours every day.
Poorak poshaahar yojana n order to improve the nutritional status the )oorak poshaahar scheme provides supplementary nutrition to the children between si3 month and si3 year of age, pregnant and lactating women and adolescent girls. The beneciaries of this scheme are identied by the anganwadi workers and the distribution of the supplementary nutrition is done.
Nutritional program or adolescent girls To address the problem of under nutrition among adolescent girl and pregnant women and lactating mother, the planning commission in the year $:EE:-:EE@% launched the nutritional program for adolescent girl. nder this project ; kg of food grains were given to under nourished adolescent girl, pregnant and lactating mother. ligibility is determined on the basis of their weight.
Kasturba !andhi balika vidyalaya scheme )rovide educational facilities for girl belonging to (", (T, minority communities and families below the poverty line in educationally backward block.
PRECONSUPTION CARE
)reconception care is the care that the women receive before she gets pregnant. t involves nding and taking care of any problem that may a4ect the women and her baby later. 8y taking action on health issue before pregnancy, any future problem to the mother can be prevented. &hen a couple is seen and counseled about pregnancy, its course and outcome well before the time of actual conception is called preconception counseling. 'bjective is to ensure that women enter pregnancy with an optimal state of health which would be safe both to herself and the fetus. The three aspects included in the preconception care are educational, informational and eugenics.
"ducational ducation should be provided on ideal age of pregnancy. )atient with medical condition should be educated about the e4ect of disease on pregnancy. The couple should be educated about avoiding the hazardous working environment. &omen should be urged to stop smoking, taking alcohol and abusing drug. "ouple should be also educated to do life style modications.
#normational )reconception care include helping to assess and identify •
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*utritional statusF supplement of folic acid or supplementation of micronutrients such as iron, iodine and folic acid )re e3isting medical conditionF treatment of conditions such as obesity, diabetes, epilepsy, hypothyroidism and hypertension. nfectious diseasesF vaccination against rubella, varicella, hepatitis 8= screening for HB/!6( and other se3ually transmitted infections 0amily planning for appropriate timed pregnancy 6rugs used are veried and changed if re2uired #aternal health is optimized.
"ugenics t is the science of improving a population by controlled breeding to increase the occurrence of desirable heritable characteristics. t5s a belief to improve the 2ualities of human species or a human population, especially by means of discouraging reproduction by persons having genetic defect or presumed to have inheritable undesired traits$negative eugenics% or encouraging
reproduction by persons presumed to have inheritable desirable traits$positive eugenics%. This process is mainly done through genetic counseling. Cenetic counseling Cenetic counseling is seeked by couples with
! family history of genetic condition, birth defect, chromosomal disorder. Two or more pregnancy looses. ! child with known inherited disorder. &omen who is pregnant or plan to become pregnant at @> years of age or older. )eople related by blood who want to have children. Cenetic screening include
(creening of inherited genetic disease. )renatal diagnosis of chromosomal or genetic disease. #anagement of inherited genetic disease prevention eliminating the casual factor or by secondary prevention $terminating the a4ected fetus%.
MATERNAL CARE $uring antenatal period !ntenatal care !ntenatal care is the care of the women during pregnancy. The primary aim of antenatal care is to achieve at the end of pregnancy a healthy mother and a healthy baby. .
6uring the rst antenatal visit the midwives should Take health history )hysical e3amination aboratory e3amination 9. "omplete urine analysis :. (tool e3amination @. "omplete blood count, including Hb estimation A. (erological e3amination >. 8lood grouping and +H typing
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;. "hest G-ray . )ap test D. Conorrhea test if needed 'n subse2uent visit )hysical e3amination $weight gain, blood pressure% aboratory test should include ? urine e3amination, hemoglobin estimate ron and folic acid supplement and medication as needed mmunization against tetanus Croup or individual instruction on nutrition, family planning, self care, delivery and parenthood. +eferral services, where necessary. !ntenatal advices on 6iet +est and sleep "lothing 6ental care "are of breast Travel (moking and alcohol Ceneral advice
$uring intranatal period "hild birth is a normal physiological process, but the midwives should be able to deal with complications that may arise. (epticemia may result from unskilled and septic manipulation. Tetanus neonatrum can occur from use of unsterilized instruments. The need for e4ective intranatal care is therefore indispensible. The
emphasis is on clean hand and ngernails, clean surface for delivery, clean cutting and care of cord, keeping the birth canal clean by avoiding harmful practices. Thorough sepsis should be maintained. 6elivery should be done with minimum injury to infant and mother. The midwife should be ready to deal with any complications that arise during pregnancy.
+ooming in should be practiced.
$uring postnatal period t is the care of the mother after delivery
)rovide care for the rapid restoration of the mother to optimum health. "heck ade2uacy of breast feeding &omen and her family should be encouraged to tell their health care professional about any change in mood emotional state and behavior that are outside of the women5s normal pattern. !t each postnatal visits parents should be o4ered information and advice to enable them to !ssess their babies general condition dentify sign and symptoms of common health problem seen in babies "ontact a health care professional or emergency service if re2uired.
NE:BORN CARE #mmediate care
Neonatal assessment Ceneral appearance • • • • • • • •
Head circumference should be around @@- @>. "hest circumference should be @E.> ? @@. !ssess anterior and posterior fontanels Temperature should be @;.> -@ degree "elsius Heart rate should be 9:E- 9;E 8reathing should be @E-;E breath/second. !ssess for apgar score !ssess for re1e3es.
RESEARCH ABSTRACT ! study was conducted to assess the scope and practice among sta4 nurse in Cujarat and the study revealed that the scope is limited as compared to international standards of midwives. Their right to practice was not legally dened, but they were not specially prohibited from practice. !s a
conse2uence the sta4 nurse faced loss of skills as their practice was restricted. The clinical midwifery education of nursing and midwifery student was marginalized because the education of medical students was given priority, and the students got only e3posed to restricted practice of sta4 nurse.
CONCLUSION The midwife is a person who has undergone a prescribed training and has been certied by a statutory body appointed by a national government to undertake the responsibility of giving the necessary care and advice to women during pregnancy, labour and postnatal period. n this topic the various position handled by the midwife and their role in providing care to the mother and child is discussed.
BIBLIOGRAPHY Te3tbook
9. Iaminio +ao. The te3t book of midwifery obstetric for nurses. 9st edition. lseiver. )age no. 9. :. 6.".6utta. Te3t book of obstetrics. ;th edition. *ew central book publisher. )age no 9E>. @. #.". Cupta. Te3t book of preventive and social medicine. @rd edition. Jaypee. )age no. >@A. A. "hris Henderson. #aye5s #idwifery-! te3t book of midwives. 9@th edition. 8aillierra Tindall publisher nternet >. ;. . D. K.
www.midwiferycouncil.health www.nursingtimes.net *ursingcareers.nhsemployer.org www.nfpa.org www.midwiferyjournal.com
