A SEMINAR ON ROLE AND SCOPE OF

MIDWIFERY PRACTICES

SUBMITTED TO SUBMITTED BY

MRS.JESMI JOHN MRS.LEKSHMI P

SENIOR LECTURER 1ST YEAR MSC NURSING

JOSCO COLLEGE OF NURSING JOSCO COLLEGE OF NURSING

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, specific 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. In all settings the midwife remains responsible and accountable for the care she provides.

DEFINITIONS

According to ICM membership (International confederation of midwives) and joint study group of maternity care and WHO, the term midwife id defined as

“A midwife is a person who, having been regularly admitted to a midwifery educational program duly recognized in the country in which it is located has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualification to be registered and or legally licensed to practice midwifery”.

RESPONSIBILITIES OF MIDWIVES

Care of women during pregnancy, childbirth, and postnatal period. Serve as a guardian of normal birth alert to possible complications. Treat complication due to miscarriage and unsafe abortion. Pregnancy advices and health education. Newborn care. Recognizing and addressing problems in the women and newborn before, during and

after child birth. Assist women to successfully breast feed. Refer women and new born to higher level of care.

ROLE OF MIDWIFE IN HEALTH CARE

NURSE CLINICIAN

A 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.

Coordinate and handles administrative duties associated with clinical operations and patient scheduling.

Facilitates patient flow and patient education. Refers patient for further care or services. Ensure the supply needed for the operations of clinic. Maintains required documents and record.

CLINICAL NURSE SPECIALISTS

Clinical nurse specialists are advanced practice nurse who hold a master or doctorate degree in a specialized area of nursing practice. Clinical nurse specialist provide direct patient care, serve as expert consultants for nursing staff, and takes an active hand in improving health care delivery systems.

WOMEN HEALTH NURSE PRACTIONER

WHNP 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 field of women’s health addressing a range of women’s health issues ,including normal pregnancy, prenatal management, family planning, well women health care, uro-gynecology, aesthetic and menopause.

CERTIFIED NURSE MIDWIFE

Certified 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 exam, newborn care, assistance with family planning decisions, preconception care, menopause management and counseling in health maintenance and disease prevention.

FAMILY NURSE CONSULTANT

Meet 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, Physicians 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.

NURSE CONSULTANT

The nurse consultant will practice autonomously at an advanced level in the delivery of high quality, safe and effective care.

The nurse consultant role blends a significant 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 excellence, provide an expert consultancy service to patient and colleague.

Plan, 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 experiences for patient and families.

Facilitate and provide education and training to staff and students.

NURSE RESEARCHER

Nurse researchers are scientists who study various aspects of health illness and health care.

By designing and implementing scientific studies, they look forward to improve health, health care services and health care outcomes.

Nurse researcher identifies research question, design and conduct scientific studies, collect and analyze data and report their findings.

Many nurse researchers teach in academic or clinical setting and often write article and research report for nursing, medical and other professional journal and publications.

NURSE EDUCATIONALIST

Nurse educationalist is a person who is a specialist in the theory and method of nursing education.

SCOPE OF MIDWIVES 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 women’s health, family planning and infant well being.

The midwives play an important role in providing essential health care and emergency health care.

Essential obstetrical care:

Intends to provide the basic maternity services to all pregnant women through

Early registration of pregnancy (within 12-16 weeks) Provision of minimum three antenatal checkups by ANM or medical officer to monitor

progress of pregnancy and to detect any risk or complication so that appropriate care including referral could be done in time.

Provision of safe delivery at home or in the institution. Provision of three postnatal checkups to monitor the postnatal recovery and to detect

complication.

It is more relevant for Assam, Bihar, Rajasthan, Orissa, Uttar Pradesh and Madhya Pradesh as most of the deliveries in these states are conducted at home in unclean environment causing high maternal morbidity and mortalility rate.

Emergency obstetric care

Complications associated with pregnancy are not always predictable; hence emergency obstetric care is an important intervention to prevent maternal mortality and morbidity. Main emphasis is on 5 major problems which cause maternal mortality- hemorrhage, sepsis, unsafe abortion, hypertensive disorder and obstructed labour – which can be treated at a well staffed, well equipped health facility. There are mainly three levels on emergency obstetric care-primary, secondary and tertiary

Primary level

Care would be provided in the community, birth center public maternal unit and private hospitals or in combination.

E.g. Women would receive all her antenatal care in the community, labour and child birth would be in hospitals.

Secondary level

Provide additional care during the antenatal, labour and birth and postnatal period for women and babies who experience complications and who have clinical needs for referral or transfer

Tertiary level

These services provide multidisciplinary specialist team for women and babies with complex and or rare feto-maternal needs who require access to specialist services.

These services provide multidisciplinary specialist team for women and babies with complex and or rare feto-maternal needs

According to W.H.O 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 first aid

Administration of antibiotics, oxytocin and anticonvulsant.

Basic emergency obstetrical care

Along with obstetrical first aid

Manual removal of placenta Removal of retained products following miscarriage or abortion Assisted vaginal delivery, preferably with vacuum extractor Newborn care

Comprehensive emergency obstetric care

This include all the basic function given above plus,

The cesarean section Safe blood transfusion Care of sick and low birth weight newborns including resuscitation Family planning services

Three phases are included

The nurse midwife plays an important part in all areas of women’s health care. The scope of midwife can be explained through their role in the following field namely;

1. Adolescent girl care2. Preconception care3. Maternal care4. Newborn care

ADOLESCENT GIRL CARE

Various 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. It is well recognized that these program when provided could significantly 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

It is also known as Rajiv Gandhi scheme of empowerment of adolescent girls. The proposal intend to empower adolescent girls of age group 11 – 18 years with spotlight on educating girls, development in their dietary and health, and upgrading diverse skill like home talent, life skill and vocational talents. It targets outfitting girls on family benefit, health sanitation and information and direction on current public facilities along with targeting girls who are out of schools.

Phase I decision to seek care

Phase II Identifing and reaching medical facility

Phase III Receipt of adequate and appropriate treatment

Kishori sakti yojana

It is for addressing the needs of self development, nutrition and health status, literacy and numerical skills, vocational skills etc of adolescent girls.

Swawlamban yojana

At Swawlamban yojana scheme, funded by department of women and child development of Rajasthan state government, they train 30 women and adolescent girl in readymade garment skills within 2 months, from Monday to Friday two hours every day.

Poorak poshaahar yojana

In order to improve the nutritional status the Poorak poshaahar scheme provides supplementary nutrition to the children between six month and six year of age, pregnant and lactating women and adolescent girls. The beneficiaries of this scheme are identified by the anganwadi workers and the distribution of the supplementary nutrition is done.

Nutritional program for adolescent girls

To address the problem of under nutrition among adolescent girl and pregnant women and lactating mother, the planning commission in the year (2002-2003) launched the nutritional program for adolescent girl. Under this project 6 kg of food grains were given to under nourished adolescent girl, pregnant and lactating mother. Eligibility is determined on the basis of their weight.

Kasturba Gandhi balika vidyalaya scheme

Provide educational facilities for girl belonging to SC, ST, minority communities and families below the poverty line in educationally backward block.

PRECONSUPTION CARE

Preconception care is the care that the women receive before she gets pregnant. It involves finding and taking care of any problem that may affect the women and her baby later. By taking action on health issue before pregnancy, any future problem to the mother can be prevented. When a couple is seen and counseled about pregnancy, its course and outcome well before the time of actual conception is called preconception counseling. Objective 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.

Educational

Education should be provided on ideal age of pregnancy. Patient with medical condition should be educated about the effect of disease on pregnancy. The couple should be educated about avoiding the hazardous working environment. Women should be urged to stop smoking, taking alcohol and abusing drug. Couple should be also educated to do life style modifications.

Informational

Preconception care include helping to assess and identify

Nutritional status: supplement of folic acid or supplementation of micronutrients such as iron, iodine and folic acid

Pre existing medical condition: treatment of conditions such as obesity, diabetes, epilepsy, hypothyroidism and hypertension.

Infectious diseases: vaccination against rubella, varicella, hepatitis B; screening for HIV/AIDS and other sexually transmitted infections

Family planning for appropriate timed pregnancy Drugs used are verified and changed if required Maternal health is optimized.

Eugenics

It is the science of improving a population by controlled breeding to increase the occurrence of desirable heritable characteristics. It’s a belief to improve the qualities 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.

Genetic counseling

Genetic counseling is seeked by couples with

A family history of genetic condition, birth defect, chromosomal disorder. Two or more pregnancy looses. A child with known inherited disorder. Women who is pregnant or plan to become pregnant at 35 years of age or older.

People related by blood who want to have children.

Genetic screening include

Screening of inherited genetic disease. Prenatal diagnosis of chromosomal or genetic disease. Management of inherited genetic disease prevention eliminating the casual factor or by

secondary prevention (terminating the affected fetus).

MATERNAL CARE

During antenatal period

Antenatal care

Antenatal 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.

I. During the first antenatal visit the midwives should Take health history Physical examination Laboratory examination

1. Complete urine analysis2. Stool examination3. Complete blood count, including Hb estimation4. Serological examination5. Blood grouping and RH typing6. Chest X-ray7. Pap test8. Gonorrhea test if needed

II. On subsequent visitPhysical examination (weight gain, blood pressure)Laboratory test should include – urine examination, hemoglobin estimate

III. Iron and folic acid supplement and medication as neededIV. Immunization against tetanusV. Group or individual instruction on nutrition, family planning, self care, delivery and

parenthood.VI. Referral services, where necessary.

VII. Antenatal advices on Diet

Rest and sleep Clothing Dental care Care of breast Travel Smoking and alcohol General advice

During intranatal period

Child birth is a normal physiological process, but the midwives should be able to deal with complications that may arise. Septicemia may result from unskilled and septic manipulation. Tetanus neonatrum can occur from use of unsterilized instruments. The need for effective intranatal care is therefore indispensible.

The emphasis is on clean hand and fingernails, clean surface for delivery, clean cutting and care of cord, keeping the birth canal clean by avoiding harmful practices.

Thorough sepsis should be maintained. Delivery should be done with minimum injury to infant and mother. The midwife should be ready to deal with any complications that arise during

pregnancy. Rooming in should be practiced.

During postnatal period

It is the care of the mother after delivery

Provide care for the rapid restoration of the mother to optimum health. Check adequacy of breast feeding Women 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 women’s normal pattern.

At each postnatal visits parents should be offered information and advice to enable them to Assess their babies general condition Identify sign and symptoms of common health problem seen in babies Contact a health care professional or emergency service if required.

NEWBORN CARE

Immediate care

Neonatal assessment

General appearance

Head circumference should be around 33- 35. Chest circumference should be 30.5 – 33. Assess anterior and posterior fontanels Temperature should be 36.5 -37 degree Celsius Heart rate should be 120- 160 Breathing should be 30-60 breath/second. Assess for apgar score Assess for reflexes.

RESEARCH ABSTRACT

A study was conducted to assess the scope and practice among staff nurse in Gujarat and the study revealed that the scope is limited as compared to international standards of midwives. Their right to practice was not legally defined, but they were not specially prohibited from practice. As a consequence the staff 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 exposed to restricted practice of staff nurse.

CONCLUSION

The midwife is a person who has undergone a prescribed training and has been certified 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. In this topic the various position handled by the midwife and their role in providing care to the mother and child is discussed.

BIBLIOGRAPHY

Textbook

1. Kaminio Rao. The text book of midwifery obstetric for nurses. 1st edition. Elseiver. Page no. 17.

2. D.C.Dutta. Text book of obstetrics. 6th edition. New central book publisher. Page no 105.3. M.C. Gupta. Text book of preventive and social medicine. 3rd edition. Jaypee. Page no.

534.4. Chris Henderson. Maye’s Midwifery-A text book of midwives. 13th edition. Baillierra

Tindall publisher

Internet

5. www.midwiferycouncil.health 6. www.nursingtimes.net 7. Nursingcareers.nhsemployer.org8. www.nfpa.org 9. www.midwiferyjournal.com