the role of midwives in mch
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The Role of Midwives in MCH. 17 th of February, 2009 Alison Lindner BSN, CNM, MPH. What Do We Know?. Skilled attendants for pregnancy care and birth are lacking - PowerPoint PPT PresentationTRANSCRIPT
The Role of Midwives in MCH
17th of February, 2009
Alison Lindner BSN, CNM, MPH
What Do We Know?What Do We Know?
Skilled attendants for pregnancy care Skilled attendants for pregnancy care and birth are lackingand birth are lacking
This lack of skilled attendants is This lack of skilled attendants is disturbing since many maternal and disturbing since many maternal and infant deaths and morbidities are infant deaths and morbidities are preventable during the prenatal period, preventable during the prenatal period, as well as during labor and birth.as well as during labor and birth.
OutcomeOutcome In much of the developing world In much of the developing world
home birth with unskilled attendants home birth with unskilled attendants or no attendant is the norm.or no attendant is the norm.
Maternal and neonatal mortality is Maternal and neonatal mortality is high in the developing worldhigh in the developing world
WHO DefinitionWHO Definition A midwife is a person, who, having been A midwife is a person, who, having been
regularly admitted to a midwifery education regularly admitted to a midwifery education program, duly recognized in the country in program, duly recognized in the country in which she is located, has successfully which she is located, has successfully completed the prescribed course of studies in completed the prescribed course of studies in midwifery and has acquired the requisite midwifery and has acquired the requisite qualifications to be registered and/or legally qualifications to be registered and/or legally licensed to practice midwifery. She must be licensed to practice midwifery. She must be able to give the necessary supervision, care and able to give the necessary supervision, care and advice to women during pregnancy, labor and advice to women during pregnancy, labor and the postpartum period, to conduct deliveries on the postpartum period, to conduct deliveries on her own responsibility and to care for the her own responsibility and to care for the newborn and the infant.newborn and the infant.
Midwifery and Maternal Midwifery and Maternal MortalityMortality
The midwife can assist in the The midwife can assist in the prevention of maternal and child prevention of maternal and child mortality and morbidity by mortality and morbidity by providing:providing: Nutritional education Nutritional education Family planning services (birth spacing, Family planning services (birth spacing,
safe abortion and post abortion care) safe abortion and post abortion care) Safe sex information to prevent STDs, Safe sex information to prevent STDs,
HIV/AIDs and cervical cancerHIV/AIDs and cervical cancer
Midwifery and Maternal Midwifery and Maternal MortalityMortality
Antepartum CareAntepartum Care Maternal nutrition - Maternal nutrition -
Vitamin A, Folic Acid, Vitamin A, Folic Acid, Protein, Iron – Protein, Iron – prevention of anemia, prevention of anemia, congenital anomaliescongenital anomalies
HIV HIV screening/prevention of screening/prevention of MTCTMTCT
Malaria prophylaxis/bed Malaria prophylaxis/bed netsnets
Recognition of PIH, Recognition of PIH, other maternal other maternal conditionsconditions
Midwifery and Maternal Midwifery and Maternal MortalityMortality
Intrapartum CareIntrapartum Care - -Identify problems Identify problems early and transfer to early and transfer to the next level of carethe next level of care
Prolonged or Prolonged or obstructed labor – use obstructed labor – use of partogramof partogram
Life Saving Skills for Life Saving Skills for mother – delivery of mother – delivery of placenta, management placenta, management of maternal of maternal hemorrhage, oral hemorrhage, oral rehydration, transfer of rehydration, transfer of carecare
Midwifery and Maternal Midwifery and Maternal MortalityMortality
Postpartum CarePostpartum Care Early identification of problems with Early identification of problems with
mother mother HemorrhageHemorrhage Infection Infection EclampsiaEclampsia
Early identification of problems with infantEarly identification of problems with infant PrematurityPrematurity Trouble breathing – needs resuscitationTrouble breathing – needs resuscitation InfectionInfection
Kangaroo Care for preterm infants
Midwifery and Maternal Mortality
Post abortion care Many legal and other barriers Training needs are great in this area Need to provide preventive services, as
well as safe abortion integrated into reproductive health services, making midwives and other skilled health workers the ideal providers.
Midwifery and Maternal Midwifery and Maternal MortalityMortality
Postpartum CarePostpartum Care Family Family
planning/child planning/child spacingspacing
Promotion of Promotion of breastfeedingbreastfeeding
So what is this telling So what is this telling us?us?
Postpartum care has been a relatively Postpartum care has been a relatively neglected aspect of maternity care. neglected aspect of maternity care.
This low level of care is disturbing, This low level of care is disturbing, since timely interventions during the since timely interventions during the postpartum period can prevent deaths postpartum period can prevent deaths of both mothers and newborn infants, of both mothers and newborn infants, and can reduce the incidence of long-and can reduce the incidence of long-term pregnancy-related morbidities term pregnancy-related morbidities
Safe MotherhoodSafe Motherhood Safe Motherhood Initiative Safe Motherhood Initiative
Launched in 1987 in Nairobi, KenyaLaunched in 1987 in Nairobi, Kenya Placed maternal health at the forefront Placed maternal health at the forefront
of the international public health of the international public health agendaagenda
Addressed the high rates of maternal Addressed the high rates of maternal mortality and morbidity related to the mortality and morbidity related to the complications of pregnancy and complications of pregnancy and childbirthchildbirth
MidwiferyMidwifery Midwifery care is key – skilled birth Midwifery care is key – skilled birth
attendants who can conduct safe, attendants who can conduct safe, clean deliveries, recognize clean deliveries, recognize complications and manage obstetric complications and manage obstetric complications (either themselves or complications (either themselves or through referral)through referral)
Trained TBAs from the communityTrained TBAs from the community Partnerships with women and Partnerships with women and
communitiescommunities
Community Mobilization• Health promotion• Referral linkages
• Support to Guides
A A communitcommunit
y y partnershipartnershi
p modelp model
LSS(Basic)
• Trainers• Referral facility staff
HBLSS• Guides
• Women, families• Home birth attendants
LSS(Advanced)• Trainers
• Referral facility staff
for saving lives
Home-Based Life Home-Based Life Saving Skills - Saving Skills -
ObjectivesObjectives Increase access to life-Increase access to life-
saving measures within saving measures within home & communityhome & community
Decrease delays in referralDecrease delays in referral Increase use of postpartum Increase use of postpartum & post abortion family & post abortion family
planningplanning
HBLSS – Intended HBLSS – Intended AudienceAudience
Pregnant women Pregnant women & family & family caregiverscaregivers
Home birth Home birth attendants, TBAsattendants, TBAs
HBLSS - FocusHBLSS - Focus
Core Topics Introduction * Woman & baby problems * Preventing problems Referral *
Mother Topics Too much bleeding * Sickness with pain & fever * Birth delay Pregnancy swelling & fits Too many children…………………………………Baby Topics Trouble breathing at birth Born too small Baby falls sick *
* Topic covered
Example-- Example-- Take Action Take Action CardCard
‘Too Much Bleeding After ‘Too Much Bleeding After Birth’Birth’Problem side Action Side
HBLSS - Community HBLSS - Community MobilizationMobilization
Meetings with community leaders to discuss ways to improve the situation including transportation and support for HBLSS guides
HBLSSHBLSS Field trials completed in Ethiopia, India Field trials completed in Ethiopia, India
and Vietnam suggest that it increases and Vietnam suggest that it increases access to basic life saving care in the access to basic life saving care in the home and community, decreases delays home and community, decreases delays in women reaching referral facilities in women reaching referral facilities and supports the communities efforts to and supports the communities efforts to decrease maternal and infant death.decrease maternal and infant death.
Further evaluations are planned.Further evaluations are planned. A manual will be available soon.A manual will be available soon.
LSS - ObjectivesLSS - Objectives Increase trained health workers Increase trained health workers
skills in managing complications skills in managing complications
Increase referral facilities ability to Increase referral facilities ability to provide emergency obstetrical care.provide emergency obstetrical care.
LSS - AudienceLSS - Audience Trained health workers in referral Trained health workers in referral
facilitiesfacilities HospitalsHospitals Health centersHealth centers
LSSLSS Competency based training program Competency based training program
that equips midwives with the skills that equips midwives with the skills to intervene in the top five life to intervene in the top five life threatening maternal conditions threatening maternal conditions including obstetrical hemorrhage, including obstetrical hemorrhage, obstructed labor, obstetric sepsis, obstructed labor, obstetric sepsis, hypertensive disorders and hypertensive disorders and complications of unsafe abortion.complications of unsafe abortion.
Classroom and clinical training.Classroom and clinical training.
SummarySummary This is just a brief example This is just a brief example
of some of the efforts to of some of the efforts to improve MCH care improve MCH care through midwifery – there through midwifery – there are many others working.are many others working.
If we are to prevent If we are to prevent unnecessary maternal and unnecessary maternal and infant death anywhere in infant death anywhere in the world we must be the world we must be committed to social justice committed to social justice and the rights of women to and the rights of women to safe and effective safe and effective reproductive care. reproductive care.
Thank You
to Katherine Carr