TRENDS IN
THE
MIDWIFERY
AND
OBSTETRICAL
NURSING
SAVITA S H
INTRODUCTION
• In the changing scenario of health care
system of today’s world, the trends in
midwifery and obstetrical nursing are also
changing. There are new advancements in
care being provided, parenthood planning,
national maternal health policies etc.
HISTORY
• Midwifery is as old as the history of human
species.
• Archaeological evidence of a woman
squatting in childbirth supported by
another woman from behind demonstrates
the existence of midwifery in 500BC.
Cont……
• Hippocrates (460BC) the father of
scientific medicine, organized trained
and supervised midwives. Hippo-
crates believed that the foetus has to
fight its way out of the womb and the
membranes. The midwives did not
appreciate the efforts of Hippocrates.
Cont….
• Aristotle, the father of
embryology, described the
uterus and the female
pelvic organs. He also
discussed the essential
qualities of the midwife.
• Leonardo da vinci made
anatomical drawings of
pregnant uterus.
• Louise Pasteur in 1879 wrote a
Cont.. thesis on puerperal sepsis
demonstrating the presence of
streptococci in the Lochia, blood.
There is much advancement in
obstetrical nursing.
Cont…… • Ambroise Pare laid the
foundation of modern
obstetrics He performed
internal podalic version
and skilfully delivered
women.
Midwifery
• In our mothers and grandmothers
days, an untrained woman,
neighbours, relative or friend delivered
most babies at home.
• All the changes started in 29th
century, when parturition moved into
the hospital setting. At that point,
child bearing became far from a family
affair.
Cont……
• Nursing was separated into
three specialities, with one nurse
caring for the mother during
labour, and delivery, another
handling postpartum mothers
and third caring for the baby.
• In the year 1940s, ‘rooming in’
concept was devised.
Cont…..
In 1960s, the focus
changed from the person
giving care to the
recipient. With that
change, came a change in
terminology and
obstetrical care became
Maternity care.
Cont…
• WHO offers 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 child care, has
a normal delivery and bears
healthy children.
Changes in social structure,
variations in family lifestyle
Role of Fathers With
increased societal emphasis
on shared parenting and the
recognition of parental
bonding, many fathers are
active in care giving and
enjoy the closeness it brings.
Cost Containment
•· Cost containment
refers to systems of health care
delivery that focus on reducing the
cost of health care by closely
monitoring the cost of personnel,
use and brands of supplies, length
of hospital stays, number of
procedures carried out, and number
of referrals requested.
Changing Patterns of Child Birth
There are increasing numbers of
working women, until they are in
there thirties.
As early marriage practices still
continue, both ends, the older and
younger mothers face increased
risks of complications during
pregnancy, such as preterm
delivery, LBW etc.
Rising Caesarean Birth Rates
• With the use of foetal
monitoring and
ultrasound for prenatal
monitoring and
ultrasound for prenatal
evaluation of foetal
condition, has come and
increased rate of
Expanded roles for nurses
•· Increasing
nursing responsibility for
assessment and
professional judgment and
providing expanded roles
for nurse practitioners,
such as the nurse-
midwife.
Family Centered Care
•· More natural childbirth
environment where partners, family members
may remain in a homelike environment, and
participate in the childbirth experience
•· By adopting a view of pregnancy,
childbirth as a family event, nurses can be
instrumental in including family members in
care and consult family members about a plan
of care and provide clear health teaching so
that family members can monitor their own
care
Access to Health Care
• · Strong predictors of access to quality
health care include having health insurance, a higher
income level, and a regular primary care provider or
other source of ongoing health care. Use of clinical
preventive services, such as early prenatal care, can
serve as indicators of access to quality health care
services. The objectives selected to measure progress in
this area are:
• · Increase the proportion of persons with
health insurance.
• · Increase the proportion of persons who
have a specific source of ongoing care.
• · Increase the proportion of pregnant
women who begin prenatal care in the first trimester of
pregnancy
Shortening Hospital Stays
•· Women who have begun
preterm labor stay in the hospital while labor
is halted and then are allowed to return home
on medication with continued monitoring.
•· Routine hospital stay for
mothers and newborns after an uncomplicated
birth is now 2 days or less.
•· Short-term hospital stays
require intensive health teaching by the
nursing staff and follow-up by home care or
community health nurses.
Increased Use of Alternative
Treatment Modalities
•· There is a growing tendency to
consult alternative forms of therapy, such as
acupuncture or therapeutic touch, in addition
to, or instead of, traditional health care
providers. Nurses have an increasing
obligation to be aware of complementary or
alternative therapies.
Increased Use of Technology
• · Today foetal monitoring has progressed
from the use of fetoscope to electronic
foetal monitors. It can be used both,
directly and indirectly.
• The field of assisted reproduction (e.g.,
in vitro fertilization), seeking information
on the Internet.
• In future, there are challenges for
nurses, as they will provide care in the
world of high technology.
• ICU AND PICU
New technology in maternity and
newborn health nursing
• Robotic gynaecological surgery
• The vita heat during labour
• Virtual reality (VR) eases
labour pain
• Clear blue digital pregnancy
test
• A contraceptive computer
chips
• Speciality care as clinical
specialist midwife counsellor
New Training Methods in Midwifery
• Practical workshop
• Case studies
• Training with simulator
mannequins in the laboratories
• Mind mapping
• Problem-based learning
CONCLUSION
• Building skills, continuous training is
very important to improve maternal
health and improve quality of care.
• Modern and effective teaching methods
in midwifery education, which are done
in accordance with proclaimed goals of
study program in midwifery, are
necessary for final reform and for
creation of professional with full of
appropriate knowledge and skills
