INTERNATIONAL

MIDWIVES DAY 2016

THEME
'Women and Newborns: The Heart of
Midwifery'
Midwife is a responsible and accountable
professional who works in partnership with
women to give the necessary support, care
and advice during pregnancy & labour

and

During postpartum period - to provide care for

the newborn and the mother.
Care
 Preventive measures
 Promotion of normal birth
 Detection of complications in mother and
child
 Accessing of medical care or other
appropriate assistance
 Carrying out of emergency measures
The midwife has an important task in health
counseling and education for the woman and her
family and the community

- IN antenatal education, preparation for

parenthood and further on women’s
health, sexual / reproductive health
and child care

A midwife practice in setting including home,

community, hospitals /clinics / health units.
 Availability

 Accessibility

 Acceptability

 Quality of care.
Evidenced based practice in
maternal and new born care
◦ Every minute in the world
◦ 380 women become pregnant out of which 190 of
these are un planned pregnancies
◦ 110 women experience pregnancy related
complications
◦ 40 women have unsafe abortion
◦ 1 die from pregnancy related complication

◦ Every year in the world

◦ 5.36 lakh women die out of pregnancy related
complications
 25% of these from India
Evidence Based Practice?

Practice with Evidence

or
Scientifically sound facts and
principles.

This will promote Practice with confidence

and care
Evidence-based practice refers to the use of
interventions and strategies, supported by
researches which document their
effectiveness.
Dunst, Trivette, and Cupsek (2002)
Antenatal care

 ……..is a key component of a healthy pregnancy

 Regular antenatal care helps to identify and treat

complications and to promote healthy behaviours

 outcome data suggest that neonates born to mothers

who do not receive antenatal care are 3 times more
likely to be of low birth weight, and 5 times more
likely to die, compared with neonates born to mothers
who receive antenatal care
US Department of Health and
Human Services: prenatal services
Health care encounters- during women’s
reproductive years to optimize pregnancy out come

By the way of counseling on

 medical care
 healthy behaviours
 to optimize pregnancy outcome
 Example, healthy women should begin folic acid
supplementation (400 micrograms/day), ideally at
least 3 months before conception and continue until
12 weeks' gestation.
Factors affecting pregnancy outcome
 consideration of family history
 genetic history
 nutritional status
 folic acid intake
 environmental and occupational exposures
 Teratogens
 history of illicit-substance use, tobacco and alcohol
consumption
 medical conditions
 Medication
 immunization status
 risk factors for STDs
 psychosocial concerns (depression, domestic violence)
 pregnancy spacing
Example : women with diabetes should be counseled on
optimizing glycaemic control, and pregnancy should be
discouraged until control is achieved
International Diabetes Federation: global
guideline on pregnancy and diabetes
Immunizations

◦ Rubella, varicella, or hepatitis B should be offered

to women who are susceptible
◦ Women should avoid pregnancy for 1 month after
receiving a live attenuated vaccine {even though
the evidence does not suggest that they are in fact
harmful }
CDC: guidelines for vaccinating
pregnant women
 Influenza vaccination is recommended in any
trimester for women who are pregnant or who
plan to become pregnant during the influenza
season

 Pertussis vaccination (Tdap) is recommended

between 27 and 36 weeks of each pregnancy

Immunization rates for these vaccines are low, leaving many

pregnant women and their infants unprotected against these
serious vaccine-preventable diseases.
Screening of fetal growth
 Appropriate fetal growth can be screened by measuring
fundal height (symphysis to uterine fundus) from 20 to 24
weeks' gestation

 The antenatal care provider should keep in mind that

fundal height measurements can be influenced by
numerous factors, including maternal size, bladder filling,
uterine fibroids, multiple gestations, and fetal presentation
◦ although most studies suggest that the sensitivity of fundal height as a
measurement of growth restiction is <50%. Fundal height in centimetres is
approximately equal to the gestation age in weeks. Discrepancies of >3 cm
should prompt ultrasound evaluation of amniotic fluid index and fetal growth.
 BIRTH ENVIRONMENT

Provide a homely environment that will

promote maternal wellbeing and take
control of labour process and minimal
intervention
 LATENT PHASE

High level of pain and anxiety in latent

phase are linked with more labour
interventions in active labour
SUPPORTING WOMEN IN LABOUR
 Emotional support
 demonstrating an effective caring attitude,
positive and calming verbal expressions and
non verbal expression , distraction, use of
humour
 Physical support and comfort measures
 Environmental control, encouragement of
different positions and mobilisation, touch,
massage, application of hot and cold packs,
hygiene, hydrotherapy
Information and advise
 Listening to women’s views ,instruction on
breathing and relaxation
 Information about routines
 Procedures and progress

Advocacy
 Assisting the client to make informed
choices, being the client’s voice when
required and conflict resolution
SUPPORTING AND INVOLVING
WOMEN AS BIRTH COMPANION

IMMERSION IN WATER FOR

LABOUR AND BIRTH
PHARMACOLOGICAL PAIN RELIEF

INTERMITTENT AUSCULATION
ASSESSING PROGRESS IN LABOUR

RUPTURING MEMBRANES
 PERSISTENT LATERAL AND
POSTERIOR FETAL POSIONS AT
THE ONSET OF LABOUR

 Mobility
 Change of position during labour
 Use of birthing pool or bath
 Use of coping strategies
 INDUCTION OF LABOUR
 Prostaglandins E2 (cervical and vaginal) are effective
agents of cervical ripening and induction of labour for an
unfavourable cervix. (I)

Intravaginal prostaglandins E2 are preferred to intracervical

 prostaglandins E2 because they results in more timely
vaginal deliveries.

J Obstet Gynaecol Can 2013;35(9)

 Heinemann et al.
Systematic review of 30 RCTs showed an increased
risk of both maternal infection (defined aspyrexia of
38°C, chorioamnionitis, peripartum infection, or
chorioamnionitis and/or endomyometritis), and
neonatal infection when all (Foley catheters,
hydroscopic dilators, laminaria) mechanical
methods analyzed

Studies limited to Foley catheters compared with

pharmacological agents for cervical ripening had
similar rates for maternal Infection and there was no
increased risk of neonatal infection

J Obstet Gynaecol Can 2013;35(9)

 There is a need for oxytocin when Foley
catheters are used

In comparison with prostaglandins, Foley catheters

 cause much less uterine tachysystole

 Foley catheters are not associated with increased

rates of maternal infection (chorioamnionitis and
 endometritis) or neonatal infection

 Use of Foley catheters does not reduce the rate of CS

from that of PG.

J Obstet Gynaecol Can 2013;35(9)

 OXYTOCIN
 Example of low-dose protocol:
 Initial dose of oxytocin..................................1 to 2 mU/min
 Increase interval......................................................30
minutes
 Dosage increment....................................................1 to 2 mU
 Usual dose for good labour.........................8 to 12 mU/min
 Maximum dose before reassessment.................30 mU/min

 Example of high-dose protocol:

 Initial dose of oxytocin..................................4 to 6 mU/min
 Increase interval............................................15 to 30 minutes
 Dosage increment...........................................4 to 6 mU/min
 Usual dose for good labour.........................8 to 12 mU/min
 Maximum dose before reassessment.................30 mU/min
Postnatal care to mothers and new born
 After an uncomplicated vaginal birth in a health
facility, healthy mothers and newborns should
receive care in the facility for at least 24 hours
after birth.

 The results of one RCT showed that the risk of

neonatal readmission when the mother and baby
were discharged from the health facility within
24 hours after birth was not significantly
different than when the discharge occurred at a
later time (RR=0.61, 95% CI 0.15 to 2.53)
 Home visits in the first week after birth are recommended
for care of the mother and newborn.

 A systematic review was commissioned to evaluate the

effects of home-based neonatal care provided by CHWs on
neonatal mortality and/or perinatal mortality in resource-
limited settings (14). The review identified five CRCTs, all
from South Asia (Bangladesh, India and Pakistan),
involving 101 655 participants (58–62). In addition, three
non-randomized trials were included for a post-hoc
sensitivity analysis of the impact on neonatal mortality
(63–65). Two studies in Africa (Ghana and the United
Republic of Tanzania) are currently evaluating the effect of
home visits for newborn care on newborn mortality.
Assessment of the newborn

 The signs should be assessed during each

postnatal care contact, and the newborn should
be referred for further evaluation if any of the
signs is present
● Stopped feeding well
● History of convulsions
● Fast breathing (breathing rate >60 per minute)
● Severe chest in-drawing
● No spontaneous movement
● Fever (temperature >37.5 °C)
● Low body temperature
Cord care

 Daily chlorhexidine (7.1% chlorhexidine digluconate

aqueous solution or gel, delivering 4% chlorhexidine)
application to the umbilical cord stump during the
first week of life is recommended for newborns who
are born at home settings

 Clean, dry cord care is recommended for newborns

born in health facilities

Use of chlorhexidine in these situations may be considered

only to replace application of a harmful traditional
substance, such as cow dung, to the cord stump.
 Bathing should be delayed until after 24 hours of
birth
 If this is not possible due to cultural reasons,
bathing should be delayed for at least six hours
 Appropriate clothing of the baby for ambient
temperature is recommended
This means one to two layers of clothes more
than adults and use of hats/caps
 The mother and baby should not be separated
and should stay in the same room 24 hours a
day
http://www.who.int/maternal_child_a
dolescent/documents/924159084x/en
/index.html
Assessment of the mother

 First 24 hours after birth

 assessment of vaginal bleeding

 uterine contraction

 fundal height

 temperature and heart rate (pulse) routinely during the

first 24 hours starting from the first hour after birth

 Blood pressure should be measured shortly after birth. If

normal, the second blood pressure measurement should be
taken within six hours

 Urine void should be documented within six hours

Assessment of the mother
Beyond 24 hours after birth:
 Micturition and urinary incontinence
 Bowel function
 Healing of any perineal wound
 Headache, fatigue, back pain
 Perineal pain and perineal hygiene
 Breast pain and uterine tenderness and lochia
 Breastfeeding progress should be assessed at each postnatal
contact
 At each postnatal contact, women should be asked about their
emotional well-being, what family and social support they have,
and their usual coping strategies for dealing with day-to-day
matters
 All women and their families/partners should be encouraged to
tell their health care professional about any changes in mood,
emotional state or behaviour that are outside of the woman’s
normal pattern

http://www.who.int/maternal_child_adolescent/docum
ents/924159084x/en/index.html
 Treatments to prevent meconium aspiration
syndrome have included amnioinfusion
during labor, intrapartum suctioning, and
endotracheal intubation and suctioning of
infants with meconium-stained fluid
 The recent evidence suggests that these
practices are not helpful and do not prevent
meconium aspiration syndrome
Judith S. Mercer, Evidence-Based Practices for the Fetal
to Newborn Transition, J Midwifery Womens
Health. 2007;52(3):262-272. © 2007 Elsevier Science,
Inc
 New Born care

 Active infants should not be incubated

and suctioned
Anti shock Garment

 MAST :Military anti shock trousers

 PASG : Pneumatic anti shock garment

{to provide vasoconstriction in the lower

extremities and abdomen }
Atraumatic Instruments
Vagistop
Obstetrics
Device
For prevention
and treatment of
vaginal
haemorrhage in
obstetrics
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AMNICOT
The rubber-latex finger
stall with its small
integrated hook allows
the pain-free rupturing
of the amnion without
further assistance.

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Atraumatic laparoscopic grasper

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CLING WRAP

Prevention of
Hypothermia
in Infants
<30 weeks
Gestation

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Bili blanket

A Bili blanket is a
portable phototherapy
device for the
treatment of neonatal
jaundice

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Atraumatic padded Restraints

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 Intermittent
pneumatic compression devices

Prevent venous
thrombosis by
enhancing blood flow
in the deep veins of
the legs
Reduce plasminogen activator
inhibitor-1
Increase endogenous
fibrinolytic activity.
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Qualities of a Nurse
midwife
 Knowledgeable

 Positive Attitude
 Clinical/ technical Skill
 Communication

 Interpersonal

relationship
 Assertive

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