Midwifery Nursing Science I
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By: NTN- 2020 Midwifery Nursing Science I Compiled by: NT Ndjuluwa Midwifery Nursing Science Tutor: Oniipa Campus-2020 1 | P a g e By: NTN- 2020 Unit 1: Introduction to Midwifery/overview Define related concepts: • Midwifery • Midwife/Accoucher • Community Midwifery • Traditional Birth Attendant (TBA) Discuss the History of Midwifery under: Midwifery History in Namibia pre-independence Midwifery History in Namibia post-independence The scope of practice of enrolled midwife accoucher Negligence Standard of nursing care Ethical framework: Confidentiality Right to privacy Right to information Informed consent Introduction to Midwifery Nursing Science • Midwifery Nursing Science is one of the three major field of nursing for the enrolled nurse/midwife/accoucher training programme, of which there are four major subjects. • Midwifery is one of the oldest known professions in the world • Midwifery preceded the medical and nursing professions • Midwives were the only caregivers for women in child birth What is Midwifery? • Is a field of study where the midwife is trained to offer a comprehensive service to women and families • From before pregnancy to the end of the postnatal period • Continues with the immunization program and the general care of the child until school age What is a midwife? • A person who has been regularly admitted to a midwifery educational program, duly recognized in the jurisdiction in which it is located • Has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/ or legally licensed to practice midwifery ( Sellers volume I, 1993: xxxiii ) 2 | P a g e By: NTN- 2020 What is a Traditional birth attendant? (TBA) • Is a person without midwifery training and has learnt the art of assisting the birth process from personal experience, or relatives, or neighbor or from known TBA’s in the community Midwifery subject for the EN/M/A program • It has two components namely: Theory and Practice • To pass the subject the Pupil enrolled nurse midwife PEN/M must meet requirements in both theory and practice The history of midwifery in Namibia pre-independence Work of the Missionaries • In January 1903 Catholic priests moved into the Kavango as far as Andara • In 1907 a Catholic mission established a small hospital at Gobabis, which also provided midwifery services • At Swakopmund a number of sisters from the Fransiscan order took over the health care of the community Work of the Missionaries… • They established a midwifery unit, the Antonius hospital at Swakopmund, which they placed in charge of a trained midwife from Germany • Germany had very strict regulations for the training and regulation of midwives • It was the first country in the world to introduce such legislation (Van Dyk, 1997:20) • On 14 December 1908 Dr. Selma Rainio, a Finnish doctor arrived at Oniipa • The work of Dr. Selma Rainio led to the extension of the Mission services • Between 1908 and 1909 further mission stations with health care facilities were established at Elim, Okahao and Tsandi • By 1910 midwives were appointed in several districts and had to serve as community nurses • Due to the heavy work load of doctors and nurses some indigenous men and women who had received elementary schooling at the missions, were given in-service preparation as health attendants • On 9 July 1911, the first proper hospital was opened in Owambo land, the well known Onandjokwe hospital • Onandjokwe hospital provided the first organized midwifery services in Owambo land, it played a major role in the training of midwives (Van Dyk:21) Problem of unqualified midwives and regulation of midwifery by law - The quality of the midwifery services provided by the “folk-midwives of both the indigenous and the settler communities caused a great concern - The authorities endeavored to ensure that midwifery was practiced by certified persons th - Early in the 20 century an effort was made to regulate the practice of midwifery 3 | P a g e By: NTN- 2020 History of midwifery in Namibia post independence st - On 21 March 1990, Namibia gained its independence - The new government of Namibia issued a policy statement which recognized health as a fundamental human right - It committed itself to the WHO target of Health for All by the year 2000 and beyond - The main goal of this policy is the equitable provision of health services with primary health care as the focal point for all health care services - The new health care policy meant that there had to be a complete re-orientation to the concept of primary health care and community-based care - In addition, plans have to be formulated for slotting medical missions, non- governmental organizations and the private sector into the overall national health plan - Provision of counseling, advice and care during pregnancy, delivery and puerperium - Keep simple records of the care given - Promotion of other health related matter e.g. family planning, immunization and breast feeding - Provide first aid in emergencies which may occur in pregnancy, labor and puerperium for both mother and baby - Assist with the identification of families at risk, e.g. acute or chronic illness, alcoholism, childhood handicapped and marital problems Collaboration between midwives/ accouchers and TBA’s - Midwives train TBA’s regarding clean and safe home deliveries and notification of births - Train them in primary health care (PHC) activities - Midwives recognize TBA’s by appreciating their work - Give support to TBA’s through support visits and trainings - Involve TBA’s in community based activities such as Expanded program on immunization (EPI) - Assist TBA’s to get identification e.g. badges or uniform Cultural framework - Many of the ancient cultures had definite customs and taboos relating to childbirth and its attendants - For example only women who had had children themselves were allowed to act as midwives - Men were not allowed to be present - Certain rituals had to be performed before, during and after labour - These factors stress the importance of the midwife to know the cultural history of midwifery in her/ his country as well as the culture of the individual woman she attends in childbirth 4 | P a g e By: NTN- 2020 - Midwives working in cross-cultural situations have to be aware that the birth process has always had special significance in all cultures, since it means the continuation of the species - The midwives helping with the birth process have always had a special place in their society, and the birth process has always been associated with a variety of taboos which protect the mother and infant - In the education of the modern midwife and in the assignment of personnel to specific areas, great care has to be taken that the midwives sent are culturally acceptable and that midwives from alien cultures cultivate a particular sensitivity to cultural aspects of the birth process Searle, C. 1987: 8 Legal framework - The midwife must observe the law, and must be responsible and accountable for her/ his actions - She had to interact in a prescribed manner with mother and child, family and the society - The midwife was always held accountable for her actions - Throughout the course of midwifery history the four core elements of professional practice namely, observance of custom or laws, independent action, interdependent action and accountability are discernible in the role fulfilment of the midwife - The fact that such concepts have survived for millenia, indicates the importance of midwifery in society and the fundamental need for a code of practice - These are characteristics which are essential elements of professional practice in modern midwifery The scope of practice of Enrolled Midwife/Acoucheur • The midwife shall provide the midwifery care as stipulated in her/ his scope of practice in the Nursing professions Act The scope of practice entails: - Assessment of the health needs of the pregnant woman - Identify health needs and promotion of health care of the mother and child, by means of examination, observations, counseling and health education during pregnancy, labour and puerperium - Handling of normal pregnancy, uncomplicated labour and normal puerperium - Deliver a normal full term pregnancy, without causing danger to the mother and baby - Identify abnormalities during antenatal care, delivery and post natal care and refer the patient to a medical practitioner or Registered midwife without delay - Provide effective care to the newborn baby and mother during puerperium - Promotion and maintenance of hygiene and physical comfort, and the re-assurance of the mother and child 5 | P a g e By: NTN- 2020 - Promotion of exercise, rest and sleep - Control, promotion and maintenance of respiratory functions, intake and output, blood pressure, temperature, pulse rate and fetal heart rate of the baby - Promotion, maintenance and improvement of the nutritional status of the mother and child - Promotion of breast feeding - Provision of information on health and family planning - Identifying and establishing a working relationship with traditional birth attendants and community leaders to improve health services in the community - Plan health care and health promotion activities of mother and child in health facilities as well as in the community - Care for the dying patient and still born infants Standards of nursing care Definition: • A standard is a desirable and achievable level of performance against which actual practice is compared (ICN,1984:24 ) • An object