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Concepts in obg
Bsc nursing (blaw 213)
Kerala University of Health Sciences
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HISTORY OF MIDWIFERY Midwifery is as old as the history of human species. Archeological evidence of woman squatting in childbirth supported another woman from behind demonstrates the existence of midwifery in 500 BC. In the Bible, in the Old Testament, Genesis came to pass, where she was in hard that the midwife said Shiphrah unto her, fear not Rachael, it is another In Exodus 1:15, it is recorded that king of Egypt spoke to the and Puah, the two midwives, who helped Hebrew women when they gave birth. These two midwives are first midwives traced in the literature. 2 HISTORY OF MIDWIFERY Midwifery is as old as the history of human species. Archeological evidence of woman squatting in childbirth supported another woman from behind demonstrates the existence of midwifery in 500 BC. In the Bible, in the Old Testament, Genesis came to pass, where she was in hard that the midwife said Shiphrah unto her, fear not Rachael, it is another In Exodus 1:15, it is recorded that king of Egypt spoke to the and Puah, the two midwives, who helped Hebrew women when they gave birth. These two midwives are first midwives traced in the literature. 2 Unit 1 Introduction to Concepts of Obstetric Nursing Hippocrates (460 BC), the Father of Scientific Medicine, organized training and supervised midwives. Hippocrates believed that the fetus had to fight its way to come out of the womb and membranes. Aristotle BC), the Father of Embryology, described the uterus and female pelvic organs. He also discussed the essential qualities of the midwives. Soranus, in the second century, was the first to specialize in obstetrics and gynecology. He used a vaginal speculum and advised on cord care. Based on the teachings of Soranus, in 1513, the first book on midwifery was printed in Germany. During the period of decline of Roman Empire from 5th to 15th centuries, untrained midwives controlled the practice of midwifery. Leonardo da Vinci made anatomical drawings of pregnant uterus. Ambroise Pare laid the foundation of modern obstetrics. He performed internal podalic version. He was the first person to deliver a woman in bed instead of the birthing stool. He also sutured perineal lacerations. In Paris (France), Ambroise Pare founded a school for midwives. Louise Bourgeois, midwife trained Pare, attended the ladies of the French court. She warned midwives against getting infected with syphilis and transmitting it to other women. She recommended induction of labor for pelvic contraction. William Harvey called the father of British midwifery, wrote the first English text book on midwifery. He explained the fetal circulation and placenta and was the first to deliver the placenta massaging the uterus. He described the raw placental surface and initiated the study of uterine sepsis. Women did not prefer men for their delivery during this period. Midwives did not usually seek medical assistance until the labor was hopelessly obstructed, as in the case of gross pelvic deformities. The resultant death of mother or ba gave physicians unwarranted reputation. For Italian midwives, Julius Caesar Aranzi wrote the first book, which ran for 17 editions. He recommended cesarean section for contracted pelvis. In 1663, French King Louise XIV, employed a Paris surgeon to attend one of his mistresses and pleased with the result, the king honored the surgeon with the title William Smellie was called the Father of British midwifery. In 1773, Charles White explained puerperal fever was infectious. He suggested clean linen, isolation, adequate ventilation and sitting posture to facilitate drainage. He used lime as disinfectant. Laennec invented a stethoscope in 1816. James Young Simpson in 1847, used chloroform in obstetrics as an anesthetic for the first time. Florence Nightingale in 1862, organized a small training school in connection with College Hospital, where she conducted training for midwives. In 1879, Louis Pasteur wrote a thesis on puerperal sepsis in which he described, the presence of streptococci in the lochia, blood and in fatal cases in the peritoneal cavity. Spencer and Ballantyne promoted the concept of antenatal care for pregnant women. During first world war, the first antenatal clinic was started. Porro in 1876, performed subtotal hysterectomy. forceps. In 1882, Max Sanger first sutured the uterine walls. Chamberlain, in 1975, designed obstetric introduced into the present technique of lower segment cesarean operation in 1926. The first book Kerr Kronig (1912) introduced lower segment vertical incision and DeLee popularized it in 1922. Munro rigidly English in 1540. For a century and half, it was the only book on midwifery in English. was translated Vesalius excluded opened from labor rooms during this period and only midwives assisted women in labor. Doctors In were name from chamber the organ. The history of cesarean section dates back to 715 BC and the demonstrated uterus as a single the full term pregnant uterus in a lower animal, extracted the fetus and 1543, The law provided notification Lex Roman law, which was followed even operation derives its perform postmortem for an abdominal delivery either in a dying woman with a hope to during a reign. the birth of Caesar, as abdominal his mother delivery for a separate burial. The operation does not derive get live ba or to related to a Latin verb caedere which lived means for long time, after his birth. The origin of the word its name is from also Unit 1 Introduction to Concepts of Obstetric Nursing Hippocrates (460 BC), the Father of Scientific Medicine, organized training and supervised midwives. Hippocrates believed that the fetus had to fight its way to come out of the womb and membranes. Aristotle BC), the Father of Embryology, described the uterus and female pelvic organs. He also discussed the essential qualities of the midwives. Soranus, in the second century, was the first to specialize in obstetrics and gynecology. He used a vaginal speculum and advised on cord care. Based on the teachings of Soranus, in 1513, the first book on midwifery was printed in Germany. During the period of decline of Roman Empire from 5th to 15th centuries, untrained midwives controlled the practice of midwifery. Leonardo da Vinci made anatomical drawings of pregnant uterus. Ambroise Pare laid the foundation of modern obstetrics. He performed internal podalic version. He was the first person to deliver a woman in bed instead of the birthing stool. He also sutured perineal lacerations. In Paris (France), Ambroise Pare founded a school for midwives. Louise Bourgeois, midwife trained Pare, attended the ladies of the French court. She warned midwives against getting infected with syphilis and transmitting it to other women. She recommended induction of labor for pelvic contraction. William Harvey called the father of British midwifery, wrote the first English text book on midwifery. He explained the fetal circulation and placenta and was the first to deliver the placenta massaging the uterus. He described the raw placental surface and initiated the study of uterine sepsis. Women did not prefer men for their delivery during this period. Midwives did not usually seek medical assistance until the labor was hopelessly obstructed, as in the case of gross pelvic deformities. The resultant death of mother or ba gave physicians unwarranted reputation. For Italian midwives, Julius Caesar Aranzi wrote the first book, which ran for 17 editions. He recommended cesarean section for contracted pelvis. In 1663, French King Louise XIV, employed a Paris surgeon to attend one of his mistresses and pleased with the result, the king honored the surgeon with the title William Smellie was called the Father of British midwifery. In 1773, Charles White explained puerperal fever was infectious. He suggested clean linen, isolation, adequate ventilation and sitting posture to facilitate drainage. He used lime as disinfectant. Laennec invented a stethoscope in 1816. James Young Simpson in 1847, used chloroform in obstetrics as an anesthetic for the first time. Florence Nightingale in 1862, organized a small training school in connection with College Hospital, where she conducted training for midwives. In 1879, Louis Pasteur wrote a thesis on puerperal sepsis in which he described, the presence of streptococci in the lochia, blood and in fatal cases in the peritoneal cavity. Spencer and Ballantyne promoted the concept of antenatal care for pregnant women. During first world war, the first antenatal clinic was started. Porro in 1876, performed subtotal hysterectomy. forceps. In 1882, Max Sanger first sutured the uterine walls. Chamberlain, in 1975, designed obstetric introduced into the present technique of lower segment cesarean operation in 1926. The first book Kerr Kronig (1912) introduced lower segment vertical incision and DeLee popularized it in 1922. Munro rigidly English in 1540. For a century and half, it was the only book on midwifery in English. was translated Vesalius excluded opened from labor rooms during this period and only midwives assisted women in labor. Doctors In were name from chamber the organ. The history of cesarean section dates back to 715 BC and the demonstrated uterus as a single the full term pregnant uterus in a lower animal, extracted the fetus and 1543, The law provided notification Lex Roman law, which was followed even operation derives its perform postmortem for an abdominal delivery either in a dying woman with a hope to during a reign. the birth of Caesar, as abdominal his mother delivery for a separate burial. The operation does not derive get live ba or to related to a Latin verb caedere which lived means for long time, after his birth. The origin of the word its name is from also Unit 1 Introduction to Concepts of Obstetric Nursing low babies, maternal and fetal morbidity and mortality. In addition, women in increasing numbers are working outside their home during pregnancy and shortly after delivery compounding the risks to themselves and the fetus of exposure to toxic chemicals, excessive noise and workplace stress. care: This concept was introduced in obstetrics Wiedenbach. It is a system for the provision of quality midwifery care that is adapted to the physical and psychological needs of the mother, newborn and her family. It enhances social support, develops parental and competence and enhances the level of midwifery practice. Rising cesarean birth rates: The use of fetal monitoring and ultrasound for prenatal evaluation of fetal condition has increased rate of cesarean birth rates. Many physicians, nowadays, because of financial gains conduct cesarean section, therefore eventually increasing cesarean birth rates. Increasing the number of intensive care units: Over the past 20 years, care of infant and children has become extremely technical. Many infants, nowadays, are born with low birth weight and some sorts of sickness. Such infants are transferred to Newborn Intensive Care Unit (NICU). For this, opportunities for advanced practice nurses also have increased. Epidural analgesia in labor: Epidural analgesia provides better pain relief in labor. However, it is not associated with improved maternal satisfaction. It does not increase lower segment cesarean section (LSCS) rates. Risk of postpartum backache is not increased. It increases the risk for vaginal instrumental delivery and also prolongs the second stage of labor. Positions during second stage of labor: Earlier, lithotomy position was used during second stage of labor. Now various studies have proved that upright or sitting positions are good for childbirth because they enhance gravity and also allow the coccyx to move backwards as the ba passes through the birth canal. In case of lithotomy position, the coccyx is pressed against the hard bed making unable to move back and thus not allowing the pelvic outlet to widen. Team midwifery practices: Every mother who is pregnant is allocated a small group of three or four midwives who are responsible for the total care of the woman through complete maternity cycle. Continuity of care with hospitalization, freedom of choice of place of delivery, avoidance of unnecessary obstetrical intervention, professional autonomy and better utilization of midwifery skills are some of the benefits of team midwifery practices. Complementary and alternative medicine (CAM): The following therapies are used in obstetric and gynecological care nurses: Aroma therapy Music therapy Acupuncture Acupressure Hot packs Infrared lamp therapy for episiotomy wound healing Yoga and meditation Massage therapy Natural childbirth: It is a method of childbirth in which medical interventions are minimized. The mother uses birthing positions according to her comfort and practices breathing and relaxation techniques to decrease pain, which makes the delivery easier. Water birth: Water birth has several benefits. Contractions cause less discomfort as the warmth of water is maintained. This method promotes relaxation of the abdominal and uterine muscles. The first stage of labor duration is also shortened. Early discharge: In earlier days, women were hospitalized for longer duration and physical activity was increased very gradually. Over the years now, however, healthcare personnel have realized the early return to normal activities is the best course for uncomplicated births. 5 Unit 1 Introduction to Concepts of Obstetric Nursing low babies, maternal and fetal morbidity and mortality. In addition, women in increasing numbers are working outside their home during pregnancy and shortly after delivery compounding the risks to themselves and the fetus of exposure to toxic chemicals, excessive noise and workplace stress. care: This concept was introduced in obstetrics Wiedenbach. It is a system for the provision of quality midwifery care that is adapted to the physical and psychological needs of the mother, newborn and her family. It enhances social support, develops parental and competence and enhances the level of midwifery practice. Rising cesarean birth rates: The use of fetal monitoring and ultrasound for prenatal evaluation of fetal condition has increased rate of cesarean birth rates. Many physicians, nowadays, because of financial gains conduct cesarean section, therefore eventually increasing cesarean birth rates. Increasing the number of intensive care units: Over the past 20 years, care of infant and children has become extremely technical. Many infants, nowadays, are born with low birth weight and some sorts of sickness. Such infants are transferred to Newborn Intensive Care Unit (NICU). For this, opportunities for advanced practice nurses also have increased. Epidural analgesia in labor: Epidural analgesia provides better pain relief in labor. However, it is not associated with improved maternal satisfaction. It does not increase lower segment cesarean section (LSCS) rates. Risk of postpartum backache is not increased. It increases the risk for vaginal instrumental delivery and also prolongs the second stage of labor. Positions during second stage of labor: Earlier, lithotomy position was used during second stage of labor. Now various studies have proved that upright or sitting positions are good for childbirth because they enhance gravity and also allow the coccyx to move backwards as the ba passes through the birth canal. In case of lithotomy position, the coccyx is pressed against the hard bed making unable to move back and thus not allowing the pelvic outlet to widen. Team midwifery practices: Every mother who is pregnant is allocated a small group of three or four midwives who are responsible for the total care of the woman through complete maternity cycle. Continuity of care with hospitalization, freedom of choice of place of delivery, avoidance of unnecessary obstetrical intervention, professional autonomy and better utilization of midwifery skills are some of the benefits of team midwifery practices. Complementary and alternative medicine (CAM): The following therapies are used in obstetric and gynecological care nurses: Aroma therapy Music therapy Acupuncture Acupressure Hot packs Infrared lamp therapy for episiotomy wound healing Yoga and meditation Massage therapy Natural childbirth: It is a method of childbirth in which medical interventions are minimized. The mother uses birthing positions according to her comfort and practices breathing and relaxation techniques to decrease pain, which makes the delivery easier. Water birth: Water birth has several benefits. Contractions cause less discomfort as the warmth of water is maintained. This method promotes relaxation of the abdominal and uterine muscles. The first stage of labor duration is also shortened. Early discharge: In earlier days, women were hospitalized for longer duration and physical activity was increased very gradually. Over the years now, however, healthcare personnel have realized the early return to normal activities is the best course for uncomplicated births. 5 Textbook and Gynecological Nursing for KUHS emphasis on shared parenting and societal the With increased Role active giving and enjoy the closeness it of in care brings. recognition are profession): Nursing and midwifery care is bonding, becoming an Midwifery Like nursing graduates, midwifery graduates demonstrate among and their babies, and are eligible for advanced education. practice, that care midwifery the mother is a specialization, it has a body of knowledge and many believe as a separate profession like nursing profession. midwifery to midwifery practice: A degree in midwifery from university: In standard Entry to establish educational criteria, a task force committee on nursing and and a degree program for midwives was devised. It is believed that this more formed competent and will help them perform high quality of maternal and child positive maternal and birth outcome. Independent nurse midwifery practice: This program establishes independent Here, midwives enjoy more autonomy focusing on mother and newborn in a particular population, enables them to bring better birth outcome. HALLMARKS OF MIDWIFERY The hallmarks of midwifery identify essential aspects of the profession. They articulate the characteristics of midwifery. They are present in the professional lives of all midwives, whether unique clinicians, educators, researchers, or a combination of these responsibilities (Tables 1 and 2). TABLE 1: Midwifery and its hallmarks 1. Recognition of pregnancy, birth and menopause as normal physical and developmental processes. 2. Advocacy of not intervening if there are no complications. 3. Incorporating scientific evidence into clinical practice. 4. Promoting care. 5. Empowerment of women as partners in health care. 6. Facilitation of healthy family and interpersonal relationships. 7. Promotion of continuity of care. 8. Health promotion, disease prevention, and health education. 9. Promoting a public health care perspective. 10. Care to vulnerable populations. 11. Advocacy for informed choice, shared and the right to 12. Cultural competence. 13. 14. Familiarity with common complementary and alternative therapies. 15. Skillful communication, guidance and counseling. Therapeutic value of human presence 16. Source: American Collaboration with other members of the health care team. College of Textbook and Gynecological Nursing for KUHS emphasis on shared parenting and societal the With increased Role active giving and enjoy the closeness it of in care brings. recognition are profession): Nursing and midwifery care is bonding, becoming an Midwifery Like nursing graduates, midwifery graduates demonstrate among and their babies, and are eligible for advanced education. practice, that care midwifery the mother is a specialization, it has a body of knowledge and many believe as a separate profession like nursing profession. midwifery to midwifery practice: A degree in midwifery from university: In standard Entry to establish educational criteria, a task force committee on nursing and and a degree program for midwives was devised. It is believed that this more formed competent and will help them perform high quality of maternal and child positive maternal and birth outcome. Independent nurse midwifery practice: This program establishes independent Here, midwives enjoy more autonomy focusing on mother and newborn in a particular population, enables them to bring better birth outcome. HALLMARKS OF MIDWIFERY The hallmarks of midwifery identify essential aspects of the profession. They articulate the characteristics of midwifery. They are present in the professional lives of all midwives, whether unique clinicians, educators, researchers, or a combination of these responsibilities (Tables 1 and 2). TABLE 1: Midwifery and its hallmarks 1. Recognition of pregnancy, birth and menopause as normal physical and developmental processes. 2. Advocacy of not intervening if there are no complications. 3. Incorporating scientific evidence into clinical practice. 4. Promoting care. 5. Empowerment of women as partners in health care. 6. Facilitation of healthy family and interpersonal relationships. 7. Promotion of continuity of care. 8. Health promotion, disease prevention, and health education. 9. Promoting a public health care perspective. 10. Care to vulnerable populations. 11. Advocacy for informed choice, shared and the right to 12. Cultural competence. 13. 14. Familiarity with common complementary and alternative therapies. 15. Skillful communication, guidance and counseling. Therapeutic value of human presence 16. Source: American Collaboration with other members of the health care team. College of Textbook of Obstetric and Gynecological Nursing for KUHS Neonatal deaths: of neonatal deaths happen during labor or within first 24 hours are among the major causes of newborn deaths. Most of these deaths can be avoided malformations Prematurity neonatal infections birth asphyxia and congenital exclusive breastfeeding, skilled attendants for antenatal, birth and postnatal care, access to immediate micronutrients, family knowledge of danger signs in a health and immunization. Gender issues: Female feticide: It is the act of aborting a ba because it is of a female gender. Sex abortion is a big problem in India. The number of abortions medical professionals has so much that today it has become an industry even though it is punishable law. increased Early marriage: Early marriage is a harmful practice that denies rights of girls to make about their sexual health and Despite being prohibited international law, it to affect lives of millions of girls under 18 around the world. Child marriages happen continues inequalities between boys and girls driven harmful social and gender norms, negligence because of protecting girls and poverty. Moreover, younger wives are considered to be more of laws parents think marriage will protect girls from violence, particularly in times of crisis or obedient and Illiteracy: In India, the problems related to reproductive and sexual health among insecurity. highest amongst the rural population. Illiteracy is the leading cause of this situation. women is the disparities. literacy of the girl child can help delay the age at which she gets married and there reduce Ensuring other Gender inequality: Women in India for years have been exposed to gender inequality that has the root cause of sexual and reproductive diseases. According to WHO, reproductive and sexual been ill health accounts for of the global burden of for women and for men. Limited access to care: Barrier to access must be removed to improve maternal and neonatal The most significant barriers to access are transportation barrier, geographical barrier, low income outcome. and barriers related to knowledge and education. access to affordable health care, lack of medical insurance, long wait appointment, cultural barriers and Increase in high risk pregnancies: In India, about pregnancies belong to related which is responsible for of perinatal morbidity and mortality. Some reasons of pregnancy category, complications in developing countries are poverty, social and cultural prejudices, Matritva violence, lack of education and lack of access to essential health care facilities. Pradhan Mantri Surakshit India Abhiyan (PMSMA) is an initiative of Ministry of Health and Family Welfare, Government of centers to with identify pregnancies early and follow them so that they can be referred to health care deliveries proper facilities so that women with pregnancies may have healthy pregnancies and but still without complications. Although government takes initiative to reduce pregnancies there is an increase in high risk pregnancy rates. OBSTETRICAL NURSING LEGAL AND ETHICAL ASPECTS RELATED TO MIDWIFERY AND Definitions Ethics: beliefs about Ethics values are the of principles of conduct governing relationship with others. They are basic Laws: Laws are rules of right and wrong that provide a framework for decisions and actions. such as the local, state or conduct or actions recognized as binding or enforced a controlling party authority, from infringing on the rights national of another government. party. They are designed to prevent the actions of 8 Textbook of Obstetric and Gynecological Nursing for KUHS Neonatal deaths: of neonatal deaths happen during labor or within first 24 hours are among the major causes of newborn deaths. Most of these deaths can be avoided malformations Prematurity neonatal infections birth asphyxia and congenital exclusive breastfeeding, skilled attendants for antenatal, birth and postnatal care, access to immediate micronutrients, family knowledge of danger signs in a health and immunization. Gender issues: Female feticide: It is the act of aborting a ba because it is of a female gender. Sex abortion is a big problem in India. The number of abortions medical professionals has so much that today it has become an industry even though it is punishable law. increased Early marriage: Early marriage is a harmful practice that denies rights of girls to make about their sexual health and Despite being prohibited international law, it to affect lives of millions of girls under 18 around the world. Child marriages happen continues inequalities between boys and girls driven harmful social and gender norms, negligence because of protecting girls and poverty. Moreover, younger wives are considered to be more of laws parents think marriage will protect girls from violence, particularly in times of crisis or obedient and Illiteracy: In India, the problems related to reproductive and sexual health among insecurity. highest amongst the rural population. Illiteracy is the leading cause of this situation. women is the disparities. literacy of the girl child can help delay the age at which she gets married and there reduce Ensuring other Gender inequality: Women in India for years have been exposed to gender inequality that has the root cause of sexual and reproductive diseases. According to WHO, reproductive and sexual been ill health accounts for of the global burden of for women and for men. Limited access to care: Barrier to access must be removed to improve maternal and neonatal The most significant barriers to access are transportation barrier, geographical barrier, low income outcome. and barriers related to knowledge and education. access to affordable health care, lack of medical insurance, long wait appointment, cultural barriers and Increase in high risk pregnancies: In India, about pregnancies belong to related which is responsible for of perinatal morbidity and mortality. Some reasons of pregnancy category, complications in developing countries are poverty, social and cultural prejudices, Matritva violence, lack of education and lack of access to essential health care facilities. Pradhan Mantri Surakshit India Abhiyan (PMSMA) is an initiative of Ministry of Health and Family Welfare, Government of centers to with identify pregnancies early and follow them so that they can be referred to health care deliveries proper facilities so that women with pregnancies may have healthy pregnancies and but still without complications. Although government takes initiative to reduce pregnancies there is an increase in high risk pregnancy rates. OBSTETRICAL NURSING LEGAL AND ETHICAL ASPECTS RELATED TO MIDWIFERY AND Definitions Ethics: beliefs about Ethics values are the of principles of conduct governing relationship with others. They are basic Laws: Laws are rules of right and wrong that provide a framework for decisions and actions. such as the local, state or conduct or actions recognized as binding or enforced a controlling party authority, from infringing on the rights national of another government. party. They are designed to prevent the actions of 8 Unit 1 Introduction to Concepts of Obstetric Nursing Laws and ethics are often seen as complimentary to each other, but at the same time they are also seen as opposite side of a coin. Midwives must follow standards and regulations that range from the national level to the individual area of practice, such as hospital, labor and delivery unit. Standards of practice: National standards provide an expectation of the delivery of care to clients. Regulations and policies at institutional levels provide care for safe delivery. Educational programs of midwifery ensures that all new can safely deliver care within the scope of midwifery State license or registration: Practice of nursing and midwifery is regulated state registration practice. councils through license to practice. If a moves to a different state, she must obtain registration in that state in order to practice there. The state license is meant to protect the consumers ensuring that the midwife has appropriate education and can provide safe care. Institutional policies: Policies and regulations of an institution govern the nursing and midwifery care to clients seeking health care in that place. Community standards: A performance will be evaluated according to the availability of medical and nursing knowledge that would be used in the management of similar patients under similar circumstances competent midwives, given the facilities, resources and options available. Ethical Principles Beneficence: It means to act in the best interest of the patient and to balance benefits against risks. The benefits that medicine is competent to seek for patients are the prevention and management of disease, injury, handicap and unnecessary pain and suffering and the premature or unnecessary death. Respect for autonomy: It means to respect the rights of an individual. Respect for autonomy enters the clinical practice the informed consent. This process is usually understood to have three elements. (i) Disclosure the physician to the condition and its management. (ii) Understanding of that information the patient. A voluntary decision the patient to authorize or refuse treatment. Nonmaleficence: It means that health personnel should prevent causing harm and is best understood as expressing the limits of beneficence. This is commonly known as non or first to do no harm. Justice: Justice signifies, to treat patients fairly and without unfair discrimination, there should be fairness in the distribution of benefits and risks. Medical needs and medical benefits should be properly weighted. Confidentiality: It is the basis of trust between health professionals and patient. acting against this principle, one destroys the trust. Informed consent: The process of obtaining permission after explaining the expected risk and benefit is called informed consent. Patients or individuals who require healthcare services have right to make their own decision about the opinions for treatment or other related issues. Truthfulness: The fact of being realistic or true to life is called realism. It is the basic principle of the natural moral law, and people everywhere recognize that honesty in dealing with others is a prerequisite for societal order and Code of Ethics for Nurses in India The nurse respects the uniqueness of individual in provision of care: A nurse: Provides care to individuals without consideration of caste, creed, religion, culture, ethnicity, gender, socioeconomic and political status, personal attributes, or any other grounds. Individualizes the care considering the beliefs, values and cultural sensitivities. Appreciates the place of individual in the family and community and facilitates participation of significant others in the care. Unit 1 Introduction to Concepts of Obstetric Nursing Laws and ethics are often seen as complimentary to each other, but at the same time they are also seen as opposite side of a coin. Midwives must follow standards and regulations that range from the national level to the individual area of practice, such as hospital, labor and delivery unit. Standards of practice: National standards provide an expectation of the delivery of care to clients. Regulations and policies at institutional levels provide care for safe delivery. Educational programs of midwifery ensures that all new can safely deliver care within the scope of midwifery State license or registration: Practice of nursing and midwifery is regulated state registration practice. councils through license to practice. If a moves to a different state, she must obtain registration in that state in order to practice there. The state license is meant to protect the consumers ensuring that the midwife has appropriate education and can provide safe care. Institutional policies: Policies and regulations of an institution govern the nursing and midwifery care to clients seeking health care in that place. Community standards: A performance will be evaluated according to the availability of medical and nursing knowledge that would be used in the management of similar patients under similar circumstances competent midwives, given the facilities, resources and options available. Ethical Principles Beneficence: It means to act in the best interest of the patient and to balance benefits against risks. The benefits that medicine is competent to seek for patients are the prevention and management of disease, injury, handicap and unnecessary pain and suffering and the premature or unnecessary death. Respect for autonomy: It means to respect the rights of an individual. Respect for autonomy enters the clinical practice the informed consent. This process is usually understood to have three elements. (i) Disclosure the physician to the condition and its management. (ii) Understanding of that information the patient. A voluntary decision the patient to authorize or refuse treatment. Nonmaleficence: It means that health personnel should prevent causing harm and is best understood as expressing the limits of beneficence. This is commonly known as non or first to do no harm. Justice: Justice signifies, to treat patients fairly and without unfair discrimination, there should be fairness in the distribution of benefits and risks. Medical needs and medical benefits should be properly weighted. Confidentiality: It is the basis of trust between health professionals and patient. acting against this principle, one destroys the trust. Informed consent: The process of obtaining permission after explaining the expected risk and benefit is called informed consent. Patients or individuals who require healthcare services have right to make their own decision about the opinions for treatment or other related issues. Truthfulness: The fact of being realistic or true to life is called realism. It is the basic principle of the natural moral law, and people everywhere recognize that honesty in dealing with others is a prerequisite for societal order and Code of Ethics for Nurses in India The nurse respects the uniqueness of individual in provision of care: A nurse: Provides care to individuals without consideration of caste, creed, religion, culture, ethnicity, gender, socioeconomic and political status, personal attributes, or any other grounds. Individualizes the care considering the beliefs, values and cultural sensitivities. Appreciates the place of individual in the family and community and facilitates participation of significant others in the care. Unit 1 Introduction to Concepts of Obstetric Nursing Nursing practice: A nurse: Provides care in accordance with set standards of practice. Treats all individuals and families with human dignity in providing physical, psychological, emotional, social and spiritual aspects of care. Respects individuals and families in the context of traditional and cultural practices, promoting healthy practices and discouraging harmful practices. Presents realistic picture truthfully in all situations for facilitating autonomous individuals and families. Promotes participation of individuals and significance of care. Ensures safe practice. Consults, coordinates, collaborates and follows up appropriately when care needs exceed the competence. Communication and interpersonal relationships: A nurse: Establishes and maintains effective interpersonal relationships with individuals, families and communities. Upholds the dignity of team members and maintains effective interpersonal relationship with them Appreciates and nurtures professional role of team members. Cooperates with other health professionals to meet the needs of the individuals, families and communities. Valuing human being: A nurse: Takes appropriate action to protect individuals from harmful unethical practice. Considers relevant facts while taking conscience decisions in the best interest of individuals. Encourages and supports individuals in their right to speak for themselves on issues affecting their health and welfare. Respects and supports choices made individuals. Management: A nurse: Ensures appropriate allocation and utilization of available resources. Participates in supervision and education of students and other formal care providers. Uses judgment in relation to individual competence while accepting and delegating responsibility. Facilitates conducive work culture in order to achieve institutional objectives. Communicates effectively following appropriate channels of communication. Participates in performance appraisal. Participates in evaluation of nursing services. Participates in policy decisions, following the principle of equity and accessibility of services. Works with individuals to identify their needs and sensitizes policy makers and funding agencies for resource allocation. Professional advancement: A nurse: Ensures the protection of the human rights while pursuing the advancement of knowledge. Contributes to the development of nursing practice. Participates in determining and implementing quality care. Takes responsibility for updating own knowledge and competencies. Contributes to core of professional knowledge conducting and participating in research. Ethical Decisions and Reproductive Health of Women Ethics in gynecologic practice: and clinical judgments in gynecologic practice are usually in harmony, like management of ruptured ectopic pregnancy. Sometimes, they may come into conflicts. In such situation, one should not override the other. Their differences must be negotiated in clinical judgment and practice to determine which management strategies protect and promote the interest. 11 Unit 1 Introduction to Concepts of Obstetric Nursing Nursing practice: A nurse: Provides care in accordance with set standards of practice. Treats all individuals and families with human dignity in providing physical, psychological, emotional, social and spiritual aspects of care. Respects individuals and families in the context of traditional and cultural practices, promoting healthy practices and discouraging harmful practices. Presents realistic picture truthfully in all situations for facilitating autonomous individuals and families. Promotes participation of individuals and significance of care. Ensures safe practice. Consults, coordinates, collaborates and follows up appropriately when care needs exceed the competence. Communication and interpersonal relationships: A nurse: Establishes and maintains effective interpersonal relationships with individuals, families and communities. Upholds the dignity of team members and maintains effective interpersonal relationship with them Appreciates and nurtures professional role of team members. Cooperates with other health professionals to meet the needs of the individuals, families and communities. Valuing human being: A nurse: Takes appropriate action to protect individuals from harmful unethical practice. Considers relevant facts while taking conscience decisions in the best interest of individuals. Encourages and supports individuals in their right to speak for themselves on issues affecting their health and welfare. Respects and supports choices made individuals. Management: A nurse: Ensures appropriate allocation and utilization of available resources. Participates in supervision and education of students and other formal care providers. Uses judgment in relation to individual competence while accepting and delegating responsibility. Facilitates conducive work culture in order to achieve institutional objectives. Communicates effectively following appropriate channels of communication. Participates in performance appraisal. Participates in evaluation of nursing services. Participates in policy decisions, following the principle of equity and accessibility of services. Works with individuals to identify their needs and sensitizes policy makers and funding agencies for resource allocation. Professional advancement: A nurse: Ensures the protection of the human rights while pursuing the advancement of knowledge. Contributes to the development of nursing practice. Participates in determining and implementing quality care. Takes responsibility for updating own knowledge and competencies. Contributes to core of professional knowledge conducting and participating in research. Ethical Decisions and Reproductive Health of Women Ethics in gynecologic practice: and clinical judgments in gynecologic practice are usually in harmony, like management of ruptured ectopic pregnancy. Sometimes, they may come into conflicts. In such situation, one should not override the other. Their differences must be negotiated in clinical judgment and practice to determine which management strategies protect and promote the interest. 11 Textbook of Obstetric and Gynecological Nursing for KUHS Ethics the pregnant in woman. While the health professional perspective on the pregnant obligations obstetric practice: There are obvious and provides to the basis of obligations, the her central own nervous perspective on those interests the basis for obligations. Because system of the fetus is Ethics developed and assisted reproduction: It involves many issues like donor insemination. the during embryonic life, therefore, mother performs autonomy based obligation for fertilization (IVF). egg sharing, freezing and storing of embryos, embryo research and In Still there are many issues involved in IVF. First there is big question whether in vitro surrogacy is alive or not. It is appropriate to think that it is a previable fetus and only the embryo give it Viable being. Hence, preimplantation diagnostic counseling about how many women to be transferred should be Donor insemination raises the issue embryos child should be told about his genetic father or not. Egg sharing is also surrounded whether the ethical issues. Ethics change from time to time keeping pace with changing social values, issue being example. It was considered unethical few years back, now in recent issue of magazine, a lengthy article has appeared supporting surrogacy with the name of the center, the a photos leading the physician and number of happy surrogate mothers. confidentiality and routine screening. The foremost issue is that the sonologist must be competent Ultrasonography: There are many issues involved, like competence and referral, disclosure. to give a definitive option. Now routine screening is adopted at weeks, but prior to screening enough prenatal informed consent for sonogram must be taken. Strict confidentiality should be maintained. the Genetics and ethics: The process of genetic research raises difficult challenges particularly in the of consent. community involvement and commercialization. Result of genetic research should be provided area to subjects only if the tests have sufficient clinical validity. Results should never be disclosed to relatives, except in case of pedigree research. Conception and the young girl: Sometime teenaged girls request for oral contraception. They already in an active sexual relationship. They do not want that their parents should know about them are taking contraceptives. Lord ethical recommendations include: Assess whether the patient understands advice Encourage the parental involvement treatment. Take into account whether the patient is likely to have sexual intercourse without contraceptive is not given. We should assess whether the physical, mental health would likely to suffer, if contraceptive advice it Embryonic is stem cell research and ethics: This involves many ethical issues and first and foremost is. life starts. destroying a life destroying the fertilized embryo. This raises the fundamental question of when of primitive Does streak, human first life begin at gastrulation (next step after blastula), at neurulation (formation embryo first feel sign of movement) or at the moment of sentience (consciousness)? When can at any of pain or first suffer? The goal should be to minimize the exploitation of human embryos stage development. Potential Areas of Litigation in Nursing Antepartum Care viewed in collection: the Recently, its preconceptual care is stressed more than antenatal care, diagnosis History and management of many cases. effect on pregnancy. Proper history taking can be a clue for Investigations: One must not Avoidance of any relevant factors can cause maternal and blood sugar, hepatitis B virus surface forget antigen to do routine like hemoglobin, ABO, Rh grouping, (VDRL) and (HbsAg), 12 venereal disease research laboratory Textbook of Obstetric and Gynecological Nursing for KUHS Ethics the pregnant in woman. While the health professional perspective on the pregnant obligations obstetric practice: There are obvious and provides to the basis of obligations, the her central own nervous perspective on those interests the basis for obligations. Because system of the fetus is Ethics developed and assisted reproduction: It involves many issues like donor insemination. the during embryonic life, therefore, mother performs autonomy based obligation for fertilization (IVF). egg sharing, freezing and storing of embryos, embryo research and In Still there are many issues involved in IVF. First there is big question whether in vitro surrogacy is alive or not. It is appropriate to think that it is a previable fetus and only the embryo give it Viable being. Hence, preimplantation diagnostic counseling about how many women to be transferred should be Donor insemination raises the issue embryos child should be told about his genetic father or not. Egg sharing is also surrounded whether the ethical issues. Ethics change from time to time keeping pace with changing social values, issue being example. It was considered unethical few years back, now in recent issue of magazine, a lengthy article has appeared supporting surrogacy with the name of the center, the a photos leading the physician and number of happy surrogate mothers. confidentiality and routine screening. The foremost issue is that the sonologist must be competent Ultrasonography: There are many issues involved, like competence and referral, disclosure. to give a definitive option. Now routine screening is adopted at weeks, but prior to screening enough prenatal informed consent for sonogram must be taken. Strict confidentiality should be maintained. the Genetics and ethics: The process of genetic research raises difficult challenges particularly in the of consent. community involvement and commercialization. Result of genetic research should be provided area to subjects only if the tests have sufficient clinical validity. Results should never be disclosed to relatives, except in case of pedigree research. Conception and the young girl: Sometime teenaged girls request for oral contraception. They already in an active sexual relationship. They do not want that their parents should know about them are taking contraceptives. Lord ethical recommendations include: Assess whether the patient understands advice Encourage the parental involvement treatment. Take into account whether the patient is likely to have sexual intercourse without contraceptive is not given. We should assess whether the physical, mental health would likely to suffer, if contraceptive advice it Embryonic is stem cell research and ethics: This involves many ethical issues and first and foremost is. life starts. destroying a life destroying the fertilized embryo. This raises the fundamental question of when of primitive Does streak, human first life begin at gastrulation (next step after blastula), at neurulation (formation embryo first feel sign of movement) or at the moment of sentience (consciousness)? When can at any of pain or first suffer? The goal should be to minimize the exploitation of human embryos stage development. Potential Areas of Litigation in Nursing Antepartum Care viewed in collection: the Recently, its preconceptual care is stressed more than antenatal care, diagnosis History and management of many cases. effect on pregnancy. Proper history taking can be a clue for Investigations: One must not Avoidance of any relevant factors can cause maternal and blood sugar, hepatitis B virus surface forget antigen to do routine like hemoglobin, ABO, Rh grouping, (VDRL) and (HbsAg), 12 venereal disease research laboratory Textbook Obstetric and Gynecological anesthetist is required to prevent medical litigations. anesthesia: Expert and than, women die during childbirth Analgesia more in obstetric year Emergency women die in India alone, with present situation when there is improvement of which of infrastructure, i., yet doctors have the risk of facing medicolegal problems regarding out obstetric care. emergency Postpartum Care Postnatal complete perincal tear (obstetric and and anal sphincter incontinence injuries): are problem Significant areas. perineal pain, dyspareunia, maternal increased morbidity perineal and mortality injury. Patients must be counseled about the risk of Forceps anal sphincter delivery with injury is associated when operative delivery is contemplated, thus avoiding litigations. Perinatal morbidity Brain damage: Any neurological or psychological deficiency is the major litigation issue compensations are claimed. A health professional will be sued if it can be proved in the court. Damage to bones and viscera: This may occur specially during breech delivery. Health professional must be very conscious during face, legs and arm delivery in breech. Nursing care of newborn: Newborn requires professional and specialized care. Failure of the neonatal nurse to meet her obligations can result in liability in employment or even a civil suit. Failure in assessing: Failure in assessing and reporting changes in condition for timely action can be considered a malpractice that brain damage has occurred during intrapartum period due to negligence of health professional. Drugs: Food and drug administration (FDA) recommendations of drugs should be followed. The health professional must not use off license drugs. If damage will be blamed of negligence when a licensed alternative drug is used. Ways to Minimize Medicolegal Problems in Midwifery Awareness of medicolegal problems: Health practitioner should be aware about the changes in laws that may influence the practice. Code of ethics: The code of ethics for the midwife should be followed. Good interpersonal relationship and clear communication: The patient must not be given false and needs to understand what to expect from the treatment. The health professionals must be polite and courteous showing sympathy toward patient. Proper counseling: Good counseling instills enormous confidence and faith. It helps in removing fear and misconceptions that may exist in the mind of the patient. Informed consent: After proper counseling, informed consent must be taken. Standard health services: Improving infrastructure: Facilities available in the institution should be displayed. Health authorities should set norms for the health sector as a whole. Adequate Quality training of care: A good consultant is needed. Also active pre and postoperative care needed. patients. Nursing education: Improve the standard of nursing education as they are in direct contact with Audits: Continuing education: Regular continuing medical education and workshops attended. Second Morbidity and mortality audits should be regularly done. Regular meeting of the staffs. Timely referral should be kept in mind. 14 Textbook Obstetric and Gynecological anesthetist is required to prevent medical litigations. anesthesia: Expert and than, women die during childbirth Analgesia more in obstetric year Emergency women die in India alone, with present situation when there is improvement of which of infrastructure, i., yet doctors have the risk of facing medicolegal problems regarding out obstetric care. emergency Postpartum Care Postnatal complete perincal tear (obstetric and and anal sphincter incontinence injuries): are problem Significant areas. perineal pain, dyspareunia, maternal increased morbidity perineal and mortality injury. Patients must be counseled about the risk of Forceps anal sphincter delivery with injury is associated when operative delivery is contemplated, thus avoiding litigations. Perinatal morbidity Brain damage: Any neurological or psychological deficiency is the major litigation issue compensations are claimed. A health professional will be sued if it can be proved in the court. Damage to bones and viscera: This may occur specially during breech delivery. Health professional must be very conscious during face, legs and arm delivery in breech. Nursing care of newborn: Newborn requires professional and specialized care. Failure of the neonatal nurse to meet her obligations can result in liability in employment or even a civil suit. Failure in assessing: Failure in assessing and reporting changes in condition for timely action can be considered a malpractice that brain damage has occurred during intrapartum period due to negligence of health professional. Drugs: Food and drug administration (FDA) recommendations of drugs should be followed. The health professional must not use off license drugs. If damage will be blamed of negligence when a licensed alternative drug is used. Ways to Minimize Medicolegal Problems in Midwifery Awareness of medicolegal problems: Health practitioner should be aware about the changes in laws that may influence the practice. Code of ethics: The code of ethics for the midwife should be followed. Good interpersonal relationship and clear communication: The patient must not be given false and needs to understand what to expect from the treatment. The health professionals must be polite and courteous showing sympathy toward patient. Proper counseling: Good counseling instills enormous confidence and faith. It helps in removing fear and misconceptions that may exist in the mind of the patient. Informed consent: After proper counseling, informed consent must be taken. Standard health services: Improving infrastructure: Facilities available in the institution should be displayed. Health authorities should set norms for the health sector as a whole. Adequate Quality training of care: A good consultant is needed. Also active pre and postoperative care needed. patients. Nursing education: Improve the standard of nursing education as they are in direct contact with Audits: Continuing education: Regular continuing medical education and workshops attended. Second Morbidity and mortality audits should be regularly done. Regular meeting of the staffs. Timely referral should be kept in mind. 14 Unit 1 Introduction to Concepts of Obstetric Nursing Documentation and record keeping: History, physical examination, drug allergies, chronic medications, plan of management, date and time of investigations done, operative and investigative notes, record of discussions with patient and relative, note to be kept of patients, not following instruction, etc. should be documented. Risk management: Risk management involves limiting health risk to the patient and also reduce legal risks to the care provider. It should not primarily be about avoiding or mitigating claims but rather a tool for improving the quality of care. Public awareness program and health education: Public awareness includes health awareness professional bodies and media. ROLE OF A NURSE IN MIDWIFERY AND OBSTETRICAL CARE Roles and Responsibilities of Midwives Care giver: Midwife provides antenatal, intranatal and postnatal care, and also provides essential newborn care. She prepares the couple for planned parenthood, provides necessary health education to the pregnant women, gives iron and folic acid as prescribed and conducts deliveries. Leader: Midwife should plan, provide and review a care, with her input and agreement, from the initial antenatal assessment up to the postnatal period. leading role is to decrease obstetrical emergencies, reduce admission to hospital resulting in significantly less intervention during birth. Coordinator: Midwives coordinate efficiently with health care team so as to provide best care to mother during antenatal, intranatal and postnatal period for the better outcome of mother and child. Educator: As an educator, midwives provide high quality, culturally sensitive health education in order to promote health and welfare of the individual, family and community. Communicator: As a communicator, the midwives must develop trusty relationship with pregnant women and family members, so that they can share their all problems freely. Manager: Midwives manage all the circumstances where appropriate and can identify and refer women to obstetricians and other specialists in a timely when necessary. Counselor: Midwives provide appropriate information and counseling to the pregnant women on prenatal including hygiene, nutrition, breastfeeding and danger signs of pregnancy and childbirth. Family planner: Midwife should counsel the eligible couple about all kinds of family planning methods and help them to take decision. Advisor: Midwives prepare the couple for planned parenthood and give advice on development of birth plan. They also give advice during complicated situation so that it will help them to take decision. Supervisor: Nurse should supervise the women during antenatal period so as to detect the warning signs of pregnancy, also provide necessary supervision and care during intranatal and postnatal period to prevent complications and to promote the health of the mother and infant. Record keeper: Record keeping is an integral part of midwifery practice. It helps making continuity of care easier and enabling identify problem in early stage. Responsibilities of the Community Midwives Provide period necessary supervision, care and advice to women during antenatal, intranatal and postpartum Conduct deliveries on their own and provide essential newborn care. Prevent basic emergency and manage complications care of pregnancy and childbirth, in accordance with the principles of obstetric Unit 1 Introduction to Concepts of Obstetric Nursing Documentation and record keeping: History, physical examination, drug allergies, chronic medications, plan of management, date and time of investigations done, operative and investigative notes, record of discussions with patient and relative, note to be kept of patients, not following instruction, etc. should be documented. Risk management: Risk management involves limiting health risk to the patient and also reduce legal risks to the care provider. It should not primarily be about avoiding or mitigating claims but rather a tool for improving the quality of care. Public awareness program and health education: Public awareness includes health awareness professional bodies and media. ROLE OF A NURSE IN MIDWIFERY AND OBSTETRICAL CARE Roles and Responsibilities of Midwives Care giver: Midwife provides antenatal, intranatal and postnatal care, and also provides essential newborn care. She prepares the couple for planned parenthood, provides necessary health education to the pregnant women, gives iron and folic acid as prescribed and conducts deliveries. Leader: Midwife should plan, provide and review a care, with her input and agreement, from the initial antenatal assessment up to the postnatal period. leading role is to decrease obstetrical emergencies, reduce admission to hospital resulting in significantly less intervention during birth. Coordinator: Midwives coordinate efficiently with health care team so as to provide best care to mother during antenatal, intranatal and postnatal period for the better outcome of mother and child. Educator: As an educator, midwives provide high quality, culturally sensitive health education in order to promote health and welfare of the individual, family and community. Communicator: As a communicator, the midwives must develop trusty relationship with pregnant women and family members, so that they can share their all problems freely. Manager: Midwives manage all the circumstances where appropriate and can identify and refer women to obstetricians and other specialists in a timely when necessary. Counselor: Midwives provide appropriate information and counseling to the pregnant women on prenatal including hygiene, nutrition, breastfeeding and danger signs of pregnancy and childbirth. Family planner: Midwife should counsel the eligible couple about all kinds of family planning methods and help them to take decision. Advisor: Midwives prepare the couple for planned parenthood and give advice on development of birth plan. They also give advice during complicated situation so that it will help them to take decision. Supervisor: Nurse should supervise the women during antenatal period so as to detect the warning signs of pregnancy, also provide necessary supervision and care during intranatal and postnatal period to prevent complications and to promote the health of the mother and infant. Record keeper: Record keeping is an integral part of midwifery practice. It helps making continuity of care easier and enabling identify problem in early stage. Responsibilities of the Community Midwives Provide period necessary supervision, care and advice to women during antenatal, intranatal and postpartum Conduct deliveries on their own and provide essential newborn care. Prevent basic emergency and manage complications care of pregnancy and childbirth, in accordance with the principles of obstetric Unit 1 Introduction to Concepts of Obstetric Nursing Conduct active management of the third stage of labor for reduction of postpartum hemorrhage. Diagnose (using the partograph) and manage or refer to women with prolonged second stage labor, and diagnose and refer to women with other labor abnormalities to concerned authority. Treat postpartum hemorrhage (including manual removal of placenta and injection oxytocic). Stabilize and refer required cases to concerned authority. Detect and manage (or refer) obstetric emergencies, according to the principles of basic emergency obstetric care. Refer to complications of labor and birth to concerned authority when necessary. Competency 5: Community midwives provide comprehensive, high quality, culturally sensitive postnatal care for women. Provide immediate postpartum care, including history, examination and counseling. Provide postpartum assessment(s) of mother and infant. Offer postpartum family planning counseling and services. Counsel on breastfeeding and provide nutritional support to woman. Detect and manage obstetric emergencies, according to the principles of basic emergency obstetric care. Refer to postpartum complications to concerned authority when necessary. Competency 6: Community midwives provide high quality care for the newborn infant and surveillance and preventive care for young children. Provide immediate newborn care with a focus on airway, warmth and breastfeeding. Provide emergency measures for newborn resuscitation. Provide routine newborn care, including physical examination, care of the umbilical cord, immunization, etc. Provide emergency care for newborns (including hypothermia, infections of eye or cord stump, etc.) and infants, according to principles of IMCI. Encourage exclusive breastfeeding and provide nutrition counseling to mothers on introduction of appropriate weaning foods. Provide basic care for infants including history and care provision including care for acute respiratory infection (ARI) and childhood disintegrative disorder preventative care including immunization and growth and counseling to parents on infant and chil
Concepts in obg
Course: Bsc nursing (blaw 213)
University: Kerala University of Health Sciences
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