M.S.

RAMAIAH INSTITUTE OF NURSING EDUCATION AND RESEARCH

ASSIGNMENTS ON DOMICILILARY MIDWIFERY

SUBMITTED TO MISS RUBY LECTURER MSRINER

SUBMITTED BY MISS SWILLY P MENON 1 MSC NURSING MSRINER

SUBMITTED ON -30/10/11

INTRODUCTION

A domiciliary midwifery programme is introducted in India ,in community set up ,inorder to seek to ensure the optimal health to every one of expectant mother and nursing mothers maintaning good health ,learning the art of child care ,undergoing child birth safely and bearing healthy children. Adequate care of mother begins even before conception starting right from the adolescent age ,through sex education and marriage counselling. Maternity schemes includes care during antenatal period , intranatal period and postnatal period. Mother and children are the vulnerable group in our population today .In India the child bearing age constitute of 19% of the population there for the midwifery services are tremendously significances in Indias health care system.

The concept of home care combines obstetrical concerns with the concept of primary health care .Such midwifery care takes in to account the womens and her familys personal and social circumstances which influence the health and well-being of her and her baby. Community midwifery is one of the functions of community health care. for mothers and infants, but advanced considerably in the 17th 19th century. Later, with advances in obstetrics and gynecology, most women gave birth in hospitals. In the 1960s, the natural Art of attending women in childbirth. It is known to date to ancient biblical, Greek, and Roman times. It declined in the Middle Ages, when childbirth carried high mortality childbirth movement, feminism, and other factors renewed interest in the personal care given by midwives. In the U.S., certified nurse-midwives (CNMs) registered nurses trained in midwifery accept only low-risk patients. If problems develop, a physician is called. CNMs also provide pre- and postnatal care and reproductive health advice. Lay midwives usually have no formal training, are unlicensed, and deliver (at home) about three-fourths of infants born throughout the world, mostly in developing countries and rural areas of developed nations

DEFINITION
Mothers with normal obstetric history may be advised to have their confinement at home, provided their home condition are satisfactory. In such case the delivery is conducted by the health worker female or trained dais. This is known as domiciliary midwifery.

Domiciliary care is provided for those of the women or couple who have the greatest amount of control over their child birth experiences .This is also the setting for their own childbirth experience and for the care of the mother and the baby receive.

The simplest definition of midwifery is with womenMidwifery means different things to different people. For many,the Midwifery Model is an attitude about women and how pregnancy and birth occur, and view that pregnancy and birth are normal events until proven otherwise. It is an attitude of giving and sharing information,of empowerment, and of respecting the right of a woman and her family to determine their own care.

Definition of The Midwife:

A midwife is a person who, having been regularly admitted to a midwifery educational programme, duly recognized in the country 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. (WHO, FIGO, ICM Statement)

AIMS OF DOMICILIARY MIDWIFERY

To promote the wellbeing of mothers and babies To support sound parenting and stable families. To reduce maternal and perinatal mortality and morbidity and promotion of reproductive health.

LEGAL ISSUES
The provision of home care services is not without risk of legal liability .Two types of legel liability can be faced by the nursing staff.

They are professional issues of negligence and violation of state licensing laws. The nurse should document each and every thing in order to avoid such risk. The nurse must know about the nurse practice act.

ANTENATAL CARE

The aim of antenatal care is to achieve at the end of pregnancy-a healthy mother and a healthy baby. Ideally ,this care should begins soon after conception and continue throughout pregnancy.

OBJECTIVES OF ANTENATAL CARE Promote, protect and maintain the health of the mother during pregnancy. Detect high risk pregnancies and give the mothers special attention. Foresee complication and prevent them. Remove anxiety and fear associated with delivery. Reduce maternal and infant mortality and morbidity. Teach mother, elements of childcare, nutrition personal hygiene and environmental
sanitation.

Sensitize the mother to the need for family planning.

ADVANTAGES OF DOMICILIARY CARE

The following are the advantages of home visits

The mother is generally more relaxed at home and there is more privacy than in the center Reduced fear in familiar surrounds Freely verbalise all sorts of feelings and dout. The nurse will be able to understand the socio economical factors the stress, strain

The home visit provides time to learn listen and observe Observation and environment and health needs. Chance of cross infection are controlled The mother will be able to keep an eye on oter children Recued mental tension

DIS ADVANTAGES OF DOMICILIARY MID WIFERY

Mother may have less supervision by the medical provisions The mother may resume her domestic duties too soon The mother may neglect her diet

ANTENATAL VISITS

Ideally ,the care should begin soon after conception and continue throughout pregnancy.A schedulde to follow for the mother is to attend the antenatal clinic once a month during the first seven months,at least 3 visits are encouraged First visit as soon as the pregnancy is known or at 20th wk Second visit ,at 32nd wk Third visit ,at 36th wk Further visit may be justified by the condition of the mother. At least one visit should be paid in home of the mother.

SELECTION OF MOTHER TO VISIT

The selection following criterion are necessary Visit all the expectant mother at once to gain an insight and understanding of the factors that may affect the pregnancy. Mothers who have history of still birth or who have lost babies during infancy. Mothers who have insecure and afarid Mothers who have signs of complication such as swelling ,dizziness head ache ,bleeding mothers who have anaemia. Underlying this the mother should be observed for every month either in clinic or in home.

PREVENTIVE SERVICES TO MOTHER IN PRENATAL PERIOD

The first visit irrespective of when it occur should include ;

The prenatal health history

The history should be taken on the first visit ,but sometimes it is not possible to complete it. In such cases, second visit is soon made to obtain the information. In prenatal history one should take , General health history Family health history Social history Post obstetric history History of present pregnancy

The prenatal examination

Routine procedures Urine examination for sugar and albumin

 Vital signs Hemoglobin level Blood pressure Antropomentric values

Physical examination General appearance Examination of head and face Examination of the breast Examination of the hands and leg Examination of the abdomen Pelvic palpations Inspection of vulvaInspect for minor disoders of pregnancy

complications of pregnancy Toxaemia of pregnancy Any infection process Pre mature rupture of membaranes Mal presentations Abnormal pregnancy

PREVENTIVE SERVICES IN NATAL PERIODS

It begins with the onset of Labour and ends with the delivery and have examined her and the baby to conform that both are in good condition however in the last weeks of pregnancy ,you have to assist the woman in making the necessary preparations for her delivery

FACTORS INFLUENCING HOME DELIVERY;

Normalcy of the pregnancy Previous hospital Avaliability of alternatives both in and out of hospital Availability of preferred health care providers in different birth settings Safety for the women Safety for the baby Avaliability of what they want in another setting such as; Presences of significant others No restriction as to the number of others they want present Presences of siblings Ability to assume responsibility for their babys birth No intravenous infusion No restriction of activity No restriction for birth positions No analgesics or anasesthesia Gentle birth

No transfer to delivery room No separation of mother and baby

Early initiation of breast feedings Degree of participation Smells, noise, cleanliness of the setting Their desire home in familiar surrounding

Prepration for home delivery

The midwife should asses the condition of home and provide necessary instructions .the mother must be told about what she should pay necessary preprations for deliveryto be take place

Domiciliary Midwifery Services in postnatal period

This is extension of post natal care is a service that provides visits to women in their home. These visits are attended by an experienced midwife, assisting in the smooth transition from the hospital environment to home. This extension of postnatal care is offered to the mothers Each family is offered visits according to their needs and a referral is made to other health professionals as required. The other health professionals we liaise closely with include: Following delivery the mother and the baby are visited daily for ten days during each of this visit the midwife througly examin the mother and baby

Care provided
- Maternal child health nurse - Breastfeeding Support Services - General practitioners - Paediatricians

Social workers - Maternity Support Workers - Physiotherapists -puperial care Domiciliary service provides the following to women

- Assessments of Maternal wellbeing

Physical examination of mother post birth Health care and advice Wound care removal of staples / sutures and assessment of wound healing psychological and emotional support Handling minor disorders of puperium Handling with complications of puperium

- Assessments of Infant wellbeing

Physical examination of baby Weight monitoring

Care of the infant

Postnatal depression discussion, advice regarding symptoms and resources - Support and assistance with feeding Breast feeding Positioning and attachment Assistance with care of the lactating breast Artificial feeding Preparation of formula / volumes Sterilization of feeding equipment - Laboratory testing

Pathology Newborn Screening Test attended at 48-72 hours of age Jaundice testing

Postnatal advices
Advise the mother to breast feed the baby adequately

Advise on perineal toileting Educate to take affortable good nutritious diet

Educate about baby care

Advise the mother to do postnatal exersices Advice the family member about supportive care Provide basic education to the mother and family

breast feeding
Postnatal care include breastfeeding successfully. For many babies breast milk is provided the main source of nourishment in the first year of life. when the standred of environmental sanitation is poor as it is bacteriologically dangerious.it is there for very important to advice mother to provide exclusive breast feeding in initial months At an average age of 4-5 months ,breastfeed must be supplemented by small amounts.

Family planning

Every attempt should be made to motivate mother when they attend postnatal clinics or during postnatal contact to adopt a sutitable method for spacing the next birth or for limiting the family size as appropriate postpartum tubal ligation is generally reccomended on the 2nd day after delivery contraceptives that will not affect lactation may be prescribed immediately following delivery after a physical examination

Health Education

Ensuring safe home environment Personal hygiene

Feeding infant Baby bath Nutritious diet for the mother Pregnancy spacing Followup cares Care of umbilicus cord Birth registration SIDS/safe sleeping smoking

Abstract
A random sample of 78 district midwives, representing 24% of all district midwives in the government health service, were interviewed to assess their knowledge and practice of

domiciliary midwifery as part of the Perinatal Morbidity and Mortality Survey in 2001. A standard questionnaire based on the WHO guidelines on appropriate technology for birth was used. Records of their two preceding home deliveries were examined and their delivery bags inspected for availability of basic supplies and equipment. A mean of 21.5 home deliveries was attended by each rural midwife in 1986 compared with 3.8 in the urban areas. Routine laboratory tests were not done on many mothers, and there were long delays in getting results. Midwives' knowledge was average overall with one-third of them showing poor knowledge of high-risk factors in infants and newborn care. Most midwives routinely shave and give enemas to mothers. Unavailability of equipment and supplies, including vitamin K and eye drops, is common; 24% of midwives made no prenatal home visit in the previous month, and 80% fell short of the set norm of 5 postnatal home visits; 84% of midwives put the baby to the mother's breast within one hour of delivery. Essential supplies and lab investigations need to be provided and measures taken to improve domiciliary midwifery through a programme of continuing education and better supervision of midwives. A strategy to promote home deliveries under specified conditions needs to be considered.

BIBLIOGRAPHY
K. Park .textbook of preventive and social medicine.18th ed .m/s banarsidas publishers,Jabalpur; page no 389. Marie Elizabeth .midwifery for nurses.1st edition , cbs puplisher: newdelhi. pageno 396-99. Stanhope ,lancaster .community health nursing.2nd edition.mosby publishers;Missouri.pno81718,14-16. http;//www.pubmed.com http;//bmj.com.