Mrs.

Anthonette Patterson Bartley

Lecturer, MScN Ed, RM, RMN, RN
May 18-July 20, 2015

At the end of the unit students will be able to:

1. Discuss the historical and current perspectives of
maternity nursing in Jamaica;
2. Discuss contemporary trends and issues of maternal
and child health;
3. Relate the social issues impacting on maternal and
child health nursing.

4. Define terms used in reference to vital statistics

relative to maternal and child health.
5. Briefly discuss the process in registering births
and deaths in Jamaica.
6. Discuss legal and ethical issues of maternal and
child health in Jamaica.

Midwifery

is not a new concept. It existed even in

Biblical Times. Exodus 1 vs. 15 21
During slavery, plantation owners had little interest
in the health of slaves until the slave trade was
abolished in 1807.
Owners actively engage doctors from England, who
took special interest in maternal and newborn care.

The

collapse of the estate health system led

plantation owners to petition the government.
In

1875, the Island Medical Services was formally

established, with a superintendent to supervise
district medical officers (DMOs) across 41 medical
districts.

In

1887, Dr Grabham- first champion of women's

health, succeeded in establishing a 12-bed Lying-In
Hospital on property adjacent to Kingston Public
Hospital.
The

hospital's main intent was to train midwives

and its first graduates emerged two years later.

October 2007, maternal health advocates marked

the 20th anniversary of the birth of the Safe
Motherhood movement.

N.B.

The 1st midwifery school was set up in

England in 1875.

Practice of Nanas
pre-emancipation period 1807 efforts were made to
provide better medical facilities, as it was important for
the slaves to remain as healthy as possible. Every estate
had its hospital or Yaw hut and its Grandy an old
woman who took care of the pregnant female before,
during and after confinement.

About

fourteen (14) days before delivery they were

sent to a woman A Nana who kept an
establishment as a midwife.

In what year did Dr Grabbam established the victoria

Jubilee hospital?
a. 1807
b. 1708
c. 1877
d. 1887

1891 hospital was handed over for occupancy by the

Public Works Department. Capacity was for 12
patients, 14 pupil midwives and a resident Matron.

1947 capacity was 110 beds, a daily average of 140

patients and 5,150 deliveries for the year.

The demands for beds increased and in 1955

preparation were made to start a new maternity block.
In October 1958 a new building of four (4) stories
high consisting of:

The bed capacity V.J.H. now 230 beds and 104 cots
with over 9000 deliveries per The hospital has a
cadre for 35 level 1 midwives and 10 level 3
midwives supervisors.

 The

training of Midwives was carried our primarily at

Victoria Jubilee Hospital

The

midwifery Law of 1919 made graduates legally

accepted as Registered Midwife. In 1932 a syllabus
for training was formulated.

There are three (4) well-established schools of

Midwifery now functioning.
V.J.H Kingston School of Nursing Midwifery
Cornwall School of Midwifery
University Hospital
Spanish town Hospital

 Pre

natal
Post natal
Antenatal
Delivery
Heath education and promotion

Discuss contemporary trends and issues of

maternal and child health;

Trend

Implication

Families are not as extended as in

previous generations.

Nurses are therefore called upon to fulfill

this role more than ever

The number of single parent families

increasing rapidly it now equals the
number of nuclear families

A single parent may have fewer financial

resources than dual employed parents.
Hence nurses need to be more aware of
alternative care options and available to
provide a backup opinion as needed.

Child and intimate partner violence s

increasing in incidence

Nurses must be aware of the legal

responsibilities for reporting violence

Contemporary childbirth is family

centerred

Husbands, children. Lesbian partners all

wants to play a part .

 Training
Use

of Technology
Costs
Legal and ethical consideration
Registration Policies

Relate the social issues impacting on maternal and

child health nursing

 Poverty
Re-emergence of poor nutrition
Lack of education maternal education
Teenage pregnancy- even though there is a
decrease from 25% -20 there is a social
connection to teenage pregnancy
Culture mule if you are not pregnant by a
certain age. And if you are too old and is
pregnant- high rates of abortion.

 Don man leadership styles.

Poor family structure
Stress
Violence- In a study published in 2012 showed
that homicide rates affected both maternal and
child health in so much that in Jamaica homicide
rate was 53/100,000 followed by Belize
42/100.000
Socio-economic status

Define terms used in reference to vital statistics

relative to maternal and child health

Crude Birth Rate

Fertility Rate
Foetal Death rate
Neonatal Mortality Rate
Perinatal Mortality rate
Maternal Mortality Rate
Infant Mortality Rate
Post-natal mortality rate

Briefly discuss the process in registering births and

deaths in Jamaica

Registration is the recording of a vital event by a Local

District Registrar (LDR). This record is then transferred
to the Registrar General's Department's vaults within
six weeks.
Births:
Registration of births is the responsibility of the
child's parents if the child was born outside of a
hospital or the Chief Resident Officer if the birth
occurred in a hospital or a birthing center.

1.

The parent(s) should ensure that the name of the

child is decided upon by the time he/ she is due to be
delivered.

1.

The registration of the birth of the child must not be

delayed. The Local District Registrar (LDR) office
nearest to the place of birth must be attended as soon
as possible in order to complete birth registration.

All birth registrations taking place over three months

require an informant to attend the LDR office and sign
the form.

All registrations taking place after one year of

occurrence are considered Late Registrations, and
require authorization from the Registrar General.

BEDSIDE REGISTRATION
The Registrar General's Department conducts
registration of births and still births at the bedside of
the mother while in hospital. Vital information,
including but not limited to, date of birth of child, sex
of child, mothers name and doctor or midwife
present at time of birth are captured.

All births must be registered:

Within 3 months and less than one year

Within 14 days Chief Resident Officer must send the

notification of birth to LDR

If the infant is not named in the hospital- Visit the LDR

for the district where the child was born and complete a
Certificate of Naming;
Give full and correct information
Check for correct spelling of name
Check date of birth
Sign registration form only if all the information is
correct
Collect Certificate of Registry (pink paper/slip)
Keep a record of the Birth Entry Number for reference

With respect to registration, it is necessary to classify

deaths as natural, sudden or violent. Natural deaths are
those where the deceased was being attended to
regularly

by a medical doctor (within at least three months of

death) and where the cause of death is not under
reasonable doubt by the medical doctor.

All deaths require either one of the following to be

completed and certified by a medical doctor, medical
officer or pathologist:

Medical Certificate of the Cause of Death

Post Mortem Examination Report

Certificate of Coroner (Form D)

Coroners Certificate of Finding of Jury (Form E)

Discuss legal and ethical issues of maternal and

child health in Jamaica.

Although ethical dilemmas confront nurses in all

areas of practice, those related to pregnancy, birth,
newborns and children seem especially different and
sometimes difficult to resolve.

Technology: makes it possible to sustain the lives of

children who would have died thus creating many
ethical issues. Conflict often arises between health
professionals and parents when parents choose to
withhold therapy or to request aggressive therapy on
behalf of their child/children and the health
professionals have a different opinion about treatment.

Family planning usage: 16 years age of consent for

sexual encounter, 18 years age for consent to health
care.

Culture

Laws governing certain procedures eg. tubal ligation

Access to care- abolition of user fees since 2007 for

child health and 2008 for maternity nursing.

Organ transplantation issues- death of a child can

benefit another child through organ transplantation.
The limited supply of organs has created numerous
ethical issues.

Please research the following definitions relating to

maternal and child health nursing statistics.
1. Crude Birth Rate
2. Fertility Rate
3. Foetal Death rate
4. Neonatal Mortality Rate
5. Perinatal Mortality rate
6. Maternal Mortality Rate
7. Infant Mortality Rate
8. Post-natal mortality rate