Class Notes: Midwives Model of Care & First Line of Defense

Week 1 Take Away: Cultivate good study habits

I am so excited to share tidbits of what I learn week by week. Each day I would put a brief summary with a possibility of expounding on some of the topics via a video in the future. My classes are 2 hours long 4 days a week; therefore these summaries cannot begin to expound upon the vastness of information flooding through my brain. But I learned, as a studying technique, to write brief summaries of each class and then expound upon the summaries through further study/ homework. I am so grateful to add this study method because my previous student life I did not have the best study habits! Enjoy

Midwives Model of Care

This class we talked about the midwives model of care. We also discussed statistics about maternal mortality/ morbidity rate and infant mortality. I am so grateful that God showed me that becoming a midwife; I can be used as a solution to the mortality and morbidity problem, through the midwives model of care. There are many factors in maternal mortality/ morbidity and infant mortality that are preventable. These statistics are not solely for the underdeveloped world, the United States is higher in maternal mortality/morbidity and infant mortality than other developed countries. Proper education, individualized care, preventative methods, and early detection health screenings, to name a few, are contributing factors in addressing. Additionally, we learned about traditional medicine and complementary medicine and the healthcare modalities that attend the two. Lastly, we looked at the pros and cons of Hospital, Birth Center and Home births.

Midwives Model of Care includes:

· Pregnancy and childbearing are natural physiologic life processes.

· Women have within themselves a God-given innate biological wisdom to give birth.

· Physical, emotional, psycho-social and spiritual factors shape the health of individuals and affect the childbearing process.

· Support women to make informed decisions and take responsibility for their own and their baby’s well-being.

· Provide guidance, education, and support to facilitate the process of pregnancy, labor, and birth, and lactation.

· Value to develop and maintain continuity of care throughout the childbearing cycle

Midwives: First Line of Defense

The statistics from last class helps us to see why the organization UNICEF (United Nations Children’s Fund) would like to see Midwives as the first line of defense for maternal and infant care. Today in class we discussed the method of approach to accomplish that goal, but first I want to define maternal mortality/morbidity and infant mortality.

Maternal Morbidity- any physical or mental illness or disability directly related to pregnancy and/or childbirth also can be a result of untreated pregnancy complications, short term and long term. These are not necessary life-threatening but can have a severe impact on the woman’s quality of life.

· Postpartum and post-abortion infections can lead to:

o Pelvic Inflammatory disease (PID)

o Ectopic Pregnancy- occurs when a fertilized egg implants outside of the uterus, typically in fallopian tubes

o Pelvic Adhesions

o Permanent infertility

· Repeated and prolong labors may lead to:

o Uterine prolapsed- occurs when the uterus slips from its normal position into the birth canal

o Urinary incontinence- loss of bladder control

o Chronic discomfort and pain

· Obstructed labor can cause:

o Rupturing of the uterus

o Obstetric fistulae- an abnormal passage between the vagina and bladder or rectum.

Maternal Mortality- death of women while pregnant or within 42 days of the termination of pregnancy (including abortion)

· Direct maternal deaths- result from obstetric complications of the pregnancy. It can be caused by interventions, omissions, incorrect treatment, or from a chain of events combining these factors. WHO (World Health Organization) estimates that the percentages of these direct causes:

o Hemorrhage (25%) - severe bleeding after birth can kill a healthy woman.

o Sepsis (15%)- infection can be eliminated if good hygiene is practiced and early signs of infection are recognized and treated in a timely manner

o Abortion (13%)

o Hypertensive disorders of pregnancy (12%)- should be detected and properly managed before the onset of life-threatening complications.

o Obstructed Labor (8%) - can be reduced by a trained birth attendant, who has the skill set to facilitate the proper passage of the baby through pelvis or in some case via C-section.

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Indirect Maternal Death- is caused by conditions or diseases that may exist before pregnancy, but are aggravated by the physiologic effects of pregnancy. Some examples are:

o Heart disease

o Iron deficiency anemia

o Tuberculosis

o Hypertension

o Malaria

o Diabetes mellitus

o Abuse, Homicide or Suicide (not easily identifiable)

Infant Mortality- The death of an infant before his or her first birthday.

· Leading five causes- birth defects, preterm birth and low birth weight, sudden infant death syndrome (SIDS), maternal pregnancy complications.

· Additional causes- preterm birth complications, pneumonia, intrapartum-related events, infection, asphyxia (lack of oxygen at birth) diarrhea, neonatal sepsis and malaria.

Infant Mortality Prevention Strategies

· Promote and support early exclusive breastfeeding

· Help to keep the newborn warm, using the skin to skin contact between mother and baby

· Promote hygienic umbilical cord and skin care

· Assess the baby for signs of serious health problems

· Identify and support newborns that need additional care

· If feasible, provide home treatment for local infections and some feeding problems

Interesting fact, globally 2.6 million children died in the first month of life. Skilled health care, especially during postnatal (immediately following birth) aids in preventing complications for mother and newborn. Continue education for midwives is necessary to equip them to meet the myriad of needs the woman and baby has, especially in developing countries. We discussed the need of educating on women health, public health and sexual health, to name a few. This broadens the midwife’s scope of practice, though, many of these topics midwives informally educate their women and families on already. I personally believe that although childbearing is a physiological process, the biopsychosocial health of the women before pregnancy will have an effect on their pregnancy. Therefore, education on women health in general and during pregnancy, especially in regards to their reproductive system, is crucial and will be added to my work as a Midwife.