Uk Primary and Maternity Care

Primary Care in the UK, Maternal Care / Midwifery

JDH Union College 0715

International Confederation of Midwives (ICM)

• ‘The midwife has an important task in health counselling and education, not only for the woman but also within the family and community. This work should involve antenatal education and preparation for parenthood and may extend to women’s health, sexual or reproductive health and child care.’

• International Confederation of Midwives (2010, revised 2013) Essential Competencies for Basic Midwifery Practice. ICM

Midwifery 2020, 2010

Midwifery 2020: Delivering expectations Executive summary

• Midwives will be the lead professionals for all healthy women with straightforward pregnancies.

• For women with complex pregnancies they will work as the key the co-ordinator of care within the multidisciplinary team, liaising closely with obstetricians, general practitioners, health visitors, public health practitioners, maternity support workers/ maternity care assistants.

• Midwives will embrace a greater public health role

• Midwives will continue to provide the majority of care to pregnant women..........in the hospital and community.

The first treatise on midwifery was written in the second

century a.d.

The invention of the printing press in 1513 led to publication of the first book on midwifery

1522 – Dr Werrt Burned alive for dressing as a woman to witness a birth

Development

• 1572 First obstetric forceps (Chamberlen)

• In the seventeenth century the only antenatal treatment was bleeding.

• 1739 Queen Charlotte’s Hospital founded

• 1847 First use of chloroform for labour pain

• 1853 Queen Victoria

• 1886 Midwifery compulsory for Medical Students

Twentieth Century

• 1901 William Ballantyne the first bed for antenatal admissions, Edinburgh

• In 1902 Supervision of Midwives was laid down in statute

• 1920 Dr (Dame) Janet Campbell started a national system of

antenatal clinics

• 1970s Peel reforms –beds for all pregnant women

• The training period for midwives has gradually lengthened lasting just three months from 1902 to 1916 until from 1981 it has been 18months for Registered nurses and 3 years for direct entrants.

(Myles, 1981 p.716).

What is the difference between providing care for pregnant women and for other patients?

“Changing Childbirth published 1993 defined 3 principles of good maternity care“

1 - The woman must be the focus of maternity care. She should be able to feel that she is in control of what is happening to her and able to make decisions about her care, based on her needs, having discussed matters fully with the professionals involved.

2 - Maternity services must be readily and easily accessible to all. They should be sensitive to the needs of the local population and based primarily in the community.

3 - Women should be involved in the monitoring and planning of maternity services to ensure that they are responsive to the needs of a changing society. In addition care should be effective and resources used efficiently.

Maternity Matters 2007

• Access to care

Maternity service providers should ensure that antenatal services are accessible and welcoming so that all women, including those who currently find it difficult to access maternity care, can reach them easily and earlier in their pregnancy.

Women should also have had their first full booking visit and hand held maternity record completed by 12 completed weeks of pregnancy.

Department of Health. (2007) Maternity matters: choice, access and continuity of care in a safe service. HMSO: London.

Who provides care?

NICE Guideline 2008

• Midwife- and GP-led models of care should be offered to women with an uncomplicated pregnancy.

• Routine involvement of obstetricians in the care of women with an uncomplicated pregnancy at scheduled times does not appear to improve perinatal outcomes compared with involving obstetricians when complications arise.

• Antenatal care: NICE clinical guideline 62 (Issued: March 2008 last modified: February 2014) NHS National Institute for Clinical Excellence. www.nice.org.uk



Pregnancy Care

• All women are booked in their pregnancy by a midwife

• Midwives can care for women throughout their pregnancy

• Offer preparation for labour and parenthood classes

• Work closely with other professionals and refer where problems occur

Pregnancy Care

• Midwife (NHS employed) • GP

• Independent Midwife

• Community – health centres, children’s centres.

• GP surgery • Hospital

jdh

Why provide care during pregnancy?

Why provide antenatal care?

• 1935 Maternal mortality rate: 500 per 100,000 births

• 1952 Confidential Enquiries into Maternal Deaths

• 1952-54 report maternal mortality = 90/100,000

• 2009-2012 Maternal mortality rate: 10.12 per 100,000 births

Why provide antenatal care?