LEGAL AND ETHICAL ISSUES IN MIDWIFERY

INTRODUCTION TO CONCEPT OF MIDWIFERY AND OSTETRICAL NURSING ,HISTORICAL PERSPECTIVES AND CURREND TRENDS ,LEGAL AND ETHICAL ISSUES

1. Here starts the lesson ! Unit-I INTRODUCTION TO MIDWIFERY AND OBSTETRICAL NURSING BHARATHI P, M.Sc NURSING ASSOCIATE PROFESSOR

2. Midwifery is as old as the history of human species. Archeological evidence of woman demonstrates the existence of midwifery in 5000BC . Introduction

3. ORIGIN OF OBSTETRICS : Obstetrics word came from a Latin word “OBSTETRIX means “MIDWIFE”. As we all know that birth is the complex final act of nature’s greatest miracle i.e. formation and arrival of a child in the world. And the science and art that deals with human reproduction is called Obstetrics Introduction

4. “SORANUS OF EPHESUS”Is the FATHER OF OBSTETRICS .He was the first to write about the Podalic Version. Introduction

5. King of Egypt spokes to the midwives, who helped Hebrew women whent hey gave birth. They were the first midwives found in the Literature. Hippocrates(460BC), the father of scientific medicine, organised trained and supervised Midwives. He believed that the fetus had to fight its way out of the womb Introduction

6. Aristotle(384-322BC), the father of embryology, described the uterus and the female pelvic organs. And the essential qualities of the midwife. Ambroise Pare(1510-1590) laid the foundations of modern obstetrics. He performed internal podalic version and skillfully delivered women. He also sutured perineal lacerations. Introduction

7. There are references to the midwives in the old testament. Genesis 35:17 “and it came to pass, when she was in hard labor, that the midwife said unto her, fear not Rachel, it is another Boy ” Introduction

8. Book Title. P52 Julius Caesar Aranzi wrote the first book for italian Midwives. He advised Cesarean section for contracted Pelvis.

9. William Harvey(1578-1657), the father of British midwifery, wrote the first English text book on Midwifery. He described the fetal circulation and the placenta The first to deliver the placenta by massaging the uterus .

10. MIDWIFERY :- According to WHO (2013), midwifery encompasses care of women during pregnancy , labour and postpartum period as well as care of newbor ns . International Confederation of Midwives (2014) states that a midwife is a person who has acquired requisite qualifications to be registered and or legally licensed to practice midwifery and uses the title ‘midwife’ and who demonstrates competency in the practice of midwifery

11. Formal education has improved aspects of midwifery and classified them into two main categories ; Certified nurse-midwife Direct entry midwife TYPES OF MIDWIVES During the 1970’s, there were three categories of midwives : • Granny midwives • Lay midwives • Traditional birth attendants

12. LEGAL AND ETHICAL ASPECTS AND OBSTERICAL NURSING

13. INTRODUCTION:- Laws and ethics are often seen as complimentary to each other , but at same time they are also seen as opposite sides of a coin. Midwives must follow standard and regulations that range from the national level to the individual area of practice, such as hospital, labor and delivery unit. .

14. 1.NATIONAL STANDARDS OF PRACTICE Various levels of legal regulations and standards define midwifery practice. National standards provide an expectation of delivery care. The educational programs of midwifery assure that all new nurse midwives can safely deliver care within the scope of usual midwifery practice 2.STATE LICENSE Midwifery practice is regulated in the state of practice through license to practice. If a midwife practices in two states, she must be licensed by both states. State license is meant to protect the consumers by ensuring that the midwife has appropriate education for the profession and can provide safe care

15. 3. COMMUNITY STANDARDS It tells that a midwife’s duty must be evaluated according to the availability of medical and practical knowledge that would be used in the treatment of similar patients under similar circumstances , by competent midwives, given the facilities , resources and options available.(2001) 4.INSTITUTIONAL POLICIES The hospital laws govern midwives working in the hospital. The midwife working in the hospital should review the policies of the units n which midwifery care is provided. The hospital laws govern midwives working in the hospital. The midwife working in the hospital should review the policies of the units in which midwifery care is provided.

16. 5.PROFESSIONAL NEGLIGENCE Medical malpractice is the legal error committed by medical personnel. In legal terms, this error is tort a civil wrong that injuries a person. If a tort is intentional , it becomes a crime of assault or battery . Negligence, a form of malpractice, is an unintentional tort. To prove a negligent tort occurred , 4 elements must be there; 1. A duty must exist between the injured party and the professional accused of wrong doing. 2. A breach of duty must have occurred. The midwife must have practiced outside the standard of care for a breach to occur. 3. The breach of duty must be proximate cause of the claimed injury. 4. There must be damage or injuries to the claimant that are recognized by the law and compensable .

17. LEGAL ISSUE IN OBSTETRIC AND GYNAECOLOGY

18. PROBLEMS OF MEDICATION Nurses provide medication to the clients . Certain problems can occur during giving medication which can result into allegation against nurses, such as improper dosage of medication, improper client medication, wrong route of medication and wrong time FAILURE IN MONITORING OF THE CLIENT It is the responsibility of the nurse to monitor the client regularly depending upon the condition of the client. She is expected to monitor the condition of the client admitted with any gynecological problem..

19. FAILURE TO REPORT CHANGES IN THE PATIENT Nurses do the regular monitoring and the assessment of the client. During assessment , she may notice any change in the client’s condition. This has to be brought to the notice of the physician. With this, a precious life can be saved . FAILURE IN ASSESSING THE CLIENT Assessment is the first thing which nurses have to do . Based on the assessment care is provided to the patients. She is responsible for assessing and reporting any minute change in the client’s condition.

20. ABORTIONS: Many abortions are performed illegally. Nurses have the right to refuse to assist in the procedure of the abortion. If the abortion is performed under the act of medical termination of pregnancy. NURSING CARE OF NEWBORN Nurses have many responsibility for the newborn. She has to take the foot print of the newborn, cord is clamped, wrist band has to be put for the identification , proper warming is maintained etc. there are many responsibilities which the nurses have to carry .

21. ETHICS IN MIDWIFERY AND GYNAECOLOGY According to Thompson and Thompson , to be professional is to be ethical, and to be ethical is to be professional . To be ethical requires an understanding of ethics, values, moral reasoning, and ethical decision – making . The nature of ethics requires one to focus on what it means to be human and how to interact with others in a respectful manner. • The goal of ethical midwifery is to do the right thing for the right reasons. Knowing how to make good decisions as well as why these decisions were made constitutes of ethical midwifery practice

22. 1.Ethical principle of beneficence : The ethical principle of beneficence requires one to act in a way that is expected reliably to produce the greater balance of benefits over harms in the lives of others. 2. Non- maleficence: It means that health professionals should prevent causing harm and is understood as expressing the limits of beneficence. 3. Respect for autonomony : This principle requires one always to acknowledge and carry out the value based preference to adult,competent patient. PRINCIPLES

23. 4. Beneficence and respect for autonomy in gynecological practice: Beneficence based and autonomy based clinical judgment in gynecology practice are usually in harmony. For example; awoman may present with an ectopic pregnancy. The gynecological must explain diagnostic findings and potential for maternal death and unlikelihood of spontaneous resolution. 5 .Empowerment and advocacy ; One of the and help woman to exercise their autonomy important role of the midwife is to support. 6.Advocacy means speaking out for someone’s rights.

24. CURRENT TRENDS IN OBSTETRICAL NURSING

25. Technological advances As the technology has revolutionized and increasingly sophisticated computers in today's world, it has become necessary for the nursing personnel to have thorough knowledge of the new technology being used . Today fetal monitoring has progressed from the use of fetoscope to electronic fetal monitors .

26. Increased cost of high-tech care As the high and sophisticated technology is being introduced into todays world, the cost are also increasing. For the procedures such as ultrasound, fetal monitoring etc, the couple has to pay good amount of money . Gradually, obstetrics care is becoming a business for the care providers

27. Changing patterns of childibrth There are increasing numbers of working women, until they are in there thirties.As early marriage practise still continue , both ends, the older and younger mothers face increased risks of complications during pregnancy , such as preterm delivery, LBW.

28. Family centred care Maternally care today has enhanced to family centred care. Definition of health include physical ,social, psychological and economic dimension ..Family centered approach is basic unit of society. Thus emphasis on this aspect is must that fosters family unity. Integration and bonding takes high priority and much anticipatory counselling is offered .

29. Increasing the number of intensive care units Over past 20 years, care of infants and children has become extremely technical .Many infants nowadays are born with low birth weight and who are ill. Such infants are transferred to NICU. For this, the opportunities for advanced practice nurses also has increased .

30. Increasing use of alternative treatment modalities Families have growing tendency to use alternative therapies such as acupuncture or the therapeutic touch. Health care providers should be aware of alternative forms of therapy, like meditation, exercises, herbal therapies.etc .

31. Early discharge In earlier days, women were hospitalized for longer duration and physical activity was increased very gradually. Over the years now, however, health care personnel have realised that early return to normal activities is the best course for uncomplicated births

32. Role of fathers With increased societal emphasis on shared parenting and the recognition of parental bonding, many fathers are active in care giving and enjoy the closeness it brings.

33. A Picture Reinforces the Concept • Promote health and self-care to expectant mothers, infants and families. • Serves as an advocate for women e.g. cultural sensitivity • Focuses on health promotion and disease prevention. • Respect for human dignity and for women as persons with full human rights. • Although all midwives attend births in hospitals, they may also work in the home, clinics, communities and maternal units. ROLES OF A MIDWIFE