Trends of maternity services. pdf

TRENDS OF MATERNITY SERVICES IN INDIA
Prepared by: Mayuri Gamit
M.Sc Nursing (OBG)
Nursing tutor

1. PREPARED BY: MAYURI GAMIT
M.SCNURSING (OBG)
NURSING TUTOR
TRENDS OF MATERNITY
SERVICES IN INDIA

2. INTRODUCTION
Inourmothersandgrandmothersdays,anuntrainedwoman,neighbors,
relativeorfrienddeliveredmostbabiesathome.Allthechangesstartedin
29thcentury,whenparturitionmovedintothehospitalsetting.Atthat
point,childbearingbecamefarfromafamilyaffair.
Themotherandnewbornremainedisolatedfromthefamilyforaweekto
tendays.
Nursingwasseparatedintothreespecialties,withonenursecaringforthe
motherduringlabour,anddelivery,anotherhandlingpostpartummothers
andthirdcaringforthebaby.

3. Intheyear1940s,‘roomingin’conceptwasdevised.Theadvantagesofthe
systemincludedareductioninneonatalinfectionfromcross-contamination,
increasedconfidenceandindependenceforthemotherandgreaterbreast-feeding
success.
In1960s,thefocuschangedfromthepersongivingcaretotherecipient.Withthat
change,cameachangeinterminologyandobstetricalcarebecameMaternitycare.
WHOoffersdefinitionofmaternitycare-theobjectofmaternitycareistoensure
thateveryexpectantandnursingmothermaintainsgoodhealth,learnstheartof
childcare,hasanormaldeliveryandbearshealthychildren.

4. 1.Changesinsocialstructure,variationsinfamily
lifestyle
Ithasalteredhealthcareprioritiesformaternalandchild
healthnurses.
Today,clientadvocacy,anincreasedfocusonhealth
educationandnewnursingrolesarewaysinwhichnurses
haveadaptedtothesechanges.

5. 2.Costcontainment
Costcontainmentreferstosystemsofhealthcaredelivery
thatfocusonreducingthecostofhealthcarebyclosely
monitoringthecostofpersonnel,useandbrandsof
supplies,lengthofhospitalstays,numbersofprocedures
carriedout,andnumberofreferralsrequested.

6. 3.Expandedrolesfornurses
Increasingnursingresponsibilityforassessmentand
professionaljudgmentandprovidingexpandedrolesfor
nursepractitioners,suchasthenurse–midwife.


7. 4.Familycenteredcare
Morenaturalchildbirthenvironmentwherepartners,family
membersmayremaininahomelikeenvironmentand
participateinthechildbirthexperience.
Byadoptingaviewofpregnancy,childbirthasafamilyevent,
nursescanbeinstrumentalinincludingfamilymembersin
careandconsultfamilymembersaboutaplanofcareand
provideclearhealthteachingsothatfamilymemberscan
monitortheirowncare.

8. Maternallycaretodayhasenhancedtofamilycentred
care.Definitionofhealthincludephysical,social,
psychologicalandeconomicdimension.
Familycenteredapproachisbasicunitofsociety.Thus
emphasisonthisaspectismustthatfostersfamilyunity.
Integrationandbondingtakeshighpriorityandmuch
anticipatorycounsellingisoffered.

9. 5.Accesstohealthcare
Strongpredictorsofaccesstoqualityhealthcareincludehavinghealth
insurance,ahigherincomelevelandaregularprimarycareproviderorother
sourceofongoinghealthcare.
Useofclinicalpreventiveservices,suchasearlyprenatalcare,canserveas
indicatorsofaccesstoqualityhealthcareservices.
Theobjectivesselectedtomeasureprogressinthisareaare:
1.Increasetheproportionofpersonswithhealthinsurance.
2.Increasetheproportionofpersonswhohaveaspecificsourceofongoing
care.
3.Increasetheproportionofpregnantwomenwhobeginprenatalcareinthe
firsttrimesterofpregnancy.

10. 6.Shorteninghospitalstays(Earlydischarge)
Womenwhohavepretermlaborstayinthehospitalwhile
laborishaltedandthenareallowedtoreturnhomeon
medicationwithcontinuedmonitoring.
Routinehospitalstayformothersandnewbornsafteran
uncomplicatedbirthisnow2daysorless.
Shorttermhospitalstaysrequireintensivehealthteachingby
thenursingstaffandfollowupbyhomecareorcommunity
healthnurses.

11. Inearlierdays,womenwerehospitalizedforlonger
durationandphysicalactivitywasincreasedvery
gradually.
Overtheyearsnow,however,healthcarepersonnelhave
realisedthatearlyreturntonormalactivitiesisthebest
courseforuncomplicatedbirths.

12. 7. Increased use of alternative treatment modalities
Thereisagrowingtendencytoconsultalternativeforms
oftherapy,suchasacupunctureortherapeutictouch,in
additionto,orinsteadoftraditionalhealthcareproviders.
Nurseshaveanincreasingobligationtobeawareof
complementaryoralternativetherapies.

13. Familieshavegrowingtendencytousealternative
therapiessuchasacupunctureorthetherapeutictouch.
Healthcareprovidersshouldbeawareofalternative
formsoftherapy,likemeditation,exercises,herbal
therapies.etc

14. 8.Increaseduseoftechnology
Thefieldofassistedreproduction(e.g.invitrofertilization),
seekinginformationontheinternetandmonitoringfetalheart
ratesbyDopplerultrasonographyareanotherexamples.
Inadditiontolearningthesetechnologies,maternalandchild
healthnursesmustbeabletoexplaintheiruseandtheir
advantagestoclients.Otherwise,clientsmayfindnew
technologiesmorefrighteningthanhelpfulthem.

15. 9.Technologicaladvances
Asthetechnologyhasrevolutionizedandincreasinglysophisticated
computersintoday’sworld,ithasbecomenecessaryforthenursing
personneltohavethoroughknowledgeofthenewtechnologybeing
used.
Duetothisadvancement,‘thehandsoncare’oftheclientis
reduced,soalsoisthe,qualitynursingcare.
Todayfoetalmonitoringhasprogressedfromtheuseoffetoscopeto
electronicfoetalmonitors.Itcanbeusedboth,directlyand
indirectly.

16. Expertsbelievethatincomingyears,birthsaregoingto
behigh–techinnovations,resultinginlowperinatal
mortalityandmorbidity.
Infuture,therearechallengesfornurses,astheywill
providecareintheworldofhightechnology.

17. 10.Increasedcostofhigh-techcare
Asthehighandsophisticatedtechnologyisbeing
introducedintotodaysworld,thecostarealsoincreasing.
Fortheproceduressuchasultrasound,fetalmonitoring
etc,thecouplehastopaygoodamountofmoney.
Gradually,obstetricscareisbecomingabusinessforthe
careproviders.

18. 11.Changingpatternsofchildbirth
Thereareincreasingnumbersofworkingwomen.
Asearlymarriagepractisestillcontinue,bothends,the
olderandyoungermothersfaceincreasedrisksof
complicationsduringpregnancy,suchaspretermdelivery,
LBWect.

19. 12.IncreasePerinatalriskfactors
Theproblemsofsocietyarereflectedinrisks;among
themareAIDSinmothersandnewborns.
LBWaccountforabout30-40%oflivebirthsin
developingcountries.
Inadditiontomaternalage,riskfactorsofLBWinclude
mother’smedicalhistory,pastpregnancy,socioeconomic
statusandprenatalcare.

20. 14.Risingcaesareanbirthrates
Withtheuseoffetalmonitoringandultrasoundfor
prenatalmonitoringandultrasoundforprenatalevaluation
offetalcondition,hascomeandincreasedrateof
caesareanbirthrates.

21. 15.Increasingthenumberofintensivecareunits
Overpast20years,careofinfantsandchildrenhas
becomeextremelytechnical.
Manyinfantsnowadaysarebornwithlowbirthweight
andwhoareill.SuchinfantsaretransferredtoNICU.For
this,theopportunitiesforadvancedpracticenursesalso
hasincreased.

22. 18.Roleoffather
Withincreasedsocietalemphasisonsharedparentingandthe
recognitionofparentalbonding,manyfathersareactiveincare
givingandenjoytheclosenessitbrings
Theinvolvedfather,aspresent,accessible,available,understanding,
willingtolearnaboutthepregnancyprocessandtoprovide
emotional,physicalandfinancialsupporttothewomancarryingthe
child.Womenemphasizedasenseof“togetherness”duringthe
pregnancy.

23. 19.PsychologicalSupportduringlabour
motherwillexperiencephysicalsensationsdiscomforttoseverepain.
Helpingthemothertobeasrelaxedaspossibleandawareofthesituationcan
helpminimizethephysicalpainandemotionaldistressoflabourandbirth.
Mothercanbehelpedwiththisbyreceivingadequatecare,timely
information,comfort,supportandreassuranceduringlabourandbirth.
Itisalsoimportanttomaintainrespectandcourtesywheneverpossibleby
explainingwhataregoingtodoandwhy,andbybeingcourteoustoherand
herfamily.

24. 20.PainlessDelivery
Painlessdeliveryreferstotheuseofanepiduralinjectionwhichisgivenbyananaesthesiologist
forpainreliefduringlabour.Itisinjectedinthelowerback,andaplastictubeisplacedthrough
whichdrugsarereleasedaroundthespinalcord.Itisinjectedonlyoncewhenyouareinactive
labourwhichmeansyouarehavingatleastthreecontractionsin10minutes.
Epiduraldoesn’talwaysprovide100%painrelief,butitsubstantiallyreducespainandsensations
inthelowerhalfofthebody.
Inearlylabour,paincanbemanagedusingnaturalmethodslikewarmshowers,massages,and
exercises.
Ithelpsawomancopebetterwithpost-partumdepressionorexhaustion.
Itrelaxesthevaginalmusclesandprovidesspaceforthebabytodescend.

25. 21.Roboticlabour
Robotscouldeventuallyplayintegralrolesinlaborwards,accordingtofindingsfromComputerScience
andArtificialIntelligenceLaboratory.
Robotsarecurrentlyemployedinhospitalstocarryoutsimpleactions,likedispensingmedication.But
cantheyunderstandpatientneedsandmakeschedulingdecisions?
Theresearchershavebeenworkingforthepasttwoyearstodeterminewhetherrobotscanbemorethan
justhelpfulcompanions.
ResearchersfromMIT’sComputerScienceandArtificialIntelligenceLaboratory(CSAIL)usedarobot
thatcouldlearnfromhumanschedulerstoanticipatebedflowandsuggestwhichnursestoassigntoC-
sectionsandotherprocedures.
Whilerobotslonghavebeenusedtoperformsmalltasks,suchasdeliveringlinensormedications,
they’renowtakingonhigher-levelresponsibilitiesthatcanincludesurgeryanddoingrounds.