Transcript Document

ADDRESSING
RESPECTFUL
MATERNITY CARE:
Reducing the
medicalisation of
maternal and
newborn care
Session Objectives
The objectives of this session are to:
 Review the concept of
‘medicalised’ care
 Provide examples of care that can
reduce harmful practices
 Share examples of evidence-based
interventions
 Share suggestions on how to keep
birth ‘normal’
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What Is Medicalised Maternal
and Newborn Care?
The routine use of practices during labor and childbirth
that:
 Are not evidence-based
 Are unnecessary or unwarranted
 Are unfamiliar and often undesirable to women
 Do not improve the health outcomes for mother or baby
and may do harm
 Prioritize needs of providers over needs of women
 Encourage technology or interventions without proven
benefit
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What Drives Medicalised Maternal
and Newborn Care?
 Medico-legal pressures
 Profit
 Non-evidence-based beliefs within the medical
community, established practices
 Convenience for providers
 Perception/illusion of safety
 Fear: the desire to control birth and reduce risk
 Desire to use technology
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What Drives Medicalised Maternal
and Newborn Care?
Take 10 minutes to think about the following questions:
 What drives medicalised
maternal and newborn
care in your practice/place
of work?
 Consider the origins of the
practice – Do you know if
it is evidence-based?
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Why Does Medicalisation Matter?
 Cost can be higher
 Can reduce access to interventions for those who really
need them
 Can lead to poorer health outcomes
 Does not involve woman fully in decision making, results in
her discomfort and disempowerment = disrespectful care
 Evidence suggests that higher rates of normal births are
linked to provider beliefs about birth, implementation of
evidence-based practice, and team working (BMJ 2002)
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For more information on the
medicalisation of childbirth…
https://www.k4health.org/toolkits
/rmc/powerpoint-overview-ofthe-medicalization-of-mnh-care
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Respectful Maternal and Newborn Care
Respectful care demonstrates:
 Respect for a woman’s rights, choices and
dignity
 Care that “does no harm”
 Care that promotes positive parenting and
improves birth outcomes
 Care that is culturally sensitive and valued by
the woman and her community
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Reversing the Trend: Partnership in Care
Aim to provide respectful maternity care that:
 is woman-centered, empowering and
supportive
 is evidence-based and shown to be beneficial
 permits free communication and full
expression of trust and commitment
 ensures all women are treated equitably
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ASK: What do Women Want?
For example…
 Respectful maternity
care – kindness, respect,
information
 Availability of drugs and
medical equipment in
clean facilities
 Support persons in labor
and birth
 Culturally appropriate
services
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Finding Evidence
How do you know if
one treatment will
work better than
another, or if it will
do more harm than
good?
 Cochrane Reviews
http://www.cochrane.org/
cochrane-reviews
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Common Medicalised Practices
That Are Harmful
 Restricting ambulation/different positions during labor and
choice of birth position
 Lack of companion/family during labor
 Over-use of anesthesia/analgesia
 Administration of oxytocin at any time before delivery in
such a way that the effect cannot be controlled
 Restricting food and fluids
 Separation of mother and baby
 Early cord clamping
 Routine episiotomy
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Unnecessary/Routine Episiotomies
 Episiotomies can reduce maternal and
neonatal morbidity if they are restricted to
evidence-based indications (WHO 2006)
 Associated morbidity includes perineal
damage by tears, pain and dyspareunia
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Restrictive Episiotomy vs.
Routine Episiotomy
Restrictive episiotomy policies found that women experienced:




less severe perineal trauma
less posterior perineal trauma
less suturing and fewer healing complications at seven days
with no difference in occurrence of pain, urinary incontinence,
painful sex or severe vaginal/perineal trauma after birth
 Overall, women experienced more anterior perineal damage with
restrictive episiotomy
http://summaries.cochrane.org/CD000081/
episiotomy-for-vaginal-birth#sthash.DHo9cyUN.dpuf
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Choice of Birth Position
Gravity is our greatest aid in giving
birth, but for historical and cultural
reasons we make women give
birth on their backs.
 Choice of positions for labor and
birth encourages a woman’s
sense of control and reduces
need for analgesia
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Choice of Birth Position (cont.)
 Women who assumed a nonsupine
position for birth:
 had fewer perineal injuries
 had less vulvar edema
 had less blood loss
 Women choosing nonsupine position
for birth:
 had shorter second stages
 required less pain relief medication
 had fewer abnormal fetal heart rates
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Alternate Positions
Midwife-Led Care Linked to Less
Medicalisation: Sandal 2013
Women who had midwife-led continuity models of care were…
…more likely to experience:
 no intrapartum analgesia/anaesthesia
 spontaneous vaginal birth
 attendance at birth by a known midwife
 a longer mean length of labour (hours)
 satisfaction with services
 regional analgesia
 instrumental birth
…less likely to experience:
 preterm birth
 fetal loss before 24
weeks' gestation
There were no differences
between groups for
caesarean births.
…less likely to experience:
 episiotomy
OUTCOMES
http://onlinelibrary.wiley.com/doi/10.1002/
14651858.CD004667.pub3/abstract
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Campaign for ‘Normal Birth’:
Tips for Providers
1.
2.
3.
4.
5.
6.
7.
Wait and see
Get her off the bed
Justify intervention
Listen to her
Be a role model
Be positive
Promote ‘skin-to-skin’ contact
http://www.rcmnormalbirth.org.uk/
practice/ten-top-tips
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Support Persons
 The presence of a birth
companion improves
birth outcomes and the
overall birth experience
 Continuous empathetic
and physical support is
associated with shorter
labour, less medication
and fewer operative
deliveries.
http://summaries.cochrane.org/CD00
3766/continuous-support-for-womenduring-childbirth
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Keep Mother and Baby Together
The day of birth is the most dangerous day for
mother and baby
State of the World’s Mothers Report, SC 2013
 Promote warming with
‘skin-to-skin’ after birth
 Promote early and
exclusive breastfeeding
 Ensure mother counselled
on danger signs
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Cord Clamping
World Health Organization (2012) recommends
delayed cord clamping
 Late cord clamping
(performed after 1 to 3
minutes after birth) is
recommended for all births
while initiating
simultaneous essential
newborn care.
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Cord Clamping (cont.)
Benefits include:
 Increased iron stores at birth and
less infant anemia
 Decreased intraventricular
hemorrhage
 Less necrotizing enterocolitis
 Less infant sepsis
 Fewer blood transfusions needed
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Be Accountable!
 Take responsibility for your
own actions
 Provide care that is evidencebased and shown to be
beneficial
 Do no harm
 Record and report
 Communicate
 Be the woman’s advocate
 Explore opportunities for collaborative working and team
building to improve respectful quality of care
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We all have a role in assuring that women
have respectful maternity care!
THANKS!