Nursing and midwifery

1. Community based midwifery care
HISTORY OF DOMICILIARY MIDWIFERY
IYUMVA Aimable
BNS Student,
CLARKE
INTERNATIONAL UNIVERSITY
Kampala

2. Objectives

By the end of the presentation, students will be
able to;
1. Define essential term.
2. Discuss the history of domiciliary care
3. Outline the importance of domiciliary midwifery
4.Give the challenges faced during domiciliary
midwifery care

3. Definition of term

Domiciliary midwifery
This refers to care given to a mother and the baby at
home rather than the hospital by a registered midwife
during antenatal, intra-natal and postnatal periods
OR
It is defined as a home delivery service undertaken by a
community midwife or the flying squad( made up of
the doctor, experienced midwife, anesthetist and
pediatrician) with a delivery kit thereby allowing
patients to deliver in their homes

4. Cont;
 Although emphasis is usually centered on the home
delivery of the pregnant woman, in actual fact this
care is a total one, embracing prenatal, intranatal and
postpartum management.
Selection criteria for home delivery;

Suitable home

Mother must be healthy with normal past obstetric
history of 1 or 2 previous normal deliveries

5. History of domiciliary midwifery

Historically, childbirth was considered a
dangerous time for mothers and babies.

According to O'Connor (1995), most births
occurred at home in the 1900's and by then, the
mortality was high where almost one child in ten
died during their first year of life in Ireland.

Urban poverty, inadequate nutrition, artificial
feeding and unsanitary living condtions were
cited as reasons for the high mortality rate
(Robins, 1995).

6. Cont..

Further more, communities were staffed by
midwives who were poorly paid and undertrained.
(O'Connor,1995)

The main cause of the high mortality rate was
puerperal sepsis and to a lesser extent toxaemia and
hemorrhage..

Between 1929 to 1933, the mortality rate rose from
5.59 per 1000 total births to 5.8 per 1000 total births
respectively.(Tew, 1995)

7. Cont..

There after the introduction of antibiotics to treat puerperal
infections, the mortality rate fell slightly in 1935.

In 1940's further improvements occurred in treatment of
toxaemia, hemorrhage and other causes of maternal deaths.

In Uganda, Only 6 percent of facilities in Uganda have services
supporting safe home delivery ; these are mainly located in the
North Central Region. In addition, 12 percent of facilities have
documentation of official support for TBAs; this includes 34
percent of facilities in the West Nile Region.(UHDS,2016)

8. Importances of domiciliary midwifery
Importances of domiciliary midwifery

Reduces on the congestion in the health units
Reduces on the congestion in the health units

Creates better rapport between midwife, mother,
Creates better rapport between midwife, mother,
her family and the community
her family and the community

Ensures that the midwife knows and understands
Ensures that the midwife knows and understands
the family in her care
the family in her care

It reduces the stress mothers go through with the
It reduces the stress mothers go through with the
hospital routine.
hospital routine.

It gives satisfaction to the mother because she
It gives satisfaction to the mother because she
doesnot have to worry about other children while
doesnot have to worry about other children while
she in hospital
she in hospital

9. Risk of cross infection is minimized to both mother
and baby.
Continuity of care is assured and on going
assessment.
Early detection of complications.
 Improves society perception towards nurses and
midwives
Reduces on costs for both the mother and the hosp,

10. disadvantages
Delay in case an emergency service is needed

11. ANY SUPPLEMENT??
THANK YOU