This document describes a pilot study of midwifery centers in low and middle income countries. It surveyed 25 midwifery centers across 10 countries, which had a total of 3,549 births. The study examined whether care provided at these centers was safe, sustainable, and provided a satisfying experience for women. Overall, the midwifery centers met many basic emergency obstetric and newborn care signals, had good maternal and neonatal outcomes, and were found to respectfully meet most women's needs. However, challenges with referrals and transferring women to other facilities were also common. The study provides initial evidence that midwifery centers may help address issues with accessing facility-based care in low-resource settings.
Human resources section7-textbook_on_public_health_and_community_medicinePrabir Chatterjee
This document discusses maternal and child health issues globally and in India. It notes that over 300 million women suffer illness from pregnancy/childbirth, and each year 3.3 million babies are stillborn and over 4 million die within 28 days of birth. In India, the maternal mortality ratio is 300 per 100,000 live births. Infant mortality is higher in rural areas and for teenage mothers. Less than half of Indian children under 2 are fully vaccinated against major illnesses.
Despite progress, malnutrition in India remains a serious problem, with over 40% of the world's malnourished children found in India despite it containing less than 20% of the global child population. Malnutrition varies widely across regions, states, age, gender and social groups, and is worst among children under two, those in northern states, and tribal and lower caste populations. The main causes of malnutrition in India are inadequate food intake, disease, poor caring practices, poverty and gender inequity. Addressing malnutrition will require improved targeting of services, enhanced service quality, reliable monitoring and evaluation, and community ownership of programs.
A registered midwife is someone who has completed an approved midwifery education program, is registered to practice midwifery, and maintains competency. The scope of midwifery practice includes providing care during pregnancy, labor, birth and postpartum, as well as family planning advice and newborn care. Midwifery practice is underpinned by values of empowering women and respecting their decisions, and sees birth as a normal process where midwives are the primary caregivers. An individual midwife's scope may change based on their experience and training, practice guidelines, and the needs of the woman and baby.
With having many challenges surrounding the nurse midwives in India, she still delivers good obstetrician care and can bringing good health of mother and child. can decrease ratio of LSCS. looking for many established centers/clinics/hospitals/birthing centers which runs by midwives independently in India
This document provides an introduction to midwifery and obstetrical nursing. It discusses the history and evolution of midwifery in India, from traditional dais (midwives) assisting with home births, to the establishment of formal midwifery training programs and certifications like Auxiliary Nurse Midwives. Today in India, there are several cadres of midwives including registered nurses with midwifery training, ANMs, and skilled birth attendants. The future of midwifery in India involves improving access to care and achieving safe motherhood.
Current trends in midwifery &; obstetrical nursingAbhilasha verma
The document discusses current trends in midwifery and obstetrical nursing. It outlines goals to reduce maternal mortality, fetal and infant death, preterm birth, and cesarean sections among low-risk women. New trends discussed include the WHO near-miss approach, maternal waiting homes, postpartum butterfly device, transvaginal Bakri balloon, wireless fetal monitoring, non-invasive prenatal testing, vaginal seeding, cervical cerclage, treating intrauterine infections, and improving nutrition. The document also discusses robotic gynecological surgery, the Vita HEAT device during labor, using virtual reality to relieve labor pains, Clearblue digital pregnancy tests, My Peri Tens devices, and an
This document discusses models of midwifery care in Central New York and summarizes a presentation given by two midwives. The presentation covered three main points: 1) It discussed models of care that use midwifery for healthy women during pregnancy and well woman care. 2) It discussed research findings that support safe and healthy outcomes for physiologic labor and birth. 3) It facilitated collaboration of a healthcare team to provide comprehensive safe maternity care for women in Central New York.
Human resources section7-textbook_on_public_health_and_community_medicinePrabir Chatterjee
This document discusses maternal and child health issues globally and in India. It notes that over 300 million women suffer illness from pregnancy/childbirth, and each year 3.3 million babies are stillborn and over 4 million die within 28 days of birth. In India, the maternal mortality ratio is 300 per 100,000 live births. Infant mortality is higher in rural areas and for teenage mothers. Less than half of Indian children under 2 are fully vaccinated against major illnesses.
Despite progress, malnutrition in India remains a serious problem, with over 40% of the world's malnourished children found in India despite it containing less than 20% of the global child population. Malnutrition varies widely across regions, states, age, gender and social groups, and is worst among children under two, those in northern states, and tribal and lower caste populations. The main causes of malnutrition in India are inadequate food intake, disease, poor caring practices, poverty and gender inequity. Addressing malnutrition will require improved targeting of services, enhanced service quality, reliable monitoring and evaluation, and community ownership of programs.
A registered midwife is someone who has completed an approved midwifery education program, is registered to practice midwifery, and maintains competency. The scope of midwifery practice includes providing care during pregnancy, labor, birth and postpartum, as well as family planning advice and newborn care. Midwifery practice is underpinned by values of empowering women and respecting their decisions, and sees birth as a normal process where midwives are the primary caregivers. An individual midwife's scope may change based on their experience and training, practice guidelines, and the needs of the woman and baby.
With having many challenges surrounding the nurse midwives in India, she still delivers good obstetrician care and can bringing good health of mother and child. can decrease ratio of LSCS. looking for many established centers/clinics/hospitals/birthing centers which runs by midwives independently in India
This document provides an introduction to midwifery and obstetrical nursing. It discusses the history and evolution of midwifery in India, from traditional dais (midwives) assisting with home births, to the establishment of formal midwifery training programs and certifications like Auxiliary Nurse Midwives. Today in India, there are several cadres of midwives including registered nurses with midwifery training, ANMs, and skilled birth attendants. The future of midwifery in India involves improving access to care and achieving safe motherhood.
Current trends in midwifery &; obstetrical nursingAbhilasha verma
The document discusses current trends in midwifery and obstetrical nursing. It outlines goals to reduce maternal mortality, fetal and infant death, preterm birth, and cesarean sections among low-risk women. New trends discussed include the WHO near-miss approach, maternal waiting homes, postpartum butterfly device, transvaginal Bakri balloon, wireless fetal monitoring, non-invasive prenatal testing, vaginal seeding, cervical cerclage, treating intrauterine infections, and improving nutrition. The document also discusses robotic gynecological surgery, the Vita HEAT device during labor, using virtual reality to relieve labor pains, Clearblue digital pregnancy tests, My Peri Tens devices, and an
This document discusses models of midwifery care in Central New York and summarizes a presentation given by two midwives. The presentation covered three main points: 1) It discussed models of care that use midwifery for healthy women during pregnancy and well woman care. 2) It discussed research findings that support safe and healthy outcomes for physiologic labor and birth. 3) It facilitated collaboration of a healthcare team to provide comprehensive safe maternity care for women in Central New York.
This document outlines the Maternal and Child Health On-Job Training Program, which aims to strengthen nurses' knowledge and skills in maternal and child healthcare through evidence-based practice. The course involves interactive lectures, skills demonstrations, clinical rotations, and case presentations. Topics include anatomy, pregnancy, labor and delivery complications, screening tests, and medical conditions in pregnancy. The goal is to improve nursing care for mothers and newborns.
Certified Midwives are delivering more and more babies in the United States and have lower rates of Cesarean Sections than OBGYNs. Learn more about Triangle Midwives, a division of Triangle Physicians for Women. Learn more at www.TriangleMidwives.com
Vital statistics related to maternal health in indiaPriyanka Gohil
This topic contains introduction of vital statistics, list of important statistics, birth rate, death rate, specific death rates, infant mortality rate, neonatal mortality rate, under five mortality rate, maternal mortality rate (detailed), perinatal mortality rate (detailed), expectation of life, general fertility rate and still births.
The term midwife reflects a philosophy of care that is directed toward women and their individual reproductive needs. A midwife usually offers a variety of options and seeks to eliminate or minimize unnecessary interventions. This philosophy is represented by the Midwives Model of Care.The Midwives Model of Care is based on the belief that pregnancy and birth are normal life processes. (American Pregnancy Association)
Role of midwife and independent nurse midwifery practitionerPinki sah
The document discusses the role of midwifery practices and independent nurse midwifery practitioners. It explains that midwives provide antenatal care, attend births, and provide postnatal care. They act as caregivers, coordinators, leaders, communicators, managers, educators, counselors, family planners, advisers, record keepers, and supervisors. It also defines independent nurse midwifery practitioners as registered nurses who provide midwifery care while maintaining accountability. It outlines the standards required for midwifery practice according to the American College of Nursing.
Community midwifery aims to promote maternal and child health through antenatal, intranatal, and postnatal care. Antenatal care includes regular checkups to monitor the health of the mother and baby, identify high-risk pregnancies, provide education on nutrition and hygiene, and begin postpartum family planning. Intranatal care focuses on a clean delivery to prevent infections. Postnatal care supports breastfeeding and family planning education while checking for postpartum complications over 10 days of visits. The overall goals are a healthy mother and baby as well as promoting reproductive health.
Certified nurse-midwives (CNMs) are advanced practice registered nurses who provide primary care to women across their lifespan, including pregnancy, birth, and postpartum care. CNMs receive a graduate-level education and certification. Research shows CNMs have equivalent or better outcomes compared to physicians and provide more holistic, patient-centered care at a lower cost. While CNM practice has grown over time, further legislative actions could help increase access to CNM care and services.
Menopause is the permanent cessation of menstruation that occurs naturally as part of aging when the ovaries stop producing estrogen and progesterone, and a woman can no longer get pregnant. Counseling women about menopause aims to address questions/concerns, provide education, facilitate informed decision making, and enhance confidence. The counseling process involves building rapport, exploring issues, and committing to actions. A survey found that over 75% of postmenopausal women received counseling on hormone replacement therapy, with no differences found between managed care and other insurance types. More efforts are needed to educate underserved women.
This document summarizes the history and development of maternal and child health services in India from 1880 to present. It outlines key programs and policies established over time to promote safe motherhood and reduce infant and child mortality, including establishment of midwifery training in 1880, the Midwifery Act of 1902, setting up an advisory committee on maternal mortality in 1930, development of primary health centers and family planning programs in the 1950s-60s, enactment of the MTP Act in 1971, expansion of family planning services through RCH programs from 1977-2005. It also discusses current programs and schemes under NRHM/NUHM and highlights issues like skilled birth attendance and the need for continued efforts to improve MCH outcomes.
This document discusses various roles and specialties within the nursing profession. It describes roles such as advanced practice nursing, nurse midwifery, geriatric nursing, psychiatric nursing, school nursing, occupational health nursing, forensic nursing, correctional nursing, disaster nursing, and nursing administration. It also discusses expanding roles and opportunities in nursing internationally due to factors like increasing health needs, economic conditions, research and knowledge growth, and support from governments and private organizations.
Midwifery has a long history in the United States dating back to when midwives attended mostly poor women in their homes. In the late 1800s, childbirth shifted to a medical model with doctors attending more births. Midwifery continued to grow with the establishment of nurse-midwifery programs and practices. Today, midwives provide care in various settings like hospitals, birth centers, and homes and focus on empowering women throughout their lifespan, not just during birth. They promote natural childbirth and use interventions judiciously when needed.
Role of nurse midwifery and obstetric careSujata Sahu
The document discusses the roles of a nurse midwife throughout the four stages of childbearing: adolescence, antenatal, intranatal, and postnatal. In each stage, the nurse midwife acts as a caregiver, counselor, teacher, and clinician. During adolescence, the midwife provides education on puberty, sexuality, and marriage. In the antenatal stage, the midwife provides prenatal care, screening for risk factors, and education. In labor and delivery, the midwife supports the mother, monitors labor, and teaches about the birthing process. After birth, the midwife assesses mother and baby, counsels on parenting and family planning, and teaches about newborn and
Public private partnership in safemotherhood program in NepalBidhya Basnet
The document discusses public private partnerships in Nepal's Safemotherhood program. It provides definitions of key terms, describes the status and activities of the program, and outlines various PPP models used. The program aims to reduce maternal and neonatal mortality by improving access to antenatal care, skilled birth attendance, emergency obstetric care, and postnatal care. It partners with various organizations to implement activities like community mobilization, ultrasound programs, and expanding emergency referral services. However, partnerships face limitations like unclear policies, weak coordination, and a lack of regulatory frameworks and research on the private health sector.
This document discusses maternal and child health services. It defines maternal and child health as promoting health, preventing disease, and providing care for mothers and children. The objectives of maternal and child health services are reducing mortality and morbidity for mothers, newborns, infants, and children, as well as promoting reproductive and adolescent health. Key services discussed include antenatal care, delivery care, postnatal care, immunizations, and child health services like growth monitoring and breastfeeding promotion. Reducing maternal, newborn and child mortality are top priorities in improving maternal and child health.
Mother and Baby Friendly Care: Mother friendly care during pregnancySaide OER Africa
Newborn Care was written for healthcare workers providing special care for newborn infants in level 2 hospitals. It covers: An essential tool in the initial and ongoing training and teaching of any healthcare worker – Miriam Adhikari, South African Journal of Child Health, Primary Newborn Care was written specifically for nurses, midwives and doctors who provide primary care for newborn infants in level 1 clinics and hospitals. It covers: Mother and Baby Friendly Care describes gentler, kinder, evidence-based ways of caring for women during pregnancy, labour and delivery. It also presents improved methods of providing infant care with an emphasis on kangaroo mother care and exclusive breastfeeding. It covers: mother-friendly care in pregnancy, a modern approach to normal labour, skin-to-skin care of infants, encouraging breastfeeding, a baby-friendly nursery.
Maternal and child health care servicesKailash Nagar
This document discusses maternal and child health care. It begins by introducing the topic and defining maternal and child health services according to the WHO. The objectives of maternal and child health programs are then outlined, including reducing mortality and morbidity for mothers and children. Key health problems, indicators, and recent trends are also summarized. The document goes on to provide details on antenatal, intranatal, and postnatal care services as well as child health services. Causes of maternal and under-five deaths in India are also presented.
Birth companions are women who have experienced labor and provide continuous one-on-one support to women in labor. They provide emotional support, information about labor progress, advice on coping techniques, comfort measures, and help advocate for the woman's wishes. The World Health Organization promotes labor companionship to improve maternal and infant health outcomes such as reduced labor time and stress, increased mother's feelings of control, and decreased medical interventions. India's Ministry of Health and Family Welfare now allows birth companions in public health facilities to help reduce maternal and infant mortality rates in line with the country's commitments under the UN's Sustainable Development Goals.
This document discusses measuring adherence within PMTCT programs. It begins by defining PMTCT as a care and treatment program for pregnant HIV-positive women and their exposed infants, noting activities occur across antenatal care, maternity wards, exposed infant clinics and HIV treatment centers. Routinely collected data only provides a general idea of adherence. New tools are needed to assess adherence at different points, like antenatal adherence and infant follow-up. These tools should reflect PMTCT as a long-term program, not just delivery. Strong systems are required to retain families in care, like functioning appointment systems and linkage between services.
This document outlines the Maternal and Child Health On-Job Training Program, which aims to strengthen nurses' knowledge and skills in maternal and child healthcare through evidence-based practice. The course involves interactive lectures, skills demonstrations, clinical rotations, and case presentations. Topics include anatomy, pregnancy, labor and delivery complications, screening tests, and medical conditions in pregnancy. The goal is to improve nursing care for mothers and newborns.
Certified Midwives are delivering more and more babies in the United States and have lower rates of Cesarean Sections than OBGYNs. Learn more about Triangle Midwives, a division of Triangle Physicians for Women. Learn more at www.TriangleMidwives.com
Vital statistics related to maternal health in indiaPriyanka Gohil
This topic contains introduction of vital statistics, list of important statistics, birth rate, death rate, specific death rates, infant mortality rate, neonatal mortality rate, under five mortality rate, maternal mortality rate (detailed), perinatal mortality rate (detailed), expectation of life, general fertility rate and still births.
The term midwife reflects a philosophy of care that is directed toward women and their individual reproductive needs. A midwife usually offers a variety of options and seeks to eliminate or minimize unnecessary interventions. This philosophy is represented by the Midwives Model of Care.The Midwives Model of Care is based on the belief that pregnancy and birth are normal life processes. (American Pregnancy Association)
Role of midwife and independent nurse midwifery practitionerPinki sah
The document discusses the role of midwifery practices and independent nurse midwifery practitioners. It explains that midwives provide antenatal care, attend births, and provide postnatal care. They act as caregivers, coordinators, leaders, communicators, managers, educators, counselors, family planners, advisers, record keepers, and supervisors. It also defines independent nurse midwifery practitioners as registered nurses who provide midwifery care while maintaining accountability. It outlines the standards required for midwifery practice according to the American College of Nursing.
Community midwifery aims to promote maternal and child health through antenatal, intranatal, and postnatal care. Antenatal care includes regular checkups to monitor the health of the mother and baby, identify high-risk pregnancies, provide education on nutrition and hygiene, and begin postpartum family planning. Intranatal care focuses on a clean delivery to prevent infections. Postnatal care supports breastfeeding and family planning education while checking for postpartum complications over 10 days of visits. The overall goals are a healthy mother and baby as well as promoting reproductive health.
Certified nurse-midwives (CNMs) are advanced practice registered nurses who provide primary care to women across their lifespan, including pregnancy, birth, and postpartum care. CNMs receive a graduate-level education and certification. Research shows CNMs have equivalent or better outcomes compared to physicians and provide more holistic, patient-centered care at a lower cost. While CNM practice has grown over time, further legislative actions could help increase access to CNM care and services.
Menopause is the permanent cessation of menstruation that occurs naturally as part of aging when the ovaries stop producing estrogen and progesterone, and a woman can no longer get pregnant. Counseling women about menopause aims to address questions/concerns, provide education, facilitate informed decision making, and enhance confidence. The counseling process involves building rapport, exploring issues, and committing to actions. A survey found that over 75% of postmenopausal women received counseling on hormone replacement therapy, with no differences found between managed care and other insurance types. More efforts are needed to educate underserved women.
This document summarizes the history and development of maternal and child health services in India from 1880 to present. It outlines key programs and policies established over time to promote safe motherhood and reduce infant and child mortality, including establishment of midwifery training in 1880, the Midwifery Act of 1902, setting up an advisory committee on maternal mortality in 1930, development of primary health centers and family planning programs in the 1950s-60s, enactment of the MTP Act in 1971, expansion of family planning services through RCH programs from 1977-2005. It also discusses current programs and schemes under NRHM/NUHM and highlights issues like skilled birth attendance and the need for continued efforts to improve MCH outcomes.
This document discusses various roles and specialties within the nursing profession. It describes roles such as advanced practice nursing, nurse midwifery, geriatric nursing, psychiatric nursing, school nursing, occupational health nursing, forensic nursing, correctional nursing, disaster nursing, and nursing administration. It also discusses expanding roles and opportunities in nursing internationally due to factors like increasing health needs, economic conditions, research and knowledge growth, and support from governments and private organizations.
Midwifery has a long history in the United States dating back to when midwives attended mostly poor women in their homes. In the late 1800s, childbirth shifted to a medical model with doctors attending more births. Midwifery continued to grow with the establishment of nurse-midwifery programs and practices. Today, midwives provide care in various settings like hospitals, birth centers, and homes and focus on empowering women throughout their lifespan, not just during birth. They promote natural childbirth and use interventions judiciously when needed.
Role of nurse midwifery and obstetric careSujata Sahu
The document discusses the roles of a nurse midwife throughout the four stages of childbearing: adolescence, antenatal, intranatal, and postnatal. In each stage, the nurse midwife acts as a caregiver, counselor, teacher, and clinician. During adolescence, the midwife provides education on puberty, sexuality, and marriage. In the antenatal stage, the midwife provides prenatal care, screening for risk factors, and education. In labor and delivery, the midwife supports the mother, monitors labor, and teaches about the birthing process. After birth, the midwife assesses mother and baby, counsels on parenting and family planning, and teaches about newborn and
Public private partnership in safemotherhood program in NepalBidhya Basnet
The document discusses public private partnerships in Nepal's Safemotherhood program. It provides definitions of key terms, describes the status and activities of the program, and outlines various PPP models used. The program aims to reduce maternal and neonatal mortality by improving access to antenatal care, skilled birth attendance, emergency obstetric care, and postnatal care. It partners with various organizations to implement activities like community mobilization, ultrasound programs, and expanding emergency referral services. However, partnerships face limitations like unclear policies, weak coordination, and a lack of regulatory frameworks and research on the private health sector.
This document discusses maternal and child health services. It defines maternal and child health as promoting health, preventing disease, and providing care for mothers and children. The objectives of maternal and child health services are reducing mortality and morbidity for mothers, newborns, infants, and children, as well as promoting reproductive and adolescent health. Key services discussed include antenatal care, delivery care, postnatal care, immunizations, and child health services like growth monitoring and breastfeeding promotion. Reducing maternal, newborn and child mortality are top priorities in improving maternal and child health.
Mother and Baby Friendly Care: Mother friendly care during pregnancySaide OER Africa
Newborn Care was written for healthcare workers providing special care for newborn infants in level 2 hospitals. It covers: An essential tool in the initial and ongoing training and teaching of any healthcare worker – Miriam Adhikari, South African Journal of Child Health, Primary Newborn Care was written specifically for nurses, midwives and doctors who provide primary care for newborn infants in level 1 clinics and hospitals. It covers: Mother and Baby Friendly Care describes gentler, kinder, evidence-based ways of caring for women during pregnancy, labour and delivery. It also presents improved methods of providing infant care with an emphasis on kangaroo mother care and exclusive breastfeeding. It covers: mother-friendly care in pregnancy, a modern approach to normal labour, skin-to-skin care of infants, encouraging breastfeeding, a baby-friendly nursery.
Maternal and child health care servicesKailash Nagar
This document discusses maternal and child health care. It begins by introducing the topic and defining maternal and child health services according to the WHO. The objectives of maternal and child health programs are then outlined, including reducing mortality and morbidity for mothers and children. Key health problems, indicators, and recent trends are also summarized. The document goes on to provide details on antenatal, intranatal, and postnatal care services as well as child health services. Causes of maternal and under-five deaths in India are also presented.
Birth companions are women who have experienced labor and provide continuous one-on-one support to women in labor. They provide emotional support, information about labor progress, advice on coping techniques, comfort measures, and help advocate for the woman's wishes. The World Health Organization promotes labor companionship to improve maternal and infant health outcomes such as reduced labor time and stress, increased mother's feelings of control, and decreased medical interventions. India's Ministry of Health and Family Welfare now allows birth companions in public health facilities to help reduce maternal and infant mortality rates in line with the country's commitments under the UN's Sustainable Development Goals.
This document discusses measuring adherence within PMTCT programs. It begins by defining PMTCT as a care and treatment program for pregnant HIV-positive women and their exposed infants, noting activities occur across antenatal care, maternity wards, exposed infant clinics and HIV treatment centers. Routinely collected data only provides a general idea of adherence. New tools are needed to assess adherence at different points, like antenatal adherence and infant follow-up. These tools should reflect PMTCT as a long-term program, not just delivery. Strong systems are required to retain families in care, like functioning appointment systems and linkage between services.
Addressing the Gaps in PMTCT Care - A Dr Besser Presentationmothers2mothers
- The document discusses the mothers 2 mothers (m2m) program, which addresses gaps in prevention of mother-to-child transmission (PMTCT) of HIV care through community health workers called Mentor Mothers.
- Mentor Mothers provide counseling, medication adherence support, infant feeding guidance, and psychosocial support to HIV-positive mothers at health facilities and through community outreach.
- Evaluation studies have shown that the m2m program improves PMTCT outcomes like increased HIV testing, antiretroviral adherence, exclusive infant feeding, and psychosocial well-being of mothers.
Invited lecture by Dr Sujoy dasgupta in the Annual Conference of the "Academy of Clinical Embryologists" (ACE) held in October 2021 in "Hybrid mode" (Kolkata and Webinar)
CORE Group Fall Meeting 2010. WHO/UNICEF - Joint Statement Service Delivery & Program Implications, - Winnie Mwebesa & Stella Abwao, Save the Children.
- The document summarizes Lesotho's national approach to rolling out more efficacious PMTCT regimens. It outlines key demographic data on HIV prevalence in Lesotho.
- It describes Lesotho's PMTCT services, including the introduction of revised guidelines in 2007 and the scale-up of services through training and decentralization. Coverage of PMTCT services increased gradually from 16.5% to over 70%.
- Challenges included staff rotations, drug stockouts, and ensuring mothers properly use the Mother/Baby Pack to administer drugs if delivering at home. Recommendations focused on improving drug supply and encouraging facility deliveries.
The document outlines key strategies for improving maternal health in India, including using the Mother and Child Tracking System (MCTS) to ensure early registration of pregnancy and full antenatal care, detecting and line listing high-risk pregnancies like severely anemic mothers to ensure management, and equipping delivery points with facilities for basic and comprehensive obstetric and newborn care available 24/7. It also discusses reviews of maternal, perinatal and child deaths to understand gaps in health services and strategies to strengthen health infrastructure for maternal and newborn care.
Focused antenatal and emergecy obstetric carePave Medicine
Focused antenatal care (FANC) aims to provide goal-oriented and timely care during pregnancy through a limited number of focused visits. The document outlines the elements and purposes of FANC, including early detection and management of diseases, individual birth planning, and 4 scheduled antenatal visits. It also discusses emergency obstetric care (EmOC) and the need to address barriers to access such as delays in seeking, reaching, and receiving appropriate care. A study in northern Tanzania found low availability of basic EmOC units, high availability of comprehensive EmOC units, and that 36% of expected deliveries occurred in EmOC facilities, above the minimum threshold of 15%.
The document discusses trends in the US maternity care workforce that have led to an imbalance between providers trained to care for higher risk vs normal pregnancies. As the population of women grows and more pursue subspecialties, the number of OB/GYNs has remained flat while demand increases. Midwives (CNMs/CMs) are well-suited to care for the majority of low-moderate risk pregnancies but public funding has disproportionately supported physician residencies over midwifery education. As a result, the workforce structure does not match the needs of the patient population.
The document discusses trends in the US maternity care workforce that have led to an imbalance between providers trained to care for higher risk vs normal pregnancies. As the population of women grows and ages, demand for maternity care is increasing. However, the number of OB/GYNs entering the field has remained flat for decades, and many are retiring or subspecializing. CNMs/CMs have increased but receive far less public funding support for their education compared to physician residents. As a result, the workforce structure is "upside down" relative to patient risk levels and needs. Increased support for midwifery education is proposed to better align supply with demand.
General practitioner and obstetric service in rural Nepal A way forwardarbin joshi
This article reviews obstetric services provided by general practitioners in rural Nepal. A retrospective analysis was conducted of 123 deliveries at a rural hospital over one year. Caesarean sections accounted for 22.7% of deliveries, most on an emergency basis. The perinatal mortality rate was high at 95.23 per 1000 births. The article recommends strengthening general practitioner obstetric services in rural Nepal through improved training of support staff, emergency response capabilities, and training for skilled birth attendants to reduce complications requiring emergency care.
Adrienne D. Zertuche, MD, MPH
Georgia Maternal and Infant Health Research Group
Georgia Obstetrical and Gynecological Society
Presentation to the Georgia Senate Women's Adequate Healthcare Study Committee
www.gacommissiononwomen.org
This document provides an introduction and overview of Kuwait's newborn screening program. It describes the history and development of newborn screening in Kuwait since 1965. It outlines the key roles and responsibilities of various stakeholders in the newborn screening system, including newborn screening offices, laboratories, and metabolic clinics. The document also provides guidelines and recommendations for newborn screening best practices, including the screening timeline, specimen collection and handling, transportation, screening methodology, and follow-up for abnormal results.
This document provides an introduction and overview of Kuwait's newborn screening program. It describes the history and development of newborn screening in Kuwait since 1965. It outlines the key roles and responsibilities of various stakeholders in the newborn screening system, including newborn screening offices, laboratories, and metabolic clinics. The document also provides guidelines and recommendations for newborn screening best practices, including the screening timeline, specimen collection and handling, transportation, screening methodology, and follow-up for abnormal results.
This document discusses normal and abnormal modes of delivery. It begins by looking at worldwide and Lebanese cesarean section (C-section) rates, noting the WHO recommended rate of 15% and Lebanon's current rate of 44-45%. Several factors that may be contributing to high C-section rates are then examined, including financial incentives for doctors and hospitals, a lack of preparation for natural birth, and defensiveness due to malpractice fears. The short and long-term risks of C-sections for both mothers and babies are also reviewed. The document advocates for reducing unnecessary C-sections through measures such as implementing national guidelines and increasing access to natural birthing options and education.
The document summarizes a study analyzing communication during simulated obstetric medical crises. Researchers observed videos of simulations involving postpartum hemorrhage, maternal code, and preeclampsia scenarios. They found that healthcare providers frequently asked the same questions multiple times within a scenario and asked similar questions across different scenarios. Common questions included whether anesthesia had been called, if the patient had an epidural, and the estimated blood loss. The repetitive communication patterns identified opportunities to improve information sharing between providers.
The journey towards making elimination of mother to child transmission a real...HopkinsCFAR
The document discusses the journey towards eliminating mother-to-child transmission of HIV (eMTCT) and the contributions of clinical research. It outlines the burden of mother-to-child HIV transmission and the progress made through PMTCT interventions and clinical trials. Landmark trials in Uganda evaluated effective ARV regimens and extended infant prophylaxis, informing WHO guidelines. Ongoing research addresses challenges like adherence and retention through interventions like peer support groups. Further research on new drugs, testing approaches, and integration of services is still needed to achieve eMTCT goals.
- Video recording of this lecture in English language: https://youtu.be/RvdYsTzgQq8
- Video recording of this lecture in Arabic language: https://youtu.be/ECILGWtgZko
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Congestive Heart failure is caused by low cardiac output and high sympathetic discharge. Diuretics reduce preload, ACE inhibitors lower afterload, beta blockers reduce sympathetic activity, and digitalis has inotropic effects. Newer medications target vasodilation and myosin activation to improve heart efficiency while lowering energy requirements. Combination therapy, following an assessment of cardiac function and volume status, is the most effective strategy to heart failure care.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
The Children are very vulnerable to get affected with respiratory disease.
In our country, the respiratory Disease conditions are consider as major cause for mortality and Morbidity in Child.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
Nutritional deficiency Disorder are problems in india.
It is very important to learn about Indian child's nutritional parameters as well the Disease related to alteration in their Nutrition.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
3. 6
Are you able to practice as the midwife
you want to be at work?
If you could design your our birth space to work in,
what would it look like?
Who would be the focus?
How would you make that happen?
How would you feel working there, with no barriers to
being a midwife?
6. 9
A health care facility serving women through their life course
Rooted in the midwifery philosophy and model of care
In a home-like shared space
Ensuring basic emergency maternal and neonatal care for all births
Integrated within the health care system
Responsive to needs of its community
With the woman's experience at its heart and center
The physical place for the practice of midwifery
fits into global QoC framework
A MIDWIFERY CENTER IS:
10. 16
Problems with facility based birth in low and middle income
countries (LMIC) (Bohren, M. et al, 2014) MDG and SDGs.
◦Distance to facility
◦Cost of delivery
◦Low QoC and fear of discrimination
◦Birth too medicalized and
dehumanized
Where are the MC globally?
FACILITY BASED BIRTH IN LMIC
11. 17
How does a MBC function in LMIC?
What do they do?
Is the care provided safe?
Is the experiences of care high quality?
Is it a viable options in a low resource health care
system?
RESEARCH PROJECT QUESTIONS
12. Data was collected on:
• 25 MLBC in 10 low and middle income
countries surveyed, 21 used (3 no births yet)
• Total of 3,549 births including transfers
IRB H-35803 Boston University
PILOT DESCRIPTIVE ANALYSIS OF MIDWIFERY
CENTER MODEL
13. Haiti (5)
Uganda
Sierra Leone
Cambodia (2)
South Africa
Peru (2)
Trinidad
Ecuador
Mexico (6)
Midwifery centers in LMIC
what's the environment like there?
PARTICIPATING MIDWIFERY CENTERS IN LMIC
Bangladesh
14. 20
PILOT DESCRIPTIVE ANALYSIS OF MIDWIFERY
CENTER MODEL
Birth centers surveyed Maternal
mortality ratio
per 100,000
Infant
Mortality per
1,000
#of births in 2016 at
MLBC (total
w/transfers)
1 in Sierra Leone 1,360 87 40
5 (+1) in Haiti 359 52 2,151
1 in Uganda 343 38 293
1 (+2) in Bangladesh 176 31 7 (just opening)
2 in Cambodia 161 25 573
1 in South Africa 138 34 99
2 in Peru 68 13 104
1 in Trinidad 63 13 59
1 Ecuador 64 18 23
6 in Mexico 38 11 200
total: 25 MLBC surveyed, 21
used (3 no births yet, 1 w/7)
3,549
Current MMR and IMR from:
https://data.unicef.org/topic/maternal-
health/maternal-mortality/
measuring quality and MW model in low resource areas
15. 21
Safety: Sustainable: Satisfying:
1. BeMONC 1. Provider to volume ratio 1. Respectful care
2. Health outcome data 2. Management model 2. Quality of care
3. Transfers 3. Staff Education
INDICATORS
Safety
16. 22
neonatal
mortality
3.5*
per 1,000
live births
maternal
mortality
105*
per 100,000
live births
Neonatal mortality
Surveys recorded 10 infant deaths in previous year.
80% had been transferred and died at the transfer facility.
Maternal mortality
There were 3 maternal deaths (2 in Haiti, 1 in Uganda) in the previous year.
All involved patients who were transferred and died at the transfer facility.
*n = 3,549 survey births
Safety measures:
1. BEmONC signal functions-
2. Outcome data
3. Transfer Relationship-
70% of BEmONC criteria met
25 min average- wide range
PROVISION OF CARE- SAFETY
BEmONC
17. 23
transfers
"sometimes is goes fine,
sometimes it doesn't. Hospital
has no phone." "not a very
good site, very subpart care, but
patients can afford it"
"sometimes the hospital is full"
"They insist advanced payment,
poor treatment, disrespect and
abuse." "Not a lot of confidence
in QoC, although outcomes
have been ok so far."- Haiti
"Sometime difficult to speak
to OBs or new hospital
directors, leadership changes
and we have to start over.
We have been here for 21
years." - Peru
"In public hospital we can accompany the
women to the C/S room, not in private",
"When we transfer for FTP, the maternity
hospital is further, but relationship is
poor", "Depends on the docs present.
Some argue with MW, some request birth
info" "Continuity of care is interrupted,
personnel don’t listen to women or
clinical hx from MW. There is obstetrical
violence and disrespect for MW work.:"
- Mexico
"QoC at hospital no
the best- sometimes
they have no power,
sometimes the
surgeon is not
there."- Uganda
Much better (was
bad). They don’t
think the birth
center should do
primes. Not
supportive of
OOH" - Trinidad
18. Country (#of
MC)
# of
births
Admin
structure
IV
antibiotics
IV anti-
convulsants
IV
uterotonics
Removal of
retained
POC by
manual
vacuum
Assisted
Vaginal
delivery
(VAVD)
Manual
removal of
placenta
Resuscitation
of newborn
Haiti (5) n=2,151
NGO (4),
public (1) part yes yes part part yes yes
Mexico (6) n=200
NGO (3),
Priv (3) part part yes part part part yes
Cambodia (2) n=573 public (2) no no yes yes yes yes yes
Peru (2) n=104 priv (2) no part yes no no part yes
Ecuador n=23 priv yes yes yes yes no yes yes
Sierra L n=40 NGO yes yes yes yes no yes yes
South Africa n=99 priv no no yes no yes yes yes
Trinidad n=59 NGO no yes yes no no yes yes
Uganda n=293 NGO yes no yes no no yes yes
Key: No no
part part
yes yes
BeMONC criteria met in midwifery center by country
Summary Don’t forget about the country context
19. 25
BEmONC criteria: Haitian hospital/MC Ugandan MC S Africa SL
1. Parenteral antibiotics 80%/ 67% yes NO YES
2. Parenteral anticonvulsants 69.2%/ 71% NO NO yes
3. Parenteral uterotonics 87%/ 100% yes yes yes
4. Removal of retained POC by MVA 55.8%/ 54% NO NO yes
5. Assisted vaginal delivery (ie VAVD) 13.3%/ 54% NO yes NO
6. Manual removal of the placenta 52.5%/ 87% yes yes yes
7. Resuscitation of the newborn 50.8%/ 100% yes yes yes
Sustainable?
BEMONC: HOW DO THE MIDWIFERY CENTERS
COMPARE TO COUNTRY DATA?
20. 26
Sustainability measures:
1. Staff to volume ratio and transfer numbers
2. Management model
3. Staff education
Primary sources
of funding
37%- NGO
32% NGO/Patient fees
16% Patient Fees
10% Public
5%- Public/NGO
Education of staff n=71
26%= NMW
26%= nurse
19%= MW
17%= SBA
7%= MW aux
3%=EMT
2%=TBA
Average
50
births per
provider/year
PROVISION OF CARE- SUSTAINABLE
midwifery training
21. 27
Traditional birth attendant- informal, experience, no degree, no license
Skilled birth attendant- trained formally, no license or degree
Nurse- college degree, OB experience
Auxiliary Midwife- min 3 yrs basic training
Midwife- min 3 yrs basic training and licensed
Nurse Midwife- degree and licensed
additionally found: OBs, EMT
EDUCATION OF STAFF
experience of care
22. 28
100% of Newborn Care measures met by MC
84% of Quality of care measures met by MC
88% of Respectful maternity care measures met by MC
Experience of care/Quality measures:
1.Respectful maternity care (RMC) (based on Landscape)
2.Quality of care (QoC)
EXPERIENCE OF CARE- SATISFYING
RMC
24. Country
(# of MC)
Staff trained
at continual
risk
assessment
during
labor?
Staff have
regular
emergency
drills?
Partograph
used with
every
birth?
Process for
tracking
admission
time for
every
women?
Process
for
tracking
birth time
for each
woman?
Process for
tracking
discharge/
transfer time
for every
woman?
Transport
to
CEmONC
arranged
Haiti (5) yes part part part yes yes yes
Mexico (6) yes part part yes yes yes yes
Cambodia (2) yes part part yes yes yes yes
Peru (2) yes yes part yes yes yes yes
Ecuador yes yes no yes yes yes yes
Sierra L yes no no no yes no no
South Africa yes no yes yes yes yes yes
Trinidad yes yes yes yes yes yes yes
Uganda yes yes yes yes yes yes yes
Key: No no
part part
yes yes
Quality of care criteria met in midwifery center by country
Quality criteria specifically for midwifery
centers in low resources areas.
Summary Looking forward- How can they strengthen a system?
25. 32
Health care workforce shortage:
◦ Utilizing appropriate provider for appropriate level of care needed.
Health care facility shortage, and cost effective:
◦ Utilizing appropriate level of facility for level of care needed
Bridging home and hospital:
◦ Providing optimal care experience
◦ Improving access and quality with an integrated health care system
Bridging professions:
◦ OB-Pediatrician-Midwife-Auxiliary-community workers- meeting women's and system's needs with
collaboration
MIDWIFERY LED BIRTH CENTERS STRENGTHEN:
future research
26. 34
Contributing Midwifery Birth Centers
Sierre Leone: Taiama Birth Center (n=40)
South Africa: Midwives Exclusive (n=99)
Ghana: Sampa Birth Center (to open)
Uganda: Shanti Uganda (n=293)
Trinidad: Mama Toto (n=59)
Peru: Pakarii Case de Nacimiento (n=104)
Ecuador: Dulce Espera (n=23)
Mexico: Casa Colobri, Luna Maya DF, Luna Maya Chiapas (n=200)
Haiti: Northwest Haiti Christian Mission, Carmelle Voltaire Women's HC, Sante Place Cazeau ("Smile Clinic"),
Maison de Naissance, Olive Tree projects, Carrie Wortham BC, (n=2,151)
Bangladesh: (Hope): Pockhali BC, Khunia Palong BC, Islampur BC, Bharuakhali BC (just opening) (n=7)
Cambodia: Thmar Krae Community BC, Sandan Community BC (Samaritan purse) (n=573)
28. RMC QoC
Country
(#of MC)
# of births at
MBC in 2016
(total
w/transfers)
BeMONC
criteria
met
RMC
criteria
met
QoC
criteria
met
Maternal
deaths
Newborn
deaths
Transfers
# IP, PP,
NB (%)
Haiti (5) 1,833 (2,151) 89% 86% 83% 2(tx site) 7 (tx site) 318 (15%)
Mexico (6) 157 (200) 69% 97% 86% 0 1 43 (22%)
Cambodia (2) 428 (573) 71% 84% 79% 0 2 (MC) 145 (25%)
Peru (2) 84 (104) 43% 93% 93% 0 0 20 (19%)
Ecuador 20 (23) 86% 95% 86% 0 0 3 (13%)
Sierra L 40 (40) 71% 67% 29% 0 0 0
South Africa 93 (99) 57% 86% 86% 0 0 6 (6%)
Trinidad 48 (59) 57% 95% 100% 0 0 11 (19%)
Uganda 275 (293) 57% 90% 100% 1 (tx site) 0 18 (6%)
2,978 (3,542) 70% 88%% 84% 3 10 564 (16%)
Summary of study data by country
BeMONC Haiti Mexico Cambodia Peru Ecuador Sierra L South Africa Trinidad Uganda
29. Country
(#of MC)
# of births at
MBC in 2016
(total
w/transfers)
Transfers #
IP, PP, NB
(%)
Transfer
time # FTE
#births/
provider
/year
Maternal
deaths
Newborn
deaths
Haiti (5) 1,833 (2,151) 318 (15%) 50 22 98 2(tx site) 7 (tx site)
Mexico (6) 157 (200) 43 (22%) 15 13 15 0 1
Cambodia (2) 428 (573) 145 (25%) 60 16 36 0 2 (MC)
Peru (2) 84 (104) 20 (19%) 15 3 35 0 0
Ecuador 20 (23) 3 (13%) 10 2 12 0 0
Sierra L 40 (40) 0 45 2 20 0 0
South Africa 93 (99) 6 (6%) 4 5 20 0 0
Trinidad 48 (59) 11 (19%) 5 2 30 0 0
Uganda 275 (293) 18 (6%) 10 5 56 1 (tx site) 0
2,978 (3,542) 564 (16%) 24 71 50 3 10
30
Median
Outcome data by country
30. # of MBC
surveyed Country
2015
MMR*/
IMR*
# of births in 2016
at MBC
(total w/ transfers)
Transfers- IP,
PP, NB (%
transferred) BeMONC RMC QoC #FTE
Maternal
deaths
Early Infant
deaths
5 Haiti 359/52 1,833 (2,151) 318 (15%) 89% 86% 83% 22 2 (tx site) 7(tx site)
21 TOTALs 2,985 (3,549) 564 (16%) 70% 88% 84% 71 3 10
Haiti
SummaryCharges: $6, $20, $60, $60,$100 SBA, MWaux, nMW, 10-60min
31. # of MBC
surveyed Country
2015
MMR*/
IMR*
# of births in 2016
at MBC
(total w/ transfers)
Transfers- IP,
PP, NB (%
transferred) BeMONC RMC QoC #FTE
Maternal
deaths
Early Infant
deaths
6 Mexico 38/11 157 (200) 43 (22%) 69% 97% 86% 13 0 1(tx site)
21 TOTALs 2,985 (3,549) 564 (16%) 70% 88% 84% 71 3 10
Mexico
SummaryCharges: $200, 350, 650, 650, 950 MW, aux MW, nMW, SBA, 15min
32. # of MBC
surveyed Country
2015
MMR*/
IMR*
# of births in 2016
at MBC
(total w/ transfers)
Transfers- IP,
PP, NB (%
transferred) BeMONC RMC QoC #FTE
Maternal
deaths
Early
Infant
deaths
2 Cambodia 161/25 428 (573) 145 (25%) 71% 84% 79% 16 0 2
21 TOTALs 2,985 (3,549) 564 (16%) 70% 88% 84% 71 3 10
Cambodia
Summary$12 USD, SBA, nsg, MW, nurseMW, 1hr
33. # of MBC
surveyed Country
2015
MMR*/
IMR*
# of births in 2016
at MBC
(total w/ transfers)
Transfers- IP,
PP, NB (%
transferred) BeMONC RMC QoC #FTE
Maternal
deaths
Early Infant
deaths
2 Peru 68/13 84 (104) 20 (19%) 43% 93% 93% 3 0 0
21 TOTALs 2,985 (3,549) 564 (16%) 70% 88% 84% 71 3 10
Peru
SummaryCharges: $900USD- $1,070 MW, Obs, 5min,
34. # of MBC
surveyed Country
2015
MMR*/
IMR*
# of births in
2016 at MBC
(total w/
transfers)
Transfers- IP,
PP, NB (%
transferred) BeMONC RMC QoC #FTE
Maternal
deaths
Early
Infant
deaths
1 Ecuador 64/18 23 3 (13%) 86% 95% 86% 2 0 0
21 TOTALs 2,985 (3,549) 564 (16%) 70% 88% 84% 71 3 10
Ecuador
Summary$1,400 USD MW, MW aux, 10-15 min to hosp
35. # of MBC
surveyed Country
2015
MMR*/
IMR*
# of births in 2016
at MBC
(total w/
transfers)
Transfers- IP,
PP, NB (%
transferred) BeMONC RMC QoC #FTE
Maternal
deaths
Early
Infant
deaths
1
Sierra
Leone 1360/87 40 0 71% 67% 29% 2 0 0
21 TOTALs 2,985 (3,549) 564 (16%) 70% 88% 84% 71 3 10
Sierra Leone
Summary$10USD TBA, nsg, nMW, 45min,
36. # of MBC
surveyed Country
2015
MMR*/
IMR*
# of births in 2016 at
MBC
(total w/ transfers)
Transfers- IP,
PP, NB (%
transferred) BeMONC RMC QoC #FTE
Maternal
deaths
Early Infant
deaths
1 South Africa 138/34 99 6 (6%) 57% 86% 86% 5 0 0
21 TOTALs 2,985 (3,549) 564 (16%) 70% 88% 84% 71 3 10
South Africa
Summary$1080 USD 4min,
37. # of MBC
surveyed Country
2015
MMR*/
IMR*
# of births in 2016
at MBC
(total w/ transfers)
Transfers- IP,
PP, NB (%
transferred) BeMONC RMC QoC #FTE
Maternal
deaths
Early Infant
deaths
1 Trinidad 63/13 59 11 (19%) 57% 95% 100% 2 0 0
21 TOTALs 2,985 (3,549) 564 (16%) 70% 88% 84% 71 3 10
Trinidad
Summary$2,300USD auxMW, MW, nMW, 5min
38. # of MBC
surveyed Country
2015
MMR*/
IMR*
# of births in 2016
at MBC
(total w/ transfers)
Transfers- IP,
PP, NB (%
transferred) BeMONC RMC QoC #FTE
Maternal
deaths
Early NB
deaths
1 Uganda 343/38 293 18 (6%) 57% 90% 100% 5 1 (tx site) 0
21 TOTALs 2,985 (3,549) 564 (16%) 70% 88% 84% 71 3 10
Uganda
Summary$2USD, MW, auxMW, TBA, 10min
39. # of MBC
surveyed Country
2015
MMR*/
IMR*
# of births in
2016 at MBC
(total w/
transfers)
Transfers- IP, PP,
NB (%
transferred) BeMONC RMC QoC #FTE
Maternal
deaths
Early Infant
deaths
1 Bangladesh 176/31 7 0 100% 90% 100% 1 0 0
21 TOTALs 2,985 (3,549) 564 (16%) 70% 88% 84% 71 3 10
Bangladesh (not included in summary data)
Summary$12 USD MW, 1 hr
40. 48
References
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Bowser, D., Hill, K., (2010) Exploring evidence for disrespect and abuse in facility-based childbirth. Report of a landscape analysis. USAID-TRAction Project. Harvard
School of Public Health. University research Co., LLC. Available from: https://www.ghdonline.org/uploads/Respectful_Care_at_Birth_9-20-101_Final1.pdf
Feldstein, A., Glasgow, R. (2008) A practical, robust implementation and sustainability model (PRISM) for integrating research findings into practice. The joint commission
journal on quality and patient safety. April 2008; 34,4.
Garfield, R., Berrymen, E. (2012). Nursing and nursing education in Haiti.[Internet] Nursing Outlook 60(2012) 16-20. Available from:
http://www.nursingoutlook.org/article/S0029-6554(11)00093-5/pdf
Jerome, J., Ivers, LC.(2011) Community health workers in health systems strengthening: a qualitative evaluation from rural Haiti. [Internet] AIDS. 2010 Jan; 24 (suppl 1);
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Koski-Karell, V., et al. (2016). Haiti's progress in achieving its 10-year plan to eliminate cholera: hidden sickness cannot be cured. Risk management and healthcare
polity. 2016:9; 87-100. Available from: https://www.dovepress.com/haiti39s-progress-in-achieving-its-10-year-plan-to-eliminate-cholera-h-peer-reviewed-fulltext-article-
RMHP
Le Nouvelliste. 50% des sages-femmes formees en Haiti exercent leur profession a l’etranger. [Internet]. Haiti. 2017-08-09. [cited Feb 7, 2018]. Available from:
http://www.lenouvelliste.com/article/174626/50-des-sages-femmes-formees-en-haiti-exercent-leur-profession-a-letranger
Martineau.(2016) Quel avenir pour la profession d’infirmiere en Haiti? [Internet]. [cited Feb 7, 2018]. Availble from: http://www.lescacosnoirs.com/quel-avenir-pour-la-
profession-dinfirmiere-en-haiti/
Moloney, A. (2013). Haiti’s new generation of doctors hope to revive ailing health sector, rebuild country. [Internet]. England, Wales. [cited Feb 7, 2018]. Availble from:
https://www.pih.org/media-coverage/reuters-haitis-new-generation-of-doctors-hope-to-revive-ailing-health-secto
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References (cont)
Monroe College. Health care in Haiti. [cited Feb 7, 2018]. Available from: https://www.monroecollege.edu/uploadedFiles/_Site_Assets/PDF/Health_Care_in_Haiti.pdf
Mullan, F. (2005). The metrics of physician brain drain. New England Journal of Medicine 2005;353,1810-8.
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universities/
TB/HaitiLibre. Häiti-Formation: Moins de 4% de étudiants es soins infirmiers, ont réussi examen d’État. [Internet] 13/03/2017. Haiti Libre.[cited Feb 7, 2018] Available from:
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http://www.who.int/workforcealliance/knowledge/publications/alliance/Global_CHW_web.pdf
UK: percent of women who began prenatal care at a birth center developed a complication that precluded out of hospital birth.
Almost 90 percent of those complications occurred during the third trimester; (postterm pregnancy most common)
• 12 percent of the women admitted to birth centers in labor were transferred to hospitals before giving birth;
4 percent of the mothers and 4 percent of the newborns were transferred to hospitals because of postpartum or newborn complications.
• Only 2.4 percent of all transfers were emergencies. The most common reasons for intrapartum transfers were failure to progress (43 percent), meconium stained amniotic fluid (11 percent), and nonreassuring fetal heart rate (8 percent).
decades of research demonstrating the strength of the model in HIC
focus meetings- Haiti, Mexico, researchers at ICM, globally with network
how are MC in low resource areas (without healthy health care system to transfer to?)
SDGs- QoC, Human rights approach, RMC
Lancet
MDG approaches to MM- SBA, facility based birth
4 not included:
1 Ghana (no births yet)
1 Haiti (no births yet)
2 Bangladesh (no birth yet)
Picking what data to measure- how to we check to see if they are safe….AND offer midwifery model of care??
self reported, retrospective, unvalidated
tx time from 5 min to 60
read/discuss circles, 70%
WIDE range of births/year (12-98 births/year/provider)
****outline rmc- think about how to present and mw model****
measures chosen b/c MC are different than hosp….
make fewer words
100%.... than pick a few big words
MC offer a potential for improved quality with improved outcomes, safety and high level of satisfaction for women.
What else do MC provide?
consider bar graph
Transfer rates in labor in Netherlands- 22% (KNOV)
(http://www.europeanmidwives.com/upload/filemanager/content-galleries/members-map/knov.pdf)
Netherlands- max transfer time- 27 min
Births per provider per year:
mean- 50
median- 30
UK Birthrate Plus national benchmark- 29.5 birth/midwife- currently doing 33 births/midwife
midwifery services in England National Audit office
(https://www.nao.org.uk/wp-content/uploads/2013/11/10259-001-Maternity-Services-Book-1.pdf)
$6, $20, $60, $60,$100 Most with bottled water, solar/generator, SBA, MWaux, nMW, 10-60min
Burdened by poverty, communities isolated by geography, scarce health professionals, scare hospitals
$200, $350,$650, $650, $950 USD, MW, aux MW, nMW, SBA, 15min
Not integrated into system yet- but in the process, humanizing birth, high levels of obstetrical violence and C/S
$12 USD, river, solar panel, SBA, nsg, MW, nurseMW, 1hr
National strategy to train MW and adapt local health centers to birthing homes with 2-3 mw each "MW provide the backbone to the health workforce for mothers and children
Samaritan Purse
-Sandan Birth Center
-Thmar Krae Birth Center
, hosptial- 1 hour drive, charge
$900USD- $1,070, MW, Obs, 5min,
Pakarii and Ruruchay Case De Nacimiento-
$1,400 USD, MW, MW aux, placenta encapsulation, 10-15 min to hosp,
intercultural model of care, humanized birth
Dulce Espera
$10USD, TBA, nsg, nMW, 45min,
no kitchen (fire pit outside), intermittent power, well, Registration process,
work collaboratively with indigenous herbalist, incorporation of traditional women's society- 'solay'.
Intense poverty, armed conflict, recent ebola epidemic, 90% FGM, #1 for high MM and NM
Taiama birth center
Midwives Exclusive BC- $1080 USD, public water and elec, generator, 4min,
MamaToto- $2,300USD, public water and elec, 5 min, auxMW, MW, nMW
Shanti Uganda-
$2USD, rain water catchment and solar panels, MW, auxMW, TBA, 10min, (often no doc there), 1 MM at tx
Began as an empowerment project- skills for women, expanded to women's health
Have employment workshops, teen program, doula training, nutrition, yoga and wellness classes
$12 USD, well, public power, MW, 1 hr to transfer
Hope Foundation
-Bharuakhali BC
-Islampur BC
-Khunia Palong BC
-Pockhali BC