從全球視角看助產(chǎn)學(xué)的發(fā)展課件

Theglobalperspectiveofmidwiferydevelopment

從全球視角看助產(chǎn)學(xué)的開(kāi)展KyllikeChristensson,RN,RM,PhDProfessorinReproductiveHealth2023-08-12KyllikeChristenssonIndia–late17thcentury印度，17世紀(jì)末Inthehonourofabelovedwifewhodiedduringchildbirth深愛(ài)的妻子不幸在分娩中死去，建立了泰姬陵TheDevelopmentoftheSwedishmidwiferysystem

瑞典助產(chǎn)學(xué)的開(kāi)展1685QueenUlrikaEleonoradecidedtosetupaMidwiferySchool

1685年UlrikaEleonora女王決定設(shè)立助產(chǎn)士學(xué)校1697Abookaboutobstetrics,DenSwenskaw?l-?fwadeJord-GummanbyJohanvonHoorn

1697年，JohanvonHoorn完成了一本關(guān)于產(chǎn)科學(xué)的著作——?瑞典專業(yè)助產(chǎn)士?

12/08/2023KyllikeChristensson3JohanvonHoorn

Firsttextbookaboutmidwifery

第一本關(guān)于助產(chǎn)學(xué)的教科書(shū)

1697DenSwenskaw?l?fwadeJord-Gumman

?瑞典專業(yè)助產(chǎn)士?TheDevelopmentoftheSwedishmidwiferysystem,cont.

瑞典助產(chǎn)學(xué)的開(kāi)展〔續(xù)〕1711CodeofpracticeandethicsformidwivesinStockholm

1711年，在斯德哥爾摩發(fā)布了助產(chǎn)士行為準(zhǔn)那么及道德標(biāo)準(zhǔn)

1712Thefirst18midwivesregistratedbyCollegiumMedicum

1712年，醫(yī)學(xué)院首次錄取了18位助產(chǎn)士學(xué)生1751Audit(CollegiumMedicum)&Nationalstatisticsofnumberofbirthsanddeathsandthecauseofdeath

1751年，對(duì)出生人數(shù)、死亡人數(shù)及死因進(jìn)行了全國(guó)性統(tǒng)計(jì)2023-08-12KyllikeChristensson2023-08-12KyllikeChristensson

100%50%20%%deliveriesassistedbyamidwife由助產(chǎn)士協(xié)助的分娩比例Midwivestrainedwith“l(fā)ifesavingskills〞接受過(guò)專業(yè)訓(xùn)練的助產(chǎn)士MMR產(chǎn)婦死亡率18901850100200300400500Therelationshipbetweenmaternalmortalityandthe

assistanceofprofessionallytrainedmidwivesatbirth,Sweden1850–90

產(chǎn)婦死亡率與專業(yè)助產(chǎn)士協(xié)助的分娩的關(guān)系，瑞典1850–90Deathper100000livebirths每10萬(wàn)活產(chǎn)的死亡數(shù)2023-08-12KyllikeChristenssonTheMidwife’slogisticsinacommonruralarea

助產(chǎn)士在農(nóng)村地區(qū)的出行方式2023-08-12KyllikeChristenssonPrevalenceofhomedeliveriesinSweden

瑞典的家庭分娩率1890 97%1930 76%1940 35%1950 5.9%Today今 0.1%HomedeliveriesinLowincomecountries=5–60%

在低收入國(guó)家，家庭分娩率可達(dá)5%至60%2023-08-12KyllikeChristenssonTowardsaHealthyMotherandInfant

為了健康的母親和嬰兒

Asimportant–thepoliticalwill

重要的政治意愿Recruitment

人才招聘

Educationalsystem

教育系統(tǒng)

Legislation

立法

Salary

薪酬

Safety

平安Aprofessionaltrainedmidwifewiththerighttouseobstetricalinstrumentssince1829

自1829年起，受過(guò)專業(yè)訓(xùn)練的助產(chǎn)士可以使用產(chǎn)科器具2023-08-12KyllikeChristenssonActionstobetakentowardsaHealthyMother

為了“健康母親〞所采取的行動(dòng)1987TheSafeMotherhoodinitiativeTBA/Daitraining

1987年，“平安母親〞行動(dòng)建議1997Lessonlearnt(SiriLanka)Skilledattendanceatbirth

1997年，斯里蘭卡的案例專業(yè)助產(chǎn)士協(xié)助分娩2023-08-12KyllikeChristenssonOnly60%ofbirthsareassistedbyaskilledattendant

只有60%的分娩

是由專業(yè)助產(chǎn)士協(xié)助進(jìn)行的700.000skilledattendants/healthprofessionalswithmidwiferyskillsareneeded

仍然需要70萬(wàn)

受訓(xùn)練的、具有助產(chǎn)技術(shù)的專業(yè)人士TowardsaHealthyMotherandinfant

為了更健康的母親和嬰兒

Eachyearmorethan250000womendieduetocomplicationsduringpregnancyand/orchildbirth

每年有超過(guò)25萬(wàn)女性死于孕期及分娩過(guò)程中的并發(fā)癥

Maternalmortalityrate(death/100000livebirths)每10萬(wàn)活產(chǎn)的死亡數(shù)：Sweden瑞典 4USA 美國(guó) 17China中國(guó) 30India 印度 190Afghanistan阿富汗 400SierraLeone塞拉利昂 1100“Womenarenotdyingbecauseofdiseaseswecannottreat.

婦女并非死于那些無(wú)法治療的疾病，Theyaredyingbecausesocietieshaveyettomakethedecisionthattheirlivesareworthsaving〞

而是死于這個(gè)社會(huì)尚未下決心去成認(rèn)她們生命的價(jià)值。

Prof.M.F.Fathalla

AssietUniversity,Egypt2023-08-12KyllikeChristenssonMaternalmortalityandmorbidity

產(chǎn)婦死亡率及發(fā)病率

low-incomecountriesvs.Sweden

低收入國(guó)家vs.瑞典Haemorrhage大出血Sepsis敗血癥Eclampsia子癇

Obstructedlabour難產(chǎn)Unsafeabortion不平安的終止妊娠Indirectcauses(e.g.malaria)間接原因〔如瘧疾〕Cardiovascular心血管疾病Stroke腦卒中Haemorrhage大出血Heartdiseases心臟病Sepsis敗血癥Mentaldistress精神損害2023-08-12KyllikeChristensson

TheSwedishcontext-TheoverallaimofMidwifery/MaternityandNewbornHealthCare

瑞典的情況——助產(chǎn)學(xué)及母嬰健康的總體目標(biāo)Ahealthymother

健康的母親Ahealthyinfant

健康的嬰兒Apleasantexperience

愉快的體驗(yàn)withasfewinterventionaspossible

盡可能少的干預(yù)Presentdistributionofvarioustypesofinterventions

當(dāng)前多種類型干預(yù)的分布

Ofunknowneffect,butingoodqualityresearchprogramDomoreharmthangood傷害多于獲益Domoregoodthanharm獲益多余傷害Ofunknowneffect–notinresearchsettingorinpoorqualityresearch效果未知——來(lái)源于非研究環(huán)境或不佳的研究環(huán)境效果未知——來(lái)源于良好的研究工程Midwiferyresearchasatooltoevaluatecurrentpracticesandimprovematernityandnew-borncare

助產(chǎn)學(xué)研究是評(píng)估當(dāng)前實(shí)踐的工具，可以改善婦幼衛(wèi)生效勞質(zhì)量Up-rightposition豎位分娩Alloweating允許進(jìn)食Non-pharmacologicalpain-relif不用藥物的疼痛緩解Allowingbirthcompanion允許分娩陪伴2023-08-12KyllikeChristensson2023-08-12KyllikeChristenssonFromhomedeliverytowardsinstitutionaldeliveries

-riskstobeconsidered

從在家分娩到醫(yī)院分娩——同樣存在諸多風(fēng)險(xiǎn) Toomanyunnecessaryinterventions

有許多非必要的干預(yù)措施 oxytocinargumentation關(guān)于催產(chǎn)素的爭(zhēng)論 episiotomy外陰側(cè)切術(shù) caesareansection剖腹產(chǎn) separationofthemotherandinfant婦嬰別離 formula嬰兒配方食品Lancet,March20054millionneonataldeaths/year,4millionstillbirths/year

每年四百萬(wàn)新生兒死亡、四百萬(wàn)死胎

Infections36%,Pretermbirths27%andAsphyxia23%

36%感染，27%早產(chǎn)，23%窒息

Interventionswithprovenefficacy(universal)couldavert41-72%ofneonataldeathsworldwide

有效的干預(yù)措施可以減少世界41%-72%的新生兒死亡2023-08-12KyllikeChristenssonThenewborninfants’needs新生兒的需求

Skin-to-skincarevs.mother/infantseparation緊密關(guān)心vs.母嬰別離Temperature

體溫Blood-glucosesandMetabolicAdaptation

血葡萄糖和新陳代謝適應(yīng)Cryingbehaviour

哭泣行為T(mén)heSwedishMidwivesScopeofactivities–ReproductiveHealth(atwomen’sallstagesoflife)瑞士助產(chǎn)士活動(dòng)范圍-女性生命全程的生殖健康A(chǔ)ntenatal-Intrapartum-PostpartumCare

產(chǎn)前-分娩時(shí)-產(chǎn)后護(hù)理sexualitycounselling性咨詢contraceptivecounselling避孕咨詢pre-conceptualcounselling孕前咨詢STI-prevention性病預(yù)防PAPsmear子宮頸抹片檢查

Menopausalcounselling更年期咨詢

New-borninfants-11-12yrs-Adolescens-ChildbearingWomen-Menopause-Elderlywomen

新生兒-11-12歲–青春期–孕婦-

更年期–老年婦女Sexualityeducation性教育12/08/2023KyllikeChristensson21GynaecologicalCare

婦科護(hù)理ReproductiveHealthincludesSexualHealthandRights

生殖健康包括性健康和性權(quán)利

inSweden85%ofcontraceptivesprescriptionsandsexualcounsellingisgivenbythemidwives

在瑞典，85%的避孕藥處方和性咨詢效勞是由助產(chǎn)士提供的Compulsorysexualityeducationinschoolssince1955

自1955年起在學(xué)校強(qiáng)制開(kāi)展性教育Youthcentres青年中心/以年輕人為中心AbortionLaw1975?終止妊娠法?12/08/2023KyllikeChristensson22Abortioncare–current“taskshifting〞projects–fromthephysician/obstetriciantothemidwife

終止妊娠的實(shí)施者正從內(nèi)科醫(yī)生、產(chǎn)科醫(yī)生轉(zhuǎn)變?yōu)橹a(chǎn)士Firsttrimestermedicalabortion–medical

頭三個(gè)月的醫(yī)學(xué)終止妊娠–藥物Secondtrimesterabortion–medical第二個(gè)三個(gè)月的終止妊娠–藥物2023-08-12KyllikeChristenssonGlobalPerspective全球視角Midwivesrecognizedasprimarycareprovidersfornormalchildbirth助產(chǎn)士已是主要分娩效勞的提供者

Practicebymidwives助產(chǎn)士的工作Higherpsychologicalsupporttowomen更多的心理支持Lessmedicalinterventions更少的醫(yī)療干預(yù)Midwiferysitutationacrosscountries幾個(gè)世紀(jì)以來(lái)的助產(chǎn)學(xué)情況Thecompetence,title,scopeofpracticeofmidwivesdiffers

助產(chǎn)士的能力、名字、工作內(nèi)容不盡相同Recognizedasautonomousinmanycountries在許多國(guó)家被是獨(dú)立的學(xué)科3pathwaystomidwifery成為助產(chǎn)士的3條途徑3yearsdirectentryeducation3年直接入職教育18monthseducationpostnursing18個(gè)月的后護(hù)士教育Integratednursingandmidwifery(notrecognizedbyICM)

護(hù)士和助產(chǎn)士合一〔并不被ICM認(rèn)可〕BharatiSharma24InternationalconfederationofMidwives–

ICMmeetingtheglobaldemands

國(guó)際助產(chǎn)士聯(lián)合會(huì)–面對(duì)全球需求

ThePhilosophyandModelofMidwiferyCare

助產(chǎn)學(xué)護(hù)理的哲學(xué)和模范InternationalDefinitionoftheMidwife

助產(chǎn)士的國(guó)際定義Internationalcodeofethicsformidwives

助產(chǎn)士的國(guó)際道德標(biāo)準(zhǔn)EssentialCompetenciesforBasicMidwiferyPractice根底助產(chǎn)學(xué)的必要能力GlobalStandardsforMidwiferyRegulation

全球助產(chǎn)學(xué)標(biāo)準(zhǔn)標(biāo)準(zhǔn)GlobalStandardsforMidwiferyEducation

全球助產(chǎn)學(xué)教育標(biāo)準(zhǔn)2023-08-12KyllikeChritenssonScalingupthecapacitiesofmidwivesrequiresacombinationof

增強(qiáng)助產(chǎn)士的能力，需要結(jié)合以下幾方面Politicaladvo