從全球視角看助產(chǎn)學的發(fā)展課件

Theglobalperspectiveofmidwiferydevelopment

從全球視角看助產(chǎn)學的發(fā)展KyllikeChristensson,RN,RM,PhDProfessorinReproductiveHealth2023-02-06KyllikeChristenssonIndia–late17thcentury印度，17世紀末Inthehonourofabelovedwifewhodiedduringchildbirth深愛的妻子不幸在分娩中死去，建立了泰姬陵TheDevelopmentoftheSwedishmidwiferysystem

瑞典助產(chǎn)學的發(fā)展1685QueenUlrikaEleonoradecidedtosetupaMidwiferySchool

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

1697年，JohanvonHoorn完成了一本關于產(chǎn)科學的著作——《瑞典專業(yè)助產(chǎn)士》

06/02/2023KyllikeChristensson3TheDevelopmentoftheSwedishmidwiferysystem,cont.

瑞典助產(chǎn)學的發(fā)展（續(xù)）1711CodeofpracticeandethicsformidwivesinStockholm

1711年，在斯德哥爾摩發(fā)布了助產(chǎn)士行為準則及道德規(guī)范

1712Thefirst18midwivesregistratedbyCollegiumMedicum

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

1751年，對出生人數(shù)、死亡人數(shù)及死因進行了全國性統(tǒng)計2023-02-06KyllikeChristensson2023-02-06KyllikeChristensson

100%50%20%%deliveriesassistedbyamidwife由助產(chǎn)士協(xié)助的分娩比例Midwivestrainedwith“l(fā)ifesavingskills”接受過專業(yè)訓練的助產(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)助的分娩的關系，瑞典1850–90Deathper100000livebirths每10萬活產(chǎn)的死亡數(shù)2023-02-06KyllikeChristenssonTheMidwife’slogisticsinacommonruralarea

助產(chǎn)士在農(nóng)村地區(qū)的出行方式2023-02-06KyllikeChristenssonTowardsaHealthyMotherandInfant

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

安全Aprofessionaltrainedmidwifewiththerighttouseobstetricalinstrumentssince1829

自1829年起，受過專業(yè)訓練的助產(chǎn)士可以使用產(chǎn)科器具2023-02-06KyllikeChristenssonActionstobetakentowardsaHealthyMother

為了“健康母親”所采取的行動1987TheSafeMotherhoodinitiativeTBA/Daitraining

1987年，“安全母親”行動倡議1997Lessonlearnt(SiriLanka)Skilledattendanceatbirth

1997年，斯里蘭卡的案例專業(yè)助產(chǎn)士協(xié)助分娩2023-02-06KyllikeChristenssonOnly60%ofbirthsareassistedbyaskilledattendant

只有60%的分娩

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

仍然需要70萬

受訓練的、具有助產(chǎn)技術的專業(yè)人士TowardsaHealthyMotherandinfant

為了更健康的母親和嬰兒

“Womenarenotdyingbecauseofdiseaseswecannottreat.

婦女并非死于那些無法治療的疾病，Theyaredyingbecausesocietieshaveyettomakethedecisionthattheirlivesareworthsaving”

而是死于這個社會尚未下決心去承認她們生命的價值。

Prof.M.F.Fathalla

AssietUniversity,Egypt2023-02-06KyllikeChristenssonMaternalmortalityandmorbidity

產(chǎn)婦死亡率及發(fā)病率

low-incomecountriesvs.Sweden

低收入國家vs.瑞典Haemorrhage大出血Sepsis敗血癥Eclampsia子癇

Obstructedlabour難產(chǎn)Unsafeabortion

不安全的終止妊娠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2023-02-06KyllikeChristensson

TheSwedishcontext-TheoverallaimofMidwifery/MaternityandNewbornHealthCare

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

健康的母親Ahealthyinfant

健康的嬰兒Apleasantexperience

愉快的體驗withasfewinterventionaspossible

盡可能少的干預Midwiferyresearchasatooltoevaluatecurrentpracticesandimprovematernityandnew-borncare

助產(chǎn)學研究是評估當前實踐的工具，可以改善婦幼衛(wèi)生服務質(zhì)量Up-rightposition豎位分娩Alloweating允許進食Non-pharmacologicalpain-relif不用藥物的疼痛緩解Allowingbirthcompanion允許分娩陪伴2023-02-06KyllikeChristensson2023-02-06KyllikeChristenssonFromhomedeliverytowardsinstitutionaldeliveries

-riskstobeconsidered

從在家分娩到醫(yī)院分娩——同樣存在諸多風險

Toomanyunnecessaryinterventions

有許多非必要的干預措施 oxytocinargumentation關于催產(chǎn)素的爭論 episiotomy外陰側(cè)切術 caesareansection剖腹產(chǎn) separationofthemotherandinfant婦嬰分離 formula嬰兒配方食品Lancet,March20054millionneonataldeaths/year,4millionstillbirths/year

每年四百萬新生兒死亡、四百萬死胎

Infections36%,Pretermbirths27%andAsphyxia23%

36%感染，27%早產(chǎn)，23%窒息

Interventionswithprovenefficacy(universal)couldavert41-72%ofneonataldeathsworldwide

有效的干預措施可以減少世界41%-72%的新生兒死亡TheSwedishMidwivesScopeofactivities–ReproductiveHealth(atwomen’sallstagesoflife)瑞士助產(chǎn)士活動范圍-女性生命全程的生殖健康Antenatal-Intrapartum-PostpartumCare

產(chǎn)前-分娩時-產(chǎn)后護理sexualitycounselling性咨詢contraceptivecounselling避孕咨詢pre-conceptualcounselling孕前咨詢STI-prevention性病預防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06/02/2023KyllikeChristensson21GynaecologicalCare

婦科護理ReproductiveHealthincludesSexualHealthandRights

生殖健康包括性健康和性權利

inSweden85%ofcontraceptivesprescriptionsandsexualcounsellingisgivenbythemidwives

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

自1955年起在學校強制開展性教育Youthcentres青年中心/以年輕人為中心AbortionLaw1975《終止妊娠法》06/02/2023KyllikeChristensson22Abortioncare–current“taskshifting”projects–fromthephysician/obstetriciantothemidwife

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

頭三個月的醫(yī)學終止妊娠–藥物Secondtrimesterabortion–medical第二個三個月的終止妊娠–藥物2023-02-06KyllikeChristenssonInternationalconfederationofMidwives–

ICMmeetingtheglobaldemands

國際助產(chǎn)士聯(lián)合會–面對全球需求

ThePhilosophyandModelofMidwiferyCare

助產(chǎn)學護理的哲學和模范InternationalDefinitionoftheMidwife

助產(chǎn)士的國際定義Internationalcodeofethicsformidwives

助產(chǎn)士的國際道德規(guī)范EssentialCompetenciesforBasicMidwifery