从全球视角看助产学的发展

The global perspective of midwifery development从全球视角看助产学的发展,Kyllike Christensson, RN, RM, PhDProfessor in Reproductive Health,2017-12-20,Kyllike Christensson,India late 17th century印度，17世纪末In the honour of a beloved wife who died during childbirth深爱的妻子不幸在分娩中死去，建立了泰姬陵,The Development of the Swedish midwifery system 瑞典助产学的发展,1685 Queen Ulrika Eleonora decided to set up a Midwifery School1685年Ulrika Eleonora女王决定设立助产士学校1697 A book about obstetrics, Den Swenska wl-fwade Jord-Gumman by Johan von Hoorn1697年，Johan von Hoorn完成了一本关于产科学的著作瑞典专业助产士,20/12/2017,Kyllike Christensson,3,Johan von Hoorn First textbook about midwifery 第一本关于助产学的教科书,1697,Den Swenska wlfwade Jord-Gumman瑞典专业助产士,The Development of the Swedish midwifery system, cont.瑞典助产学的发展（续）,1711 Code of practice and ethics for midwives in Stockholm1711年，在斯德哥尔摩发布了助产士行为准则及道德规范1712 The first 18 midwives registrated by Collegium Medicum1712年，医学院首次录取了18位助产士学生1751 Audit (Collegium Medicum) & National statistics of number of births and deaths and the cause of death1751年，对出生人数、死亡人数及死因进行了全国性统计,2017-12-20,Kyllike Christensson,2017-12-20,Kyllike Christensson,100%,50%,20%,% deliveries assisted by a midwife 由助产士协助的分娩比例,Midwives trained with “life saving skills” 接受过专业训练的助产士,MMR 产妇死亡率,1890,1850,100,200,300,400,500,The relationship between maternal mortality and the assistance of professionally trained midwives at birth, Sweden 1850 90产妇死亡率与专业助产士协助的分娩的关系，瑞典 185090,Death per100 000live births每10万活产的死亡数,2017-12-20,Kyllike Christensson,The Midwifes logistics in a common rural area助产士在农村地区的出行方式,2017-12-20,Kyllike Christensson,Prevalence of home deliveries in Sweden瑞典的家庭分娩率,1890 97%1930 76%1940 35%1950 5.9%Today 今 0.1%,Home deliveries in Low income countries = 5 60 %在低收入国家，家庭分娩率可达5%至60%,2017-12-20,Kyllike Christensson,Towards a Healthy Mother and Infant为了健康的母亲和婴儿,As important the political will重要的政治意愿Recruitment 人才招聘Educational system教育系统Legislation立法Salary薪酬Safety 安全,A professional trained midwife with the right to use obstetrical instruments since 1829自1829年起，受过专业训练的助产士可以使用产科器具,2017-12-20,Kyllike Christensson,Actions to be taken towards a Healthy Mother为了“健康母亲”所采取的行动,1987 The Safe Motherhood initiative TBA/Dai training1987年，“安全母亲”行动倡议1997 Lesson learnt (Siri Lanka) Skilled attendance at birth1997年，斯里兰卡的案例 专业助产士协助分娩,2017-12-20,Kyllike Christensson,Only 60 % of births are assisted by a skilled attendant只有60%的分娩是由专业助产士协助进行的700.000 skilled attendants / health professionals with midwifery skills are needed仍然需要70万受训练的、具有助产技术的专业人士,Towards a Healthy Mother and infant为了更健康的母亲和婴儿,Each year more than 250 000 women die due to complications during pregnancy and/or childbirth每年有超过25万女性死于孕期及分娩过程中的并发症,Maternal mortality rate (death/100 000 live births) 每10万活产的死亡数：Sweden 瑞典4USA 美国 17China 中国 30 India印度 190Afghanistan 阿富汗 400Sierra Leone 塞拉利昂 1100,“Women are not dying because of diseases we cannot treat.妇女并非死于那些无法治疗的疾病，They are dying because societies have yet to make the decision that their lives are worth saving”而是死于这个社会尚未下决心去承认她们生命的价值。Prof. M.F.FathallaAssiet University, Egypt,2017-12-20,Kyllike Christensson,Maternal mortality and morbidity产妇死亡率及发病率 low-income countries vs. Sweden 低收入国家 vs. 瑞典,Haemorrhage 大出血Sepsis 败血症Eclampsia 子痫Obstructed labour 难产Unsafe abortion 不安全的终止妊娠Indirect causes (e.g. malaria) 间接原因（如疟疾）,Cardiovascular 心血管疾病Stroke 脑卒中Haemorrhage 大出血Heart diseases 心脏病Sepsis 败血症Mental distress 精神损害,2017-12-20,Kyllike Christensson,The Swedish context - The overall aim of Midwifery/Maternity and Newborn Health Care瑞典的情况助产学及母婴健康的总体目标,A healthy mother健康的母亲 A healthy infant健康的婴儿 A pleasant experience 愉快的体验 with as few intervention as possible尽可能少的干预,Present distribution of various types of interventions当前多种类型干预的分布,Of unknown effect, but in good qualityresearch program,Do more harmthan good伤害多于获益,Do more good than harm获益多余伤害,Of unknowneffect not inresearch settingor in poor quality research,效果未知来源于非研究环境或不佳的研究环境,效果未知来源于良好的研究项目,Midwifery research as a tool to evaluate current practices and improve maternity and new-born care助产学研究是评估当前实践的工具，可以改善妇幼卫生服务质量,Up-right position 竖位分娩Allow eating 允许进食Non-pharmacological pain-relif 不用药物的疼痛缓解Allowing birth companion 允许分娩陪伴,2017-12-20,Kyllike Christensson,2017-12-20,Kyllike Christensson,From home delivery towards institutional deliveries - risks to be considered从在家分娩到医院分娩同样存在诸多风险,Too many unnecessary interventions有许多非必要的干预措施oxytocin argumentation 关于催产素的争论episiotomy 外阴侧切术caesarean section 剖腹产separation of the mother and infant 妇婴分离formula 婴儿配方食品,Lancet, March 2005,4 million neonatal deaths/year, 4 million stillbirths/year每年四百万新生儿死亡、四百万死胎Infections 36%, Preterm births 27% and Asphyxia 23%36%感染，27%早产，23%窒息Interventions with proven efficacy (universal) could avert 41-72% of neonatal deaths worldwide有效的干预措施可以减少世界41%-72%的新生儿死亡,2017-12-20,Kyllike Christensson,The newborn infants needs 新生儿的需求Skin-to-skin care vs. mother/infant separation 紧密关怀 vs. 母婴分离,Temperature 体温Blood-glucosesandMetabolic Adaptation血葡萄糖和新陈代谢适应Crying behaviour哭泣行为,The Swedish Midwives Scope of activities Reproductive Health ( at womens all stages of life)瑞士助产士活动范围-女性生命全程的生殖健康,Antenatal-Intrapartum-Postpartum Care产前-分娩时-产后护理,sexuality counselling 性咨询contraceptive counselling 避孕咨询pre-conceptual counselling 孕前咨询STI-prevention 性病预防 PAP smear 子宫颈抹片检查,Menopausal counselling 更年期咨询,New-born infants - 11-12yrs - Adolescens - Childbearing Women - Menopause - Elderly women 新生儿 - 11-12岁 青春期 孕妇 - 更年期 老年妇女,Sexuality education 性教育,20/12/2017,Kyllike Christensson,21,Gynaecological Care 妇科护理,Reproductive Health includes Sexual Health and Rights生殖健康包括性健康和性权利in Sweden 85% of contraceptives prescriptions and sexual counselling is given by the midwives在瑞典，85%的避孕药处方和性咨询服务是由助产士提供的,Compulsory sexuality education in schools since 1955自1955年起在学校强制开展性教育Youth centres 青年中心/以年轻人为中心Abortion Law 1975 终止妊娠法,20/12/2017,Kyllike Christensson,22,Abortion care current “task shifting” projects from the physician/obstetrician to the midwife终止妊娠的实施者正从内科医生、产科医生转变为助产士,First trimester medical abortion medical头三个月的医学终止妊娠 药物Second trimester abortion medical第二个三个月的终止妊娠 药物,2017-12-20,Kyllike Christensson,Global Perspective 全球视角,Midwives recognized as primary care providers for normal childbirth 助产士已是主要分娩服务的提供者Practice by midwives 助产士的工作Higher psychological support to women 更多的心理支持Less medical interventions 更少的医疗干预Midwifery situtation across countries 几个世纪以来的助产学情况The competence, title, scope of practice of midwives differs 助产士的能力、名字、工作内容不尽相同Recognized as autonomous in many countries 在许多国家被是独立的学科3 pathways to midwifery 成为助产士的3条途径3 years direct entry education 3年直接入职教育18 months education post nursing 18个月的后护士教育Integrated nursing and midwifery (not recognized by ICM) 护士和助产士合一（并不被ICM认可）,Bharati Sharma,24,International confederation of Midwives ICM meeting the global demands国际助产士联合会 面对全球需求,The Philosophy and Model of Midwifery Care 助产学护理的哲学和模范International Definition of the Midwife助产士的国际定义International code of ethics for midwives助产士的国际道德规范Essential Competencies for Basic Midwifery Practice 基础助产学的必要能力Global Standards for Midwifery Regulation全球助产学规范标准Global Standards for Midwifery Education全球助产学教育标准,2017-12-20,Kyllike Chritensson,Scaling up the capacities of midwives requires a combination of增强助产士的能力，需要结合以下几方面,Political advocacy 政治宣传To convince those who make the polices, thos