History and Contemporary Perspectives IN MIDWIFERY & OBSTETRICS

1. History and Contemporary Perspectives IN MIDWIFERY & OBSTETRICS

2. Introduction • Midwifery is as old as the history of human species. Archeological evidence of a women squatting in child birth supported by another women from behind demonstrate the existence of midwifery in 500 BC

3. Obstetrics word is come from a Latin word “OBSTETRIX” means “MIDWIFE”

4. Origin of Obstetrics As we all know that birth is the complex final act of nature’s greatest miracle i.e. formation and arrival of a child in the world. And the science and art that deals with human reproduction is called Obstetrics.

5. “SORANUS OF EPHESUS” Is the FATHER OF OBSTETRICS He was the first to write about the Podalic Version.

7. Contd… Earlier man were not welcomed in this field. During Middle Ages in Europe midwives were of low types and executioner and barbers were called to help with difficult deliveries. Later on in 16th & 17th century Ambroise Pare of Paris and Chamberlens stimulate men to take interest in obstetrics.

8. History of Midwifery in India: • In Ancient India, care of women and practice of Midwifery were totally in the hands of village dais. • Women were subject to the purdah system. • The occupation of dais was hereditary and all dais was from lower caste as the period of childbirth was considered a time of impurity. • The worst room in the household was allotted for delivery.

9. Contd… • Dais gained their skill through observation and practice. • And when dais could not handle the situation serious morbidity and mortality were the result and these all were explained as “Beyond human control phenomena.”

10. The historic taboo associated with the examination of femalegenitalia has long inhibited the science of gynecology. This 1822 drawing by Jacques-Pierre Maygnier shows a "compromise" procedure, in which the physician is kneeling before the woman but cannot see her genitalia. Modern gynaecology has shed these inhibitions.

11. …During British India: In 1900 A.D. Dr. Ida sophia Scudder after got news from the village people that 3 women died during delivery who were actually calling her to help then she decided and started with Christian Medical College & Hospital (CMCH) at Vellore. Later in 1950,the doors of CMC & H opened for male training.

12. Contd… • In 1899, Zenana Bible and medical mission started training of nurses. • In 1883 Lady Dufferin came to India allotted fund to start maternity hospitals and training of nurses and midwives all over the country. • It was with help of this Fund that Lady Reading Health School was established in 1918 at Delhi.

13. Midwifery in Independent India: In 1946,Bhore committee laid the foundation for public health planning in India laid great stress on the need for qualified midwives and health visitors. In 1947,INC combine the Nursing and Midwifery courses into single course. In 1955,Shetty Committee recommended training and posting ANMs in health services with a qualification of class VIII & supervised by LHV. In 1959,Bischoff supported the training of personnel.

14. Contd… ANMs for 3 yrs. And midwifery for 1 yr. • In 1975, MPHW scheme launched by Kartar Singh Committee. • MPHW were registered as ANMs and were designated as Female Health Workers ,posted at subcentres for 5000 rural population. • They supervise the deliveries conducted by dias.

15. Historical development in Obstetrics • In 1739,in London,WilliamSmellie and his student William Hunter become obstetrician and work for the same. • In 1744,Willam Smellie introduce steel lock forceps. • In 1752,Willam Smellie publish ‘Textbook of Obstetrics’. • In 1760,Puerperal fever was on peak in London in Lying-in hospital.

16. Contd… • On Jan 14th,1794 first Cesarean operation was performed by Dr. Jesse Benaett of Virginia on his wife. • First school of midwives was established at Pare instigation at the hotel Dieu in Paris. • In 18th century National regulation of education and practice of midwifery begans.

17. Contd… • In 1807, Samuel Bard publish first book on obstetrics on four stages of labour. • In 1847, Semmelweis, in Vienna, demonstrate that washing of hands in chlorine of lime solution before examining women in labor reduce puerperal fever. Chloride of lime used as antiseptic.

18. Contd… • Obstetrical forceps was developed by Dr. Peter Chamberlen. In the past only Greeks used variety of hooks and tractors to deliver dead fetus. • In 1853,Dr. James Y. Simpson of Glasgow succeeded in introducing the use of Chloroform anesthesia as an aid in obstetrics called “ERA OF MODERN OBSTETRICS”.

19. Contd… • Then, Pinard Fetoscope was developed and Ian Donald from Glasgow introduce Ultrasound in Obstetrics. • In 1950,Fritz Fuch of Copenhagen performed Amniotomy identified the fetal cells present in it which identify sex of the baby by barr bodies.

20. Contd… • Later on emphasis on Antenatal check-ups, blood pressure, urine analysis was came in attention. • In 1892,Dr. Pierre Budin initiated consultation for nursing mothers. • In 1949,first world health organization expert committee on maternal child health met in Geneva.

21. Contd… • In 1950,Oral contraceptives was introduce for the control of fertility. • Then b-HCG tracing was done with chorionvillus sampling at 10th wk. • Identification of IUGR was done by NS test. • Later on RaoulPalwer & Patrick steptol discover LaproscopicSterlization. • In 1960,Witness abortion get started.

22. Contd… • 1971 – MTP Act • 1974 – Family Planning Services Incorporated In MCH Care • 1977 – Renaming Family Planning To Family Welfare

23. Contd… • 1978 – Expanded Programme on Immunization • 1985 – Universal Immunization Programme • 1992 – Child Survival& Safe Motherhood Programme

24. Contd… • 1996 – Target Free Approach • 1997 – RCH Programme Phase-1 (15-10-1997) • 2005 – RCH Programme Phase-2 (01-04-2005)

25. Contempary perspective of Obstetrics • In current view all the focus from obstetrics care shifted to perinatal care. • Advancement in Obstetrics care has reduces the MMR. • Govt. has started programme to identify high risk mothers. • Training of health personnels, Allocation of facilities & equipment decreases MMR.

26. Contd… • MMR can be reduces: • Early registration of pregnancy. • Atleast three antenatal check-ups. • Dietary supplements can correct anemia. • Prevention of infection and hemorrhage during puerperium. • Prevention of complications e.g. Ecalmpsia, malpresentation, ruptured uterus.

27. Contd… • Treatment of medical conditions e.g. hypertension, DM, TB. • Anti-malaria and tetanus prophylaxis. • Clean delivery practice. • Institutional deliveries for women with BOH and risk factors. • Promotion of family planning.

28. Contd… • MCH services has started which aims at reduction in morbidity and mortality rate of mother and baby. • Baby friendly hospital scheme has launched in 1993 for effective breastfeed to child. • Genetic counseling to the couples. • Screen the mother for HIV.

29. Future evidence based practice: • Mapping of human genome and genetic research. • Use of intrauterine shunts. • Aseptic techniques to be used during PV, PROM. • Care of mother during labor. • Care after delivery for puerperal infections.

30. Bibliography: • Nurse Midwifery Helen Varney 2nd edition page no.19-20 • Obstetrics nursing Erna Ziegel/Carolyn conant van Blarcorn 6th edition page no. 771-797 • The Indian Journal of Nursing and Midwifery Vol 1,Number 3 Dec 1998

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