從全球視角看助產(chǎn)學(xué)的發(fā)展課件

從全球視角看助產(chǎn)學(xué)的發(fā)展1、舟遙遙以輕飏，風(fēng)飄飄而吹衣。2、秋菊有佳色，裛露掇其英。3、日月擲人去，有志不獲騁。4、未言心相醉，不再接杯酒。5、黃發(fā)垂髫，并怡然自樂(lè)。從全球視角看助產(chǎn)學(xué)的發(fā)展從全球視角看助產(chǎn)學(xué)的發(fā)展1、舟遙遙以輕飏，風(fēng)飄飄而吹衣。2、秋菊有佳色，裛露掇其英。3、日月擲人去，有志不獲騁。4、未言心相醉，不再接杯酒。5、黃發(fā)垂髫，并怡然自樂(lè)。

Theglobalperspectiveofmidwiferydevelopment

從全球視角看助產(chǎn)學(xué)的發(fā)展KyllikeChristensson,RN,RM,PhDProfessorinReproductiveHealth2021-04-13KyllikeChristenssonIndia–late17thcentury印度，17世紀(jì)末Inthehonourofabelovedwifewhodiedduringchildbirth深?lèi)?ài)的妻子不幸在分娩中死去，建立了泰姬陵從全球視角看助產(chǎn)學(xué)的發(fā)展1、舟遙遙以輕飏，風(fēng)飄飄而吹衣。從全1從全球視角看助產(chǎn)學(xué)的發(fā)展課件從全球視角看助產(chǎn)學(xué)的發(fā)展課件3從全球視角看助產(chǎn)學(xué)的發(fā)展課件4從全球視角看助產(chǎn)學(xué)的發(fā)展課件TheDevelopmentoftheSwedishmidwiferysystem,cont.

瑞典助產(chǎn)學(xué)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(zhǔn)則及道德規(guī)范

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)2023-09-10KyllikeChristenssonTheDevelopmentoftheSwedish62023-09-10KyllikeChristensson

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(zhuān)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(zhuān)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)2023-08-03KyllikeChristensson72023-09-10KyllikeChristenssonTheMidwife’slogisticsinacommonruralarea

助產(chǎn)士在農(nóng)村地區(qū)的出行方式2023-08-03KyllikeChristensson82023-09-10KyllikeChristenssonPrevalenceofhomedeliveriesinSweden

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%2023-08-03KyllikeChristensson92023-09-10KyllikeChristenssonTowardsaHealthyMotherandInfant

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(guò)專(zhuān)業(yè)訓(xùn)練的助產(chǎn)士可以使用產(chǎn)科器具2023-08-03KyllikeChristensson102023-09-10KyllikeChristenssonActionstobetakentowardsaHealthyMother

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

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

1997年，斯里蘭卡的案例專(zhuān)業(yè)助產(chǎn)士協(xié)助分娩2023-08-03KyllikeChristensson112023-09-10KyllikeChristenssonOnly60%ofbirthsareassistedbyaskilledattendant

只有60%的分娩

是由專(zhuān)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(zhuān)業(yè)人士TowardsaHealthyMotherandinfant

為了更健康的母親和嬰兒

2023-08-03KyllikeChristensson12

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

Eachyearmorethan250000w“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)尚未下決心去承認(rèn)她們生命的價(jià)值。

Prof.M.F.Fathalla

AssietUniversity,Egypt從全球視角看助產(chǎn)學(xué)的發(fā)展課件142023-09-10KyllikeChristenssonMaternalmortalityandmorbidity

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2023-08-03KyllikeChristensson152023-09-10KyllikeChristensson

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)2023-08-03KyllikeChristensson16Presentdistributionofvarioustypesofinterventions

當(dāng)前多種類(lèi)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)源于良好的研究項(xiàng)目Presentdistributionofvariou17Midwiferyresearchasatooltoevaluatecurrentpracticesandimprovematernityandnew-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)生服務(wù)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2023-09-10KyllikeChristenssonMidwiferyresearchasatoolt182023-09-10KyllikeChristenssonFromhomedeliverytowardsinstitutionaldeliveries

-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婦嬰分離 formula嬰兒配方食品2023-08-03KyllikeChristensson19Lancet,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Lancet,March20054millionne202023-09-10KyllikeChristenssonThenewborninfants’needs新生兒的需求

Skin-to-skincarevs.mother/infantseparation緊密關(guān)懷vs.母嬰分離Temperature

體溫Blood-glucosesandMetabolicAdaptation

血葡萄糖和新陳代謝適應(yīng)Cryingbehaviour

哭泣行為2023-08-03KyllikeChristensson21TheSwedishMidwivesScopeofactivities–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(xún)contraceptivecounselling避孕咨詢(xún)pre-conceptualcounselling孕前咨詢(xún)STI-prevention性病預(yù)防PAPsmear子宮頸抹片檢查

Menopausalcounselling更年期咨詢(xún)

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10/09/2023KyllikeChristensson22GynaecologicalCare

婦科護(hù)理sexualitycounselling性咨詢(xún)22ReproductiveHealthincludesSexualHealthandRights

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(xún)服務(wù)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》10/09/2023KyllikeChristensson23ReproductiveHealthincludesS23Abortioncare–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2023-09-10KyllikeChristenssonAbortioncare–current“task24GlobalPerspective全球視角Midwivesrecognizedasprimarycareprovidersfornormalchildbirth助產(chǎn)士已是主要分娩服務(wù)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）BharatiSharma25GlobalPerspective全球視角Midwive25InternationalconfederationofMidwives–

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)際道德規(guī)范EssentialCompetenciesforBasicMidwiferyPractice基礎(chǔ)助產(chǎn)學(xué)的必要能力GlobalStandardsforMidwiferyRegulation

全球助產(chǎn)學(xué)規(guī)范標(biāo)準(zhǔn)GlobalStandardsforMidwiferyEducation

全球助產(chǎn)學(xué)教育標(biāo)準(zhǔn)2023-09-10KyllikeChritenssonInternationalconfederationof26Scalingupthecapacitiesofmidwivesrequiresacombinationof

增強(qiáng)助產(chǎn)士的能力，需要結(jié)合以下幾方面Politicaladvocacy政治宣傳Toconvincethosewhomakethepolices,thosewhoallocatebudgetsandthosewhoregulatethecivilservice

說(shuō)服那些政策制定者、計(jì)劃預(yù)算者和行政機(jī)構(gòu)的領(lǐng)導(dǎo)Scientificadvocacy科學(xué)宣傳Todemonstrateeffectivenessancosteffectivenessofvariousoptions

論證各種選項(xiàng)的成本效益Ethicaladvocacy道德宣傳To