ADDRESSING RESPECTFUL MATERNITY CARE: Reducing the medicalisation of maternal and

ADDRESSING RESPECTFUL MATERNITY CARE: Reducing themedicalisation of maternal andnewborn care

Session Objectives

The objectives of this session are to:

Review the concept of ‘medicalised’ care

Provide examples of care that can reduce harmful practices

Share examples of evidence-based interventions

Share suggestions on how to keep birth ‘normal’

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What Is Medicalised Maternaland Newborn Care?

The routine use of practices during labor and childbirth that:

Are not evidence-based Are unnecessary or unwarranted Are unfamiliar and often undesirable to women Do not improve the health outcomes for mother or

baby and may do harm Prioritize needs of providers over needs of women Encourage technology or interventions without

proven benefit

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What Drives Medicalised Maternaland Newborn Care?

Medico-legal pressures Profit Non-evidence-based beliefs within the medical

community, established practices Convenience for providers Perception/illusion of safety Fear: the desire to control birth and reduce risk Desire to use technology

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What Drives Medicalised Maternaland Newborn Care?

What drives medicalised maternal and newborn care in your practice/place of work?

Consider the origins of the practice – Do you know if it is evidence-based? 5

Take 10 minutes to think about the following questions:

Why Does Medicalisation Matter?

Cost can be higher Can reduce access to interventions for those who

really need them Can lead to poorer health outcomes Does not involve woman fully in decision making,

results in her discomfort and disempowerment = disrespectful care

Evidence suggests that higher rates of normal births are linked to provider beliefs about birth, implementation of evidence-based practice, and team working (BMJ 2002)

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https://www.k4health.org/toolkits/rmc/powerpoint-overview-of-the-medicalization-of-mnh-care

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For more information on themedicalisation of childbirth…

Respectful Maternal and Newborn Care

Respectful care demonstrates:Respect for a woman’s rights, choices and dignityCare that “does no harm”Care that promotes positive parenting and improves birth outcomesCare that is culturally sensitive and valued by the woman and her community

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Reversing the Trend: Partnership in Care

Aim to provide respectful maternity care that:is woman-centered, empowering and supportiveis evidence-based and shown to be beneficialpermits free communication and full expression of trust and commitmentensures all women are treated equitably

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ASK: What do Women Want?

For example… Respectful maternity care – kindness, respect, information

Availability of drugs and medical equipment in clean facilities

Support persons in labor and birth

Culturally appropriate services

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Finding Evidence

Cochrane Reviews http://www.cochrane.org/cochrane-reviews

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How do you know if one

treatment will work better

than another, or if it will do more

harm than good?

Common Medicalised PracticesThat Are Harmful

Restricting ambulation/different positions during labor and choice of birth position

Lack of companion/family during labor Over-use of anesthesia/analgesia Administration of oxytocin at any time before

delivery in such a way that the effect cannot be controlled

Restricting food and fluids Separation of mother and baby Early cord clamping Routine episiotomy

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Unnecessary/Routine Episiotomies

Episiotomies can reduce maternal and neonatal morbidity if they are restricted to evidence-based indications (WHO 2006)

Associated morbidity includes perineal damage by tears, pain and dyspareunia

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Restrictive Episiotomy vs.Routine Episiotomy

Restrictive episiotomy policies found that women experienced:less severe perineal traumaless posterior perineal traumaless suturing and fewer healing complications at seven dayswith no difference in occurrence of pain, urinary incontinence, painful sex or severe vaginal/perineal trauma after birth

Overall, women experienced more anterior perineal damage with restrictive episiotomy

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http://summaries.cochrane.org/CD000081/episiotomy-for-vaginal-birth#sthash.DHo9cyUN.dpuf

Gravity is our greatest aid in giving birth, but for historical and cultural reasons we make women give birth on their backs.

Choice of positions for labor and birth encourages a woman’s sense of control and reduces need for analgesia

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Choice of Birth Position

Choice of Birth Position (cont.)

Women who assumed a nonsupine position for birth: had fewer perineal injuries had less vulvar edema had less blood loss

Women choosing nonsupine position for birth: had shorter second stages required less pain relief medication had fewer abnormal fetal heart rates

Alternate Positions

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Midwife-Led Care Linked to Less Medicalisation: Sandal 2013

Women who had midwife-led continuity models of care were…

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…less likely to experience: regional analgesia episiotomy instrumental birth

…more likely to experience: no intrapartum analgesia/anaesthesia spontaneous vaginal birth attendance at birth by a known midwife a longer mean length of labour (hours) satisfaction with services

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004667.pub3/abstract

OUTCOMES…less likely to experience:

preterm birth fetal loss before 24

weeks' gestation

There were no differences between groups for caesarean births.

Campaign for ‘Normal Birth’:Tips for Providers

1. Wait and see2. Get her off the bed3. Justify intervention4. Listen to her5. Be a role model6. Be positive7. Promote ‘skin-to-skin’ contact

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http://www.rcmnormalbirth.org.uk/practice/ten-top-tips

Support Persons

The presence of a birth companion improves birth outcomes and the overall birth experience

Continuous empathetic and physical support is associated with shorter labour, less medication and fewer operative deliveries.

http://summaries.cochrane.org/CD003766/continuous-support-for-women-during-childbirth

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Keep Mother and Baby Together

The day of birth is the most dangerous day for mother and baby State of the World’s Mothers Report, SC 2013

Promote warming with ‘skin-to-skin’ after birth

Promote early and exclusive breastfeeding

Ensure mother counselled on danger signs

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Cord Clamping

World Health Organization (2012) recommends

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delayed cord clampingLate cord clamping (performed after 1 to 3 minutes after birth) is recommended for all births while initiating simultaneous essential newborn care.

Cord Clamping (cont.)

Benefits include: Increased iron stores at birth and less infant anemiaDecreased intraventricular hemorrhage Less necrotizing enterocolitis Less infant sepsisFewer blood transfusions needed

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Be Accountable!

Take responsibility for your own actions

Provide care that is evidence-based and shown to be beneficial

Do no harm Record and report Communicate Be the woman’s advocate

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Explore opportunities for collaborative working and team building to improve respectful quality of care

We all have a role in assuring that women have respectful maternity

care!

THANKS!