从全球视角看助产学的发展课件

Theglobalperspectiveofmidwiferydevelopment

从全球视角看助产学的发展KyllikeChristensson,RN,RM,PhDProfessorinReproductiveHealth2023-02-06KyllikeChristenssonIndia–late17thcentury印度，17世纪末Inthehonourofabelovedwifewhodiedduringchildbirth深爱的妻子不幸在分娩中死去，建立了泰姬陵TheDevelopmentoftheSwedishmidwiferysystem

瑞典助产学的发展1685QueenUlrikaEleonoradecidedtosetupaMidwiferySchool

1685年UlrikaEleonora女王决定设立助产士学校1697Abookaboutobstetrics,DenSwenskawäl-öfwadeJord-GummanbyJohanvonHoorn

1697年，JohanvonHoorn完成了一本关于产科学的著作——《瑞典专业助产士》

06/02/2023KyllikeChristensson3TheDevelopmentoftheSwedishmidwiferysystem,cont.

瑞典助产学的发展（续）1711CodeofpracticeandethicsformidwivesinStockholm

1711年，在斯德哥尔摩发布了助产士行为准则及道德规范

1712Thefirst18midwivesregistratedbyCollegiumMedicum

1712年，医学院首次录取了18位助产士学生1751Audit(CollegiumMedicum)&Nationalstatisticsofnumberofbirthsanddeathsandthecauseofdeath

1751年，对出生人数、死亡人数及死因进行了全国性统计2023-02-06KyllikeChristensson2023-02-06KyllikeChristensson

100%50%20%%deliveriesassistedbyamidwife由助产士协助的分娩比例Midwivestrainedwith“lifesavingskills”接受过专业训练的助产士MMR产妇死亡率18901850100200300400500Therelationshipbetweenmaternalmortalityandthe

assistanceofprofessionallytrainedmidwivesatbirth,Sweden1850–90

产妇死亡率与专业助产士协助的分娩的关系，瑞典1850–90Deathper100000livebirths每10万活产的死亡数2023-02-06KyllikeChristenssonTheMidwife’slogisticsinacommonruralarea

助产士在农村地区的出行方式2023-02-06KyllikeChristenssonTowardsaHealthyMotherandInfant

为了健康的母亲和婴儿

Asimportant–thepoliticalwill

重要的政治意愿Recruitment

人才招聘

Educationalsystem

教育系统

Legislation

立法

Salary

薪酬

Safety

安全Aprofessionaltrainedmidwifewiththerighttouseobstetricalinstrumentssince1829

自1829年起，受过专业训练的助产士可以使用产科器具2023-02-06KyllikeChristenssonActionstobetakentowardsaHealthyMother

为了“健康母亲”所采取的行动1987TheSafeMotherhoodinitiativeTBA/Daitraining

1987年，“安全母亲”行动倡议1997Lessonlearnt(SiriLanka)Skilledattendanceatbirth

1997年，斯里兰卡的案例专业助产士协助分娩2023-02-06KyllikeChristenssonOnly60%ofbirthsareassistedbyaskilledattendant

只有60%的分娩

是由专业助产士协助进行的700.000skilledattendants/healthprofessionalswithmidwiferyskillsareneeded

仍然需要70万

受训练的、具有助产技术的专业人士TowardsaHealthyMotherandinfant

为了更健康的母亲和婴儿

“Womenarenotdyingbecauseofdiseaseswecannottreat.

妇女并非死于那些无法治疗的疾病，Theyaredyingbecausesocietieshaveyettomakethedecisionthattheirlivesareworthsaving”

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.Fathalla

AssietUniversity,Egypt2023-02-06KyllikeChristenssonMaternalmortalityandmorbidity

产妇死亡率及发病率

low-incomecountriesvs.Sweden

低收入国家vs.瑞典Haemorrhage大出血Sepsis败血症Eclampsia子痫

Obstructedlabour难产Unsafeabortion

不安全的终止妊娠Indirectcauses(e.g.malaria)间接原因（如疟疾）Cardiovascular心血管疾病Stroke脑卒中Haemorrhage大出血Heartdiseases心脏病Sepsis败血症Mentaldistress精神损害2023-02-06KyllikeChristensson

TheSwedishcontext-TheoverallaimofMidwifery/MaternityandNewbornHealthCare

瑞典的情况——助产学及母婴健康的总体目标Ahealthymother

健康的母亲Ahealthyinfant

健康的婴儿Apleasantexperience

愉快的体验withasfewinterventionaspossible

尽可能少的干预Midwiferyresearchasatooltoevaluatecurrentpracticesandimprovematernityandnew-borncare

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-rightposition竖位分娩Alloweating允许进食Non-pharmacologicalpain-relif不用药物的疼痛缓解Allowingbirthcompanion允许分娩陪伴2023-02-06KyllikeChristensson2023-02-06KyllikeChristenssonFromhomedeliverytowardsinstitutionaldeliveries

-riskstobeconsidered

从在家分娩到医院分娩——同样存在诸多风险

Toomanyunnecessaryinterventions

有许多非必要的干预措施 oxytocinargumentation关于催产素的争论 episiotomy外阴侧切术 caesareansection剖腹产 separationofthemotherandinfant妇婴分离 formula婴儿配方食品Lancet,March20054millionneonataldeaths/year,4millionstillbirths/year

每年四百万新生儿死亡、四百万死胎

Infections36%,Pretermbirths27%andAsphyxia23%

36%感染，27%早产，23%窒息

Interventionswithprovenefficacy(universal)couldavert41-72%ofneonataldeathsworldwide

有效的干预措施可以减少世界41%-72%的新生儿死亡TheSwedishMidwivesScopeofactivities–ReproductiveHealth(atwomen’sallstagesoflife)瑞士助产士活动范围-女性生命全程的生殖健康Antenatal-Intrapartum-PostpartumCare

产前-分娩时-产后护理sexualitycounselling性咨询contraceptivecounselling避孕咨询pre-conceptualcounselling孕前咨询STI-prevention性病预防PAPsmear子宫颈抹片检查

Menopausalcounselling更年期咨询

New-borninfants-11-12yrs-Adolescens-ChildbearingWomen-Menopause-Elderlywomen

新生儿-11-12岁–青春期–孕妇-

更年期–老年妇女Sexualityeducation性教育06/02/2023KyllikeChristensson21GynaecologicalCare

妇科护理ReproductiveHealthincludesSexualHealthandRights

生殖健康包括性健康和性权利

inSweden85%ofcontraceptivesprescriptionsandsexualcounsellingisgivenbythemidwives

在瑞典，85%的避孕药处方和性咨询服务是由助产士提供的Compulsorysexualityeducationinschoolssince1955

自1955年起在学校强制开展性教育Youthcentres青年中心/以年轻人为中心AbortionLaw1975《终止妊娠法》06/02/2023KyllikeChristensson22Abortioncare–current“taskshifting”projects–fromthephysician/obstetriciantothemidwife

终止妊娠的实施者正从内科医生、产科医生转变为助产士Firsttrimestermedicalabortion–medical

头三个月的医学终止妊娠–药物Secondtrimesterabortion–medical第二个三个月的终止妊娠–药物2023-02-06KyllikeChristenssonInternationalconfederationofMidwives–

ICMmeetingtheglobaldemands

国际助产士联合会–面对全球需求

ThePhilosophyandModelofMidwiferyCare

助产学护理的哲学和模范InternationalDefinitionoftheMidwife

助产士的国际定义Internationalcodeofethicsformidwives

助产士的国际道德规范EssentialCompetenciesforBasicMidwifery