IMPROVING THE QUALITY OF DELIVERY AND POSTNATAL CARE
The 2nd International Symposium for Doctors and Midwives entitled "Improving the quality of delivery and postnatal care” took place in Wroclaw on September 25, 2009. Conference was organized by Foundation Woman and Nature chaired by Dr. Preeti Agrawal. Gathered scientific authorities from several countries spoke about the problem of improving the care of mother and her newborn baby.
During the conference lectures were presented by: Professor Miriam Katz, a gynecologist - obstetrician from Israel; Dr. Eva Gundberg, gynecologist -obstetrician from Sweden; Dr. Dorothy Kornas Biela, psychologist from the Catholic University of Lublin, Professor Jacek Rudnicki, neonatologist from Szczecin and Professors Bogdan Chazan (Warsaw) and Jan Oleszczuk (Lublin), gynecologists-obstetricians.
Opening the conference, Dr Preeti Agrawal emphasized that pregnancy is not a disease, and the birth is not a medical procedure. In her speech, Dr Agrawal pointed up the humanistic aspects of midwifery, by which we can improve the quality of delivery and quality of life.
Speakers brought up various aspects of hospital care for mother and child. They reminded that the postnatal period is a time of joy for a woman. It is also a time for new challenges, which should ensure child's safety and care. In particular it concerns children who were born sick or with very low body weight. In case of having a premature or sick baby, requiring intensive care or therapy, participation of the parents during hospitalization takes on particular significance - said Professor Jacek Rudnicki. During the stay at premature or intensive care unit parents become the members of the therapeutic team, they learn to observe the basic functions of the new born its feeding and care.
Kangaroo Mother Care - return to Nature
Kangaroo Mother Care takes inspiration from nature. Once again, we see that nature is the best teacher to qualify the medical stuff - said neonatologist Jacek Rudnicki. In the intensive therapy we are using a number of highly sophisticated techniques and complicated medical equipment such as respirators or incubators - none of them interfere with Kangaroo Mother. Introducing these new ideas dramatically change the new born experience on the world and introduces a new idea. According to Professor we must skillfully combine modern technology with the needs of child such as: love, closeness, cuddling, and above all security.
An excellent method is Kangaroo Mother Care, which appeared in the poor countries, where it due to the lack of the specialized equipment. However, the method has spread rapidly in rich countries, where its advantages have been noticed. Thanks to KMC mother's breath and heartbeat calm the child, stimulate breathing, and immunize its body with friendly bacteria from her breast. Kangaroo Mother Care provides direct "skin to skin" contact - emphasized the Professor.
According to Professor, his method helps in creating trust between both parents and their children as well as with medical staff. It also gives parents the courage and children happiness and health. Constant presence of parents with the child strengthens the emotional bond.
Love begins in the mother's womb
Dr Biela referring to the numerous researches showed that prenatal attachment of parents to their child has a significant impact on their mutual positive relationship after the birth. Various forms of prenatal communication give parents a sense that their child is a close family member from the very beginning, with whom they share a lot of experiences, thoughts, plans and have a "common history". Prenatal bond promotes positive experiences of childbirth and enables the mothers to communicate attention, affection and unconditional love. Positive relationships have a beneficial effect on breast-feeding.
Maternal milk-the most precious gift
Sometimes mother's milk is compared to liquid gold and I think it is very accurate comparison - began her lecture Dr. Marzena Kostuch from the Medical University of Lublin. Infants should be exclusively breastfed up to 6 months of age, then the second year or more infants and young children should receive valuable and nutritious foods, however they still should be breastfed. In Poland, only about 8% of children are exclusively breastfed at 6 months of age - Dr. Kostuch deplored. Then she presented the functioning of the "Baby Friendly Hospital". Hospitals which are awarded with this title must inform all women about the benefits of breastfeeding and ensure optimal conditions of lactation after childbirth. In "Baby Friendly Hospital" mother and baby stay together from birth to release from the hospital. Immediately after birth the child should be placed on the naked belly of the mother. The child and the mother should stay in "skin to skin" touch. This first contact between mother and child should last until the end of the first feeding of the child, in practice it takes up about 2 hours.
Pregnancy after the time-the dilemmas ...
Professor Chazan introduced to participants an important issue of pregnancy after the deadline. At the beginning he presented statistics which show that pregnancies over 41st week, constitute 25 percent of all pregnancies. It is widely accepted that pregnancy after the deadline is an indication for labor induction. According to Professor it has an unquestionable relationship with the concerns of pregnant woman, concerns often tensioned by the family and friends, asking when the labor finally will happen? As a result, the pregnant woman feels a kind of "pregnancy fatigue". I encourage my patients to enjoy the fact of being pregnant. Many women feel that the time of: growing belly, baby's movements and waiting for the birth, should not be artificially shortened, because each of this period, has its value. Then he wondered whether inducing labor in so many cases, is not like falling from the rain under the gutter? So how we should proceed? On one hand, we should consider the complications of labor induction, and everything connected with it, on the other hand, complications involving so-called pregnancy after the deadline. Very essential is the result of induction, that is whether a woman will be able to give birth natural way. A great measure depends on the preparation in school of birth, and on the extent how a woman is self-motivated to experience childbirth and what is her resistance to pain. Very important is the involvement of personnel - especially midwives. If midwives have good contact with patients and their families, if they spend with them much time, then the chance of spontaneous birth is much greater. Professor Jan Oleszczuk talked about how to effectively improve the quality of care for pregnant and giving birth women.
Good Care requires cooperation
Professor Oleszczuk presented functioning status of prenatal care in the Lublin province. Thanks to good organization and consistency this relatively poor Polish region managed to achieve the lowest rates of prenatal mortality and morbidity. One of the greatest achievements of Professor Oleszczuk was the introduction of three-level care, namely the rule that birthing place of a pregnant woman should be adequate to the severity of the newborn and mother risks. Professor argued that in any case, the three-care should not be considered as a centralizing. Three-level care applies only to an average risk (12% of all births), or a high risk (3% of all births). Optimal care of women with a high risk pregnancy provides Prenatal Center, in other words 3rd degree of medical cover - convinced the Professor. It is essential also to ensure that all needy women and newborns will have equal access to the full range of diagnostic and therapeutic services, regardless their place of residence, wealth and personal connections. In the implementation of three-prenatal care rules, we must remember that it is teamwork which requires mutual trust and the exchange of information.
Caesarean section-benefit or danger?
Caesarean section topic appeared several times during the conference. Professor Chazan drew attention to the alarming increase of cesarean section performances, especially those on the request and with the so called social reasons. The professor argued that the natural labor is the best thing a mother can give to her child. Passing through the birth canal baby acquires resistance to infection, its respiratory system has time to adapt to new conditions; psychological benefits are also very important -vulnerable to stress, through natural birth child becomes resistant to stress. WHO recommendations say that the use of caesarean section is justified in approximately 15% of the births, meanwhile in Poland statistics show that about 30% of women deliver by cesarean section and this number is constantly growing (2% per year). In any case, future natural birth and the wider future of midwifery is drawn in a way difficult to predict- said in their lectures gynecologists Professor Miriam Katz and Dr. Ewa Gundberg.
At the crossroads - the challenges of modern obstetrics
The relationship between doctor and patient is sacred, is part of the treatment process and determines its effects - underlined at the beginning of her lecture Dr. Eva Grundberg. Then she named the most important conditions for a good doctor patient relationship: eye contact, personal interest, attentive listening, well-targeted questions, openness and acceptance. Obstetricians should also have a minimum of psychological knowledge and pursue his profession with the individual approach to each woman. Expectant mothers must be well educated and prepared for childbirth. Doctor's attitude should be characterized by empathy and authentic belief in the fact that women are made to bear children. Dr. Gundberg openly questioned what happens with the doctors, why they are more interested in technology than in patients and, finally, why so often opt for surgery instead of normal childbirth? Why they do not you know anything about the psychology of women, and to do not have faith in women and their physiology? At the end she reminded the participants what the essence of the obstetrician’s mission is: unconditional love for their profession, unlimited time for patients and work with passion, because life without passion is boring and nothing comes of working - ended Swedish gynecologist.
Professor Miriam Katz has pointed out that the contemporary obstetric practice adversely affect professional responsibility crisis or on the other hand the feminist movement. The growing and increasingly noticeable group of women protesting against the medicalisation of normal labor, questioning the importance of USG, fetal monitoring, testing pH and the widespread use of labor induction and cesarean delivery. They claim that the twentieth century obstetrics deprive women of matriarchal system of support and control over childbirth and cast them into the hands of the patriarchal world of medicine. It is undoubtedly true, but this is only one side of the coin. Usually they forget that as a result death of mothers and infants is a rare phenomenon in modern delivery rooms, reminded Professor Katz. Also, the professor pointed out that today's labor ward, equipped with modern instrumentation, is cold and depersonalized, so tendency to the more home-style in a hospital is a good direction. Contemporary giving birth seems to be "between" belief in the integrity of nature, and trust to the possibilities of technology. More than ever birth is at a crossroads, at the crossing of a natural approach, the technological sophistication of the century. So will labor return to homes under the tutelage of midwives, or whether will appear more physiological, less medically approached to healthy, normal birth? It seems that two things happen at the same time at most places in the world. We must be careful only not to overdo it, urged Professor Miriam Katz.
Panel discussion - time for summaries
The complement of the conference was a debate. This was a common reflection how to reduce prenatal mortality and improve the care of premature. The starting point was the analysis of the situation in Lower Silesia. Professor Marian Gabrys commenting disastrous mortality results emphasized the importance of educational activities, which are cheaper than purchasing expensive medical equipment. Further training is a professional and moral obligation of doctors and midwives - people who are involved in such an important event, which is the birth of a new human being.
In the unanimous opinion of participating in the debate the leading cause of high mortality in preterm infants are not deficiencies in equipment and hospital-based, but just organizational weaknesses and lack of promotion of breastfeeding. The care during pregnancy also is failing and that is really where all the problems start, what leads to the premature birth and sometimes even death of a child. That's why it is vital to properly conduct prevention and health care provision, taking under consideration the degree of risk. We still have a lot of work, but the first steps were taken-concluded conference participants.
The honorary patrons of the Conference were: The Minister of Health - Ewa Kopacz and the President of the Senate Health Committee - Wladyslaw Sidorowicz.
Media patrons: TVP, Polskie Radio, Zwierciadło, Magazyn Pielęgniarki i Położnej oraz Dziennik - Gazeta Prawna.