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Role of Midwifery in the Evolution of Prenatal Care

Zhang Luyao

History 4710 02

Instructor:

10 September 2012

Introduction

Antenatal care is now a common after it was introduced in the early part of the twentieth century. It was introduced with the aim of preventing eclampsia, preeclampsia and maternal mortality that were highly prevalent before the start of the century. Before this idea was universally accepted, pregnant women were encouraged to remain at home. Traditionally expectant women were not supposed to take part in the activities of the rest of the society. These mothers did not visit midwives or doctors. It has been a long journey in this regard and those who have been behind the achievements need to be highly commended. Though we have not reached the destiny of prenatal care what has been achieved in this field so far is more than what could have been imagined as possible a century ago.

In the modern world, prenatal care is mainly associated with nursing. Nurses are the people who are engaged with duty of providing care to the pregnant women. The nurses are the ones who handle them during pregnancy, when they go to deliver and later during postnatal care. Nursing has therefore played an important role in the provision of prenatal care. Technological advancements have also played an important role in the provision of prenatal care. Half a century ago, it was not possible to tell the status of an unborn child. This is possible today due to the use of the advanced technology. This ensures that both the mother and child are taken care of in the right way and they go through the term safely. Prenatal care in the 21st century is an entire transformation of how it was in the 19th century with minor traces of modern care if any.

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Historical evolution

There is little to compare between the prenatal care in the nineteenth and twenty-first centuries. Modern midwifery involves the use of science that makes the service effective and reliable. In the 1940s there about 376 deaths for every 100,000 births. This had changed by 1991 where the number of deaths had dropped to only 10.3 for every 100,000 births and 12.9 for every 100, 000 births by 1997. The lack of pre-natal care exposed the women to the risk of death resulting from maternal related causes. By 2001, 99b% had access to prenatal care during their pregnancy[1].

In the USA, about two-thirds of women gave at home 75 years ago according to Laura Thomas. These women had no painkillers they were attended to by their family doctors as then reliance on midwives and nurses was reducing. Laura has noticed that more people are seeking the services of obstetricians and more births were taking place within institutions of healthcare. In 1936, the American Medical Association conducted a convention in Kansas City in which childbirth analgesics elicited a heated debate. The convention also discussed the extent to which the pain during child bearing could be minimized. There convention could not come up with an agreement on what could be used to reduce the pain in a mother while giving birth without any harm on either the mother or child. The proposals that have been suggested have posed danger to the mother and child[2].

There was a dramatic change in the years between 1960s and 1970s with respect to trends in childbirth. The 1950s gad seen many people having births in hospitals. The method that was used to reduce the pain in the mother while giving birth was epidural anesthesia in which the women could no longer control the process of giving birth. The process of childbirth is a natural one that can be undertaken safely unless one has health issues. This was taken over by the doctors who devised various ways of avoiding the pain in mothers. Many researches were conducted that had a major impact in improving prenatal care and reducing the deaths that were very common. The researches included the role of breastfeeding in improving the chances of a child to survive after the birth. During that time there was a common belief that encouraged women to use modern formulas to feed their babies. However, researchers came up with findings that rendered support to breast-feeding as being able to provide the baby with immunity against early childhood diseases. The research also proved that breast milk had the right formula and did not give the baby digestive complications[3].

The nurses of today have taken up the role assisting women in matters relating to nutrition, pregnancy in adolescents, infertility as well pregnancy in women aged above thirty-five. Pregnant women who are at high risk of developing pregnancy related complications are those that have poor nutrition, are too young or too old be pregnant. However, since the emergence of prenatal care their chances of carrying a pregnancy to term have greatly increased. Today such women can relax assured that they will necessarily have to suffer in the course of the pregnancy or delivery. The services of midwives have combined with technology in lowering the number of children who die while giving birth.

The 19th century education that was scientific was instrumental in leading researchers into finding ways of reducing the medical problems people faced at that time. Universities and other communities where studying was done conducted scientific research and communicated their findings on various subjects. Among the findings was the Pasteur theory of infectious diseases, Lister’s antisepsis writing and the paperwork on puerperal fever work by Holme and Semmelwei. The erudition knowledge was not circulated to the midwifery profession, as it was not considered a formal medical field. Other medical fields like were recipients of new advances in hygiene and pharmacology to name just a few, but the same was never diverged to the practice of midwifery.

Midwifery begun to be formalized in the mid-19th century, but this was far below the recognition that was granted other disciplines in medicine. Very many health problems were linked with midwifery. Mortality rates were high in comparison to the field of physicians. During the migration that took place in the 20th century, the immigrants took with them their midwives who were familiar with their family backgrounds, culture, beliefs, diet and needs of their expectant women. The occurrence of WWI shifted the provision of midwifery services from the home to the hospitals.

The shift of these services to the hospitals where the mothers could receive professional care from nurses, improve the kind of services the women received while giving birth. In the traditional setting, the women went in labor without their partners to render them moral support. As soon as they gave birth, the newborns were taken away from them. As time went by technology, advanced mothers could give birth in sterile and safe surroundings where they are kept in seclusion to avoid any contamination. In traditional settings, some of the practices employed were unclean and exposed the babies to health risks such as pneumonia.

The traditional midwife was not learned and assisted in childbirth by experience and taking chances. The modern midwife is educate and is in a position to deliver the baby ensuring the safety of both child and mother. A nurse offering the services of a midwife should have a minimum qualification of a bachelor’s degree but higher qualifications are encouraged. To join this profession a person is supposed to be trained as both a nurse and midwife before the state can issue a license to provide the services. In many cases midwives work as doctors whereby they provide their clients with all round services in healthcare. Traditionally, the wife was not in a position to do any more than assisting the mother give birth. Thus if the mother had complications, it was highly unlikely the midwife would be able to provide the appropriate assistance. In modern times, there is no need to have the services of a midwife and doctor together. The midwife is in a much better position to provide all round health care to a mother than a general physician is.

The variables used in assessing and managing pregnancy have expanded from what was done traditionally to the modern ones that include psychological changes that occur during pregnancy. The expansions include the ordinary pregnancy, the system of reproduction, pregnancy discomforts, respiratory system, skeletal changes, urinary system, cardio vascular system, metabolic changes, gastro intestinal system and pregnancy diagnosis. Others include assessment during labor, vaginal examinations, postnatal assessments and setting of a fitting delivery area[4].

It is generally believed in midwifery that childbirth is an ordinary and healthy process and therefore should be treated as such. There is no evidence yet to prove this belief wrong. This means that the midwife need not intervene but should allow the natural process of birth to take place. Midwives therefore see themselves as being assistants to the mothers in allowing the natural birth process to take course. Though they may share this feature with the traditional midwife, there is a difference in that the traditional midwife had scanty knowledge in healthy matters. In the event of health complications during delivery, the traditional midwife had to seek the assistance of a physician. In modern times, the midwife is in a position to tackle health related issues.

Many studies have proved that the advancement in midwifery has helped the eradication of deaths at birth by improving prenatal care. A study in 1971 conducted by Levy, Wilkinson, and Marine in California showed improvements in both prenatal and neonatal care. The nurse midwives were introduced to the rural settings and after 18 months, it was observed that prematurity rates dropped from 11% to 6.6%. When these nurses were later replaced by physicians the rate of premature deaths increased from 10.3% to 12%.

Conclusion

The aim of this paper is to find out midwifery has played a role in prenatal care. The study has shown that the traditional midwife lacked the knowledge to deal with complications that often occur during childbirth. This resulted in an increased number of deaths during this process where both the mother and child lost their lives. The traditional midwifes based their knowledge on experience. Modern midwifery has improved greatly mainly due to the advancement in technology and growth in medical education. Modern midwives are highly educated and they have the ability to provide healthcare besides aiding in the childbirth process. The modern midwife’s work does not end with childbirth but extends to taking of the expectant mothers health during the pregnancy, while delivering and after the birth.

Bibliography

Ettinger, Laura, Nurse-Midwifery: The Birth of A New American Profession, Ohio: Ohio State University Press, 4, 2006

Leppert, Phyllis and Peipert, Jeffrey, Primary Care for Women, New Jersey: Lippincott Williams & Wilkins, 106, 2003.

  1. Ettinger, Laura, Nurse-Midwifery: The Birth of A New American Profession, Ohio: Ohio State University Press, 4, 2006
  2. Leppert, Phyllis and Peipert, Jeffrey, Primary Care for Women, New Jersey: Lippincott Williams & Wilkins, 106, 2003.
  3. Pillitteri, Adele, Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family, London: Lippincott Williams & Wilkins, 385, 2009.
  4. Pillitteri, Adele, Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family, London: Lippincott Williams & Wilkins, 385, 2009.

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