g.c. rijninks van driel msc rm

G.C. Rijninks van Driel MSc RM

Postnatal care European Midwives Association

2005/36/EC DIRECTIVE European Midwives Association

Provision of sound family planning information and advice

Diagnosis of pregnancies and monitoring normal pregnancies; carrying out the examinations necessary for the monitoring of the development of normal pregnancies

Prescribing or advising on the examinations necessary for the earliest possible diagnosis of pregnancies at risk

Provision of programmes of parenthood preparation and complete preparation for childbirth including advice on hygiene and nutrition

2005/36/EC DIRECTIVE European Midwives Association

Caring for and assisting the mother during labour and monitoring the condition of the foetus in utero by the appropriate clinical and technical means

Conducting spontaneous deliveries including where required episiotomies and in urgent cases breech deliveries

Recognising the warning signs of abnormality in the mother or infant which necessitate referal to a doctor and assisting the latter where appropriate; taking the necessary emergency measures in the doctor’s absence, in particular the manual removal of the placenta, possibly followed by manual examination of the uterus

2005/36/EC DIRECTIVE European Midwives Association

Examining and caring for the newborn infant; taking all initiatives which are necessary in case of need and carrying out when necessary immediate resuscitation

Caring for and monitoring the progress of the mother in the postnatal period and giving all necessary advice on infant care to enable her to ensure the optimum progress of the newborn infant

Carrying out treatment prescribed by doctors Drawing up the necessary written reports

POSTNATAL CARE SURVEY Survey conducted after the EMA AGM in Slovenia

in 2009. Developed by Marianne Mead, in collaboration

with Susanne Simon and Kerstin Belfrage Bristol on Line december 2009- january 2010 Corrections by March 2010 25 countries participated:

… Austria, Belgium, Croatia, Cyprus, Denmark, Estonia, Finland, France, FYR Macedonia, Germany, Greece, Ireland, Italy, Latvia, Luxembourg, Malta, Norway, Portugal, Slovakia, Slovenia, Spain, Sweden, The Netherlands, Turkey and the United Kingdom

European Midwives Association

NUMBER OF PROFESSIONALS

Estonia The Netherlands

Midwives 540 2444Midwives in association

220 2170

General Practitioners

853 8760

Obstetricians 272 739Paediatricians 241 1090

European Midwives Association

BIRTH STATISTICS

Estonia The Netherlands

Births 16.109 170.494Spontaneous vaginal births

74.8% 75%

CS rate 20.2% 15.1%

European Midwives Association

PROFESSIONALS PER 1000 BIRTHS

European Midwives Association

Estonia Netherlands0

5

10

15

20

25

30

35 34

1417

4

midwivesobstetricians

LENGTH OF TIME OF CARE Most EU countries the “ legal definition” of

the postnatal period is 42 days (6 weeks) However length of time postnatal care by

midwife

European Midwives Association

Estonia The Netherlands

Day 1 > 90% > 90%Day 2 > 90% > 90%Day 3 75-90% > 90%Day 4 and 5 10-25% > 90%Day 7 < 5 % > 90%> Day 9 < 5 % < 5%

PROVISION OF CARE Estonia:

… At home… Public hospital … Private hospital … Health centre

The Netherlands:… At home… Public hospital… Birth centre… Health centre

European Midwives Association

REQUIRED EXAMINATION Estonia:

… Mother gynecologist (midwife)… Baby GP or paediatrician

The Netherlands:… Mother none… Baby none

European Midwives Association

MATERNAL CHOICE Estonia:

… Midwife, but not as the only professional… GP… Obstetrician

The Netherlands:… Midwife, can be the only professional… GP… Obstetrician, in case of pathology

European Midwives Association

MATERNAL CAREObservations Estonia NetherlandsHistory taking Midwife MidwifeTemperature Midwife HCAPulse Midwife HCABlood pressure Midwife MidwifeFundal height Midwife HCALochia Midwife HCAPerineum Midwife HCA / midwifeBreasts Midwife HCABreast feeding Midwife HCAArtificial feeding Midwife HCAMental health Midwife MidwifePostnatal depression screening

- -

Maternal nutrition Midwife HCA

European Midwives Association

NEONATAL CAREObservations Estonia NetherlandsGeneral examination Paediatrician MidwifeTemperature Midwife HCAHeart rate Paediatrician MidwifeRespiration Paediatrician MidwifeFeeding assesment Midwife MidwifeBreast feeding advice Midwife HCAArtificial feeding advice

Midwife HCA

Weight Midwife HCAHeel prick Midwife Public Health

NurseBaby bath demonstration

Midwife HCA

European Midwives Association

FAMILY PLANNING

By midwife or by other health professionals? Estonia:

… By midwife 10-25%… Most likely other: obstetrician in hospital

The Netherlands:… By midwife 75-90%… Most likely other: obstetrician in hospital

European Midwives Association

POSTNATAL CARE IN THE NETHERLANDS

96.4 % of all women have a part of their postpartum period at home with help of health care assistant

After a normal delivery in hospital they go home within 6 to 12 hours

After a CS they go home after 4 to 5 days

After homebirth 80% breastfeeding

After hospital birth 63% breastfeeding

DUTCH TRADITIONS

“ Beschuit met muisjes”

DUTCH TRADITIONS

We believe baby's are brought by storks…….

And decorate our houses to announce a baby arrived….

DUTCH TRADITIONS

Family visiting

Announcement of birth

Postnatal care visits

THE DUTCH MIDWIFE IN PRIMARY CARE

QUESTIONS? European Midwives Association