Evaluation of services provided by community midwives to women in

Evaluation of services provided by community midwives to women in

● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No. 1/2016 (26-31)
●
26
Evaluation of services provided by community
midwives to women in postnatal period
(Ocena realizacji świadczeń położnej rodzinnej w okresie
poporodowym)
M Lewicka 1,A,D, M Sulima 1,B,E, S Grzeszczak 2,C,F
Abstract – Introduction. The community midwife’s role for women in postnatal period, their babies and families, consists primarily in providing care of mother and her child.
Aim of the study. The paper aimed at evaluating community
midwifery services provided to women in postnatal period.
Materials and methods. The evaluation of community midwifery
services rendered to women in postnatal period included the
group of 214 newly delivered mothers. The survey was carried
out with the use of diagnostic poll method. The survey questionnaire, self-designed for the purposes of the paper, was used as a
research tool.
Results. It was observed that there is a statistically significant
correlation between the number of patronage visits and type of
the last delivery (p=0.03140). In the group of women who gave
birth naturally community midwives usually made three patronage visits, whereas in case of women after caesarean delivery, the
number of such visits usually equalled two. The research indicates that the vast majority of newly delivered mothers evaluated
the services provided by community midwives as ‘good’. Some
women ‘did not use’ such services, and a low percentage of women considered them as ‘bad’ or ‘very bad’.
Conclusions. Women in postnatal period evaluate the services
provided by community midwives as ‘good’ or ‘very good’. The
number of patronage visits, particularly in the group of women
after C-section, should be increased.
Wyniki. Stwierdzono istotną statystycznie zależność pomiędzy
liczbą przeprowadzonych wizyt patronażowych a sposobem
ukończenia ostatniej ciąży (p=0,03140). W grupie badanych kobiet po porodzie siłami natury położne rodzinne realizowały najczęściej trzy wizyty patronażowe natomiast u położnic po cięciu
cesarskim najczęściej odbywały dwie wizyty. Z badań wynika, że
zdecydowana większość badanych położnic oceniała „dobrze”
świadczenia udzielane przez położne rodzinne. Część kobiet „nie
korzystała” ze świadczeń udzielanych przez położną rodzinną
podczas wizyt patronażowych. Nieznaczny odsetek kobiet oceniło
świadczenia „źle” i „bardzo źle”.
Wnioski. Kobiety w okresie poporodowym „dobrze lub „bardzo
dobrze” oceniają świadczenia udzielane przez położne rodzinne.
Należy dążyć do zwiększenia liczby wizyt patronażowych, szczególnie w grupie kobiet po cięciu cesarskim.
Słowa kluczowe - świadczenia położnej rodzinnej, okres
poporodowy.
Author Affiliations:
1.Department of Obstetrics, Gynecology and ObstetricalGynecological Nursing
Faculty of Nursing and Health Sciences, Medical University,
Lublin
2.A graduate of Obstetrics, Nursing Faculty of Nursing and
Health Sciences, Medical University, Lublin
Key words - the provision of midwives , period postnatal.
Authors’ contributions to the article:
Streszczenie – Wstęp. Wykonywanie zawodu położnej rodzinnej,
w odniesieniu do kobiety w okresie poporodowym, jej dziecka i
rodziny, polega w szczególności na sprawowaniu opieki nad matką i noworodkiem.
Cel pracy. Celem pracy była ocena realizacji świadczeń położnej
środowiskowo/rodzinnej w odniesieniu do kobiet w okresie poporodowym.
Materiał i metody. Badanie oceny realizacji świadczeń położnej
rodzinnej w odniesieniu do kobiet w okresie połogu przeprowadzono w grupie 214 położnic. Badanie przeprowadzono metodą
sondażu diagnostycznego. Narzędzie badawcze stanowił autorski
kwestionariusz ankiety stworzony dla potrzeb pracy.
A. The idea and the planning of the study
B. Gathering and listing data
C. The data analysis and interpretation
D. Writing the article
E. Critical review of the article
F. Final approval of the article
Correspondence to:
Dr Magdalena Lewicka Department of Midwifery, Gynaecology
and Gynaecological Nursing; Faculty of Nursing and Health
● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No.1/2016 ●
Sciences, Medical University of Lublin, Chodźki 6 Str., PL-20093 Lublin, Poland, e-mail: [email protected]
Accepted for publication: January 8, 2016.
I. INTRODUCTION
he community midwife’s role for women in postnatal
period, their babies and families, primarily includes:
caring for mother and her child, examining it, taking all
urgent actions, such as immediate life support, as well as
observing symptoms of irregularities requiring doctor’s
referral, implementing doctor’s recommendations in the
course of diagnosis, treatment and rehabilitation, undertaking, to a certain degree, prevention, diagnostics, treatment
and rehabilitation measures by herself, as well as educational and health-oriented activities [1,2]. The scope of the
community midwife’s responsibilities also includes cooperation with the obstetrician/gynaecologist, family doctor,
community or GP nurse, as well as with representatives of
organisations and institutions acting for the benefit of
health [3].
The primary care midwife has a duty to take care of a
newly delivered mother and her baby within 48 hours after
she receives the notice of live birth until the end of the sixth
week of the baby’s life. Throughout that period she should
make at least four patronage visits [4,5].
Women who would like to become community midwives
must be licensed to practise as such, and must obtain additional qualifications (qualifying course), or complete
a specialisation programme in either family, community or
GP nursing, or in health promotion and health-oriented
education. Qualifications for the primary care midwife can
also be obtained by masters of nursing who have at least
three years of working experience in the primary care sector [6,7].
Family midwives can work under the employment contract, service relationship or a civil law contract [1]. In addition, pursuant to Act of 15th April 2011, it is possible to
run medical activity as a sole proprietorship, in the form of
private practice, private specialist practice, private practice
run exclusively within the healthcare entity company under
the contract made with this entity, or in the form of civil,
general or limited liability partnership, as well as
a group practice [8].
The aim of the paper was to evaluate the community/family midwifery services provided to women in postnatal period.
T
II.
27
MATERIALS AND METHODS
The survey evaluating the family midwifery services
provided to postnatal women was carried out via Ankietka.pl website. It was voluntary and anonymous, and used
the diagnostic poll method, as well as the self-designed
survey questionnaire as a research tool.
The survey included 214 newly delivered mothers, who
were divided into two age groups: up to 26 years, and
above 27. The women aged 26 or less comprised 49.53 %
(n=106), while those above 27 years of age – 50.47%
(n=108). Within the group of surveyed women, the majority had a university degree (70.09 %, n=150), whereas 26.17
% (n=56) had secondary, and 3.74% (n=8) – primary or
vocational degree. The vast majority lived in the city
(78.50%, n=168), the rest (21,50%, n=46) – in the countryside. The survey included 78.50%, (n=168) married women
and only 21.50% (n=46) unmarried. Most of the surveyed
women (63.55%) had one child (n=136), whereas 28.98%
(n=62) had two. 6.54 % (n=14) of them had three, and
0.93%, (n=2) of the surveyed women had four and more
children. 81.31% of the respondents (n=174) gave birth
naturally,
whereas
18.69%
(n=40)
underwent
C-Section.
The survey results were subject to statistical analysis.
The level of significance was set up at p<0,05, which indicated statistically significant differences and correlations.
The database and statistical surveys were done on the basis
of the Statistica 9.1 (StatSoft, Poland) computer programme.
III.
RESULTS
Table 1 presents correlations between the number of patronage visits and age, degree, place of domicile, marital
status, number of children and type of delivery.
According to 34.58% (n=74) of the women, family/community midwives made usually three patronage visits. Two patronage visits were paid to 32.71% (n= 70) of
the postnatal women, whereas four and more ones only to
17.76% (n= 38). 14.95% (n=32) of the respondents had
only one patronage visit. A statistically significant correlation was discovered between the number of patronage visits
and the type of delivery (p=0.03140). In the group of women who gave birth naturally midwives made usually three
patronage visits, whereas in the case of women after Csection, the number of visits was two.
● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No.1/2016 ●
Table 1. Correlation between the number of patronage
visits and age, degree, place of domicile, marital status,
number of children, and type of delivery
28
Table 2. Correlation between the evaluation of family
midwifery services and age, degree and place of domicile
Socio-demographic variables
30.43
56.52
0.00
13.04
14
26
0
6
30.95
55.95
13.04
65.22
0.00
21.74
6
30
0
10
17.86
65.48
0.00
16.67
26.09
12
32
69.57
4.35
0.00
0
2
28.57
65.48
2.38
8.70
39.13
0.00
52.17
4
18
0
24
3.57
52.38
0.00
44.05
6
88
0
74
8.70
0.00
47.83
43.48
4
0
22
20
1.19
41.67
0.00
0
96
57.14
2
0.00
70
2.67
1.914/p=0.38386
52.00
45.33
3.57
48
110
4
6
25.33
70.67
2.67
0.00
46.67
48.00
8
5.33
0
72
3.13
0.00
0
22
30
0
28
110
16.00
0.00
18.67
65.33
24
98
0
28
38
106
2
4
1.33
34.38
56.25
3.13
6.25
22
36
2
4
2
0.394/p=0.82091
1.105/p=0.57530
13.10
52
0.00
12.00
94
32.00
0
18
56.00
48
28.13
56.25
0.00
18.75
65.63
0.00
15.63
12
42
0
10
0.00
54.72
3.207/p=0.20111
15.63
18
0
10
36
30
64
27.78
16.67
18
66
61.11
0
0.00
24
22.22
28
25.93
70.37
76
48
0
Did not
use
χ²/p
1.85
2
2
39.62
Bad/ver
y bad
Good
59.26
0
0.00
14
12.96
52.83
0.00
13.21
1.89
0.229/p=0.89139
58
Rehabilitation
Very
good
Table 2 presents correlation between the evaluation of
family midwifery services and age, degree and place of
domicile.
56
5.66
χ²/p
20.00% 15.00%
70
60.00%
Did not
use
4
5.00%
6
68
%
8
2
24
%
0.661/p=0.88211
78
2
N
0.510/p=0.77471
0.00
N
%
Countryside
0.002/p=0.99868
43.75
C-section
37.93% 18.39%
3.13
Natural
% 17.24% 26.44%
Bad/
Very
bad
Good
34
32
53.13
66
34.38
46
N
0.00
30
%
62.50
N
0
7.69%
28
30.77%
2
% 17.95% 43.59%
22
6
0
24
N
City
2.512/p=0.47309
40
34
Higher
0.217/p=0.89674
1.476/p=0.68777
54
14
2≤
χ²/p
Very
good
49.06
N
36.76% 23.53%
6.347312
p=0.0958
% 13.24% 26.47%
Did not
use
0.00
32
45.28
50
2
36
1
Bad/
very
bad
6
18
30.43% 17.39%
Good
0
8
Un-married
N
Number of
children
14
1.535/p=0.46414
48
14
Nursing
10
Services provided by family midwife
N
35.71% 17.86%
Very
good
Treatment
% 13.10% 33.33%
1.096333
p=0.7779
Married
% 21.74% 30.43%
Type of delivery
30
8.847212
p=0.0314
Marital status
χ²/p
60
1.85
56
4
22
3.70
N
21.74% 26.09%
50.00
43.48%
Did not
use
0
8.70%
12
0.00
%
10
50
20
46.30
4
0
N
Bad/
Very
bad
0.00
Countrysid
e
38.10% 15.48%
4.347480
p=0.2263
Domicile
% 16.67% 29.76%
Good
44.44
26
0
64
0.00
50
60
28
City
Place of domicile
0.334/p=0.84589
55.56
N
34.67% 18.67%
Diagnostics
% 12.00% 34.67%
69.81
Very
good
Higher
%
Primary/vocati
onal.
secondary
N
%
0.530/p=0.76717
16.98
χ²/p
0.00
28
13.21
52
Did not
use
30.19
52
34.38% 15.63%
62.26
18
10
5.66
N
22
Bad/
Very
bad
0
14
18
Primary/ N
vocational.
secondary % 21.88% 28.13%
33.33% 12.96%
14
Degree
% 14.81% 38.89%
Good
18
14
N
0
36
Very
good
%
Degree
27 ≤
14
42
Health promotion & prevention of diseases
16
27 ≥
2.733710
p=0.4345
N
35.85% 22.64%
1.873591
p=0.5990
Age
% 15.09% 26.42%
36
N
33.96
24
≤ 26
74
38
26 ≥
32
28
Evaluation of
services
χ²
p
66
16
4≤
6
3
52
2
6
N
1
42
Variables
5.66
Number of patronage visits
84
Age
3.925/p=0.14045
● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No.1/2016 ●
Table 3. Correlation between evaluation of family midwifery services and marital status, number of children and type
of delivery
χ²/p
25.00
10
30
75.00
0.00
0
0
0.00
32.18
51.72
20.00
70.00
0.00
10.00
8
28
0
4
16.09
64.37
0.00
30.00
70.00
0.00
0.00
12
28
0
0
27.59
65.52
2.30
4.60
0.00
65.00
0.00
35.00
0
26
0
14
5.75
45.98
0.00
48.28
10
0
84
80
0.00
0
0.00
24
60.00
40.00
0
0.00
54.02
16
3.45
6
0
94
74
0.00
53.85
42.53
5.13
51.28
0.00
43.59
0.00
0
46.15
0
2.963/p=0.22726
42
36
19.54
0
34
48
4
8
114
25.64
5.13
2.56
66.67
4
2
4
0
34
40
4.41
48.53
0.00
4.41
39.71
6
54
0
76
1.462/p=0.69099
47.06
6
0
64
66
8.70
52.17
0.00
39.13
8.70
43.48
0.00
47.83
0.00
0
28
28
0.00
17.95
112
0
14
20
0.00
4.41
52
29.41
0
6
66.18
40
0.00
8.70
90
26.09
65.22
8
30
0
4
4
24
0
18
4
20
0
22
3.925/p=0.14045
16.09
56
0.00
10.26
17.95
64.10
14
0.00
17.65
50
16.18
0
24
66.18
22
0.00
21.74
90
13.04
65.22
90
30.77
58.97
28
0
8
46
30.88
0.00
0
20
14.71
54.41
42
0.00
13.04
74
30.43
56.52
30.95
14
26
55.95
0
6
0
10
30
17.86
65.48
28.57
66.67
3.57
48.81
1.19
41.67
0.00
0
Did not
use
0.130/p=0.93694
57.14
2
Bad/Very
bad
96
Good
1.339/p=0.51172
70
Very
good
1.060/p=0.58861
0.00
χ²/p
0.00
0
Did not
use
3.840/p=0.27926
47.62
6
Bad/Very
bad
80
Good
2.519/p=0.47186
82
Very
good
0.063/p=0.96858
55.88
χ²/p
%
Csection
N
%
5.061/p=0.07960
2.38
4
Did not
use
N
2.38
48
Bad/Very
bad
4
Nursing
Good
%
0.467/p=0.79170
0.510/p=0.77471
112
Very
good
Treatment
Services provided by the family midwife
χ²/p
N
Natural
0.00
Did not
use
%
Delivery
16.67
30
110
Bad/
Very bad
0
Good
0.002/p=0.99868
28
Diagnostics
Very
good
N
0.00
Did not
use
%
6
Bad/Very
bad
%
2≤
1
13.10
94
52
N
0
Good
N
22
Health promotion and prevention of diseases
Very
good
Married
Nonmarried
χ²/p
IV. DISCUSSION
The family midwife has a duty to make four or more patronage visits in postnatal period, depending on the mother’
s individual needs [8]. According to Bączek et al. [9],
a family midwife is the first person who can recognise
mother’s and baby’s health problems. In addition, Zydorek
et al. [8] claim that patronage visits, apart from enabling
observation of the mother’s labour and baby development,
give a chance to evaluate the environment in which mother
and her baby are staying. Based on the own research it
transpires that midwives usually made three patronage visits, significantly more frequently in the case of women who
gave birth naturally than those after C-section (p<0,05).
During patronage visits the family midwife takes up actions in the field of health promotion and prevention
measures, nursing as well as diagnostics, treatment and
rehabilitation services [10,12]. She performs her duties
usually in cooperation with other primary care practitioners. According to Biskupska and Niewiadomski [13], the
quality of this cooperation is usually evaluated as ‘good’ or
‘very good’ with regard to the care over women, newly
born babies and infants until the second month after birth.
As part of health promotion and prevention programme, the
family midwife should provide a newly delivered mother
with knowledge about her own and baby’s food regime in
postnatal period, the right course of labour, early symptoms
of its effects, lowered mood after delivery, and baby blues.
She should also promote breast feeding and advise on lactation-related issues. Midwives also share knowledge with
Socio-demographic variables
Number of children
Marital status
Rehabilitation
Based on the research analysis, it transpires that the majority of women evaluated health promoting and disease
preventing, as well as diagnostics, care, treatment and rehabilitation services provided during patronage visits as
good. The smallest number of women evaluated these services as ‘bad’ or ‘very bad’. Nevertheless, no statistically
significant correlation was observed between evaluation of
midwifery services and age, degree, or place of domicile
(p>0.05).
Table 3 presents the correlation between evaluation of
family midwifery services and a marital status, number of
children, and type of delivery.
The research indicates that the vast majority of women
evaluated the services provided by the community midwives as ‘good’. Some women ‘did not use’ such services,
and a low percentage of women considered them as ‘bad’
or ‘very bad’. No statistically significant correlation was
observed between evaluation of family midwifery services
provided during patronage visits and marital status, number
of children, and type of delivery (p>0,05).
29
1.984/p=0.37079
0.819/p=0.66374
● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No.1/2016 ●
women by instructing them on the baby’s nursing, its proper psychosomatic development, as well as on prevention of
hip joint pathologies, allergies, infectious diseases and immunisation schedules for new-borns. In addition, they
should also offer counselling with regard to possibilities for
getting support in various life stages and phases [11,14,15].
The analysis of own research shows that the services related to health promotion and disease prevention were evaluated as ‘good’ by 59.26% of the women aged 27 and older,
by 58.97% of the women with two and more children, and
by as much as 75% of those who underwent C-section.
Diagnostic services provided to women and their newborn children include an interview and evaluation of the
family members’ relation with a child, identification of
possible risk factors, mother’s mental state and her conscience, general physical and breast examination, temperature, pulse, blood tension, examination of the involution of
the uterus, physical examination of the new-born, its temperature and weight, evaluation of the child’s breathing,
umbilical cord stump healing, post-vaccination reactions,
verification of inborn reflexes, and assessment of transition
stages of the new-born [10,16]. Based on the own research,
it was stated that the highest percentage of women aged up
to 26 years old (69.81%), the women with one child
(66.18%), and those after C-section (70.00%) evaluated
diagnostic services provided by midwives as ‘good’.
The family midwife provides nursing and medical services to newly delivered mothers and new-borns, which
include: removing stitches from the groin or post-caesarean
wounds, treating the wound after episiotomy, perineal tear
and C-section, changing dressing, doing injections, administering medicines according to the doctor’s prescription,
treating cracked nipples, attending to the child’s umbilical
cord stump, bathing the baby, as well as assisting with the
feeding, dressing and diapering [11,16]. The own research
showed that women in postnatal period generally evaluated
nursing services provided by midwives as good. However,
5.13 % of the newly delivered mothers who had two or
more children, and 3.13 % of those with elementary, vocational or secondary degree evaluated them as ‘bad’ or ‘very
bad’.
The family midwife provides rehabilitation services aiming to liven up fresh mothers, both after natural delivery,
and C-section [11]. This part of the midwife’s responsibilities was highly evaluated also by the participants of the
own research.
The findings of the own research correspond with the data presented in 2011 NIK Report (The Supreme Chamber
of Control 2011 Report), according to which 95.5% of the
surveyed women evaluated the services provided by midwives during patronage visits as ‘good’ or ‘very good’ [17].
30
V. CONCLUSIONS
 Women in postnatal period evaluate the services
provided by community midwives as ‘good’ or
‘very good’.
 The number of patronage visits, particularly in the
group of women after C-section should grow.
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[5] Dzierżak-Postek E, Grzybowska K, Krauze M. Model opieki
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A, Frankowicz-Gasiul B, Kamieńska J, Olszewski J. Opieka
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