Evaluation of services provided by community midwives to women in postnatal period

JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE No. 1/1 (-31) 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,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 1 newly delivered mothers. The survey was carried out with the of diagnostic poll method. The survey questionnaire, self-designed for the purposes of the paper, was d 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=.31). 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. Some women did not such services, and a low percentage of women considered them as or very. Conclusions. Women in postnatal period evaluate the services provided by community midwives as or very. The number of patronage visits, particularly in the group of women after C-section, should be increased. Key words - the provision of midwives, period postnatal. 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 1 położnic. Badanie przeprowadzono metodą sondażu diagnostycznego. Narzędzie awcze stanowił autorski kwestionariusz ankiety stworzony dla potrzeb pracy. Wyniki. Stwierdzono istotną statystycznie zależność pomiędzy liczbą przeprowadzonych wizyt patronażowych a sposobem ukończenia ostatniej ciąży (p=,31). W grupie anych kobiet po porodzie siłami natury położne rodzinne realizowały najczęściej trzy wizyty patronażowe natomiast u położnic po cięciu cesarskim najczęściej odbywały dwie wizyty. Z ań wynika, że zdecydowana większość anych 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 Obstetrical- Gynecological Nursing Faculty of Nursing and Health Sciences, Medical University, Lublin.A graduate of Obstetrics, Nursing Faculty of Nursing and Health Sciences, Medical University, Lublin Authors contributions to the article: 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.1/1 7 Sciences, Medical University of Lublin, Chodźki Str., PL-- 93 Lublin, Poland, e-mail: m.lewicka@umlub.pl II. MATERIALS AND METHODS Accepted for publication: January, 1. T 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,]. 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 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 [,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 [,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 11, 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 []. The aim of the paper was to evaluate the community/family midwifery services provided to women in postnatal period. The survey evaluating the family midwifery services provided to postnatal women was carried out via Ankietka.pl website. It was voluntary and anonymous, and d the diagnostic poll method, as well as the self-designed survey questionnaire as a research tool. The survey included 1 newly delivered mothers, who were divided into two age groups: up to years, and above 7. The women aged or less comprised 9.53 % (n=1), while those above 7 years of age 5.7% (n=). Within the group of surveyed women, the majority had a university degree (7.9 %, n=15), whereas.17 % (n=5) had secondary, and 3.7% (n=) primary or vocational degree. The vast majority lived in the city (7.5%, n=), the rest (1,5%, n=) in the countryside. The survey included 7.5%, (n=) married women and only 1.5% (n=) unmarried. Most of the surveyed women (3.55%) had one child (n=13), whereas.9% (n=) had two..5 % (n=1) of them had three, and.93%, (n=) of the surveyed women had four and more children. 1.31% of the respondents (n=17) gave birth naturally, whereas.9% (n=) underwent C-Section. The survey results were subject to statistical analysis. The level of significance was set up at p<,5, 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 3.5% (n=7) of the women, family/community midwives made usually three patronage visits. Two patronage visits were paid to 3.71% (n= 7) of the postnatal women, whereas four and more ones only to 17.7% (n= 3). 1.95% (n=3) 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=.31). In the group of women who gave birth naturally midwives made usually three patronage visits, whereas in the case of women after C- section, the number of visits was two.

5 5.7 55.5.5 7 5. 9 57.1 7.3 Rehabilitation 39.. 3.3 5.33 7 1.7 3. 5. 3.13.7 1.19.7 Type of delivery.71 p=.31 5. 5.3 3.75 7.7 7.5 5.17 Treatment 5 9. 5 5 3 53.13 7. 5.3 39.13 Number of children.3731 p=.95 5. 3.7 3.13 5.33 3.57.7 Marital status 1.9333 p=.7779 Services provided by family midwife 5. 1.5.5.7 3.57.35 Nursing 1.9 1.5 3.13 1.33.3. 7 7.37 3 5.5 1 7.7 11 5. 3 9.57 3 3.19 5.93 3.3 3 5.33.57 1.9 1 13.1. 1 15.3.7 1.7 1 1.7 Domicile.37 p=.3 Diagnostics 7 9.1 1.11 5.3 9 5.33 11 5. 3 5. 1.9 1.7 1.75 1. 3 17. 13. Degree 1.73591 p=.599 Age.73371 p=.35 Health promotion & prevention of diseases 1 13.1 1 1.9 1 15.3 1. 13.1 13. 5 5.3 59. 3 5.5 5. 9 55.95 5.5 3 33.9 3 7.7.13 3. 5 3.95 1 3.3 JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE No.1/1 Table 1. Correlation between the number of patronage visits and age, degree, place of domicile, marital status, number of children, and type of delivery Variables Number of patronage visits 1 3 N 1 3 % 15.9%.% 35.5%.% χ² p Table. Correlation between the evaluation of family midwifery services and age, degree and place of domicile Evaluation of services Socio-demographic variables Age Degree Place of domicile Primary/vocati 7 Countryside onal. Higher City secondary N % N % N % N % N % N % 7 Primary/ vocational. secondary N 1 3 1 % 1.1% 3.9% 33.33% 1.9% N 1 1 % 1.%.13% 3.3% 15.3% Higher N 5 5 % 1.% 3.7% 3.7%.7% χ²/p.53/p=.7717.33/p=.59 /p=.99 City Countrysid e Married N 5 % 1.7% 9.7% 3.1% 15.% N 1 1 %.7% 3.% 1.7%.9% N 5 3 % 13.1% 33.33% 35.71% 17.% χ²/p 1.535/p=.1.17/p=.97.51/p=.7771 Un-married N 1 1 1 % 1.7% 3.3% 3.3% 17.39% very 1 N 3 5 3 % 13.%.7% 3.7% 3.53% χ²/p 1.7/p=.777.51/p=.739.1/p=.11 N 1 3 % 17.95% 3.59% 3.77% 7.9% Natural N 3 3 % 17.%.% 37.93%.39% C-section N % 5.% % % 15.% χ²/p.9/p=.9139.39/p=.91 1.91/p=.33 Table presents correlation between the evaluation of family midwifery services and age, degree and place of domicile. ver y χ²/p 3.7/p=.111 1.15/p=.5753 3.95/p=.15

9 57.1 7.3 7 55. 53.5 9 5. Rehabilitation 7 1.7 3. 5 39.71 3.15 7.53 1 1.19.7.1 3.5 7. 39.13 7. 3 3.59. 1 35. Treatment.1 5.17.53 51. 5.9 5. 3.57.7.1 5.13 1 5.75 Services provided by the family midwife.3.7.1.5..3 5.13.3 Nursing 11.7 3 5. 9. 5.7 11 5.5 7.57.9 9.1 5. 7.59 1 3 1.7 1 1.7 17.5 1 17.95 3 19.5 1 Diagnostics 11 5. 3 5. 9. 5.1 11.37 7 3 17. 13. 1. 1 17.95 1.9 Health promotion and prevention of diseases 13.1 13. 1.71 1. 1.9 9 55.95 5.5 7 5.1 5.97 9 51.7 3 75. 5 3.95 1 3.3 3. 3.77 5 3. 1 5. JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE No.1/1 9 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. The smallest number of women evaluated these services as or very. Nevertheless, no statistically significant correlation was observed between evaluation of midwifery services and age, degree, or place of domicile (p>.5). 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. Some women did not such services, and a low percentage of women considered them as or very. 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>,5). Table 3. Correlation between evaluation of family midwifery services and marital status, number of children and type of delivery Socio-demographic variables Marital status Number of children Delivery C- Nonmarried Married 1 Natural section N % N % N % N % N % N % χ²/p /p=.99.7/p=.7917 5.1/p=.79 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 []. 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. [] 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<,5). 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 [1,1]. 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 or very 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 χ²/p.51/p=.7771.3/p=.95 1./p=.51 χ²/p.519/p=.7 3./p=.79 1./p=.999 χ²/p 1.339/p=.5117.13/p=.939.93/p=.7 χ²/p 3.95/p=.15 1.9/p=.3779.19/p=.37

JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE No.1/1 3 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 [11,1,15]. The analysis of own research shows that the services related to health promotion and disease prevention were evaluated as by 59.% of the women aged 7 and older, by 5.97% 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 [1,1]. Based on the own research, it was stated that the highest percentage of women aged up to years old (9.1%), the women with one child (.%), and those after C-section (7%) evaluated diagnostic services provided by midwives as. 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 [11,1]. The own research showed that women in postnatal period generally evaluated nursing services provided by midwives as. 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 or very. 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 11 NIK Report (The Supreme Chamber of Control 11 Report), according to which 95.5% of the surveyed women evaluated the services provided by midwives during patronage visits as or very [17]. V. CONCLUSIONS Women in postnatal period evaluate the services provided by community midwives as or very. The number of patronage visits, particularly in the group of women after C-section should grow. VI. REFERENCES [1] Augustyniuk K, Goldyn D, Kulesza-Brończyk B, Sienkiewicz A, Baryła-Pankiewicz E, i wsp. Satisfaction of newly delivered mothers with care provided in maternity wards evaluation study. JPHNMR 15; 1:39-. 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