Klicka hr fr att ndra format p bakgrundsrubriken,Klicka hr fr att ndra format p bakgrundstexten,Niv tv,Niv tre,Niv fyra,Niv fem,*,Kyllike Christensson,*,Klicka hr fr att ndra format p bakgrundsrubriken,Klicka hr fr att ndra format p bakgrundstexten,Niv tv,Niv tre,Niv fyra,Niv fem,The global perspective of midwifery development,从全球视角看助产学的发展,Kyllike Christensson,RN,RM,PhD,Professor in,Reproductive,Health,2024-11-18,Kyllike Christensson,India late 17th century,印度，,17,世纪末,In the honour of a beloved wife who died during childbirth,深爱的妻子不幸在分娩中死去，建立了泰姬陵,The Development of the Swedish midwifery system,瑞典助产学的发展,1685 Queen Ulrika Eleonora decided to set up a Midwifery School,1685年,Ulrika Eleonora,女王决定设立助产士学校,1697 A book about obstetrics,Den Swenska wl-fwade Jord-Gumman,by Johan von Hoorn,1697年，Johan von Hoorn完成了一本关于产科学的著作,瑞典专业助产士,18/11/2024,Kyllike Christensson,3,Johan von Hoorn First textbook about midwifery,第一本关于助产学的教科书,1697,Den Swenska wlfwade Jord-Gumman,瑞典专业助产士,The Development of the Swedish midwifery system,cont.,瑞典助产学的发展（续）,1711 Code of practice and ethics for midwives in Stockholm,1711年，在斯德哥尔摩发布了助产士行为准则及道德规范,1712 The first 18 midwives registrated by Collegium Medicum,1712年，医学院首次录取了,18,位助产士学生,1751 Audit(Collegium Medicum)&National statistics of number of births and deaths and the cause of death,1751年，对出生人数、死亡人数及死因进行了全国性统计,2024-11-18,Kyllike Christensson,2024-11-18,Kyllike Christensson,100%,50%,20%,%deliveries assisted by a midwife,由助产士协助的分娩比例,Midwives trained with“life saving skills”,接受过专业训练的助产士,MMR,产妇死亡率,1890,1850,100,200,300,400,500,The relationship between maternal mortality and the assistance of professionally trained midwives at birth,Sweden 1850 90,产妇死亡率与专业助产士协助的分娩的关系，瑞典,185090,Death per,100 000,live births,每,10,万活产的死亡数,2024-11-18,Kyllike Christensson,The,Midwifes,logistics in a common rural area,助产士在农村地区的出行方式,2024-11-18,Kyllike Christensson,Prevalence of home deliveries,in Sweden,瑞典的家庭分娩率,1890 97%,1930 76%,1940 35%,1950 5.9%,Today 今 0.1%,Home deliveries in Low income countries=5 60%,在低收入国家，家庭分娩率可达,5%,至,60%,2024-11-18,Kyllike Christensson,Towards a Healthy Mother and Infant,为了健康的母亲和婴儿,As important the political will,重要的政治意愿,Recruitment,人才招聘,Educational system,教育系统,Legislation,立法,Salary,薪酬,Safety,安全,A professional trained midwife with the right to use obstetrical instruments since 1829,自,1829,年起，受过专业训练的助产士可以使用产科器具,2024-11-18,Kyllike Christensson,Actions to be taken towards a Healthy Mother,为了“健康母亲”所采取的行动,1987,The Safe Motherhood initiativ,e,TBA/Dai training,1987,年，“安全母亲”行动倡议,1997 Lesson learnt(Siri Lanka)Skilled attendance at birth,1997,年，斯里兰卡的案例 专业助产士协助分娩,2024-11-18,Kyllike Christensson,Towards a Healthy Mother and infant,为了更健康的母亲和婴儿,Each year more than 250 000 women die due to complications during pregnancy and/or childbirth,每年有超过,25,万女性死于孕期及分娩过程中的并发症,Maternal mortality rate(death/100 000 live births),每,10,万活产的死亡数：,Sweden,瑞典,4,USA,美国,17,China,中国,30,India,印度,190,Afghanistan,阿富汗,400,Sierra Leone,塞拉利昂,1100,“,Women are not dying because of diseases we cannot treat.,妇女并非死于那些无法治疗的疾病，,They are dying because societies have yet to make the decision that their lives are worth saving”,而是死于这个社会尚未下决心去承认她们生命的价值。,Prof.M.F.FathallaAssiet University,Egypt,2024-11-18,Kyllike Christensson,Maternal mortality and morbidity,产妇死亡率及发病率,low-income countries vs.Sweden,低收入国家,vs.,瑞典,Haemorrhage,大出血,Sepsis,败血症,Eclampsia,子痫,Obstructed labour,难产,Unsafe abortion,不安全的终止妊娠,Indirect causes(e.g.malaria,),间接原因（如疟疾）,Cardiovascular,心血管疾病,Stroke,脑卒中,Haemorrhage,大出血,Heart diseases,心脏病,Sepsis,败血症,Mental distress,精神损害,2024-11-18,Kyllike Christensson,The Swedish context-,The overall aim of Midwifery/Maternity and Newborn Health Care,瑞典的情况,助产学及母婴健康的总体目标,A healthy mother,健康的母亲,A healthy infant,健康的婴儿,A pleasant experience,愉快的体验,with as few intervention as possible,尽可能少的干预,Present distribution of various types of interventions,当前多种类型干预的分布,Of,unknown,effect,but,in good quality,research,program,Do more harm,than good,伤害多于获益,Do more good,than harm,获益多余伤害,Of unknown,effect not in,research setting,or in poor quality,research,效果未知,来源于非研究环境或不佳的研究环境,效果未知,来源于良好的研究项目,Midwifery research as a tool to evaluate current practices and improve maternity and new-born care,助产学研究是评估当前实践的工具，可以改善妇幼卫生服务质量,Up-right position,竖位分娩,Allow eating,允许进食,Non-pharmacological pain-relif,不用药物的疼痛缓解,Allowing birth companion,允许分娩陪伴,2024-11-18,Kyllike Christensson,2024-11-18,Kyllike Christensson,From home delivery towards institutional deliveries-risks to be considered,从在家分娩到医院分娩,同样存在诸多风险,Lancet,March 2005,4 million neonatal deaths/year,4 million stillbirths/year,每年四百万新生儿死亡、四百万死胎,Infections 36%,Preterm births 27%and Asphyxia 23%,36,%,感染，,27%,早产，,23%,窒息,Interventions with proven efficacy(universal)could avert 41-72%of neonatal deaths worldwide,有效的干预措施可以减少世界,41%-72%,的新生儿死亡,2024-11-18,Kyllike Christensson,The newborn infants needs,新生儿的需求,Skin-to-skin care vs.mother/infant separation,紧密关怀,vs.,母婴分离,Temperature,体温,Blood-glucoses,and,Metabolic,Adaptation,血葡萄糖和新陈代谢适应,Crying behaviour,哭泣行为,The Swe