GOOD AFTERNOON

HISTORY AND HISTORY AND CONTEMPARY CONTEMPARY PERSPECTIVESPERSPECTIVESSubmitted By:Submitted By:Archana BhattiArchana BhattiM.SC. 1M.SC. 1stst yr. yr.

Obstetrics word is come from a latin word Obstetrics word is come from a latin word

“ “OBSTETRIX”OBSTETRIX”

meansmeans

“ “MIDWIFE”MIDWIFE”

ORIGIN OF OBSTETRICSORIGIN OF OBSTETRICS

As we all know that birth is the complex final As we all know that birth is the complex final

act of nature’s greatest miracle i.e. formation act of nature’s greatest miracle i.e. formation and arrival of a child in the world. And the and arrival of a child in the world. And the science and art that deals with human science and art that deals with human reproduction is called Obstetrics.reproduction is called Obstetrics.

““SORANUS SORANUS OF EPHESUS”OF EPHESUS”

Is theIs the FATHER OF FATHER OF OBSTETRICSOBSTETRICS

He was the He was the first to write first to write about the about the Podalic Podalic Version.Version.

CONTD…CONTD…

Earlier man were not welcomed in this field. Earlier man were not welcomed in this field. During Middle Ages in Europe midwives were During Middle Ages in Europe midwives were of low types and executioner and barbers of low types and executioner and barbers were called to help with difficult were called to help with difficult deliveries.Later on in 16deliveries.Later on in 16thth &17 &17thth century century Ambroise Pare of Paris and Chamberlens Ambroise Pare of Paris and Chamberlens stimulate men to take interest in obstetrics.stimulate men to take interest in obstetrics.

HISTORY OF MIDWIFERY IN INDIA:HISTORY OF MIDWIFERY IN INDIA:

In Ancient India,care of women and practice In Ancient India,care of women and practice of Midwifery were totally in the hands of of Midwifery were totally in the hands of village dais.village dais.

Women were subject to the purdah system.Women were subject to the purdah system. The occupation of dais was hereditary and all The occupation of dais was hereditary and all

dais was from lower caste as the period of dais was from lower caste as the period of childbirth was considered a time of impurity.childbirth was considered a time of impurity.

The worst room in the household was alloted The worst room in the household was alloted for delivery.for delivery.

CONTD…

Dais gained their skill through observation Dais gained their skill through observation and practice.and practice.

And when dais could not handle the And when dais could not handle the situtation serious morbidity and mortality situtation serious morbidity and mortality were the result and these all were explained were the result and these all were explained as “Beyond human control phenomena.”as “Beyond human control phenomena.”

The historic taboo associated with the examination of female genitilia has long inhibited the science of gynaecology. This 1822 drawing by Jacques-Pierre Maygnier shows a "compromise" procedure, in which the physician is kneeling before the woman but cannot see her genitalia. Modern gynaecology has shed these inhibitions.

……DURING BRITISH INDIA:DURING BRITISH INDIA:

In 1900 A.D. Dr. Ida sophia Scudder after got In 1900 A.D. Dr. Ida sophia Scudder after got news from the village people that 3 women news from the village people that 3 women

died during delivery who were actually died during delivery who were actually calling her to help then she decided and calling her to help then she decided and started with Christian Medical College & started with Christian Medical College &

Hospital (CMCH) at Vellore.Later in 1950,the Hospital (CMCH) at Vellore.Later in 1950,the doors of CMC & H opened for male training.doors of CMC & H opened for male training.

CONTD…

In 1899,Zenana Bible and medical mission In 1899,Zenana Bible and medical mission started training of nurses.started training of nurses.

In 1883 Lady Dufferin came to India alloted In 1883 Lady Dufferin came to India alloted fund to start maternity hospitals and training fund to start maternity hospitals and training of nurses and midwives all over the country.of nurses and midwives all over the country.

It was with help of this Fund that Lady It was with help of this Fund that Lady Reading Health School was established in Reading Health School was established in 1918 at Delhi.1918 at Delhi.

MIDWIFERY IN INDEPENDENT INDIA:

In 1946,Bhore committee laid the foundation In 1946,Bhore committee laid the foundation for public health planning in India laid great for public health planning in India laid great stress on the need for qualified midwives and stress on the need for qualified midwives and health visitors.health visitors.

In 1947,INC combine the Nursing and In 1947,INC combine the Nursing and Midwifery courses into single course.Midwifery courses into single course.

In 1955,Shetty Committee recommended In 1955,Shetty Committee recommended training and posting ANMs in health services training and posting ANMs in health services with a qualification of class VIII & supervised with a qualification of class VIII & supervised by LHV.by LHV.

In 1959,Bischoff supported the training of In 1959,Bischoff supported the training of personnel.personnel.

CONTD…

ANMs for 3 yrs. And midwifery for 1 yr.ANMs for 3 yrs. And midwifery for 1 yr. In 1975,MPHW scheme launched by Kartar In 1975,MPHW scheme launched by Kartar

Singh Committee.Singh Committee. MPHW were registered as ANMs and were MPHW were registered as ANMs and were

designated as Female Health Workers ,posted designated as Female Health Workers ,posted at subcentres for 5000 rural population.at subcentres for 5000 rural population.

They supervise the deliveries conducted by They supervise the deliveries conducted by dias.dias.

HISTORICAL DEVELOPMENT IN HISTORICAL DEVELOPMENT IN OBSTETRICSOBSTETRICS In 1739,in London,Willam Smellie and his In 1739,in London,Willam Smellie and his

student Willam Hunter become obstetrican student Willam Hunter become obstetrican and work for the same.and work for the same.

In 1744,Willam Smellie introduce steel lock In 1744,Willam Smellie introduce steel lock forceps.forceps.

In 1752,Willam Smellie publish ‘Textbook of In 1752,Willam Smellie publish ‘Textbook of Obstetrics’.Obstetrics’.

In 1760,Puerperal fever was on peak in In 1760,Puerperal fever was on peak in London in Lying-in hospital.London in Lying-in hospital.

CONTD…CONTD…

On Jan 14On Jan 14thth,1794 first Cesarean operation ,1794 first Cesarean operation was performed by Dr. Jesse Benaett of was performed by Dr. Jesse Benaett of Virginia on his wife.Virginia on his wife.

First school of midwives was established at First school of midwives was established at Pare instigation at the hotel Dieu in Paris.Pare instigation at the hotel Dieu in Paris.

In 18In 18thth century National regulation of century National regulation of education and practice of midwifery begans.education and practice of midwifery begans.

CONTD…CONTD… In 1807,Samuel Bard publish first book on In 1807,Samuel Bard publish first book on

obstetrics on four stages of labour.obstetrics on four stages of labour. In 1847,Semmelweis,in Vienna,demonstrate In 1847,Semmelweis,in Vienna,demonstrate

that washing of hands in chlorine of lime that washing of hands in chlorine of lime solution before examining women in labor solution before examining women in labor reduce puerperal fever.Chloride of lime used reduce puerperal fever.Chloride of lime used as antiseptic.as antiseptic.

CONTD…CONTD… Obstetrical forceps was developed by Dr. Obstetrical forceps was developed by Dr.

Peter Chamberlen.In the past only Greeks Peter Chamberlen.In the past only Greeks used variety of hooks and tractors to deliver used variety of hooks and tractors to deliver dead fetus.dead fetus.

In 1853,Dr. James Y.Simpson of Glasgow In 1853,Dr. James Y.Simpson of Glasgow suceeded in introducing the use of suceeded in introducing the use of Chloroform anesthesia as an aid in obstetrics Chloroform anesthesia as an aid in obstetrics called “ERA OF MODERN OBSTETRICS”.called “ERA OF MODERN OBSTETRICS”.

CONTD…CONTD…

Then,Pinard Fetoscope was developed and Then,Pinard Fetoscope was developed and Ian Donald from Glasgow introduce Ian Donald from Glasgow introduce Ultrasound in Obstetrics.Ultrasound in Obstetrics.

In 1950,Fritz Fuch of Copenhagen performed In 1950,Fritz Fuch of Copenhagen performed Amniotomy identified the fetal cells present Amniotomy identified the fetal cells present in it which identify sex of the baby by barr in it which identify sex of the baby by barr bodies.bodies.

CONTD…CONTD…

Later on emphasis on Antenatal check-Later on emphasis on Antenatal check-ups,blood pressure,urine analysis was came ups,blood pressure,urine analysis was came in attention.in attention.

In 1892,Dr. Pierre Budin initiated consulation In 1892,Dr. Pierre Budin initiated consulation for nursing mothers.for nursing mothers.

In 1949,first world health organization expert In 1949,first world health organization expert committee on maternal child health met in committee on maternal child health met in Geneva.Geneva.

CONTD… In 1950,Oral contraceptives was introduce for In 1950,Oral contraceptives was introduce for

the control of fertility.the control of fertility. Then b-HCG tracing was done with chorion Then b-HCG tracing was done with chorion

villus sampling at 10villus sampling at 10thth wk. wk. Identification of IUGR was done by NS test.Identification of IUGR was done by NS test. Later on Raoul Palwer & Patrick steptol Later on Raoul Palwer & Patrick steptol

discover Laproscopic Sterlization.discover Laproscopic Sterlization. In 1960,Witness abortion get started.In 1960,Witness abortion get started.

CONTD…

1971 – MTP Act 1971 – MTP Act

1974 – Family Planning Services Incorporated 1974 – Family Planning Services Incorporated

In MCH CareIn MCH Care

1977 – Renaming Family Planning To Family 1977 – Renaming Family Planning To Family

WelfareWelfare

CONTD…

1978 – Expanded Programme on 1978 – Expanded Programme on

ImmunizationImmunization

1985 – Universal Immunization Programme1985 – Universal Immunization Programme

1992 – Child Survival& Safe Motherhood 1992 – Child Survival& Safe Motherhood

ProgrammeProgramme

CONTD…

1996 – Target Free Approach

1997 – RCH Programme Phase-1 (15-10-

1997)

2005 – RCH Programme Phase-2 (01-04-

2005)

CONTEMPARY PERSPECTIVE OF CONTEMPARY PERSPECTIVE OF OBSTETRICSOBSTETRICS In current view all the focus from obstetrics In current view all the focus from obstetrics

care shifted to perinatal care.care shifted to perinatal care. Advancement in Obstetrics care has reduces Advancement in Obstetrics care has reduces

the MMR.the MMR. Govt. has started programme to identify high Govt. has started programme to identify high

risk mothers.risk mothers. Training of health personnels,Allocation of Training of health personnels,Allocation of

facilities & equipment decreases MMR. facilities & equipment decreases MMR.

CONTD… MMR can be reduces:MMR can be reduces: Early registration of pregnancy.Early registration of pregnancy. Atleast three antenatal check-ups.Atleast three antenatal check-ups. Dietary supplements can correct anemia.Dietary supplements can correct anemia. Prevention of infection and haemorrhage Prevention of infection and haemorrhage

during puerperium.during puerperium. Prevention of complications e.g. Prevention of complications e.g.

Eccalmpsia,malpresentation,ruptured uterus.Eccalmpsia,malpresentation,ruptured uterus.

CONTD…CONTD…

Treatment of medical conditions e.g. hypertension,DM,TB.

Anti-malaria and tetnus prophylaxis. Clean delivery practice. Institutional deliveries for women with BOH

and risk factors. Promotion of family planning.

CONTD…CONTD…

MCH services has started which aims at MCH services has started which aims at reduction in morbidity and mortality rate of reduction in morbidity and mortality rate of mother and baby.mother and baby.

Baby friendly hospital scheme has launched Baby friendly hospital scheme has launched in 1993 for effective breastfeed to child.in 1993 for effective breastfeed to child.

Genetic counselling to the couples.Genetic counselling to the couples. Screen the mother for HIV.Screen the mother for HIV.

FUTURE EVIDENCE BASED PRACTICE:FUTURE EVIDENCE BASED PRACTICE:

Mapping of human genome and genetic Mapping of human genome and genetic research.research.

Use of intrauterine shunts.Use of intrauterine shunts. Aseptic techniques to be used during Aseptic techniques to be used during

PV,PROM.PV,PROM. Care of mother during labor.Care of mother during labor. Care after delivery for puerperium infections.Care after delivery for puerperium infections.

BIBLIOGRAPHY:BIBLIOGRAPHY: Nurse Midwifery Helen Varney 2Nurse Midwifery Helen Varney 2ndnd edition edition

page no.19-20page no.19-20 Obstetrics nursing Erna Ziegel/Carolyn Obstetrics nursing Erna Ziegel/Carolyn

conant van Blarcorn 6conant van Blarcorn 6thth edition page no. 771- edition page no. 771-797797

The Indian Journal of Nursing and Midwifery The Indian Journal of Nursing and Midwifery Vol 1,Number 3 Dec 1998Vol 1,Number 3 Dec 1998