日本 の助 産婦 が持 つ べ き実践 能 力 と責任 範 囲
<英
訳>
The
practical
skills
and resposibilities
that
a midwife
should
have
今 般,「 日本 の助 産 婦 が 持 つ べ き実 践 能 力 と責 任 範 囲 」 を英 訳 す る こ とに な りま した 。 この検 討 内 容 は1994年3月 の 日本 助 産 学 会 総 会 に お い て "将 来 の助 産 婦 の あ り方"を 検 討 し て も ら いた い との要 望 を受 け,理 事 会 で 「将 来 の助 産 婦 の あ り 方 委 員 会 」 を発 足 させ,6名 の委 員 で検 討 し答 申 した 内容 で す 。 理事 会 か ら は,21世 紀 の助 産 婦活 動 を展 望 し,現 行 の 助 産 婦 活 動 に と ら わ れ な い で,こ れ か らの 助 産 婦 の あ り方 を 自由 に創 意性 を もっ て検 討 す る よ う に と い う課題 で 諮 問 され ま し た。 委 員会 で は,助 産 婦 業 務 の 実 態 や助 産 婦 教 育 に 関 す る国 内 外 の 資 料 を収 集 し助産 婦 の 独 自性 を明 確 に し て,日 本 の 助 産 婦 のCore Competencies に な る こ とを 目標 に検 討 いた し ま した 。 大 枠 の 内 容 が検 討 で きた 時 点 で,関 連 職 者 の意 見 を 求 め建 設 的 な意 見 を加 味 して再 検 討 し,1998年12月 に理 事 会 に 「日本 の助 産 婦 が 持 つ べ き実践 能 力 と責 任 範 囲 」 と し て 答 申 い た し ま した 。 こ の 内 容 は, 1999年1月 の本 学 会 誌 第12巻 第2号 に掲 載 され ま した。 併 せ て,助 産 婦 に 関連 す る商 業 誌 に も掲 載 い た し ま した。 折 し も期 を 同 じ く し て,1999年5月 のICMマ ニ ラ大 会 にお い て 「基 本 的 助 産 婦 業 務 に必 須 な能 力 」 が 採 択 さ れ ま した 。ICMは 国 際 連 合 の 公 式 NGOの 地 位 を有 す る唯 一 の 国 際 助 産 婦 団 体 で あ り,世 界 中 の 家 族 の た め に安 全 な母 性 とプ ラ イ マ リ ・ヘ ル ス ケ ア の戦 略,お よび助 産 婦 の 定 義 と教 育 を支 持 す るす べ て の 国連 機 関 と密 接 に連 携 し て い る助 産 婦 の 国 際 団体 で す。 こ こで は 「助 産 婦 が 必 須 とす る能 力 」 は,助 産 婦 教 育 の発 展 を期 す る 者 に は そ の 指 針 と な り,行 政 や 政 策 立 案 者 に は "助 産 婦 とは""助 産 婦 とは何 をす る人"と 助 産 婦 を知 ら しめ る情 報 に な る と述 べ られ て い ます 。 そ こで本 学 会 に お い て も,日 本 の助 産 婦 が 時 代 の推 移 の 中 で何 を 目指 し,ど の よ う に母 性 と家 族 を対 象 に,安 全 でか つ プ ラ イ マ リ ・ヘ ル ス ケ ア を 意 図 した活 動 を 行 お う と し て い る の か を 明 示 し て,そ の必 須 能 力 を世 界 の助 産 婦 の 方 々 に も知 っ て も ら う とい う意 図 か ら英 訳 を行 い ま した 。 この 英 訳 は,ICM大 会 参 加 時 に 他 国 の助 産 婦 の 方 々 と,助 産 婦 の あ り方 や必 須 能 力 を検 討 す る 資 料 に した り,国 際 会 議 時 に 日本 の助 産 婦 活 動 を 紹 介 す る資 料 と して活 用 で きる よ うに と考 え ま し た。 助 産 婦 の必 須 能 力 も時 代 の要 請 に応 じて 逐 次 検 討 し改 善 して い く必 要 が あ り ます が,今 回 は1998 年12月 に報 告 した 内容 の英 訳 で す 。助 産 婦 の 皆 様 方 の有 意 義 な活 用 を期 待 して お ります 。 将 来 の 助 産 婦 の あ り方 委 員会 平 澤 美 恵 子,松 岡恵,江 角二 三 子,園 生 陽 子, 堀 内成 子,村 上 睦 子 日本助 産 学会 誌 第15巻 第1号(2001.8) 43
The practical skills and responsibilities that a midwife should have
The
practical
skills
and
responsibilities
that
a midwife
should
have
(draft proposal by Japan Academy of Midwifery, December 14, 1998)
Introduction
The mission of the midwife, as a professional dedicated to providing support for women, is to contribute to the health and welfare of women, their children and their families. The fun-damental professional stance of the midwife is given in the following 11 articles.
1 . The midwife is dedicated to providing support to women and promoting and protecting their rights.
2 . The midwife appreciates diversity in life styles, striving to provide care that is appropri-ate to her client's needs and accords with her client's wishes.
3 . The midwife provides information necessary for her client to make informed choices about the care she wants.
4 . The midwife practices with evidence-based techniques.
5 . The midwife takes responsibility for her decisions, which she makes on the basis of the ethical principles of her profession.
6 . The midwife engages in lifelong study on her own initiative in the interest of maintain-ing and improvmaintain-ing her requisite practical skills.
7 . The midwife accumulates practical data for research purposes, evaluates results and applies her findings to her practice.
8 . The midwife has respect for and cooperates with colleagues and specialists in other fields who also provide care to her clients.
9 . The midwife has professional responsibility for the training of midwives having less experience than herself.
10. The midwife provides consultation in reproductive health and reproductive rights as appropriate to the health needs and life stage of her client.
11. The midwife takes full responsibility for providing the following prenatal care, within the defined scope of her profession.
(1) Overseeing the client's health and providing care in accordance with the needs of the client and her newborn or older infant, as long as there no irregularities occur during the pregnancy, delivery or postpartum periods.
(2) In cases when irregularities in the birth require emergency measures, providing care to the client according to her needs. In such situations, the midwife administers medical or medical support care* according to standards established by prior consultation with a physician on tasks falling within the scope of those permitted the midwife.
* Note Medical support care is defined as tasks carried out in accordance with standards set out upon consultation with a physician.
(3) Taking appropriate emergency measures in the event of emergencies that endanger the life of the mother or the child.
日本助 産 学 会誌 第15巻 第1号(2001.8) 44
(4) In cases requiring medical supervision, the midwife performs as a part of the medical team in accordance with the doctor's instructions and provides care to the client and
her family in accordance with their needs.
I Care and scope of responsibilities during pregnancy
A. Care to the client and family and scope of responsibilities
The midwife conducts examinations to confirm pregnancy and other examinations through-out pregnancy, records the history of the pregnancy and has responsibility for overseeing the health of the client and the client's family. These responsibilities include assisting the client and her family to provide living conditions conductive to good physical and mental health and helping them prepare for parenthood. This can be done using techniques of counseling, education or by other means that establish good communication. This support involves the preparation, implementation and evaluation of a plan that reflects the client's intentions and wishes and is based on an assessment of such factors as past pregnancies and birth, the cli-ent's experience with child care, her living environment, personal history, family relations, network of support by family or others, emotional changes occurring with pregnancy and maternal behavior.
1 . Examination to confirm pregnancy
(1) Assessment through questioning the client about her condition (2) Assessment by the basal body temperature method
(3) Use of reagent to test for immunological pregnancy reaction (4) Assessment by bimanual palpation
(5) Ultrasonic method (abdominal, vaginal) 2. Examination for stage of pregnancy
(1) Menstrual history (2) Fundal height (3) Physical examination (4) Ultrasonic method
3 . Examination for evaluation of state of pregnancy to date (general pregnancy screening) (1) General condition of the client
Questioning the client about her physical condition, external examination, ment, internal examination
(2) Condition of the embryo, fetal movement patterns, CTG, ultrasonic method (positions of embryo and placenta, development of embryo, amniotic fluid volume)
(3) Clinical examinations
Measurement of blood pressure and protein/sugar content of urine, analysis (standard blood test, STD tests)
4. Psycho-social examination of client (1) Emotional state during pregnancy
(2) Maternal behavior
(3) Changes in sexual consciousness and behavior
(4) Network of support from family and/or others (5) Living environment and health related habits
(6) Occupation
The practical skills and responsibilities that a midwife should have
5 . Examinations concerned with maintaining a well-balanced daily life during pregnancy
and providing care that takes account of the client's decisions and preferences
(1) Assessment of the client's self-care competence, providing support appropriate to the level of competence
(2) Preventive care and care to maintain or improve health as appropriate to the client's physical condition and care appropriate to any deviate situations that may exist
- Assessment of and counseling concerning everyday activities (including work and sports)
- Assessment of and counseling concerning nutrition
- Assessment of and counseling concerning minor troubles
- Support for psychologically or socially at-risk clients (unmarried , etc.) - Assessment of and counseling concerning consciousness about breast feeding
- Counseling concerning emotional reactions to psychological and social circumstances
(3) Assessment of symptoms of unhealthy deviations
- If assessment confirms risks or abnormalities associated with pregnancy , give over the task of diagnosis and treatment to a physician
(4) Providing client with information on public and private systems that provide financial support
6. Providing instruction to client, her husband and family about preparing for birth and paring for parenthood
(1) Assessment of topics concerned with development during pregnancy and planning, ducting and evaluating individual or group classes
(2) Planning, conducting and evaluating classes about preparing for birth
(3) Planning, conducting and evaluating classes about preparing for parenthood
7 . Care to the client and her family in emotional crisis due to miscarriage, premature birth, abnormality of fetus, intrauterine fetal death or babies dying during or after birth
(1) Providing explanations to the client or family as necessary, in accordance with their needs and helping them to achieve realistic understanding of the situation
(2) Support for giving expression to emotion
(3) Helping to establish bonding with children having disabilities
B. Prenatal testing and support for resulting decisions made by the client or family The midwife provides up-to-date information concerning prenatal testing to the client or her family, who may have anxiety concerning the health of the fetus. The midwife provides care during prenatal testing and provides moral support during the period leading up to the testing. In providing this support, the midwife gives consideration to the quality of life and welfare of the fetus, the client and her family and cooperates with other specialists such as doctors, clinical psychologists, medical social workers, medical technicians and counselors to provide second opinions, etc.
Midwives who provide support in this area receive education in the necessary specialties to maintain a satisfactory level of competence.
1 . Providing information based on up-to-date research
(1) Objectives of prenatal testing, the types, methods and accuracy of the tests involved and predictable risks
(2) Types of treatment available in cases when fetal abnormalities are found, their tives, methods, success rates, foreseeable dangers, etc.
(3) Types of treatment available in cases when fetal abnormalities are not found, their objectives, methods, success rates, foreseeable dangers, etc.
(4) Government measures and activities by private groups in support of child care. ing counseling and moral support regarding decisions made during the course of
natal testing
2. Provides counseling and moral support as necessary to assist the client's decision-making
while awaiting results from prenatal examinations and thereafter (1) Decision to or not to undergo testing
(2) Decisions regarding abnormalities found by testing - Continuing pregnancy , abortion, treatment of fetus
3. Providing counseling concerning emotional burdens incurred in the course of prenatal ting and providing continuing support following birth, care and the next pregnancy
(1) Moral support
- Factors contributing to emotional burdens include restrictions on the client's time , invasion of her privacy, loss of self esteem, feelings of guilt, inferiority, emotional
injury, losses, conflicts, etc.
4. Providing information concerning economic burdens incurred through prenatal testing and treatment that might be called for and on available social resources
5. Providing support and counseling, primarily in the areas of genetics, to women having a history of pregnancy or birth of abnormal babies or women not pregnant but having
anxiety concerning the health of their children
II Care during birth and scope of responsibility
Regardless of the setting in which the birth occurs the midwife diagnoses the process of delivery, applies appropriate midwifery techniques during delivery to insure the safety of mother and child, supports family members in obtaining a satisfactory experience of the birth and has full responsibility for management of the care given her client. The midwife provides psychological support by saying the appropriate thing at the appropriate time or through non-verbal communication, encourages her client to breath in the most comfortable way, gives massage, counter-pressure and other forms of care through physical contact, assists in expulsion of the fetus, provides perineal protection, and assists the neonate to begin breathing. After birth, the midwife discusses and evaluates with her client their respec-tive roles in the birth.
1 . Examination at the outset of delivery (1) Discussion with the woman
(2) Symptoms of the onset of labor 2. Examination of the progress of delivery
(1) Assessment based on history of the pregnancy and related factors
(2) Physical examination (external examination, monitoring position of fetal pulse as fetus descends, measurement of contractions by abdominal palpation and the effectiveness of
this method
(3) Overall physical changes (sweating, facial expression, verbalizations, actions, position, etc.)
(4) Internal examination (cervical dilation, effacement, presenting part, descent of fetus, rotation, presence or absence of forewaters, position and hardness of cervix,
The practical skills and responsibilities that a midwife should have
phalopelvic disproportion, etc.)
(5) Interpretation of data from electronic fetal monitor, etc. 3 . Examination of condition of the client and fetus
Assessment of the client's health
(1) Assessment of fetus
- Characteristics of fetal pulse rate
, fetal movement, interpretation of data from tronic fetal monitor, ultrasonic testing (amniotic fluid, estimation of size of fetus, placenta praevia, etc.
(2) Assessment of client
- Degree of physical exhaustion , mental and emotional state, actions taken to ate labor pain, etc.
4 . Attending to the client and her family during delivery
(1) Care that satisfies basic needs and maximizes comfort.
- Supplemental solid and liquid nutritional intake , elimination, bodily position, resting, maintaining cleanliness, attention to environment, communication with family, etc.
(2) Techniques for easing labor pain
- Relaxation , breathing techniques, massage, counter-pressure, maintaining warmth, aroma therapy, warm baths, foot baths, etc.
(3) Techniques for preparing body and mind for delivery, explaining about the prospects for the delivery, assessment and adjustment of energy balance, selection of the best
position to facilitate delivery, assessing of strength and encouraging resting, support
for family member participation
(4) Providing information about medical procedures taken during delivery (use of drugs, birth expediting techniques etc.) and act in accordance with choices made by the client
(5) Observing emotional reactions of family members and supporting the experience of
birth by the client and her family
5. Prevention and early discovery of abnormalities in mother and/or child in the course of delivery
(1) Assessment of deviation from the norm
- Mental and physical state of client , monitoring of delivery by partogram, abnormal labor and fetal heart patterns, time of membrane rupture and amount and
teristics of amniotic fluid, time and amount of bleeding by the mother, fetal
descent and rotation, etc.
(2) Application and interpretation of necessary tests at time of delivery
- Biochemical tests (liver functions , coagulation, blood count, CRP) , CST, ultrasonic method, continuous fetal monitoring
6 . Assisting natural, vaginal delivery
(1) Respecting the client's right to have her baby as she wishes
(2) Assisting cooperative actions between the client and her family
(3) Assistance that provides for application of emergency measures if they are needed 7. Identification of abnormalities when they occur and giving emergency treatment
(1) Observation of general condition (physical condition and mental) and measurement of vital signs ECG, blood pressure, etc.)
(2) Decision-making when abnormalities occur, appropriate intervention and notifying sician
- Resuscitation of the embryo , changing supine position when signs of low blood sure appear, measures to prevent rapid drop in intrauterine pressure, measures
against hyperventilation
(3) Kristeller's expression, placental expression, episiotomy and suture (4) Resuscitation of compromised neonate
- Maintaining warmth
, inducing respiration and insuring a clear airway, manual ficial respiration, tracheal aspiration, heart massage, etc.
(5) Measures against bleeding during delivery
- Applying pressure using both hands , cervical counter-pressure, insertion of IV, shock position
(6) Measures against eclampsia - Insuring a clear airway
, insuring that the client won't fall and shielding her from disturbances, insertion of IV, fetal monitoring
(7) Assistance in breech delivery during emergency
(8) Introduction of techniques to expedite birth
- Kristeller's expression
, vacuum extraction, delivery by forceps, cesarean section - Insertion of IV , administration of drugs and suturing of the perineum in accordance
with covenant with doctor concerning administration of emergency measures 8 . Acting on the basis of appropriate decisions taken as part of the medical team when
abnormal situations arise
(1) Summoning the necessary personnel (2) Roles and coordinated action
- Contacting physician , contacting nurses in hospitals (including request for tion)
(3) Contacting and dealing with family members, giving explanations to the client and her family
(4) Establishing contact with and working with persons in related fields
9 . Determination of necessity for transferring the client to medical facility when ities arise and taking appropriate action in conducting the transfer
(1) Contacting and working with associated medical institution
(2) Sharing of information
(3) Providing continuing care
(4) After the emergency, mutual evaluation of the case and the care provided 10. Evaluation of delivery
- After the delivery , engage in mutual role evaluations with the mother III Postnatal care of mother and baby and scope of responsibilities
A. Postnatal care to the client and scope of responsibilities
The midwife conducts examinations and gives care pertaining to physical recovery until the end of breast feeding (about 18 months after birth) and has responsibility for health man-agement, including breast feeding.
Support is given for the client's adjustment to her own emotional and psychological changes, her change in social status, sexual changes and support for her new experiences with a view to helping establish her autonomy as a mother. In addition, support is provided to family members with a view to deepening ties between mother and child and mother- fam-ily ties.
The practical skills and responsibilities that a midwife should have
1 . Postnatal examinations
Examinations are to be conducted daily while the client is at the birth facility, upon departure from the birth facility, during home visits and one month after birth.
Postnatal assessment
(1) Screening related to general condition (2) State of recovery of the uterus
- Palpation , bimanual palpation
(3) Properties and quantity of lochia (4) Condition of vulva and anus
- Condition of scars , redness or swelling (5) Condition of breasts
- Development of lacteal glands , condition of breasts and nipples, condition of tion, condition of breast feeding, whether or not there are problems
2. Diagnosis of psychological and social aspects of motherhood
Psychological and social evaluation
(1) State of the health of family members, financial state, human relationships, physical environment
(2) Child care history : parent-child relationship
(3) Present mental state
- Facial expressions , verbal and behavioral characteristics, sleeping and eating habits, etc.
(4) Acceptance of pregnancy (whether positive or negative)
(5) Acceptance of the delivery (whether positive or negative) - Talking out the delivery experience
(6) Clients whose pregnancies involve psychological or physical risk (7) Gap between expectation toward the new baby and reality
3 . Giving the client assistance commensurate with the level of her physical recovery from childbirth to increase her ability to care for herself and to learn the fundamentals of
child-raising.
(1) Care that satisfies basic needs and creates comfort.
- Intake of solid and liquid nourishment , elimination, body position, resting, exercise, maintaining cleanliness, provision for needs in the home environment,
tion with family
(2) Care that promotes learning the fundamentals of child-raising
- Providing the physical environment needed for the mother to have contact with her newborn baby
- Assisting the mother to learn the infant's daily pattern of physiological changes - Assisting the mother in learning the fundamentals of care for the infant
(3) Assisting the mother become accustomed to the rhythms of her new life with her baby
4 . Identifying deviation from standard pattern of recovery from birth and giving ate care
(1) Insufficient adaption due to inability to lead an everyday life commensurate with state of physical recovery from childbirth
- Incomplete recovery of the uterus , toxemia aftereffects, bleeding, infection, soreness of vulva
(2) Methods of promoting postnatal recovery - Helping to cope with discomfort
, exercises to strengthen the pelvic floor muscles
(3) Assessment of anxiety caused by the client's child care methods and providing moral support for "maternity blues"
5 . Assisting with breast feeding
(1) Assessment of the client's will to breast feed
(2) Assessment of and giving advice concerning the family's understanding of breast ing
(3) Assistance aimed at enabling the client to care for herself, based on examination of the state of her breasts
- Stimulation or suppression of lactation , dealing with troubles
(4) Identification of the state of the child's development (weight increase, behavior, etc) and responding appropriately
(5) Assessment of and giving advice concerning the client's living environment and her use of social resources according to her working needs
(6) Formation of a human network to support continued breast feeding
(7) Providing information based on up-to-date research about breast feeding 6. Giving support to mothers who cannot or will not breast feed
(1) Giving support to the mother who for some reason did not have the option of breast feeding from the time of pregnancy
(2) Giving support to the mother who for some reason became unable to breast feed after birth
(3) Giving support to the mother who chooses not to breast feed B. Care to the neonate and scope of responsibilities
The midwife's responsibilities to the neonate are to assess the baby's special needs as determined by the pregnancy and delivery, to enable physiological adaption to life outside the womb and to manage care most beneficial to the neonate's mental and physical health.
The midwife helps enable the mother and family to provide the neonate with appropriate care throughout all stages of growth.
1 . Assessment of transition to life outside the womb and providing care
(1) Reviewing the course of the pregnancy and delivery to determine the state of the mother's health and her living habits
- Physiological , social and psychological risk factors (2) Assessment and care immediately after birth
- Evaluation of state of health
* Assessment of Apgar score, breathing, congenital anomaly , check of umbilical blood vessels, assessment of placental conditions and measurement, external
injuries, number of weeks of gestation and signs of maturity, bodily
ments, reactions, movement
- Assistance for making the transition from the womb to the new environment * Maintenance of warmth, insuring a clear airway, sleeping position
- Care as appropriate to the ways in which the parents express their interest in the new baby
(3) Assessment and care within the first two hours after birth - Evaluation of state of health
The practical skills and responsibilities that a midwife should have
* Physical evaluation, number of weeks of gestation, signs of maturity, vital signs, first bowel movement/urination, blood sugar level (as necessary)
* Providing a warm environment
* Prevention of infection (eye drops , cutting of cord, sterilization and cleaning up * Assessment with first breast feeding, within 30 minutes after birth
(4) Assessment of parents' actions to bond with the neonate and providing care that encourages bonding
- Evaluation of bonding behavior
* Active verbal and non-verbal bonding expression toward the neonate * Providing environment that facilitates the parents' bonding behavior 2. Conducting assessment transition to life outside the womb and providing care
(1) Physiological assessment
- Confirmation of adaptive phenomena , weighing, defecation and urination, vital signs (2) Screening tests
- Inherited metabolic abnormality , congenital hip dislocation, measurement of cutaneous bilirubin, total serum bilirubin, neurological assessment, Moro's reflex
(3) Assessment of parental child-raising capability and assisting parents in child care
- Advice on formation of child care roles
- Assessment of growth and development as the basis for child care
- Advice on child-raising techniques and support for development of child-raising
capability
- Evaluation of child-raising capability
* Attachment of parents to the neonate during postnatal confinement * Identification of parental behavior
* Understanding of the parents' about infant development
* Continuing plan for managing the health of the neonate
* Understanding of the parents concerning early discovery of sickness in the baby - Understanding of the neonate's needs
* State of attachment to the unborn child at the time of delivery * Physiological needs of the neonate
* Identification of characteristics of the neonate contributing to parental ment
* Physical condition of the neonate as it affects parental attachment
(4) Support for efforts to establish communication with the child
- Providing empathetic support at the emotional level to the mother - Support that takes into account the joys and rigors of child-raising 3. Support to mother, child and family one month after birth
(1) Cooperation between health clinic or center and the maternity facility
(2) Visits to mother and child and telephone counseling during the period of confinement C. Care for high risk mothers and infants and scope of responsibility
The midwife has responsibility for giving ongoing support to the mother and family of high risk infants (such as very early pre-term babies saved by advanced medical techniques) for about the first year after birth to enable them to give the necessary care to ensure the baby's attainment of development standards.
The support includes follow-up with the purpose of preventing mistreatment and is con-ducted in cooperation with midwife at the maternity facilities or with public health nurses or
welfare personnel in the community who work to establish consumer networks. 1 . Providing support to ease mental shock to the parents
2. Providing support for formation of parental attachment
(1) Providing support to ease mental shock to the parents
(2) Laying the groundwork to enable parents to express love for the neonate
* Open system , early breast feeding, early physical contact (kangaroo care, etc.), participation in child care
3 . Establishment of system of care within the framework of the advanced medical ment for the new baby to enable the parents to participate
(1) Continuous care
(2) Networking between medical and health and welfare systems (3) Home visits
(4) Formation of consumer network
4 . Being fully receptive to and providing support for the family's plans for the next nancy
IV Care to women and scope of responsibility
The midwife provides support to the woman to enable her to take charge of management of the maintenance and improvement of her own health. Specifically, she has responsibility for dealing with a wide variety of problems in the areas of reproductive health and repro-ductive rights throughout all of women's life stages by giving counseling, engaging in educa-tional activities, disseminating information, giving classes, etc.
In engaging in these activities, the midwife guarantees the rights of the individual's free-dom of choice and privacy, the right to receive education and information concerning repro-ductive health and reproductive rights.
Midwives who engage in these activities receive the necessary specialized postgraduate edu-cation and thereafter maintain a satisfactory level of competence in the area.
A. Support to adolescent women
The midwife provides support to adolescent women with understanding of the physical and psychological adjustments that come with secondary sexual characteristics unique to this period, providing appropriate advice and instruction to prepare the adolescent women to face normal growth and development.
In providing her support, the midwife conducts assessments of the subject's understanding of her stage of development, her ability to make decisions, think things through, express her-self and do things for herher-self. The midwife observes the subject's psychological changes and crises, physical development and appearance of secondary sexual characteristics and endeavors to detect early signs of disorders in developing sexual functions. She has under-standing about how easy it is to slip into problematical behavior patterns during adolescence. She assesses deviation from a healthy condition. On the basis of this she consults with health and medical institutions and cooperates with the families, partners, schools and communities of adolescent women to give support for their needs in improving health.
1 . Assessment of state of body development in accordance with age
- Height , weight, breast development, body hair, overall body development, tion
The practical skills and responsibilities that a midwife should have
2 . In cases of delayed appearance of secondary sex characteristics, decides if medical vention is necessary and, if it is, gives referral to a doctor.
3 . Assesses everyday living habits as concerned with growth and development and provides necessary support.
- Eating and sleeping habits
, exercise, staying warm, smoking, alcohol, drugs
4 . Provides counseling to women having the special problems of adolescence and, if sary, provides support to family or teachers dealing with problems related to adolescent
women.
- Changes in body image , emergence of secondary sex characteristics, establishment
of sexual identity, anxiety about the future, anxiety about becoming independent,
relations with peers, interest in the opposite sex, control of sexual behavior, lion against parents, school, adult society, self-esteem
5 . Provides information about human sexual functions and behavior in the home, school and community in appropriate settings, making use of educational material and other persons
qualified to give instruction in this area. In addition, provides support for educating
lescent women to responsibly make their own decisions about sex and to be tolerant of
diversity in decisions concerning sex made by other individuals.
6 . Provides support for adolescent women having reproductive capability and their partners in learning about the respective physiological and psychological aspects of man's and
woman's sexuality, respect for human rights, the concept of partnership, family planning,
the running of a household, preparing for parenthood
7 . Participates in community and school activities against sexual violence
8 . Determines whether medical intervention in needed by victims of sexual violence, ring them to the appropriate institutions, and providing continuing support in cooperation
with counselors, schools, guardians, etc.
9. Provides information to adolescent women and their partners who do not have financial independence that is necessary for their understanding of cycles of repeated pregnancies,
birth and child care. Provides sufficient information for making informed decisions about termination of pregnancy. Provides ongoing assistance in obtaining understanding and
support from guardians, partners, medical and welfare institutions, school and the
munity at large.
B. Support for Family Planning
The midwife prepares individualized family planning programs based on the beliefs of her clients concerning reproductive health and reproductive rights and gives support for im-plementing those programs. This support consists of information, instructions, assistance and evaluation of measures for contraception or facilitating pregnancy based on an assessment of the client's age, health, understanding and ability to implement the plan.
1 . Assesses the woman and her partner from the physical, psychological and social aspects, providing a family planning program appropriate to this assessment and giving support
in its implementation.
2 . Counsels the woman and her partner on maintaining good health for the purpose of paring for pregnancy.
3 . Provides information to the woman and her partner to enable them to select appropriate fertility regulation methods and give support in making their choice.
4 . Provides instruction in the use of the contraceptive method selected by the women and her partner.
- Rhythm (basal body temperature) method
, condom, jelly, contraceptive film, pessary, IUD, pill
5. Evaluate whether the fertility regulation method selected by the women and her partner contributes to their quality of life or is otherwise appropriate.
C. Giving support to women and their families concerned about infertility
The midwife establishes communication with and, using appropriate counseling techniques, provides counseling to the woman and her family concerned about infertility, and investigates in order to fully understand the woman's situation. Based upon that understanding, the mid-wife assesses functions of ovaries, oviducts and uterus, her relationship with her partner, their sexual activity, their living situation and factors needed for achieving pregnancy or, if necessary, provides support for their reconciliation to infertility.
1 . Counsels women concerned about infertility, counsels their families and helps to improve the capability of the woman and her family to deal with the situation.
2 . Provides support for the woman and her family to select the types of examinations or treatment available from a doctor on the basis of their needs and facilitates individual
decisions about receiving treatment.
3 . Provides support to enable the couple to improve their health or personal relations in order to regulate their pattern of sexual relations. Provides support for the periodic
surement of basal body temperature in order to plan the timing their sexual relations. 4 . Provides information on all of the following: success and failure rates of tests and
tility treatments, physical, mental and financial hardship associated with treatment,
amount of time treatment requires and post-treatment follow-up.
5 . Facilitates understanding of the physical, mental, social and economic aspects of tility and treatment.
6 . Gives support for informed decision-making concerning the beginning of treatment and its continuation or termination.
D. Support to women of middle and advanced age
The midwife provides support for understanding of the physiological and psychological changes accompanying the slowing down and termination of ovulation in women of middle age, gives appropriate advice and instruction concerning dealing with these changes and pro-vides assistance in insuring that they do not adversely affect the quality of her life.
This support involves assessing the woman's health, taking into account critical psychologi-cal changes and the ailments that tend to occur with aging and providing support for taking measures to improve health through medical consultation.
1 . Assesses bodily functions affected by aging in women of middle and advanced years - Aging and the circulatory system , respiratory system, digestive tract, metabolism,
urinary tract, ovaries and endocrine system, skin, bone and muscular systems 2 . Assesses psychological aspects of women in middle and advanced years
- Doubts and dissatisfaction concerning their lives , feeling of loss, anxiety about the future, barriers to realizing new possibilities, re-emergence of conflicts
3 . Provides support for prevention of barriers to health that are prone to develop in middle and advanced years
(1) Provide care commensurate with state of health
(2) Interview of woman (personal history, environment at home and place of employment,
psychological aspects, malaise)
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The practical skills and responsibilities that a midwife should have
(3) Support for insuring good nourishment, eating and exercise habits
4 . Assesses sexual activities in middle and advanced years and provides support as sary
- Situation of marriage
, age, pleasures derived from sexual experience in youth, supportiveness of partner, health problems of partner, past psychological or social
stress conditions, stresses in present life
5 . Provides support for the woman in learning to accept the psychological and physical
changes that come with aging and to take control of her own health in the interest of improving her quality of life.
6 . Assesses the state of abnormalities that tend to occur in women of middle and advanced
years and provides care for ameliorating whatever symptoms may exist. When the risk of an abnormality is discovered and identified the midwife refers the woman to the
appropriate doctor for diagnosis and treatment.
- Potential abnormalities in women of middle to advanced age include menopausal
disorders, breast cancer, uterine cancer, ovarian cancer, osteoporosis, obesity, tinence and prolapse of uterus
7 . Assessment of changes in sexual identity, sexual relationships or sexual identity ring following the removal of sex organs as the result of breast cancer, uterine cancer,
ovarian cancer, etc. Assessment of anxiety, grief, feelings of humiliation, etc. resulting from this loss.
E. Prevention of STD in women and providing support when it occurs
The midwife has understanding of the health situation of women with sexually transmitted diseases and provides support for the women take control of her own health. She provides the up-to-date information concerning STD and works with health and medical teams to provide treatment and assistance for the maintenance and improvement of health.
1 . Assessment of the possibility of STD
(1) Interview to determine health history, residential history, current medical history and relevant information about the family and whether there has been or are sexual
tions with the risk of infection
(2) Examination of vaginal secretions
(3) Evidence of symptoms from the client's complaints: vaginal itch or pain, abdominal or back pain
2. Providing counseling and ongoing moral support to the women and her partner to tate their own decisions about available options in accordance with examination results 3 . When there is reason to suspect STD infection, referral to a doctor and providing
tance in obtaining the partner's support and understanding.
4 . Capability of engaging in public educational activities on prevention of infections of mother and child. Capability of deciding what kinds of examinations are necessary.
- Rubella
, toxoplasmosis, ATLA, hepatitis B and C, GBS, HIV, herpes, chlamydia, etc.
5 . Participation in public educational activities for the prevention of STD and taking sonal responsibility for such activities as necessary.
F. Support to women having menstrual disorders
The midwife understands the situation of the health of women having menstrual disorders and provides support to assist women in taking control of their own health, provides up to
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date information concerning menstrual disorders and works with public health and medical teams in providing treatment and assistance for maintaining and improving health.
1 . Assessment to determine if there is a need to treat for menstrual disorders
(1) Interview to determine health history, residential history, current medical history and relevant information about the family, menstrual history (amount of discharge, cycle)
(2) Evidence of symptoms from the client's complaints: menstrual cramps, malaise, etc. 2. Providing support for ameliorating menstrual disorders in everyday life
(1) Improvement of living habits: meals (salt, irritants, favorite foods, sugar, water, oil) exercise
(2) Advise the keeping of a menstrual record to facilitate early preventive measures (3) Determination of psychological state and providing appropriate support
V Care for families and scope of responsibility
The midwife has responsibility for providing support to the families of her clients in order to bring out their self-care functions for the sake of helping to insure the client has a prob-lem-free pregnancy and delivery and can give quality child care. The midwife's support is also in the interest of deepening family ties and preparing the family to cope with changes in family life. This support is provided by establishing communication, counseling and inform-ing family members of community services available to them and encouraginform-ing their use.
1 . Assessment of the living environment of the family 2 . Assessment of problems with the family's development
3. Diagnosis of the flexibility of the family in adapting to the new family
4. Examination of changes in human relationships within the family and providing support as needed
(1) Relationships to be examined
- Parent-child , husband-wife, siblings, inter-generational parent-child relationships
(2) Points to examine
- Changes in roles , changes in power structure and dependence relationships, changes in values, changes in decision-making patterns, changes in ways of dealing with
conflict, changes in communication patterns
(3) Promoting the capability of self-care by each family member
5 . Support for enabling the family to understand and make use of community and social services
(1) Use of health, medical and welfare services concerned with children and women (2) Use of public and private volunteer community services
(3) Promotion of formation family and community and social networks
VI Community health care of mothers and children and scope of responsibility
The midwife assesses health standards for children, women and families with reference to specific community needs and has responsibility for conducting community health surveys, counseling making home visits to provide for the health needs of mothers and children in the community. In addition, the midwife provides information acquired in her practice to
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The practical skills and responsibilities that a midwife should have
ment or public institutions for improving the health and environmental conditions of mothers, children and families. The midwife also speaks out publicly on these issues.
1 . Actions taken as a part of community medical systems or as a member of professional
organizations
(1) Assessing community health standards for children and women and analyzing them in relation to living environments and life styles in the community
(2) Determining the health needs of children and women in the community
(3) Working with health, medical and welfare institutions and individuals concerned with the health of children and women in order to keep abreast of relevant information
and to disseminate this information to women
(4) Submit policy proposals to government institutions, organizations, etc. for solving health problems and meeting health needs
2. Supporting and building networks of consumers and midwives
(1) The formation of and providing of support to self-care groups (for pregnant women, about child-raising, for pregnancy high risk groups) associated with hospitals or other
medical institutions or in communities
(2) Working to make community self-care groups effective by promoting their networking activities
(3) Promoting networking between midwife and consumer groups for joint planning, mentation and evaluation of activities aimed at effecting improvements in midwife
care
3 . Work as a community member of local government - sponsored health care projects for mothers and children
(1) Giving consultation and making instructional home visits to women during pregnancy or after birth, conducting health checks of women and their babies
(2) Participating in regular checks given at health centers to women during pregnancy and in the postnatal stage and to infants at 3 months, 6 months and one year after
birth
(3) Conducting thoroughgoing prenatal and infant health programs and working with local government to evaluate these programs's effectiveness
VII Activities and responsibilities for preserving one's autonomy as a professional
The midwife has responsibility to actively participate in professional organizations with an objective of establishing her competence to function as an antonymous professional. She also has a professional responsibility to conduct her own research for improving her professional
value. This category of activities includes research on reforming and guaranteeing the quality of midwife care and also active participation in activities by organizations related to her profession, such as consumer groups and groups of other professionals.
1 . The midwife participates in advancing the role and functions of her profession through her organizational activities.
2 . The midwife expresses criticism of the state of practice of her profession with a view to improving the level of care given by midwives.
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midwife care and uses this data for research on providing evidential based midwifery techniques.
4. The midwife evaluates and interprets research results and applies them critically. 5. The midwife uses research results in educational and continuing educational programs. 6. The midwife establishes networks of midwives transcending her own sphere of activities
in order to contribute to the improvement of midwifery care.
7. The midwife stays sensitive to changes in social needs by keeping herself well informed through her network activities with consumers and other professionals and always
tains a spirit of mutual evaluation.
8. The midwife is supportive of individuals and other midwives belonging to her network. 9 . The midwife contributes to administrative decision-making that affects the midwifery
profession and midwifery education.
10. The midwife makes proposals as necessary for improving the effectiveness of health vices for women, mothers and children.
