Evidence-Based Practice in Maternal & Child Health

EVIDENCE-BASED
PRACTICE IN
MATERNAL & CHILD
HEALTH
EVIDENCE-BASED
PRACTICE
❑ EBP is the integration of clinical expertise, patient
values, and the best research evidence into the
decision making process for patient care. Clinical
expertise refers to the clinician’s cumulated
experience, education and clinical skills. The patient
brings to the encounter his or her own personal
preferences and unique concerns, expectations, and
values. The best research evidence is usually found
in clinically relevant research that has been
conducted using sound methodology.
(Sackett D, 2002)
EBP
EVIDENCE-BASED
PRACTICE
❑ EBP is “the conscientious, explicit and judicious use
of current best evidence in making decisions about th
e care of the individual patient. It means integrating in
dividual clinical expertise with the best available exter
nal clinical evidence from systematic research.”
(Sackett D, 1996)
EVIDENCE-BASED
PRACTICE PROCESS
❑The EBP process is a method that allows
the practitioner to assess research, clinical
guidelines, and other information resources
based on high quality findings and apply
the results to practice.
Introduction
❑ Maternal health refers to the health of women during
pregnancy, childbirth and the postpartum period.
❑ Good maternal health and nutrition are important
contributors to child survival.
❑ Lack of essential interventions to address maternal health
and nutrition, and other health conditions often
contribute to indices of neonatal morbidity and mortality
❑ Poor maternal, newborn and child health remains a
significant problem in developing countries
Statistics:
❖ Worldwide, 385,000 women die during pregnancy and child-
birth annually.
❖ Estimated 7.6 million of children under the age of five.
❖ Majority of maternal deaths occur during or immediately
after childbirth.
❖ Common medical causes for maternal death include bleeding,
high blood pressure, prolonged and obstructed labor, infec-
tions and unsafe abortions.
❖ A child’s risk of dying is highest during the first 28 days of life.
Statistics:
❖ 40% of under-five deaths take place, translating into three
million deaths.
❖ Up to one half of all newborn death occurs within the first 24
hours of life and 75% occur within the first week.
❖ Globally, the main causes of neonatal death are preterm birth,
severe infections and asphyxia.
❖ Children in low-income countries are nearly 18 times more
likely to die before the age of five than children in high-income
countries.
❑Every day, approximately 800 women die
from preventable causes related to
F pregnancy and childbirth.
A ❑99% of all maternal deaths occur in
developing countries.
C
❑Maternal mortality is higher in women
T living in rural areas and among poorer
S communities.
❑Skilled care before, during and after
childbirth can save the lives of women
and newborn babies.
❑Between 1990 and 2010, maternal
mortality worldwide dropped by almost
50%.
❑Every day, +8000 newborn babies die
F from preventable causes.
A ❑Nearly 99% of all neonatal death occur
in low- and middle-income countries.
C
❑70% of global deaths among newborn
T babies happen in just two WHO
regions:(AFRICA& SOUTH-EAST ASIA).
S
❑Essential maternal and newborn care
and access to care for complications
can save the lives of mothers and
newborn babies.
SIX EVIDENCE-BASED CARE PRACTICES OF
PREGNANT CLIENT DURING LABOR PERIOD:
1. Promote physiological birth.

2. Avoiding medically unnecessary induction of
labor.
3. Allowing freedom of movement for the
laboring woman.
4. Providing continuous labor support.
5. Avoiding routine interventions and restrictions
6. Encouraging spontaneous pushing in non-
supine positions.
FOUR EVIDENCE BASED CARE PRACTICES F
OR NEWBORN AFTER DELIVERY: (WHO)
1. Immediate and thorough drying: provides war

mth to the child and prevents hypothermia
from setting in.
2. Early skin-to-skin contact: establishes mother
and child bonding and minimizes the risk of
sepsis and hypoglycemia
3. Properly timed cord clamping and cutting:
prevents anemia and hemorrhage
4. Non-separation of the newborn and mother
for early initiation of breastfeeding
REVIEW:
✓ The ability of a woman to accept her pregnancy depends
on social, cultural, family, and individual influences.
✓ The psychological tasks of pregnancy are centered on
ensuring safe passage for the fetus. These consist of, in
the first trimester, accepting the pregnancy; in the second
trimester, accepting the baby; and in the third trimester,
preparing for parenthood.
✓ Common emotional responses that occur with pregnancy
include grief, narcissism, introversion or extroversion, str
ess, couvade syndrome, body image and boundary conf
usion, emotional lability, and changes in sexual desire.
REVIEW:
✓ Physiologic changes that occur with pregnancy are both
local (uterine, ovarian, and vaginal changes) and system
ic (respiratory, cardiovascular, urinary, and skin changes)
.
✓ Women may have read about the expected psychologica
l and physiologic changes of pregnancy, but once these
changes are actually being experienced, they may find t
hem more intense than anticipated.
✓ The diagnosis of pregnancy is based on three types of fi
ndings: presumptive (subjective), probable (objective), a
nd positive (documented).
✓
REVIEW:
✓ The positive signs of pregnancy are demonstration of a f
etal heartbeat separate from the mother’s, fetal moveme
nt felt by an examiner, and visualization of the fetus by ul
trasound.
✓ Although a woman may be in a physician’s office or pren
atal clinic for only an hour, if her pregnancy was confirme
d at that visit, she invariably feels “more pregnant” when
she leaves. Early diagnosis is important so that a woman
can begin to change unhealthy habits or, if she desires,
have adequate time to carry out a therapeutic terminatio
n of pregnancy.

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EVIDENCE-BASED

1. Promote physiological birth.

1. Immediate and thorough drying: provides war

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