New perinatal care standards - what exactly will change?
What rights do you have to be born? What is the medical staff obliged to do? How should care of a woman and a newborn baby look after giving birth? Health Minister Lukasz Szumowski presented new standards of perinatal care, which will apply from January 1, 2019. What exactly will change?
Health Minister Łukasz Szumowski and Deputy Minister Józef Szczurek-Żelazko, during a press conference at the Ministry of Health, announced the most important points of the new organizational standards of perinatal care.
The meeting was also attended by experts who, together with the team appointed by the Minister, prepared draft standards: prof. Ewa Helwich - national consultant in the field of neonatology, prof. Krzysztof Czajkowski - national consultant in the field of obstetrics and gynecology and Ewa Janiuk - midwife, vice-president of the Supreme Chamber of Nurses and Midwives.
As we read in the draft Regulation of the Minister of Health on the standard of organizational perinatal care, it takes into account the guidelines of the World Health Organization (WHO), the achievements of medicine based on scientific experience and Polish experience in the care of mother and child.
As is clear from the conference note (dated 4 April 2018) published on the website of the Supreme Chamber of Nurses and Midwives, the basic assumption of the changes is to ensure safety and maintain good health of the mother and the child while minimizing medical intervention.
And although it sounds quite general, this point includes:
improvement of birth safety and comfort,
protection of women and children against excessive medicalization,
unification of the rules of caring for the woman giving birth,
informing the mentee about the organization of perinatal care and patient's rights,
promoting antenatal education, which aims to reduce the fear of women before delivery, and thus reduce the number of cesarean sections,
dissemination of natural feeding.
New standards of perinatal care - changes
Although a significant proportion of perinatal care provisions remain unchanged, several significant changes have also been introduced.
Standard for everyone
The new regulations are not limited to pregnancy and delivery of a physiological nature. They are to apply to all pregnancies and births. The latest legal act includes provisions regarding pregnancy, alleviating childbirth pain, as well as rules of organizing the work of staff in particularly difficult cases, such as miscarriage, stillbirth and the birth of a seriously ill child.
Staff training and monitoring the implementation of standards
The new regulations require training of personnel in the scope of applying standards, but also monitoring their observance, taking into account these activities in the organizational regulations of entities carrying out perinatal care (see: hospitals), as well as updating knowledge. What does this mean in practice? Previous standards have not always been respected and nobody has controlled it. Now it has to change.
Elimination of obligatory hospitalization after the 41st week of pregnancy
The new standard removes the rule of referring a pregnant woman to forced hospitalization after the end of the 41st week of pregnancy, the use of which may have contributed to excessive medical treatment consisting in induction of labor and more births. The new standard protects the health of the patient and her child through increased monitoring of their condition, indicating the need to terminate the pregnancy before the 42nd week of pregnancy without prior hospitalization, if there are no premises, that is, disturbing symptoms threatening their health or life.
Checking the risk of postnatal depression
Until now, this was a neglected topic. She tried to take action in this direction Foundation for human birth. Under the new standards, the person caring for pregnant and puerperal women is to assess the risk and severity of postpartum depression symptoms. The proposal that was made in the project is three times identifying the risk of depression: in the first trimester of pregnancy (11-14 weeks), one month before delivery (33.-37 weeks) and one month after delivery during the midwife's visit to the place of residence or stay of mother and child.
Unification of the antenatal education program framework
In the new standards, the midwife is responsible for antenatal education, who has complete freedom in the selection of people who, in her opinion, professionally present the content of the specialty presented by them. Pre-natal education will be available to women from the 21st week of pregnancy to delivery (as before). The size and frequency of meetings is to be adapted to the individual needs of the pregnant woman (up to 21 weeks once a week and from 32 weeks two times a week).
Choosing a midwife
The draft regulation clarifies the obligation to refer a pregnant woman to the midwife of primary health care (POZ), if the carer is a doctor (between the completed 21st and 26th pregnancy). The referral to the midwife was considered insufficient (as it results from the research, only 3% percent of gynecologists refer patients to midwives) and it was proposed that the midwife's POZ additionally confirmed the patient's admission to care after delivery by entering into the antenatal care plan and the pregnancy records of their data or an entity that performs medical activities in the field of primary health care. In practice, this means caring for the pregnant woman to choose and get to know her midwife before the delivery (ideally within the framework of education, see above).
The new regulations also pay special attention to the proper use of midwives' knowledge and competence to enable them to be more independent in caring for their mother and newborn baby.
Relief of childbirth pain
Alleviation of labor pain in new standards is not treated as an additional medical intervention. The patient must be provided with complete and complete information about which pain relief methods are available to her, how they work and what adverse effects may have at every decision-making stage. Alleviation of labor pain concerns both non-pharmacological methods (relaxation techniques, ball, TENS, etc.) and pharmacological methods (inhalation, regional, opioid use).
Getting to know the place of birth
Under the new regulations, the possibility of getting pregnant with the place of delivery, filling in medical records and prior anesthetic consultation was introduced in order to provide information about indications and contraindications for the use of general anesthesia (expertly: regional Angola) during labor.
Special situations
In the new standards, the term "obstetric failure" has been replaced by the term "special situations", which should be understood as: miscarriage, birth of a dead child, unable to live or burdened with lethal illnesses, birth of a sick child or child with congenital malformations. Under the new regulations, medical personnel were required (if they diagnosed severe, incurable fetal diseases during the prenatal period or during delivery) to inform about the possibility of obtaining further help within palliative and hospice care. It means an emphasis on women's surroundings in a special situation of special care.
Treatments and care of the newborn next to the mother
This provision imposes on the medical personnel the obligation to perform all nursing procedures and mandatory standard procedures for the newborn in the presence of the mother in the "mother with a child" room.
Contact support "skin to skin"
The new regulations clarify the time of clinical examination of a newborn child so that it does not interfere with the provision of a two-hour uninterrupted skin-to-skin contact between the newborn and the mother.
Support for lactation
The latest standards place great emphasis on natural feeding and promotion of breastfeeding. Hospitals are to be obliged to provide every needy mother with the equipment to effectively obtain breast milk and are encouraged to administer milk from the breast milk banks in the case of premature babies with significant immaturity, which can not be fed with mother's milk.
Administration of modified milk as medical intervention
The new records place the administration of modified milk to newborns on the list of medical interventions (next to amniotomy, induction of labor, stimulation of uterus contraction, perineum incision and caesarean section), the restriction of which is the goal of introducing standards.
Food during delivery
This change means that the decision about the possibility of eating during the delivery will be made by the doctor (up to now, the midwives who spend most of their time at the maternity) may decide.
Childbirth at home
New entries can complicate the issue of home births. The organization of care in non-hospital settings includes the development and agreeing in the form of a written agreement with the relevant entities carrying out medical activities, agreements regarding the procedures and conditions for transferring a woman or child to the hospital (in situations of danger and inability to give birth at home). As the midwives receiving home births indicate, there is a threat from the above entities (obstetric / neonatological wards) refusal to sign written contracts, which has often happened.
The draft regulation was submitted for public consultation until 7/05/2018
On 31/12/2018, the existing medical standards of perinatal care cease to apply.
On January 1, 2012, new organizational standards for perinatal care are to be implemented in the form of a Regulation of the Minister of Health.
Part XIII point 7 of the draft regulation, which is to provide the necessary medical equipment for effective milk sourcing for each mother in need, will apply only from January 1, 2022.
Health Minister Łukasz Szumowski and Deputy Minister Józef Szczurek-Żelazko, during a press conference at the Ministry of Health, announced the most important points of the new organizational standards of perinatal care.
The meeting was also attended by experts who, together with the team appointed by the Minister, prepared draft standards: prof. Ewa Helwich - national consultant in the field of neonatology, prof. Krzysztof Czajkowski - national consultant in the field of obstetrics and gynecology and Ewa Janiuk - midwife, vice-president of the Supreme Chamber of Nurses and Midwives.
As we read in the draft Regulation of the Minister of Health on the standard of organizational perinatal care, it takes into account the guidelines of the World Health Organization (WHO), the achievements of medicine based on scientific experience and Polish experience in the care of mother and child.
As is clear from the conference note (dated 4 April 2018) published on the website of the Supreme Chamber of Nurses and Midwives, the basic assumption of the changes is to ensure safety and maintain good health of the mother and the child while minimizing medical intervention.
And although it sounds quite general, this point includes:
improvement of birth safety and comfort,
protection of women and children against excessive medicalization,
unification of the rules of caring for the woman giving birth,
informing the mentee about the organization of perinatal care and patient's rights,
promoting antenatal education, which aims to reduce the fear of women before delivery, and thus reduce the number of cesarean sections,
dissemination of natural feeding.
New standards of perinatal care - changes
Although a significant proportion of perinatal care provisions remain unchanged, several significant changes have also been introduced.
Standard for everyone
The new regulations are not limited to pregnancy and delivery of a physiological nature. They are to apply to all pregnancies and births. The latest legal act includes provisions regarding pregnancy, alleviating childbirth pain, as well as rules of organizing the work of staff in particularly difficult cases, such as miscarriage, stillbirth and the birth of a seriously ill child.
Staff training and monitoring the implementation of standards
The new regulations require training of personnel in the scope of applying standards, but also monitoring their observance, taking into account these activities in the organizational regulations of entities carrying out perinatal care (see: hospitals), as well as updating knowledge. What does this mean in practice? Previous standards have not always been respected and nobody has controlled it. Now it has to change.
Elimination of obligatory hospitalization after the 41st week of pregnancy
The new standard removes the rule of referring a pregnant woman to forced hospitalization after the end of the 41st week of pregnancy, the use of which may have contributed to excessive medical treatment consisting in induction of labor and more births. The new standard protects the health of the patient and her child through increased monitoring of their condition, indicating the need to terminate the pregnancy before the 42nd week of pregnancy without prior hospitalization, if there are no premises, that is, disturbing symptoms threatening their health or life.
Checking the risk of postnatal depression
Until now, this was a neglected topic. She tried to take action in this direction Foundation for human birth. Under the new standards, the person caring for pregnant and puerperal women is to assess the risk and severity of postpartum depression symptoms. The proposal that was made in the project is three times identifying the risk of depression: in the first trimester of pregnancy (11-14 weeks), one month before delivery (33.-37 weeks) and one month after delivery during the midwife's visit to the place of residence or stay of mother and child.
Unification of the antenatal education program framework
In the new standards, the midwife is responsible for antenatal education, who has complete freedom in the selection of people who, in her opinion, professionally present the content of the specialty presented by them. Pre-natal education will be available to women from the 21st week of pregnancy to delivery (as before). The size and frequency of meetings is to be adapted to the individual needs of the pregnant woman (up to 21 weeks once a week and from 32 weeks two times a week).
Choosing a midwife
The draft regulation clarifies the obligation to refer a pregnant woman to the midwife of primary health care (POZ), if the carer is a doctor (between the completed 21st and 26th pregnancy). The referral to the midwife was considered insufficient (as it results from the research, only 3% percent of gynecologists refer patients to midwives) and it was proposed that the midwife's POZ additionally confirmed the patient's admission to care after delivery by entering into the antenatal care plan and the pregnancy records of their data or an entity that performs medical activities in the field of primary health care. In practice, this means caring for the pregnant woman to choose and get to know her midwife before the delivery (ideally within the framework of education, see above).
The new regulations also pay special attention to the proper use of midwives' knowledge and competence to enable them to be more independent in caring for their mother and newborn baby.
Relief of childbirth pain
Alleviation of labor pain in new standards is not treated as an additional medical intervention. The patient must be provided with complete and complete information about which pain relief methods are available to her, how they work and what adverse effects may have at every decision-making stage. Alleviation of labor pain concerns both non-pharmacological methods (relaxation techniques, ball, TENS, etc.) and pharmacological methods (inhalation, regional, opioid use).
Getting to know the place of birth
Under the new regulations, the possibility of getting pregnant with the place of delivery, filling in medical records and prior anesthetic consultation was introduced in order to provide information about indications and contraindications for the use of general anesthesia (expertly: regional Angola) during labor.
Special situations
In the new standards, the term "obstetric failure" has been replaced by the term "special situations", which should be understood as: miscarriage, birth of a dead child, unable to live or burdened with lethal illnesses, birth of a sick child or child with congenital malformations. Under the new regulations, medical personnel were required (if they diagnosed severe, incurable fetal diseases during the prenatal period or during delivery) to inform about the possibility of obtaining further help within palliative and hospice care. It means an emphasis on women's surroundings in a special situation of special care.
Treatments and care of the newborn next to the mother
This provision imposes on the medical personnel the obligation to perform all nursing procedures and mandatory standard procedures for the newborn in the presence of the mother in the "mother with a child" room.
Contact support "skin to skin"
The new regulations clarify the time of clinical examination of a newborn child so that it does not interfere with the provision of a two-hour uninterrupted skin-to-skin contact between the newborn and the mother.
Support for lactation
The latest standards place great emphasis on natural feeding and promotion of breastfeeding. Hospitals are to be obliged to provide every needy mother with the equipment to effectively obtain breast milk and are encouraged to administer milk from the breast milk banks in the case of premature babies with significant immaturity, which can not be fed with mother's milk.
Administration of modified milk as medical intervention
The new records place the administration of modified milk to newborns on the list of medical interventions (next to amniotomy, induction of labor, stimulation of uterus contraction, perineum incision and caesarean section), the restriction of which is the goal of introducing standards.
Food during delivery
This change means that the decision about the possibility of eating during the delivery will be made by the doctor (up to now, the midwives who spend most of their time at the maternity) may decide.
Childbirth at home
New entries can complicate the issue of home births. The organization of care in non-hospital settings includes the development and agreeing in the form of a written agreement with the relevant entities carrying out medical activities, agreements regarding the procedures and conditions for transferring a woman or child to the hospital (in situations of danger and inability to give birth at home). As the midwives receiving home births indicate, there is a threat from the above entities (obstetric / neonatological wards) refusal to sign written contracts, which has often happened.
The draft regulation was submitted for public consultation until 7/05/2018
On 31/12/2018, the existing medical standards of perinatal care cease to apply.
On January 1, 2012, new organizational standards for perinatal care are to be implemented in the form of a Regulation of the Minister of Health.
Part XIII point 7 of the draft regulation, which is to provide the necessary medical equipment for effective milk sourcing for each mother in need, will apply only from January 1, 2022.
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