十种方法，改善孕产妇和新生儿护理质量

目前每年有30.3万名孕产妇死亡，260万死产，还有270万新生儿出生后28天内死亡。完善医疗服务有助于避免上述许多死亡。...



如今，全球日益认识到，优质医疗服务是保持母婴生存和健康的关键。目前每年有30.3万名孕产妇死亡，260万死产，还有270万新生儿出生后28天内死亡。完善医疗服务有助于避免上述许多死亡。

越来越多的婴儿在医疗机构出生。在联合国及其合作伙伴支持下新成立的“改善孕产妇、新生儿护理质量和儿童健康网络”旨在帮助各国提升医疗机构护理质量以及尊重寻求治疗者的权利和尊严。

下面，就让我们用图片故事来讲述：世卫组织基于《改善医疗机构孕产妇和新生儿护理质量标准》，是建议各国怎么改善医疗机构护理质量以及预防孕产妇和新生儿死亡的。

1

孕妇应在适当的时侯获得适当的护理世界卫生组织建议孕妇在怀孕期间至少做八次产检以检查和处理可能存在的问题，减少死产或新生儿死亡的可能性。医生还可利用产检为孕妇提供一系列支持与信息，包括健康的生活方式、疾病预防和计划生育。

2

新生儿应在出生后立即得到基本护理应将新生儿放在母亲的胸部，保持直接皮肤接触，直到第一次母乳喂养之后。让新生儿保持干净温暖，护理他们的眼睛与脐带。新生儿出生24小时之后可以洗澡，按照国家指南补充维生素K和接种疫苗，监测温度，发现和处理并发症。在出院前，即通常在出生后24小时左右，对新生儿做全面评估，也是第一次体检。

3

个头小、患病婴儿应得到精心护理个头小的婴儿（比如早产或个头小于胎龄的婴儿）有较大可能在新生儿期死亡、存在长期健康问题和终生残疾。应一直让婴儿保持温暖，由其母亲母乳喂养。在婴儿条件允许的情况下，应支持母亲采取袋鼠妈妈护理法。应在设备良好的新生儿病房照顾个头很小和患病新生儿，并由训练有素的医务人员密切监测其并发症情况。

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预防医院获得性感染医院获得性感染增加死亡和患病风险，增加住院费用和延长住院时间。标准防护措施对于预防医院获得性感染很必要。包括医务人员在检查病人前后用肥皂和水或含酒精的手消毒剂洗手，安全储存和处理感染性废弃物和尖锐物体，给产房和新生儿护理区的所有器械杀菌消毒。

5

医院应有适宜的物理环境医疗机构一定要配备能安全可靠使用的水、电、卫生、手卫生和废物处理设施。空间设计、构造和维护需考虑隐私以及便于提供优质服务。医疗机构还需具备充足的药物、医疗物资和设备。

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与产妇及家人有效沟通，响应其需求病人应知道关于护理的所有信息，让他们感到有参与关于治疗的所有决策。医务人员和病人间的有效沟通能减少不必要的焦虑，使得产妇即使在有并发症的情况下，也能觉得分娩是积极体验。

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需转诊的产妇和新生儿能被迅速转诊医疗机构应具备每天24小时运行和一周运行7天的交通服务，以在必要时运输产妇和新生儿。有随时可用的转诊医疗机构电话号码清单。转诊系统应受到监管和问责，其政策应保护女性免于经济障碍。

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没有女性应在分娩、生产和产后初期受到伤害不必要和有害的操作能导致并发症，给产妇和新生儿造成伤害。比如阴道分娩前的常规灌肠或会阴剃毛，婴儿出生后立即洗澡，让婴儿远离母亲，营销宣传母乳替代品和人工喂奶。

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医疗机构需始终具备合格的护理人员所有医疗机构的分娩和生产区都应有数量充足合格和训练有素的员工以及熟练的助产士24小时在岗以应对预期工作量。助产士提供优质护理时面对的普遍障碍包括：社会尊重较低，薪酬低，工作时间长，人手不足，缺乏功能齐全的设施环境。重视以助产士经验为基础的专业教育与卫生人力管理很重要。

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拥有完整、准确的标准化病历所有婴儿都应该获得出生证明。完整、准确的病历记录是医疗服务、临床随访、早期发现并发症和健康结果的重要记录，也有助于明确尚待完善的领域。新生儿的免疫接种情况、孕龄、出生体重、检查结果等详细信息应录入系统，使得母婴的所有医疗记录都能相互关联起来。There is increasing global awareness that good quality care is key to keeping mothers and babies alive and well. Today, each year there are 303 000 deaths of women during pregnancy and childbirth, 2.6 million stillbirths, and 2.7 million deaths of babies during the first 28 days of life. Better care can prevent many of these deaths.

More babies are being born in health facilities. A new UN- and partner-supported "Network for Improving Quality of Care for Maternal, Newborn and Child Health" aims to help countries improve the quality of care in those facilities and to respect the rights and dignity of those who seek care.

This photo story describes some of WHO’s recommendations on how countries can improve quality of care in their health facilities and prevent maternal and newborn deaths, based on its Standards for improving quality of maternal and newborn care in health facilities.1. Pregnant women should receive the right care, at the right times

WHO recommends a woman see her health provider at least 8 times during her pregnancy to detect and manage potential problems and reduce the likelihood of a stillbirth or neonatal death. Antenatal care also offers an opportunity for health workers to provide a range of support and information to pregnant women, including on healthy lifestyles, preventing diseases, and family planning.

2. Newborns should receive essential care immediately after birth

Newborns should be kept in skin-to-skin contact on their mother’s chest and enabled to breastfeed. They need to be kept clean and warm, and given care for their eyes and umbilical cord. Bathing should be delayed for 24 hours, vitamin K and vaccines given as per national guidelines, temperature monitored, and complications identified and managed. A complete assessment before discharge, normally around 24 hours, serves as a first postnatal check-up.3. Small and sick babies should be well cared for in a facility

Small babies (such as preterm babies or babies born small for their gestational age) are at much greater risk for death during the neonatal period and for long-term health problems and lifelong disabilities. These babies should be kept warm at all times and fed with their mothers’ own breast milk. Mothers should be supported to practise kangaroo mother care as the baby’s condition allows. Very small and sick newborns should be cared for in well-equipped neonatal units and closely monitored by trained staff for complications.

4. All women and newborns must receive care that prevents hospital-acquired infections

Hospital-acquired infections increase the risk of death and disease, and add to the cost of care and the duration of stay in a hospital. Standard precautions are essential to prevent hospital-acquired infections. These include washing hands with soap and water or alcohol-based hand rub before and after examining a patient, safely storing and disposing of infectious waste and sharp objects, and sterilizing and disinfecting instruments in the labour and delivery room and newborn care area.5. Health facilities must have an appropriate physical environment

Health facilities must have water, energy, sanitation, hand hygiene, and waste disposal facilities which are functional, reliable, and safe. The space needs to be designed, organized, and maintained to allow for privacy and facilitate the provision of quality services. Facilities also need to have adequate stocks of medicines, supplies, and equipment.

6. Communication with women and their families must be effective and respond to their needs

Patients should receive all information about their care and should feel involved in all decisions made regarding their treatment. Effective communication between health providers and patients can reduce unnecessary anxiety and make childbirth a positive experience for a woman, even if she experiences complications.7. Women and newborns who need referrals can obtain them without delay

Health facilities should have available equipped transport services that operate 24 hours a day, 7 days a week, to transport women and newborns as necessary. A list of known network facilities and their telephone numbers should be readily available. The referral system is also supervised and accountable, with a policy that protects women from financial barriers.

8. No woman should be subjected to harmful practices during labour, childbirth, and the early postnatal period

Unnecessary and harmful practices can lead to complications and harm mothers and their newborns. These include routine enemas and pubic or perineal shaving before vaginal birth, immediate bathing of the baby, keeping well babies away from the mother, and advertising and promoting breastfeeding substitutes and bottle-feeding.9. Health facilities need well-trained and motivated staff consistently available to provide care

All labour and childbirth areas of the health facility should have competent, well-trained staff and skilled birth attendants present 24-hours a day in sufficient numbers to cope with the expected workload. Common barriers for midwifery personnel to provide quality care include low social esteem, poor pay, long working hours, insufficient staffing, and lack of fully functioning facility environments. It is important to focus on professional education and health workforce management that builds on the experiences of midwives.

10. Every woman and newborn should have a complete, accurate, and standardized medical record

All babies should receive a birth certificate. Complete, accurate medical recording is important for documenting care, clinical follow-up, early detection of complications, and health outcomes, and helps to identify areas for improvement. Details of newborns, including vaccinations, gestational age, birth weight and examination findings, should be recorded in a system that allows the linking of women and their newborns in all records.

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