Organizational Standard of Perinatal Care

Standard Organizational Perinatal care (hereinafter "Standard") is an inventory of best medical practices in perinatal care. It is valid for all medical entities in Poland. Doctors, midwives and other specialists in this area of ​​care as well as managers of medical entities will find a set of guidelines for medical and organizational proceedings in the Standard. The provisions contained therein are based on current medical knowledge based on scientific evidence. 

Are you pregnant and wondering if you should know the content of the Standard? What is the value of this document for pregnant women and for midwives and doctors? In this article you will find answers to these questions and you will find out what the new standards of perinatal care look like.

Why was this document written?

At the very beginning, it is worth focusing on the goals for which the Standard was created. These include:

• Need to improve the quality of care in the perinatal periodby developing a model of conduct for the entire medical staff providing this care;
• Increasing women's satisfaction with experiences related to the perinatal period, by defining the rights of pregnant, giving birth and women after childbirth and the obligation to respect them;
• Protection of the physiological process of childbirthby reducing medically unjustified interventions;
• Defining the rules of medical and organizational proceedings in case of obstetric complications or failures;
• Introduce new standards of perinatal care to harmonize the quality of care in the perinatal period in all entities in Poland.

What is the value of the Standard for perinatal care professionals?

Working with standards is part of the practice of medical art. It is a tool prepared by experts in a given field, developed in accordance with the current medical knowledge. It is a model that describes the best model of medical management and organization of perinatal care. While adhering to the Standard is not a substitute for a careful review of your particular clinical situation, referencing it is helpful in ensuring high-quality care.

The key elements of the treatment process, incl. an interview correctly collected from the patient, the ability to analyze the collected data on the basis of this interview and conducted research, as well as the skills and experience of a specialist, should occur in parallel with his knowledge and respect for standards.

On the way to new standards of perinatal care

The first document Standard of perinatal care entered into force in 2012. It was prepared by a team of specialists, primarily in the perinatal field, but also by representatives from outside of medicine, working to improve the quality of care in this area. It was obligatory for all medical entities in Poland providing care in the perinatal period.

It contained a model of medical and organizational procedure and a record of women's rights in the perinatal period. It lists a number of some kind of novelty that had not been mentioned in the most important guidelines in force until then. The importance of the woman making informed decisions regarding both care during pregnancy and the procedure during and after childbirth was emphasized. Emphasis was placed on aspects such as woman's activity during childbirth, assuming birthing positions by her i availability of methods of relieving labor pain, and care for her sense of security i ensuring comfort.

The beginnings new standards of perinatal care

Records, for example, about the preparation of a birth plan, educational visits with a midwife, vertical birthing positions or the importance of skin-to-skin contact after childbirth, are less surprising now, but at that time some of them were surprising, both for the medical society and for pregnant women .

The standard, in its content, went beyond medical issues, and the new so-called "Soft" elements of care for a woman in the perinatal period, such as: the correct way of addressing the pregnant woman, respecting her intimacy, emphasizing the importance of building a sense of security during childbirth and not separating from a loved one, raised it to the rank of an indispensable component of perinatal care practice. Previously, these elements were often regarded as less important and applied at will.

The standard listed the above-mentioned practices, defined the rights of women in the perinatal period and obliged them to implement them.

Enlargement the standard of perinatal care

In 2016, the document, so far relating to physiological pregnancy and physiological birth, was changed. It was extended by the scope of management in the case of complicated pregnancy and obstetric failures. At that time, also due to the legal complexities of the Standard, a process of change began. As a result, the document about the shape of medical procedure standards was replaced by the Organizational Standard in perinatal care.

The new standard Organizational Perinatal care

From January 1, 2019, a new one applies Organizational Standard of Perinatal Care.

Although the content of the new document contains mainly the duplicate content of the previous one, the changes relate to very important issues, including it is recommended to control the risk of depression in pregnant and postpartum women, emphasis is placed on respecting the birth plan, implementing pain relief measures in childbirth and promoting breastfeeding.

Co Standard brought into reality perinatal care?

We are already used to most of the changes that the Standard has contributed to. Family childbirth, skin-to-skin contact after childbirth, active childbirth and methods of relieving labor pain are elements that have blended into the everyday life of delivery rooms. Increasingly effective, respecting the birth plan and supporting lactating women is carried out.

There is still a lot of work to be done. The standard applies to all facilities in Poland, and there are still discrepancies in the quality of conditions provided by hospitals. However, the Standard obliges to systematically monitor specific indicators of perinatal care and patient satisfaction, and to improve the quality of care. So one can only hope that it will only get better.

Expanding social awareness

Social awareness of the issues related to the perinatal period and proper delivery is increasing, it is no longer a taboo subject. Pregnant women choose a hospital on the recommendation of other women. There is greater awareness of pain relief methods available, and so are the benefits of breastfeeding.

One of the objectives of the Standard is to limit the number of medical interventions without any indications for their use. It is worth remembering that the experiences passed on in stories and relationships have great power and just as they become an argument for choosing a specific midwife, doctor or place for childbirth, they also become an argument for choosing a specific way of delivery. That is why it is so important to constantly improve the quality of care, and the birth stories to be as positive as possible.

Woman and child in the foreground 

First of all, in Standard, the woman and her child are placed in the foreground. They are recognized as the subject of all personnel activities. The standard is also an invaluable source of information about women's rights in perinatal care.

The document emphasizes the value of reliable antenatal education in the form of educational meetings. This gives the woman a chance to better understand what to expect at the different stages of care and what she is entitled to.

A primary care midwife, Standard indicates as a specialist responsible for the implementation of education. The acquired knowledge makes it easier to make the right decisions about the health of a woman and a baby, and about the conduct in the perinatal period.

Women's rights in perinatal period and Standard

Choosing the person conducting the pregnancy

You have the right to choose the person responsible for the pregnancythis could be a doctor or midwife. After 21 weeks of pregnancy, you should be referred to a primary care midwife who will provide you education in the field of pregnancy, childbirth, baby care, puerperium and lactation, it will also help you prepare a birth plan. After giving birth and returning home from hospital, this midwife will look after you and your newborn baby and visit you several times. In the new Standard, it is recommended for every pregnant woman, twice before and once after childbirth, controlling the risk and severity of depression symptoms.

Possibility to choose a hospital and indicate a loved one

You can give birth in a hospital of your choice. You have the right to presence of a loved one indicated by youthat will accompany you during childbirth. The exclusion of the implementation of this right may take place in the event of an epidemic threat or a threat to the health of the childbearing person. On admission to the hospital, you will hand over the prepared birth plan, that is, your written-down expectations related to childbirth and hospital stay. This plan will be attached to your medical records. It will be a valuable guide for midwives and doctors to understand your needs.

Guarantees included in the Standard

You can accept during normal labor convenient and beneficial delivery positions. You have the right to use the methods of relieving labor pain. While you are in the hospital, you will be treated with respect, recognizing your right to intimacy and privacyThe Standard definitely emphasizes this.

Immediately after delivery, if your and your newborn's health condition allows it, a minimum of 2 hours is recommended. contact "skin to skin". This means that the baby will be drained, placed on your breast, you will cuddle and enjoy the many benefits of these extraordinary moments. You will get professional support in breastfeeding. You will not be separated from your little one while in hospital. To carry out any medical procedure with you and your baby you will have to give your consent.

Is it worth knowing this document?

If we do not know our rights, it is difficult for us to exercise them. If we do not understand some of the medical issues, we can persist in making a wrong decision, believing it to be the right one. It is not that if you are planning a pregnancy or are expecting a baby, you should learn medical textbooks. It is enough for you to reach for the Standard or accessible studies written on its basis. There you will find an essence in the field of perinatal topics. It is worth knowing that you can take part in antenatal education with a GP midwife. She will equip you with reliable knowledge and answer your questions.

Respecting the Standard is part of the work of midwives and doctors. But even their efforts do not guarantee the achievement of all its goals, if pregnant, giving birth and women in childbirth do not know and understand its provisions. If they do not want to make decisions and actively participate in the various stages of care.

Standard was created for you, among others. And influenced by your voice as well, it can perpetuate positive changes and even evolve.

Źródła:

Regulation of the Minister of Health of 20 September 2012 on the standards of medical procedure in the provision of health services in the field of perinatal care provided to women during physiological pregnancy, physiological delivery, puerperium and care for a newborn;

Regulation of the Minister of Health of August 16, 2018 on the organizational standard of perinatal care. The organizational standard of healthcare in entities providing healthcare services in the field of perinatal care is determined, which is attached to the regulation. The regulation shall enter into force on 1 January 2019 (...).