Opieka położnicza

Rozwój opieki położniczej w ciągu ostatnich 50 lat z perspektywy klinicystów z całego świata

Prof.Dr. Harald Abele
prof. dr Harald Abele
Zastępca Dyrektora Medycznego w Universitäts-Frauenklinik Tübingen w Niemczech i członek Faculty of Medicine at the University of Tübingen

1. How have advances in technology changed the way you work?
Technology often functions as a kind of safeguard in our work. In the past, we moved from bed to bed and room to room to monitor each mother and fetus, but now we have central monitoring systems that allow multiple caregivers to check for changes in maternal or fetal blood pressure, or to review CTGs, pulse rate data and so on.
These technologies are an integral part of modern-day obstetrical care. At the same time, though, they only provide indirect indications of how the mother and child are doing. That’s where the experience of the obstetrician continues to play a greater role.


2. Which developments have surprised you the most during your time in the field of obstetrical care?
One thing I have observed is a trend towards ‘defensive medicine’, with legal considerations and safeguards becoming increasingly important – not least in decision-making for clinical procedures. We also need to be able to use the data we obtain as a form of verification; that’s a question of monitoring and documenting everything as well as we can.
I’ve also noticed that obstetrical care has become increasingly service-driven. I remember my earlier days on the labor ward, in the mid-to-late 1990s, when we had one station, 17 beds and one toilet. Today, as soon as we have three or more expectant mothers in a single room, we receive complaints. This is less about the quality of care we provide during labor and birth, and more about offering a pleasant environment and the right logistics. Today, hospitals often focus on these aspects when marketing themselves.


3. How has the labor experience evolved from the mother’s perspective?
Whenever I discuss this topic, I like to show people photographs of babies and mothers from 40 years ago. The picture of the baby is much the same now as it was then, aside from the improvement in image quality and the move from black-and-white to color! It’s the image of the woman, the mother, that has changed enormously – the perception of what is ‘ideal’.
Again, some of these changes can be linked to the service-driven nature of obstetrical care today. Women come into the care environment and expect to be healthy, and for everything to go well during their stay. It’s like when they go into a hotel and are disappointed if the room doesn’t look as good as it did in the pictures. Of course, any disappointment is greater in the field of medical care because it’s about health, which is of fundamental importance to us all.


4. How have public and clinical attitudes changed with respect to mobility in labor?
Women today have access to a huge amount of information. To help them filter out the most relevant details, I believe we must look to develop and implement a standardized global system of consultation on birthing options.
From a clinical perspective, I notice that younger midwives are often incredibly motivated to ensure as much of a natural physiological labor process as possible, even though this can be physically intensive. Older midwives tend to use their experience and understanding of each mother’s needs to adapt their approach.
Ultimately, different women have different needs. Some prefer freedom of movement; others prefer a bed. In that sense, our experience as obstetricians is vital. While it is good to have a clear idea of what a ‘good birth’ should be, the mother may have a very different perspective, so we have to learn and implement different strategies to manage that and give the woman the freedom and space she needs.


5. What future advances would you like to see in the field of labor and delivery that would improve your job or the mother’s experience?
Firstly, my dream was always to have totally wireless monitoring, so that the woman and her child could be monitored ‘invisibly’ – without the need for lots of cables. With that in mind, I would like to see a continuing trend towards miniaturizing the monitoring technology we use, so that is less conspicuous visually.
Secondly, I would like to make greater use of all the data we capture during the labor and birthing process. This will require complex algorithms which can analyze and learn from this information, paving the way for improvements to the care we deliver to each mother and child. For me, it’s about supporting obstetricians and midwives to make the right decisions.