Midwife

Main Purpose: Provide obstetrical care to pregnant women and their babies, doing follow up before, during and after delivery, according to MSF obstetrical and reproductive health protocols, universal hygienic and newborn caring standards, in order to ensure their health conditions and avoid post-delivery complications. Accountabilities: Ensure the implementation of : ü  Antenatal care ü  Postnatal care, ü   Family planning, ü  Obstetrical care (BEmONC 1) ü  Neonatal care ü  Comprehensive abortion care ü  Management of victims of sexual violence (in collaboration with Gynecologist/ Mental health/ Supervisor) ü  Reproductive tract infections in accordance with MSF Reproductive Core Package of Activities and reinforce the implementation of standardized protocols. Assess the need of  emergency referral of pregnant women and newborns Monitor drugs consumption, control/ordering of orders – inform  supervisors in advance of any ruptures/low supply in order to ansure a regular and ongoing supply of drugs and equipment required for WHC activities Properly follow up all newborns  from delivery until discharge, Inform mothers and relatives about importance of  breast feeding, vaccination and possible complications resulting from  harmful traditional practices. Ensure patients’ privacy and confidentiality is respected Ensure  that administrative procedures of admissions and  hospitalizations comply with MSF protocols Verify that patients are properly informed and receive the required documents (birth certificate, vaccination card, etc.) Participate in the organization of the ward in collaboration with other midwifes, nurses and  supervisors.  Ensure transfer of relevant information to the next shift team (specially identifying risk cases) Contribute to keep the ward clean and tidy Respect medical universal precautions (sort waste and use appropriate containers and bins cleaning and instrument sterilization procedures according to MSF specifications Respect universal hygiene and asepsis rules during care, including self-protection measures Watch over the hygiene of the patients Watch over the ward’s medication and renewable stock (1 ) BEmONC = basic emergency obstetric and neonatal care = Administration of antibiotics, oxytocics, anticonvulsants, manual removal of the placenta, removal of retained products following abortion, assisted vaginal delivery, preferably with vacuum extractor and newborn care including neonatal resuscitation Working hours: 40 hours weekly The schedule might change accordingly with the task: OPD include only daily activities , IPD is organized in rotation to assuring 24/24hours activity Attention! To cover 24/24 shift, night and day shift needs to be filled in   Task description:   Ante-natal consultations: Offer a complete follow up of patients according to the protocols: ü  Obstetrical and medical history ü  Clinical examination (palpation, auscultation, uterus height measurement, fetal heart rate, vital signs) ü  Preventive treatment (tetanus immunization, disinfest-,anaemia prevention) and curative (if needed) Ensure that routine laboratory tests are performed, interpret the results and adapt the approach if necessary Detect pregnancy related complications and adapt follow up if needed Inform and refer to the head midwife or doctor in case of complications/problems exceeding one’s own competence Complete antenatal files, registers and data collection. Refer patients whom needs counselling to health promotion team and/or mental health team based on criteria Prescribing of medicine strictly within MSF protocol Family planning: Ensure appropriate individual counselling (information) in order for women to choose the method of their choice, knowing indications, contra-indications and the side effects of each method Perform a basic clinical examination to exclude contra-indications Administer and/or provide the method of contraception according to its use and protocol Inform and refer to the gynaecologist or OPD supervisor in case of complications/problems exceeding one's own competence Complete family planning files, registers and data collection. Prescribing of medicine strictly within MSF protocol Post-natal consultations ü  Offer a complete follow up of the mothers according to protocols: ü  Delivery history ü  Perform clinical examination (measurement of uterine height, vital signs, condition of the perineum and breasts) ü  Preventive treatment (anaemia prevention etc.) and curative (if needed) ü  Offer a complete follow up of the new-borns according to protocols (if not done by paediatrician): ü  Weight, care of the umbilical cord Preventive treatment (vaccination, eye ointment) Ensure that routine laboratory tests are performed, interpret the results and adapt the approach if necessary Detect complications related to the post-natal period and adapt the follow up if needed Inform and refer to the gynaecologist  or OPD supervisor of any  complications/problems exceeding one's own competence Complete post natal consult files, registers and data Prescribing of medicine strictly within MSF protocol Welcome the patient, take history, vital signs and perform a full obstetrical examination – counter check patient data against ANC file. Admit patients according to admission criteria. Decide whether hospitalization is required, for non-admitted patients – record data and advise accordingly. Register the patient and complete the hospitalization file. In case of emergency – consult with gynecologist and complete assessment and documentation for  referral- accompany patient to tertiary level care if deemed necessary. Accompany the patient to the correct ward, do complete handover to the midwife in charge of the patient Monitor patients during labour and complete partogram once active labour has commenced; report any abnormalities during labour timeously to gynecologist and base intervention/action on set guidelines. Ensure the monitoring and recording of the pregnant women admitted is done in accordance to MSF guidelines (vital signs, fetal heart rate, cervical dilatation etc.) Ensure adequate support to woman in labour (and/or by female relative), and refer to mental health if needed. Observation patients: Follow protocols on management and treatment. Refer any complication/change in maternal or fetal wellbeing immediately to attending gynecologist. Decision for referral will be done in accordance with referral guidelines and on recommendation of gynecologist; only in the absence of a gynecologist will the most senior midwife take the decision to refer the women to tertiary level of care – medical documentation completed by midwife/gynecologist. Conduct a ward round with the gynecologist at designated times (or more when needed). Distribute and administer drugs and perform procedures (i.e. amniotomy) ONLY according to protocol and prescription Midwife conducts the delivery, and actively manages third stage of labour. If any signs of complications are detected during the second/third stage of labour, notify the IPD midwife supervisor and/or gynecologist. After assessment, training and endorsement by the supervisor/MWAM perform the following procedures independently: Amniotomy, vacuum delivery (only if ALSO trained), episiotomy, repair of tears, manual vacuum aspiration, manual removal of placenta and uterine revision- all procedures conducted in conjunction with MSF guidelines. Initiate fourth stage of labour and observe mother and newborn for at least one hour post-delivery in the delivery room for monitoring and observation. Hand over the newborn to delivery room nurse who will perform the initial exam and care, vaccinations, identification etc. - in the absence of the nurse, this task will be performed by the midwife/gynecologist. In case of complications of the newborn call the pediatrician (weekdays) and initiate resuscitation of the newborn Complete all the required information/data in the delivery register and patient, and complete birth registration certificate. Transfer woman and newborn to postpartum ward and follow up according to set MSF guidelines. Upon the decision for referral of women to higher level of care: prepare the patient, complete referral form and inform family accordingly. Transfer the patient to the ambulance and accompany if needed for closer monitoring. Admission of the patient: Follow up of admitted patients during labour/observation: Manage normal deliveries and initial newborn care: Midwifery care for patients in need of referral:   Follow up of women / newborns postpartum: Ensure the follow up of the newborns and the mothers in the maternity ward, complete documentation Prepare the discharge of mothers and their babies, comprehensive health education provided (family planning, danger signs, follow up etc.) Competences: Analysis capacity (decision-making capacity and global vision of the project) Teamwork (ability to work with other people, whether they be medical or non-medical – bear in mind other priorities...) Ability to act as part of a multi-cultural and multidisciplinary team. Initiative Quality-driven (go beyond his/her “formal” responsibilities seeking quality outputs and improvement of working processes) Problem solving capacity Communication skills (capacity to listen and communicate in an effective, specific, positive way) Flexibility (capacity to adjust to changes, willing to go beyond her/his job profile if needed) Flexible for changes in the job profile and even of location due to instability of context. Ability to cope with stress. Ready to work in an unstable context Additional tasks: Respect the medical and patient confidentiality Participate in collecting needed data for monthly medical reports Participate in the regular meetings of the medical team Collaborate with the medical doctor and /or nurse in the management of Sexual Violence cases Rotation  between IPD and OPD and among different stations in each department if required Participates in all training delivered to the department and makes an ongoing effort to maintain        and update obstetrical/medical knowledge and skills On request perform any other additional duties given by the immediate supervisor in order to allow the organisation to function optimally Competences: Results  and quality orientation Teamwork and cooperation  Behavioral flexibility  Commitment to MSF’s principles Stress management