Abstract

PIP:

Since May 1965 nurse-midwives have been inserting many of the IUDs used in the family planning programme in Barbados, run by the Population Council Research Project. The director of the project, Dr. G.T.M. Cummins, has given the Bulletin the information on which this report is based. There is a shortage of doctors in Barbados, as elsewhere, and this is more acute in hospital work; because of this, hospital doctors have to confine themselves mainly to supplying essential life-saving services. Private doctors are not able to meet the demand for contraceptive advice on a national scale, although they do much for their own patients who ask for help in family planning. For a mass campaign in Barbados the answer was thought to be the training of nurse-midwives in contraception, and particularly in the insertion of IUDs without direct medical supervision. Several factors were in favour of using nurse-midwives in this work. They have a general background training in medicine and obstetrics and can talk easily to their patients about the delicate subjects of pregnancy, delivery and contraception. They are looked on by their patients as professionals with authority, and are acquainted with the sociological problems of unlimited childbearing. They are able to be employed whole-time in contraceptive work, unlike the doctors, who are usually harassed with other urgent problems. Nurse-midwives' services are more suited economically to the needs of underdeveloped countries than those of doctors. They can also take Papanicolaou smears when fitting IUDs, and give other contraceptive advice. The nurse-midwives are given careful training and always have medical consultation available. Women with knowledge of practical nursing, such as state enrolled nurses, act as their assistants. The nurse-midwives are trained to recognize which women should not have an IUD inserted and to understand the implications of lesions found during clinical examination before IUD insertion. They are also taught the use of other types of contraceptives. In over 3000 IUD insertions nurse-midwives compared excellently with doctors, even though the doctors included specialist gynaecologists. In 1966 a detailed comparison was made of 500 IUDs fitted by nurse-midwives and 500 fitted by doctors. During the early part of the study some women in whom technical difficulties arose in fitting were referred by the nurse-midwives to the doctors. Lippes loops, mainly size D, were used. No significant differences in the number of pregnancies, expulsions and removals were found.