ROLE OF MIDWIFERY PRACTICE

INTRODUCTION

Midwife means ‘with woman’ or in France ‘wise woman’. The midwife is recognized worldwide as being
the person who is alongside and supporting women during birth. However the midwife also has a key role
in promoting the health and well being of childbearing women and their families before conception,
antenatally and postnatally, including family planning.

If chosen as the primary care gives for pregnancy the role of the midwife will take place, of an
obstetrician. For instance UK, approximately 75% of the prenatal care is performed by midwives for all
low risk mothers and obstetricians only see high risk patients.

ACTIVITIES OF A MIDWIFE

The midwife has diverse and complex functions:

1. A midwife is a highly trained expert and carries out clinical examinations, provide health and
parent education and support the mother and her family throughout the child bearing prices to
help them adjust to their parental role.
2. Provides sound family planning information and advice.
3. She diagnoses pregnancies and monitor normal pregnancies to carry out examination necessary
for the monitoring of the development of normal pregnancies.
4. She give advice regarding personal hygiene and nutrition to the pregnant mother, and cares
throughout pregnancies and first six weeks of birth.
5. Care for and assist the mother during labour and monitors the condition of the foetus by the
appropriate clinical and technical means.
6. Conducts spontaneous deliveries including where required an episiotomy and in urgent cases of
breech delivery.
7. To recognize the warning signs of abnormality in the mother or infant which necessities referral
to a qualified medical doctor‘s absence, in particular, the manual removal of placenta, possibly
followed by manual examination of the uterus.
8. To examine and care for the newborn infant, to take all initiatives, which are necessary in case of
need and to carry out where necessary immediate resuscitation.
9. To care for and monitor progress of the mother in the post-natal period and to give all necessary
advice to the mother on infant care to enable her to ensure the optimum process of the newborn
infant.
10. To carry out the treatment prescribed by a medically qualified doctors.
11. To maintain necessary records.
12. Midwife teaches about pregnancy , the process of labor, birth and recovery, and parenting skills,
this can promote significant improvement in maternal and infant health.
13. She plans care with each woman in labor that is tailored to meet her specific needs and
expectations.
14. Puts the care plan into practice and evaluate the care given to measure its effectiveness.
 15. She is a skilled professional providing continuous care for several months and assists in critical
decision making regarding appropriate care in pregnancy, labor and the post-partum period.
16. Plays important role in disaster and complex humanitarian emergencies at the periphery of the
health care system where there are no doctors.
17. The midwife should develop partnership with the woman from the beginning of her pregnancy.
This requires a social rather than medical model of maternity care, endorsing the involvement of
the woman and her partner in decision making and requiring the woman to be able to voice her
needs and wishes freely.
18. The midwife should strive to build a relationship of mutual trust and create an environment in
which expectations , wishes, fears, and anxieties can be readily discussed. This requires good
communication skills.
19. She should provide emotional and psychological care to woman during labor. The attitude and
reactions to childbirth vary considerably and are influenced by different social, cultural and
religious factors. For a multigravida, the previous experiences of birth will also be important.
20. The midwife should forward as an advocate to support the woman in unknown and unfamiliar
situations and people ; greater pain than expected or the effect of analgesic pain than expected or
the feeling of vulnerability, loss of personal identity and powerfulness.

Many women anticipate labor with mixed feeling of fear and excitement . They may be apprehensive
about entering an unknown and perhaps threatening hospital environment and concerned about
relinquishing her personal autonomy and identity. Alternatively, expectations of labour may be unrealistic
and may be unfulfilled leading to feeling of disappointment, failure or loss .In these situations the
midwife should support the mother’s.

Basic role:

All maternal and child health function in a variety of settings are caregivers, client advocate, researcher,
case manager and educator.

1. Care giver

The midwife understands and facilitates normal childbearing  and provides the adequate care to the
mother and the baby, spreads health and well-being to women and their families

2. Client advocate

The midwife supports, facilitates and implements the woman's choice. Helps the mother to protect her
basic rights .

3.Researcher

The midwife is a good researcher and does not implement interventions with a sound base on evidence
and can critically evaluate the evidence-base for midwifery knowledge .She goes through various studies
and conduct studies to provide the best care to the mother and child.
4.Manager

A midwife quickly comprehends the range of normal maternal, fetal and neonatal well-being practice,
diagnoses factors that may adversely affect maternal or fetal well-being, locates appropriate
assistance or intervention while providing continued family support  ,manages skilled emergency
interventions  and assists during bereavement

5.Educator

The midwife provides health education to the mother and the family members . She is a resource to the
women and their communities

Expanded role

As trends in maternal and child health care changes , so do the roles of maternal and child health nurses.
Many nurses with a specified number of years of direct patient care, education programa are certified in
their speciality . In addition, maternal and child health nurses function in a variety of advanced practice
roles.

1.Clinical Nurse Specialist

Clinical nurse specialist are nurses prepared at the master’s- degree level who are capable of acting as
consultant in their area of expertise, as well as serving as role models, researchers, and teachers of quality
nursing care. Example of areas of specialization are neonatal, maternal , child and adolescent health care ,
childbirth education, and lactation consultation.

2.Case Manager

A case manager is a graduate level nurse who supervises a group of patients from the time they enter a
health care setting until they are discharged from the setting, or ina seamless care system, into their homes
as well, monitoring the effectiveness, cost and satisfaction of their health care. Case management can be a
vastly satisfying nursing role, because if the health care setting is ‘seaming’ or one that follows people
both during an illness and on their return to the community, it involves long-term contacts and lasting
relationships.

3. Women health nurse practitioner

A women health nurse practitioner is a nurse with advanced study in the promotion of health and
prevention of illness in women. Such a nurse plays a vital role in educating women about their
bodies and sharing with them methods to prevent illness, in addition, they care for women with
illness such as STD’s offering information and counseling them about reproductive life planning.
They play a large role in helping women remain well so that they enter pregnancy in good health
and maintain their health through out life.
4. Family Nurse Practitioner

A FNP is an advanced practice role that provides health care not only to women but to total families. In
conjunction with a physician, an FNP can provide prenatal care for a women with an
uncomplicated pregnancy. The FNP takes the heath and pregnancy history, performs physical and
obstetric examination, orders approximate diagnostic and laboratory tests and plans continued
care throughout the pregnancy and for the family afterwards. FNPs then monitor the family
indefinitely to promote health and optimal family functioning.

5.Neo-natal Nurse Practitioner

A neonatal nurse practitioner(NNP) is an advanced practice role for nurses who are skilled in the care of
newborn, both well and ill. NNPs may work in level1, level2 or level3 newborn nurseries;
neonatal follow-up clinics or physician groups. They also transport ill infants to different care
settings. The NNP’s responsibilities include managing and carrying out patient care in INC ,
conducting normal newborn assessment and physical examination and providing high-risk follow
up discharge planning.

SCOPE OF MIDWIFERY PRACTICES

Paramount to the practices of any health care provider is an awareness of the individual professional
scope of practice. Understanding and adhering to one’s scope of practice of recipient of health care
practices, as well as in the safe- guarding of health care professionals themselves. For, instance, a person
with a broken bone will not seek care from a psychologist. The prevention of such inappropriate and
potentially dangerous scenarios is the very reason why defining one’s scope of practice is vital to the
wellbeing of individuals seeking health care . In midwifery education , students learn from the start of
their training that safety is vital to offering quality midwifery care, and understanding one’s scope of
practice is a large part of achieving this.

The scope of midwifery nursing practices is the range of roles , functions, responsibilities and activities
which a registered nurse is educated, competent and has authority to perform.

IMPORTANT CONSIDERATIONS IN DETERMING THE SCOPE OF MIDWIFERY PRACTISES

A. COMPETENCE:

Competence is the ability of the registered nurse r registered midwife to practice safety and effectivety,
fulfilling his/her professional responsibilities within her scope of practice.

A competent professional midwife possess many attributes.these include practical and technocal skills,
communication and interpersonal skills, organizational and managerial skills, the ability to practice safely
and effectively utilizing evidence , the ability to adapt a problem solving approach to care utilizing critical
thinking , the ability to perform as part of a multidisciplinary team demonstrating a professional attitude,
accepting responsibility and being accountable for once action.
 B. ACCONTABILITY AND AUTONOMY:

Accountability is the fullfillment of a formal obligation to disclose to referent others the purpose,
principles, procedures, relationships, result, income and expenditures for which one has authority. In the
course of his/her professional practice, a nurse or a midwife must be prepared to make explicit rationale
for decisions in the make explicit the rationale for decision in the context of legislation, professional
standards and guidelines, evidence based practice and professional and ethical conduct.

Accountability can’t be achieved unless the nurse or midwife has autonomy to practice . Nurse are
autonomous in midwifery . This means that they have the freedom to make discretionary and binding
decisions in accordance with their scope ofpractise. Authority is the legitimate power to fulfill a
responsibility.

C. CONTINUING PROFESSIONAL DEVELOPMENT

Continuing professional development encompasses experiences, activities, and process that contribute
towards the development of a midwife as a health care professional. This means, it is a lifelong process of
learning, both structured and informal.

Continuing education is a vital component of continuing professional development and takes place after
the completion of the pre-registration education programme for midwives and nurse. It consists of
planned learning experiences that are designed to augment the knowledge, skills and attitude of a
registered nurse or registered midwife, for the enhancement of midwifery practices , patient care
education, administration, and research.

D. SUPPORT FOR PROFESSIONAL NURSING AND MIDWIFERY PRACTICE

Inorder for the midwives to practice completely and to realize these potential in the interest of quality
patient care; certain supports need to be in place. This include – local and national guidelines, policies and
protocol that have been developed collaboratively with practicing nurses and midwives, and with
reference to legislation and research- based literature.

E. DELEGATION

Delegation is the transfer of authority by a nurse midwife to another person to perform a particular role.
Each registered midwife is accountable for his/her own practice. The midwife is accountable for his/ her
own practice. The midwife who is delegating is accountable for the decision to delegate . This means that
the delegate function is appropriate and that support and resourses areavailable to the person to whom the
role has been delegated. The miwife is accountable for carrying out the delegated role in an appropriate
manner.

THE PRINCIPLES TO BE KEPT IN MIND WHILE DELEGATING ROLES

 The nurse midwife must ensure that the primary motivation for delegation is to serve the interest
of the patient.
 The midwifery must ensure that the delegation is appropriate with reference to the definitions and
philosophies of nursing or midwifery as appropriate .
  The nurse or midwife must take the level of experiences , competence, role and scope of practice
of the person to whom the role is being delegated into account.
 The nurse or midwife must not delegate to junior colleagues , tasks and responsibilities beyond
their skill and experiences.
 The midwife must ensure appropriate assessment , planning, implementation and evaluation of
delegate role.
 The midwife must communicate the role in a manner understandable to the person to whom it is
being delegated.
 The midwife must communicate the role in a manner understandable to the person to whom it is
being delegated.
 The midwife must decide on the level of supervision and feedback necessary.

The Nurse to whom a particular role has been delegated should take account of the following
principles.
- The nurse or midwife must consider if it is within their scope of practice . If the delegated
role is beyond the current scope of practice. If the delegated role is beyond the current scope
of practice of the nurse or midwife need to consider the appropriateness of this delegation.
- The midwife must acknowledge any limitations of competence.
- The nurse or midwife must provide appropriate feedback to the delegator.

6. EMERGENCY SITUATION

Nothing in this document will be constructed as preventing a nurse midwife from taking appropriate
action in the case of an emergency . The best interest of the patient must be served by appropriate nursing
or midwifery intervention in emergency situations.

PRINCIPLES OF DETERMING THE SCOPE OF PRACTICE

The following principles are the basis for making decisions with regard to the scope of practice for an
individual nurse/midwife.

 The primary motivation for expansion of practice must be best interest of patient and promotion
and maintenance of the best quality health services for the population.
 Expansion of practice must be made in the content of the definition of nursing midwifery and the
values that underpin midwifery practice.
 Expansion of practices must only be made with due consideration to legislation , national policy,
local policy and guidelines. If necessary at local level, appropriate protocols and guidelines
should be devised and appropriate supports put in place.
 In determining the scope of practice the midwife must make a judgement as to whether she is
competent to carry out the role function.
 The midwife must take measures to develop and maintain the competence necessary for
professional practice . The midwife must acknowledge any limitation of competence.
 Expansion of practice must be based on appropriate assessment , planning, communication and
evaluation.
  The midwife who is delegating a particular role function is accountable for the decision to
delegate . This means that the delegated role is appropriate and that, support and resources are
available to the person to whom it has been delegated.
 The individual midwife is accountable for her practice. This means that she is accountable for
decision and determines the scope of practice.

INDEPENDENT NURSE MIDWIFE

PRACTITIONER
Definition
Independent midwives are fully qualified midwives who have chosen to work outside the National Health
Scheme in a self employed capacity. The legal role of a midwife encompasses the care of women and
babies during pregnancy, birth and the early weeks of motherhood.

Usually one midwife gives care to a woman her family through out a pregnancy. Having established a
trusting relationship , the same midwife would care for the woman and her baby and support afterwards.

Research have shown that many women till want this type of midwifery care and that it help women to
cope with the challenges of labor and the transition to parenthood. In recent times, health advisers and
government policy makers have promoted independent midwives style of care as the’ Gold Standard to
which the National Health Scheme(NHS)’ should aspire to independent midwives are currently working
to ensure that all women can assess ‘ gold standard care in the future’.

Working place
A pregnant women is entitled to choose where she wants to have her baby. Midwives can work with
women at : Home, Hospital, In separate midwifery aid units ,Private birth centers.

Mode of Duties
Independent midwives have more freedom to practice individualized care compared to those working
with the NHS, who can be restricted by guidelines and protocols.

Independent midwives are regulated by the Nursing and Midwifery Council. They are subjected to the
same supervision as NHS midwives are required to keep up to date with their practices and are only
allowed to act within their sphere of competence as midwives.

For instance, there are currently approximately 150 independent midwives in U.K. They often work in
partnership or have close connection with other independent nurse midwives, enabling them to provide
seamless care to the women who use their services.

The independent midwives form relationship of trust with pregnant women, which then help women to
feel safe and supported when they go into labor. Many independent midwives have become very
experienced and in areas of child birth; that within the NHS are usually dealt with by obstetric
management . These include breech birth, twins and vaginal birth after caesarean . The majority of births
attended by independent midwives at any stage during pregnancy , no matter how close you are to your
due date. Some will give free consultations to women who are considering all their birthing options.

Practicalities to be aware
1. Cost: Independent midwife charge for their services. The amount will depend on the living
status and the type of services they offer.
2. Place of Birth: Most of the midwives attend birth at home. There are a small number of
independent midwife services in U.K. with their own centers. If a women is planning
hospital birth or need to be transferred to hospital , she can do so and a midwife can
accompany her if so she designs.
3. Independent midwifes have the same referral rights as NHS midwives and are able to
arrange a consultant appointment or hospital admission if required.

Professional Autonomy of a Midwife

 The midwife is responsible for all care unless she makes a referral to mother to another health
professional.
 Any guidelines and policies should have been developed and approved by midwifery after
process of consultation.

Principles
The National Nursing , midwifery and Health visiting practice(UKCC) describes seven guiding principles
which establish autonomous midwifery philosophy and values in relation to expected outcomes of
midwifery programmes:

A.Provision of Women centered care

Every woman expects to be treated as though she is special and important .Although at times maternity
units and community workloads can be busy, individual women wants midwives to be there for them , not
for someone else.It is essential that midwives have an understanding of social , cultural and context
differences so that they can respond to the needs of women and their families in a variety of care setting
and priorities and manage work appropriately. Of particular importance is working with families to draw
up a plan of care and support and then evaluate and modify that care as circumstances.

B. Ethical And Legal Obligations

The practice of a midwife is controlled by law, under the Nurses Midwives and Health Visitors Act and
Midwives Act. Midwives also need to be familiar with other Acts of Parliament and Statutory Instruments
that impact on their practice. The code of professional conduct sets requirements for the behavior of
midwives and nurses in relation to such things as confidentiality, respect and personal responsibility for
ethical choices. For example, midwives may find themselves expected to care for women who have
decided to terminate their pregnancy. Even though the midwife have objection regarding it, she cannot
refuse to provide care for the woman. Counselling services are normally provided for women and staff
facing ethical dilemmas and stressful situations.

C. Respect for Individuals And Communities

Society is composed of people from many cultures, ethics, and religious backgrounds. Midwifery care
must be provided in a non-discriminatory way without prejudice; Where midwives find they don’t have
the skill or expertise to provide effective care for individuals or groups then need to seek assistance. In
areas where there are number of residents who don’t speak the local language, link workers or an
interpreting service can be more appropriate than asking another family member; especially a child, to
communicate between the woman and the midwife.

D. Quality and Excellence

Individual midwives should strive for continuous improvement and excellence in midwifery practice. To
protect the health and well-being of mother and babies , supervision of midwives is enshrined in statute.
Clinical governance has more recently been established to assure the quality of all the health services
provided by an individual NHS Trust and has many principles that mirror statutory supervision of
midwives. Auditing of standards and discussion of difficult maternity care scenarios are ways in which all
professional groups can work together to improve the quality of services. Involvement of mother in
evaluating care and suggestion for areas that need improvement have become even more important in
contributing to become even more important in contributing to quality and excellence in the maternity
services.

E.The changing nature and context of Midwifery Practices

Midwives need to be flexible and also become change agents when necessary. Theu need to adapt to new
technologies to improve the quality of care, providing quality care and there by developing their existing
skills and identify changes needed.

F.Evidence – based Practice and learning

The practitioners of midwifery should have evidence for effective care and not assume that all research is
of value but that it must be critically analysed. It intends to foster the use of sysytematic reviews such as
effective care in pregnancy and childbirth.

G.Life-long Learning

Midwife should adapt a style of learning complex and problem solving skills and become expert
practitioners with upto date knowledge of informations. Midwives also need to grasp opportunities to
learn from each other by observing , discussing different ways of practicing and where necessary seeking
out an education or training event.
The Independent Nurse midwifery management processes
Regardless of the practice setting, the nurse midwife care encompasses four aspects of management:

1.Independent Management

Nurse midwife are responsible and accountable for the management decision they make in caring for the
patient. Nurse midwife provides independent management when they sysytematically obtain or update a
complete and relevant database for assessment of the patients health status. This includes the history the
physical examination results, the laboratory data. On the basis and interpretation of this findings, nurse
midwives accurately identical problems and diagnosis and implement a plan of action.

2.Consultation

When nurse midwives identify problems or complication they seek advice from another member of the
health care team often a physician. When they retain independence management responsibility for the
patient while seeking advice, this is called consultation, may centre on an ongoing health problems, a non
obstetrical , time limited problem that arises during pregnancy. After consultation the nurse midwife and
the women discuss the recommendations if any and modify the plan of care accordingly. In this process
nurse midwife retain responsibility for decision.

3.Co management or collaborative care

One out come of consultation may be the decision to shift to co management or collaborative care. This
usually occurs if part of the women’s care is related to an ongoing medical or gynecological complication
beyond the scope of the nurse midwives practice. In this situation the nurse midwife and the physician
collaboratively treat the patient.

The range of services provided:

 Pre-pregnancy advice
 Advice about birth options
 Childbirth education classes
 Continuous midwifery care during pregnancy
 Preparation for and attendance at births in an appropriate environment of the parent’s choice.
 Postnatal care following birth at home, birth centre or hospital.
 Separate postnatal care for women who want private midwifery care for this period only or who
are discharged home early from hospital
 Lactation consultancy
 Referral to and advice about other health professional such as medical and natural health
practitioners, eg obstetricians, paediatricians, GPs , chiropractors, osteopaths, naturopaths ,
homeopaths
 Some midwives have a special interest and expertise in supporting women in special areas such
as vaginal birth after caesarean section(VBAC), breech births, water births and postnatal
depression.
Independent practice Midwife in India
In India 1,00,000 women die every year due to pregnancy related cause (GOI 2005). Over 50 million
women suffer from malnutrition in India. Morbidity due to pregnancy is 18 times higher in developing
countries and IMR is 7 times higher in developing countries. Risk to a woman of dying from pregnancy
related causes: developed countries 1: 4000 to 10,000 where as in India it is 57/1000. IMR in developed
countries 1 in 5000 to 10,000 and in India 64/1000.

Major contributing factors for these problems are:

Lack of skilled health care

Posts for doctors with obstetric skills in rural and tribal areas often lie vacant

Nurse midwives are available at the first level of referral but are unskilled for the level of
management required to supervise at-risk deliveries.

Poor utilization of midwifery skill.

Lack of a supportive policy environment

In order to improve this conditions, the Nursing Council (INC), the parent body of the nursing councils
in the country, has rolled out a series of initiatives, many of which are in the early implementation stage,
while the rest have been forwarded by INC for approval to the Union Health ministry.

Aimed to ease the impact of the shortage of gynecologists in community health centres, INC performed
a pilot study for the ‘ Independent Nurse Practitioner Project’ in Infant Mortality Rate(MMR) in West
Bengal at SSKM Hospital female medical and surgical wards. The project provided an 18 months training
in midwifery, besides an additional training in emergency obstetric care to candidates who have
completed their BSC in nursing and have two to three years of experience in OB-GYN wards to take care
of ANMs in rural sectors. These nurses were called independent nurse as they were trained to prescribe
medicines following approved protocols and take decisions independently in absence of gynecologists.

The result of the pilot study has been submitted to health ministry and the government of India examined
the protocol to extent this project all over India. The GOI response to the challenge:

– INC entrusted with responsibility of developing a new cadre of midwives who will work
in rural and tribal areas of India

Phase 1

– Funded under the India-Australia Training and Capacity Building Project (IATCBP) as
“The Specialist Midwifery Sub-Project”.

– Supported by technical assistance from Faculty of Nursing, University of Newcastle,

Australia
Development of new cadre

• Consensus building

• Development phase

• Implementation phase

Consensus building

Step 1: Need for a new cadre of specialist midwifery identified

Step 2: Consensus on key issue related to the new cadre.

Step 3: Consensus on role and function of nurse practitioner in midwifery

Development phase

Step 4: Base-line data collected

Step 5: Development of code of ethics

Step 6: Development of practice standards

Step 7: Development of a framework for service standards

Implementation phase

Step 8: Development of clinical guidelines

Step 9: Development of curriculum framework

Step 10: Writing the curriculum

Step 11: Development of assessment tools

Step 12: Piloting selected modules and assessment

Step 13: Review and revision

Outcomes

 The provision of qualified NP in midwifery with skills and knowledge to manage ob and gynae
emergencies in rural and tribal areas of India

 To increase the number of women and infants seeking treatment at the CHCs where the NP is
placed thus reducing the risk of maternal and infant mortality and morbidity

 To decrease maternal and infant mortality and morbidity in the rural and tribal areas of India by
providing quality ob and gynae services through NP placed in CHCs.
Training & placement of Independent Nurse Midwife Practitioner Course

 Duration: 18 months (including 6 months internship)

 Eligibility/ Qualifications

o B. Sc. Nursing, 2 years experience (at least one year in midwifery)

o Age: < 45 yrs

 Placement: CHC / PHC with facilities for supporting the role & function of new cadre

 Post: convert one post of staff nurse to NP in Midwifery

 Salary: equivalent to principal nursing school

 Mode of Offer: Full-time only

 Proposed Course Locations: Colleges of Nursing and Medical Colleges in Calcutta (West Bengal)
and Indore (Madhya Pradesh)

 Proposed Intake for the First 2 years:

 First year: 6 each from training location

 Second year: Intake to be reviewed based on the experience of the initial intake

 Professional Recognition and Accreditation: INC

Responsibilities & practice

o Promotion of health of women throughout their life cycle with special focus on women during
childbearing years and their new babies.
o Provide autonomous care to women prior to & during pregnancy, during & after childbirth, care
of newborn & assume responsibility and accountability for their practice.
o Practice within the existing peripheral health system consisting of birth attendants, ANM’s,
nurses, doctors & specialists
o NP will be posted at a facility where no obstetricians are posted or available

Job description

 Promote health of women before pregnancy through education and counseling for healthy family
life including planning for pregnancies.
 Promote health of women during pregnancy through:
 Quality, technically advanced antenatal care to women with normal pregnancy
 Early detection of risk situations and management that commensurate with their level of
competence
 Management of minor disorders of pregnancy
 Referrals as required
Regulations of practice

• INC Act (1947) amended to allow INC to:

– Regulate the practice of the NP in midwifery according to the code of ethics

– License the NP to practice independently (as per practice standards)

– Authorize & be responsible for preparing, approving & implementing the curriculum

• Code of ethics & practice standards are key for licensing & regulation of NP

TEACHING INSTITUTIONS

Government (State/Center/Autonomous) nursing teaching institution offering diploma or degree

programs in nursing having parent/ affiliated Govt. Hosp. facilities of maternity, neonatal and
pediatric units. Or Other non-Govt. nursing teaching institution offering diploma or degree
programs in nursing having parent Hosp. facilities of maternity, neonatal and pediatric units
The institution conducting this course should have a 50 bedded parent hospital having mother and
neonatal units,Case load of minimum 500 deliveries per year, 8-10 level II neonatal beds,
Affiliation with level III neonatal bed
The number of seats available depend on the number of deliveries conducted in the parent
institutions ie,
10 students for minimum 500 deliveries per year
20 students for minimum 1000 deliveries per year
STAFFING PATTERN
1. Full time teaching faculty
 Ratio 1:5
 Qualification:
 M. Sc. Nursing with Obstetrics and Gynaec/Community/Pediatrics
Specialty
 Nurse practitioner in midwifery with B. Sc. nursing
 Experience: Minimum 3 years
2.Guest faculty - multi-disciplinary in related specialties
Distribution of the Course:
1. Teaching: Theory & Clinical practice 42 weeks

2. Internship 4 weeks

3. Examination 2 weeks
4. Vacation 2 weeks
5. Public holidays 2 weeks
------------------
52 weeks
Curriculum
Theory
 Clinical Nursing-I
(Inclusive of foundation courses) 90 Hrs
Clinical Nursing II- 90 hrs
Paper III
(i) Supervision & Management 30 Hrs
(ii) Clinical Teaching 30 Hrs
(iii) Elementary Research & Statistics 30 Hrs

TOTAL 270 Hours

Practical
Integrated Clinical Practice 1410 Hrs
Internship 160 Hrs
Total 1570 Hrs
Clinical Experience
 Maternal and neonatal care Services 38 weeks
 Antenatal OPD including Infertility clinics
/Reproductive medicine, Family welfare and
post partum clinic / centre 6 weeks
 Antenatal and Postnatal ward 4 weeks
 Labour room 8 weeks
 Neonatal Intensive Care Unit 4 weeks
 Obstetric/Gynae operation Theatre 4 weeks
 Gynae ward 2 weeks
 Paediatric OPD/under five clinic 2 weeks
 Paediatric ward 2 weeks
 CHC,PHC,SC 6 weeks
 Total practical hours 38 weeks (1410 hrs)
 Internship - 4 weeks in community
Institutions conducting NP Course

 Gujarat:

o Ahemdabad

o Baroda

o Bhavnagar: under process

PROPOSED CADRE OF NURSE MIDWIFE PRACTITIONERS
 State Nurse Midwife Practitioner Admin PostProposed -4 Accepted -1
 Chief Nurse Midwife Practioner at Regional Level Admin Post (6)
 Senior Nurse Midwife Practioner (26) at District/Med College attached Hospital
 Nurse Midwife Practioner (3016) at PHC,CHC, Taluka Medical College attached Hospital
 SALARY SCALE OF NEW CADRES

s.no. Designation Pay scale No of post Total expenditure

1. Staff Nurse Midwife 10,000-15,200 4 12.02 lakh
Practitioner
2. Chief nurse Midwife 8000-13,500 6 14.76 lakhs
Practitioner
3. Senior nurse midwife 6500-10,000 30 50.07 lakhs
practitioner
4. Nurse Midwife 5500-9000 3016 43.43 lakhs
Practitioner

Research findings
1. Health Care–Seeking Practices of Pregnant Women and the Role of the Midwife in Cape Town,
South Africa

Naeemah Abrahams rn, rm, mphil†, Rachel Jewkes mbbs, msc, mfphm, md‡, Zodumo Mvo
socsc (hon), mphil§ (Journel for Midwifery & women’s health, volume 46, issue 4, page
no:240-247)

ABSTRACT

The objective of this study was to investigate the health-seeking practices of pregnant women in
a periurban area in Cape Town, South Africa. This qualitative study was based on 103 minimally
structured in-depth interviews of 32 pregnant women. Most women were interviewed on several
occasions, and a group discussion was held with women. The interviews were taped, transcribed,
analyzed ethnographically, and, if necessary, translated into English. Antenatal care attendance
was influenced by a number of factors, including women's knowledge of the role of antenatal
care, perceived health needs, booking systems, nurse-patient relationships, economics, child care,
and transport. The expected benefits were weighed against the anticipated costs before decisions
about seeking care were made. The findings highlight the importance of women's perceptions of
quality of care in influencing their health seeking practices. The study suggests that considerably
more attention needs to be given to this aspect of maternity services.
2.Childbirth as healing: three women's experience of independent midwife care

M Milan 

120, Straight Road, Old Windsor, Berkshire 5LL 2SB, UK

Abstract

This article sets out to demonstrate that, for some women, childbirth may be experienced as healing and
life-changing. The author works as an independent midwife. Interviews with three ex-clients were
analysed, and the common themes identified and grouped. The three women had negative memories of
the birth of their first child, but all birthed their second babies at home. The quality of care received was
described as empowering, reassuring and emotionally supportive. Practical inputs such as listening
presence, information, referrals, touch, were all identified as facilitative. The women framed their
perception of the changes which had occurred in terms of reassessment of themselves and their
capabilities in the light of the achievement of the birth experience.

Conclusion

The role of midwife is very important. Every midwife should know the scopes of midwifery practices
and the role played by independent nurse midwife practitioner in the society, to provide the best and safe
care for the mother and the child.

REFERENCE

1. Varney Helen, Kriebs M Jan, “Varney’s Textbook of Midwifery “, All India Publishers and
Distributors,2005, IVth edition, Page no: 3-4
2. Henderson Christine, Myles midwifery , A textbook of Midwifery , published by Davis Karlene
Dame,2004, 13th edition, page no: 433-434
3. Wrong L Donna, Hockenberry J Marilyn, Perry E. Shannor, Lowermilk Leonard Dietra,
Maternity Child nursing Care, published library of congress, 2006, 3 rd edition, page no:299-300
4. http://scholar.google.co.in/scholar?q=independent+midwife&hl=en&as_sdt=2%2C5
5. http://scholar.google.co.in/scholar?
hl=en&q=role+of+midwife&btnG=Search&as_sdt=2%2C5&as_ylo=&as_vis=0