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INTRODUCTION TO MIDWIFERY

CHAPTER 1

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INTRODUCTION

• The medical term “obstetrics or care of women during childbirth is derived from the Greek word obstare, which means to “keep watch”.
• Pediatrics is a word derived from the Greek word pais, meaning “child”.

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HISTORY OF MIDWIFERY IN INDIA

• Maternal Nursing in the Western World

• The last recorded obstetrics practices are found in Egyptian records dating back to 1500 B.C.
• From time to time educated women, daughters of medical men and clergymen became midwives and an obstetrical college for women was founded in London in 1864.
• Florence Nightingale was a pioneer in the efficient training of midwives.

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• A board for the examination of midwives was constituted in London, and the first examination in 1872 was done for six candidates.
• The bill on the recognition of midwifery was passed on 31st July 1902 in the Parliament in London.

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• Maternal Nursing in India

• In Ancient India the care of women during childbirth was carried out and taken care of by the indigenous village dais.
• As early as in 1877, Miss Hewlett of Zanana Missionary Society started the first training school for a dais in Amritsar.
• Later on these trainees were also helped by a fund initiated by Lady Curzon to improve the conditions of childbirth in the country in 1900.

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• Madras Presidency succeeded in enacting the Registration of Nurses and Midwifery Act, 1926 to promote a registered midwife for service during childbirth.
• In its initial phase, it was difficult to get Indian nurses for training. Different funds were granted to various hospitals to build hospitals and supply teaching materials and employ trained sisters in nursing schools.

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TRENDS OF MATERNITY CARE IN INDIA

Ministry of Health and Family Welfare (MoHFW),Ministry of Women and Child Development (MWCD),NITI Aayog and state governments along with collaboration of UNICEF are working to supports the capacities of health managers and supervisors at district and block-level to plan, implement, monitor and supervise effective maternal healthcare services with a focus on high-risk pregnant women and those in hard-to-reach, vulnerable and socially disadvantaged communities.

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• Cost of personnels have been reduced.
• Nurses role has been expanded for attaining increased responsibility
• Reduced routine hospital stay
• Growing trend of alternative and complimentary forms of therapy

As per WHO, maternity care means to ensure that all pregnant and nursing mothers stay healthy throughout pregnancy and delivery period and give birth to a healthy child. For this, following mentioned points are being taken care of:

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• Increased utlization of technology in health care
• Increased caesarean rates due to use of prenatal evaluation.
• Providing respectful maternity care
• Increased cost of advanced care.

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Various trends in maternity care in India which are the interventions by the Government of India, are as follow:

• Family-Centered Maternity Care
• Janani Suraksha Yojna (JSY)
• Janani-Shishu Suraksha Karyakarm (JSSK)
• Labour Room Quality Improvement Initiative (LaQshya)
• Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA)
• Concept of Labor, Delivery and Recovery Rooms (LDR)
• Respectful Maternity Care (RMC)
• Labour Companion-A Companion of Choice

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• RMNCH A+
• Maternal Near Miss (MNM)
• Newer contraceptives Introduced Under RCH Programme
• Training in BEmONC and CEmONC
• Vande Mataram Scheme
• Skilled Birth Attendants (SBA)
• Reaching Every Mother
• Continuum of Care

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MIDWIFERY IN INDIA TRANSFORMATIVE

EDUCATION FOR RELATIONSHIP BASED AND

TRANSFORMATIVE MIDWIFERY PRACTICE IN

INDIA

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The midwifery training which was initially started with diploma rose to a degree level and made to reach to Master’s and Ph.D. level. As a result amount of research related to maternal nursing is also growing.

• Prior to independence, midwifery training had started as a separate course in India. Young girls qualifying at the class VIII level were selected to undergo this training.
• In 1946 Bhore Committee reported the lack of skilled and qualified midwives as a cause for high maternal and newborn mortality rate.

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• In 1955, the Shetty Committee recommended training and posting of ANM in MCH Centres.
• The Indian Nursing Council established the GNM programme in 1947
• The second change was to replace the diploma in Midwifery to ANM course of 2 years.
• In 1975 after the recommendation of Kartar Singh Committtee MPHW course of 18 months was initiated.

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Key Learnings from the History of Midwifery

in India

• Role clarity of NPM and their integration into the existing health system
• Career progression of NPMs
• Lack of legal and regulatory framework
• Training of midwives

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NURSE PRACTITIONER IN MIDWIFERY

• The NPM is a registered nurse-midwife with an additional 18 months of post-basic training In midwifery.
• Generally, ‘in service’ candidates who are GNMs/BSc-level staff nurses with 2 years of experience in maternity care are eligible for 18 months of NPM training.
• This training will enable them to combine high quality clinical skills with evidence-based decision making.

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• While the regular staff selected for training is away for 18 month’s residential course, replacement with contractual staff shall be considered so as not to compromise service delivery for women and newborns.
• If contractual candidates are selected for NPM training, their continuity within the system must be secured with the help of a service agreement.
• The education and training of NPMs must be carried out at accredited NPM Training Institutes recognized by INC.