THE GAZETTE OF INDIA EXTRAORDINARY PART-III SECTION-4 PUBLISHED BY AUTHORITY

(TO BE GAZETTED)

INDIAN NURSING COUNCIL

8th Floor, NBCC Centre, Plot No. 2, Community Centre
Okhla Phase-1, New Delhi-110020

New Dated,___________, 2020

NOTIFICATION

Indian Nursing Council {Nurse Practitioner in Midwifery (NPM) Program}, Regulations, 2020

F.No. 11-1/2019-INC:—In exercise of the powers conferred by sub-section (1) of Section 16 of Indian Nursing
Council Act, 1947 (XLVIII of 1947) as amended from time to time, the Indian Nursing Council hereby makes the
following regulations namely:—

Short Title and Commencement—

1. These Regulations may be called Indian Nursing Council {Nurse Practitioner in Midwifery (NPM)
Program}, Regulations, 2020
2. These Regulations shall come into force on the date of notification of the same in the Official Gazette of India.

Definitions

In these Regulations, unless the context otherwise requires,

i. ‘the Council’ means the Indian Nursing Council constituted under the Act;
ii. ‘SNRC’ means the State Nurse and Midwives Registration Council, by whichever name constituted, by the
respective State Governments;
iii. ‘RN & RM’ means a Registered Nurse and Registered Midwife (RN & RM) and denotes a nurse who has
completed successfully, recognised Bachelor of Nursing (B.Sc. Nursing) or Diploma in General Nursing and
Midwifery (GNM) course, as prescribed by the Council and is registered in a SNRC as Registered Nurse and
Registered Midwife;

1. INTRODUCTION AND BACKGROUND

1.1 Introduction
In 2015, India became one of the 193 countries to commit to the Sustainable Development Goals (SDGs),
which aim to transform the world by 2030 to a more prosperous, more equal, and more secure planet for all. Needless
to say, India’s responsibility is immense as these ambitious goals cannot be achieved without accelerating progress in
one-sixth of the world that resides in our country.
Health is central to commitments made by the Government of India. For us to be able to ensure healthy lives
and promote wellbeing for all at all ages, it is critical to focus on improving our core health indicators, which include
maternal and infant mortality.
When a pregnant woman enters the health system, she puts her faith in the system to receive high quality
services for herself and her newborn. Responding to this faith India has strengthened maternal and child health services
in our country under the National Health Mission. India has made tremendous progress over the last few decades in

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increasing institutional deliveries through the National Health Mission and schemes like the Janani Suraksha Yojana
and Janani Shishu Suraksha Karyakram, and this has greatly reduced the maternal and infant mortality. India’s maternal
mortality ratio has declined from 254/lakh live births in 2004-06 to 130/ lakh live births in 2014-16 (Sample
Registration System. India has shown impressive gains in reduction of Maternal Mortality evident from the fact that
the compound annual rate of decline of MMR has increased significantly from 5.8% during (2007-09 to 2011-13) to
8.01% (2011-13 to 2014-16). Similar achievements are also visible in reduction of under-five and infant mortality
rates.
Investments on maternal and child health remain a key focus area under the National Health Mission.
Operationalizing First Referral Units, new Maternal and Child Health Wings, Obstetric High Dependency Units and
Intensive Care Units, capacity building initiatives such as Dakshata trainings, quality antenatal care strengthening
programmes such as the Pradhan Mantri Surakshit Matriva Abhiyan etc continue to be a key priority.
In addition to above, the Government of India has recently launched the LaQshya- Labor Room and Maternity
Operation Theatre Quality Improvement Initiative. Substantial global evidence exists that addressing the time around
and immediately after childbirth is critical for saving the lives of mothers and newborns. Studies conducted by White
Ribbon Alliance have also highlighted the need to focus on respectful maternity care. The LaQshya programme has
thus been launched to provide quality intrapartum and immediate postpartum care and promote respectful maternity
care.
Despite the tremendous progress, nearly 32,000 pregnant women each year still lose their lives during
pregnancy, childbirth and the postnatal period each year. In addition, 5,90,000 newborns die every year in the first
month of life. Additional efforts are needed in India to increase Universal Health Coverage (UHC) and to achieve
Sustainable Development Goals (SDGs) for maternal and newborn and child health. The National Health Policy 2017
aims at the reduction of maternal mortality ration to 100/ lakh live births by 2020.

The survival of women and newborns is closely correlated with the care and attention received during
pregnancy and, most importantly, at the time of delivery. Delayed management of cases, due to lack of access to skilled
care, is one of the major reasons for the deaths, particularly in the rural areas. Skilled and respectful care during
childbirth is important because millions of women and newborns develop serious and hard to predict complications
before, during or immediately after delivery.

Evidence shows that quality midwifery care, provided by midwives educated to international standards,
reduces maternal and newborn mortality and stillbirth rates by 83% and with 56 improved maternal and newborn health
outcomes. It is also evident that 87% services can be delivered by midwives educated to international standards. There
also has been an increasing body of evidence globally that Midwife-led Care Units (MLCUs) can address maternal
and neonatal mortality and morbidity by promoting quality and continuity of care through provision of women-centric
care and promoting natural births. Where a model of Midwife-Led Continuity of Care (MLCC) is introduced, this
reduces preterm birth by 24%. Beyond survival, quality midwifery care improves breastfeeding rates and psychosocial
outcomes, and reduces the use of unnecessary interventions, in particular caesarean sections and increases access to
family planning (Lancet Series, 2014; UNFPA, 2014 & WHO 2017).

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 The International Confederation of Midwives outline the Midwifery philosophy and model of care 1.
Midwifery has a unique body of knowledge, skills and professional attitudes drawn from disciplines shared by other
health professions such as science and sociology, but practised by midwives within a professional framework of
autonomy, partnership, ethics and accountability. Midwifery is an approach to care of women and their newborn
infants whereby midwives: optimise the normal biological, psychological, social and cultural processes of childbirth
and early life of the newborn; work in partnership with women, respecting the individual circumstances and views of
each woman; promote women’s personal capabilities to care for themselves and their families; collaborate with
midwives and other health professionals as necessary to provide holistic care that meets each woman’s individual
needs. Midwifery care is provided by an autonomous midwife.

1.2 The ‘Midwifery Services Initiative’ of India

Considering the need for trained human resources to provide quality care to 30 million pregnancies every year
in India and at the same time recognizing the challenges earlier, Government of India has proposed an alternative
model of service provision for strengthening reproductive, maternal and neonatal health services by nurse practitioners
in midwifery through Midwife Led Care Units (MLCUs). Quality maternity care provided by midwives through the
MLCUs is vital to this transformation. The recognition that quality of care will not only save lives but will also provide
a positive experience of childbirth means that the change required must be transformative. This will require making
fundamental change to the way services are delivered, and the culture of care provided to women. The ‘Guidelines on
Midwifery Services in India’ set transformative change must be at the heart of midwifery education.
The ‘Midwifery Services Initiative’ aims to create a new cadre of midwives titled “Nurse Practitioners in
Midwifery” (NPM) who are skilled in accordance with ICM competencies, knowledgeable and capable of providing
compassionate women centered, reproductive, maternal and newborn health services (RMNCH) and to develop an
enabling environment for integration of this cadre into the public health system in order to achieve the SDGs for
maternal and newborn health (MoHFW, 2018).

1.3 Preparing Nurse Practitioners in Midwifery (NPM) for the future of India
Quality education is essential to prepare international-standard midwives complying with the ICM
competencies with the knowledge and skills to provide the full scope of midwifery care that women and newborns
need. Evidence indicates that the optimum duration of training required to acquire needed midwifery skills and
competencies is 18 months. The existing one year Nurse Practitioner in Midwifery post basic diploma program of the
Council is re-designed and upgraded to an 18 month intensive residency program to develop more NPMs for providing
respectful, highest standards of quality and evidence based care at the institution and community levels with specific
emphasis on providing safe and competent midwifery care. The essential components for quality midwifery based on
the Quality Maternal and Newborn Care (QMNC) framework is integrated in the curriculum.

1
: https://www.internationalmidwives.org/assets/files/definitions-files/2018/06/eng-philosophy-and-
model-of-midwifery-care.pdf

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 The Nurse Practitioner in Midwifery (NPM) will be responsible for promotion of health of women throughout
their life cycle, with special focus on women during their childbearing years and their newborns. She will be
responsible for providing respectful maternity care during preconception, pregnancy, childbirth, and post-natal period
including the care of newborn. She will be responsible and accountable for her practice. The NPMs will practice
independently and collaboratively with the doctors in the hospital and within the existing peripheral health system
consisting of skilled birth attendants, auxiliary nurse midwives, nurses, doctors and specialists. She can be posted in a
facility where no obstetricians are available and provide midwifery care based on predetermined midwifery care
protocols alongside treatment protocols and drugs permitted for use by NPMs.

Responding to this urgent need, the NPM curriculum is designed in line with ICM competencies for midwives
that emphasizes humanizing transformation. The curriculum which aims to strengthen the technical knowledge,
clinical skills and attitude of the NPMs in midwifery. The training aims to prepare competent NPMs, who can provide
quality and compassionate care to the mother, neonate and family, demonstrating international standards of midwifery
practice. The program will also equip the NPMs to utilize the principles of effective communication, counseling,
leadership, supervision and management and enable them to understand and utilize the research end evidence relevant
to midwifery practice.

2. PHILOSOPHY AND VISION

2.1 Philosophy

The Council believes that strengthening midwifery education to International Standards is a key step to
improving quality of women centered respectful care and reducing maternal and newborn mortality and morbidity.
The Council believes that registered nurses need to be given additional training to work as nurse practitioner in
midwifery in clinical and community settings to provide Midwifery Led Continuum of Care (MLCC) bringing about
transformation in terms of humanization and autonomous role in the midwifery services provided by the NPMs as per
the aspirations of Government of India (GoI).

The Council believes that competency-based training integrating ICM competencies would enable the Nurse
Practitioners in Midwifery (NPM) to demonstrate knowledge, skills and behaviors based on sound evidence-based
knowledge, focusing on the concept of ‘women-centered and respectful care’ that is central to midwifery practice. The
NPMs will be able to combine their knowledge, skills with interpersonal, social and cultural competencies and work
as part of inter- professional team.

The philosophy of the midwifery training is underpinned by the internationally accepted definitions of a
midwife, incorporating the globally understood key elements of midwifery care. The ICM defines a midwife as: ‘ a
person who has successfully completed a midwifery education program that is duly recognized in the country where it
is located and that is based on the ICM Essential Competencies for Basic Midwifery Practice and the framework of
the ICM Global Standards for Midwifery Education; who has acquired the requisite qualifications to be registered
and/or legally licensed to practice midwifery and use the title ‘midwife’ and who demonstrates competency in the

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practice of midwifery’. This philosophy is adapted by the Council’s philosophy in preparing NPMs through the
proposed curriculum.

The Council also believes that a variety of innovative educational strategies can be used in the theoretical and
clinical settings to provide best theoretical and clinical learning experiences. The teaching learning approaches will
integrate adult learning principles, competency-based education, collaborative learning, experiential learning, mastery
learning and self-directed learning. The Council also believes that effective collaborative and interdisciplinary learning
can be facilitated by involving medical and other faculty from related disciplines such as Obstetrics and Gynecology,
Pediatrics and Public Health. It is hoped to facilitate developing policies towards creation of cadre positions for
appropriate placement of these NPMs to function in midwife lead care units (MLCUs) with appropriate career
progression opportunities.

2.2 VISION
The program is envisioned to provide high quality education, which meets international standards and prepares
NPMs to work autonomously to their full scope of practice in respectful partnerships with women and in collaboration
with the obstetrician, pediatrician and the other health care team members when indicated, to provide compassionate,
quality, evidence-based, woman-centered and family-focused care during pregnancy, labour and postnatal period. The
program prepares NPMs to champion positive childbirth experience, optimal transition to parenthood and safe
reproductive health care.

The nurse practitioners in midwifery from this program will meet educational and practice standards of the
Council with focus on the ICM Essential Competencies for Midwifery Practice. They will uphold recognized standards
of midwifery practice, embrace, support the qualities and values of the midwifery practice, and be motivated, flexible
and evidence-informed practitioners. They will be prepared to grow and advance through learning and continuing
experience.

The NPMs are equipped to work within midwifery led care and continuity of care models in India, both with in
the newly formed midwife-led care units within public health facilities and/or integrated into primary health care
within the community.

3. AIM & OBJECTIVES

3.1 AIM

The aim of Nurse Practitioner in Midwifery program is to prepare a cadre of NPMs who are confident and
skilled in accordance to competencies prescribed by the ICM and the Council for providing high quality respectful,
dignified, compassionate and evidence based midwifery care to woman, newborn and family and working
autonomously with their full scope of practice, as per regulations of the Council/MoH&FW.

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3.2 OBJECTIVES

The program will prepare the NPMs to

3.2.1 Facilitate a positive childbirth experience for women and their families, placing women at the center
of care inclusive of psychosocial, spiritual and cultural background across community settings and
within institutions contributing to natural childbirth providing humanized care to improve quality of
care
3.2.2 Work in partnership with women, families and the other health care team to plan and provide the
necessary support, care and advice during pregnancy, labour and the postpartum period up to six
weeks
3.2.3 Advocate for ethical, compassionate respectful and culturally sensitive care in pregnancy, labour
and childbirth, and post-partum, including promoting the woman’s autonomy and rights to informed
decision making
3.2.4 Contribute to reduction of over medicalization of maternity care and reduce impacts of socio-
economic inequalities including hard to reach and tribal areas
3.2.5 Educate women individually or in groups to have knowledge about family planning, a healthier
pregnancy including diet, nutrition, mother baby bonding, breastfeeding support, family integrity
and optimal start to life to enhance health and disease prevention
3.2.6 To assume responsibility for her own decisions and actions as an autonomous primary maternity care
practitioner and lifelong learner
3.2.7 Recognize abnormalities and complications and implement appropriate management and care,
including managing emergency care and timely referral
3.2.8 Draw on research informed/evidence-based knowledge to be an effective problem solver and to think
critically and reflect on practice
3.2.9 Work within the legal and professional boundaries by understanding their role within the broader
health care profession and engage inter-professionally; with doctors, nurses, and other health care
providers as part of a maternity care team

4. CURRICULUM- CONCEPTUAL MODEL

Midwifery Education recognizes that learning and continuing competency are lifelong pursuits thus this
curriculum aims to facilitate a passion for learning through well-designed teaching and learning strategies aligned
to evidence informed and contemporary midwifery knowledge and practice.

The conceptual model has been designed to reflect a holistic approach to midwifery education.
Conceptually, it sets seven core values at the center of the curriculum, highlighting qualities that are central to
provide a positive childbirth experience. Key approaches that inform contemporary midwifery practice are
integrated throughout the curriculum, alongside maternity and newborn care priorities. The ICM Essential
Competencies for Midwifery Practice and the Council educational and practice standards direct the course aims,
objectives and content. The course delivery will incorporate evidence informed teaching and learning principles.

The values, integrated concepts, maternity care priorities, midwifery competencies, teaching and learning
principles are informed by the Guidelines on Midwifery Services in India, Strengthening Quality Midwifery
Education Framework for Action, The Framework for Quality Maternal and Newborn Care and Lancet Series on

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 Midwifery, Council’s Educational and practice standards, ICM Essential Competencies for Midwifery Practice
and ICM Global Standards for Midwifery Education.

The curriculum conceptual model that informs the overall program design and course development is
illustrated in Figure 1 below.

Figure 1. Curriculum Conceptual Model

4.1 Curriculum Principles

4.1.1 Core values

The core values provide a foundation to develop midwives who are committed to promoting a positive childbirth
experience for all women and were derived from core government, WHO and ICM documents. These values include;
(i) compassion (ii) respect (iii) woman, baby and family-centredness (iv) equity and rights (v) collaboration and
team work (vi) ethical practice, (vii) moral courage.

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4.1.2 Integrated concepts

Within the curriculum there are seven concepts which represent key approaches that inform contemporary midwifery
practice. These concepts include: (i) social inequities and midwives as primary health practitioners (ii) evidence-
based midwifery practice (iii) cultural competence (iv) quality maternity and newborn care (v) continuity of
midwifery care (vi) midwifery as a relationship between a woman, baby, family and a midwife (vii) optimizing
physiological birth (viii) Community knowledge.

4.1.3 Maternity care priorities

The program provides a strong focus on identified maternity care needs and priorities which are addressed across the
curriculum (i) improving maternity and newborn care for vulnerable and hard to reach women, (ii) reducing
maternal and newborn maternity and morbidity (iii) effective management of emergency care (iv) Human
rights and gender-based violence (v) strengthening midwifery-led care (vi) humanizing and promoting natural
childbirth

4.1.4 ICM Essential competency standards for midwifery practice and Council’s practice standards

The ICM (2019) competencies are grouped under four main categories. They are 1. General competencies that apply
to all aspects of midwifery practice and specific competencies that are specific to 2. Pre-pregnancy and antenatal
3. Labour and birth 4. Ongoing care of woman and newborn. These competencies provide framework for the
courses within the program. The Council practice standards guide midwifery practice and provide regulations.

4.1.5 Continued Professional Development

The quality of midwifery practice is achieved when the practice is led by autonomous role of NPMs. Continued
professional development is essential for advancing and building the future of midwifery practice in India.

5. SCOPE OF PRACTICE
The Scope of Practice of a Midwife is combined with the ICM definition and sets out the boundaries of a
midwife’s practice is adapted for NPM in India and is as follows:

 The NPM is recognised as a responsible and accountable professional who works in partnership with women
to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct
births on the midwife’s own responsibility and to provide care for the newborn and the infant.
 This care includes preventative measures, the promotion of normal birth, the detection of complications in
mother and child, the accessing of medical care or other appropriate assistance and the carrying out of
emergency measures.
 The NPM/midwife has an important task in health counselling and education, not only for the woman, but
also within the family and the community. This work should involve antenatal education and preparation for
parenthood and may extend to women’s health, sexual or reproductive health and childcare.
 NPM may practise autonomously in any setting including the home, community, hospitals, clinics or health
units mostly in MLCUs that is envisaged by GoI.

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  The NPM will be able to perform full scope of practice as per education and training and Council’s/MoHFW
regulations and guidelines.

6. COMPETENCIES

The Council adapted the International Confederation of Midwives (ICM) competencies for training of nurse
practitioners in midwifery for India and the framework is given below:

General Competencies

Pre- Care
preganncy duiring
and labour
Antenatal and child
care birth

Ongoing care
for women
and newborns

Figure 2. ICM Essential Competencies for midwifery Practice (2019)

The competencies are organized under 4 categories/domains.

COMPETENCY CATEGORY 1 : GENERAL COMPETENCIES

NPMs demonstrate professional accountability as an autonomous practitioner in the delivery of midwifery care as per
ICM standards adopted by the Council that are consistent with moral, altruistic and humanistic principles in midwifery
practice.
Competencies:
1a. Assume responsibility for own decisions and actions as an autonomous practitioner
1b. Assume responsibility for self-care including personal safety and self-development as a midwife
1c. Appropriately delegate aspects of care and provide supervision
1d. Utilize research to inform practice
1e. Uphold the fundamental human rights of individuals when providing midwifery care
1f. Adhere to jurisdictional laws ethical, regulatory requirements, codes of conduct for midwifery practice
1g. Facilitate women to make individual choices about care
1h. Demonstrate effective interpersonal communication with women and families, health care teams, and community
groups

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1i. Facilitate normal birth processes in institutional and community settings, including women’s homes
1j. Assess the health status, screen for health risks, and promote general health and well-being of women and infants
1k. Prevent and treat common health problems related to reproduction and early life
1l. Recognize conditions outside midwifery scope of practice and refer appropriately
1m. Care for women who experience physical and sexual violence and abuse

COMPETENCY CATEGORY 2 : PRE-PREGNANCY AND ANTENATAL CARE

NPMs Perform health assessment of woman and fetus, promote their health and well-being, detect complications
during pregnancy, and provide care to women with unexpected pregnancy
Competencies:
2a. Provide pre-pregnancy and antenatal care
2b. Determine health status of women
2c. Assess the fetal wellbeing
2d. Monitor the progression of pregnancy
2e. Promote and support health behaviors that improve their wellbeing
2f. Provide anticipatory guidance related to pregnancy, birth, breastfeeding, parenthood, and change in the family
2g. Detect, manage, and refer women with complicated pregnancies
2h. Assist the woman and her family to plan for an appropriate place of birth
2i. Provide care to women with unintended or mistimed pregnancy

COMPETENCY CATEGORY 3: CARE DURING LABOUR AND CHILDBIRTH

The NPMs continue to monitor and provide care to woman during labour that facilitates physiological processes and
a safe birth, immediate care to newborn infant and detect complications in mother and infant.

Competencies:
3a. Promote physiologic labour and birth
3b. Manage a safe spontaneous vaginal birth and prevent complications
3c. Provide care of the newborn immediately after birth

COMPETENCY CATEGORY 4
: ONGOING CARE OF WOMEN AND NEWBORNS
The NPMs continue to perform health assessment of mother and infant, provide health education and support for breast
feeding, detect complications, and initiate family planning services.
Competencies:
4a. Provide postnatal care for the healthy woman
4b. Provide care to healthy newborn infant
4c. Promote and support breast feeding
4d. Detect and treat or refer postnatal complications in woman

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4e. Detect and manage health problems in newborn infant
4f. Provide family planning services

7. PROGRAM DETAILS

7.1 PROGRAM DESCRIPTION

The NPM program is an 18-month residency program, which includes 12 months of residency education and training
followed by 6 months of intensive practicum/internship. The program mainly focuses on Competency based education
and training facilitated by mastery and experiential learning centered around transformational and relationship-based
teaching and learning integrating Council’s/global educational and midwifery practice standards. The change in
paradigm shift to women-centered and respectful midwife led midwifery services is emphasized throughout the
program recognizing their scope of practice.

The curriculum comprises of theory and practicum (lab and clinical), offered in four course modules namely
i) Foundations to midwifery ii) Normal Pregnancy, birth, postpartum and care of newborn iii) Complex care of
woman and care of compromised newborn. Besides the foundational training, the curriculum encompasses hands
on skill training and orientation to the treatment protocols/national midwifery guidelines and drugs permitted for use
by NPMs relevant to midwifery practice

The program is designed so that learning is scaffolded across the program to enable the progressive
development of the knowledge, skills and values essential for the students to practice with professional competence as
qualified midwives recognizing that the students are registered nurses with some prior midwifery experience. The first
two series of courses provide the opportunity to develop contemporary midwifery knowledge, skills and values with a
focus on promoting normal pregnancy, birth and puerperium, including healthy fetal and neonatal development. The
third set of courses focuses on the deviation from normal including complex care of the woman and newborn as well
as the midwife’s role in primary health care. The final four courses focus on readying the student for their role as an
autonomous midwife practitioner working in and advocating the new model of midwifery-led care in India. As
described in the curriculum conceptual model, students have opportunity for consolidated learning. The integrated
concepts are incorporated into content and learning activities that increase in complexity throughout the program.
Alongside this, maternity care priorities are addressed with varying emphasis depending on course objectives.
Similarly, the core values and ICM Essential Competencies are also interwoven into course content, learning activities
and practice experience throughout the program.

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7.2 PROGRAM STRUCTURE

Courses/modules Theory Practicum (Hours)

(Hours)
Skills Lab Clinical
Hours) (Hours)
Module I: Foundations to Midwifery 90 20 180

1. Indian Healthcare System & Maternal and Neonatal Health (MNH)

scenario in India
2. Professionalism and professional midwifery practice
3. Woman centered continuity of midwifery care & Respectful Maternity
and Newborn Care
4. Humanization of childbirth and the impact of communication
5. Legal issues relevant to midwifery practice
6. Ethics in Midwifery
7. Education and counseling in midwifery
8. Community engagement and research informed practice

Module II: Normal pregnancy, birth, puerperium and care of newborn 100 40 980

1. Basic sciences applied to midwifery: Maternal, Fetal and Newborn

Physiology, Pharmacology & diagnostics
and Infection Control
2. Normal Pregnancy, Birth and Puerperium
3. Care of the newborn
Module III: Complex Care of woman and care of compromised newborn 40 35 570
1. Perinatal psychological health
2. Complex care of the woman
3. Care of the compromised newborn
4. Healthy families and communities
Total Hours 2055 hours 230 95 1730
Internship 1035 hours 1035 Hours

7.3 GUIDELINES FOR STARTING THE NURSE PRACTITIONER MIDWIFERY PROGRAM

7.3.1 The program may be offered at

1. The Government (State/Center/Autonomous) nursing teaching institution offering degree programs in nursing
having parent / affiliated Government Hospital facilities of maternity, and neonatal units along with primary,
secondary and tertiary health care facilities.

Or
Other Non-Govt. nursing teaching institution offering degree programs in nursing having parent hospital
facilities of maternity and neonatal units along with primary, secondary and tertiary health care facilities.

2. The eligible institution shall get recognition from the concerned SNRC for starting the Nurse Practitioner in
Midwifery program for the particular academic year, which is a mandatory requirement.

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 3. The Council will conduct inspection for two consecutive years for continuation of the permission to conduct
the program.

7.3. 2 Staffing

1. NMP Faculty: M.Sc. Nursing with OBG/Pediatrics/Community health nursing specialty or B.Sc. (N) with
NPM educator training
2. Medical Preceptors: Medical faculty from Obstetrics and Gynecology, Pediatrics and Public Health with 3
years post PG experience/ consultant
3. Guest faculty: NHM/MoH&FW officials/Experts from other fields

Teacher student ratio- 1:10

Preceptor student ratio-1:10
No. of seats –Maximum 30 per batch

7.3.3 Physical facilities

1. Classroom – 1
2. Skills/simulation lab– 1 with necessary equipment and supplies
3. Library – Current nursing textbooks including midwifery, maternal, neonatal
& journal (National and International publications), relevant GOI guidelines/modules
4. Teaching Aids –
 LCD projector
 Screen for projection
 Computer
 Laptop
 Tablet for IT applications (For ex. Safe Delivery App, e-Partograph and other apps)
 Connectors to project tab screens to external screen
 4 Mbps internet leased line
5. Office facilities for midwifery educators

7.3.4 Clinical facilities

Minimum Bed strength and other Clinical Facilities:

 100-200 bedded Parent Hospital having minimum 50 maternity beds or 50 bedded maternity hospital
with an established MLCU
 Labour room as per the LaQshya guidelines of Government of India
 Minimum 6 labour tables/beds
 Maternal and neonatal units
 Case load of minimum 6000 deliveries per year
 Maternity OT and Obstetric HDU/ICU
 Separate Kangaroo Mother Care Unit
 8-10 level II neonatal beds
 Affiliated Heath Subcentre, Community Health Centre and Primary Health Centre
 Referral links to tertiary care hospital
 Affiliation to Tertiary Hospital – Medical College Hospital
 Affiliation with level III neonatal beds

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7.4. ADMISSION REQUIREMENTS

7.4.1 Eligibility for admission

The candidate seeking admission to this program should have the following qualifications:

 Registration Be a R.N. & R.M. with Diploma in General Nursing and Midwifery or BSc. (N) qualification

 Possess a minimum of two-years of recent clinical experience in the maternity care with passion toward
midwifery.

 In service candidates are also eligible for admission and will be receiving their regular salary. Being a
residency program, the other students undergoing the program will be given salary equivalent to their
counterparts in the respective organization.

 Age 45 years or younger at the time of admission.

Note: The candidate in order to practice midwifery during the period of training, has to obtain temporary/transfer
registration (R.N & R.M) in the respective state where the candidate is enrolled in the NPM program.

7.4.2 Selection process

Selection Criteria and Process Overview for Recruitment of NPM is outlined below:

 The Entrance exam will be conducted in two parts with certain percentage weightage for each component.
The overall score for entrance examination is 100 marks (60 for written test & OSCE and 40 for interview).

 Part 1 -Written test and OSCE:

- Written Test (40%): Multiple Choice Questions and two short essay (2 hours duration) covering the
areas of antenatal, intrapartum, postnatal, complication management and neonatal care. Short essays will
be screened for technical proficiency as well as fluency in written English. Some weightage should be
given for proficiency in written English.

- OSCE- Objectively Structured Clinical Examination (20%)

 Part 2-Interview (40%)

Successful candidates who clear the written test and OSCE will be screened for the following at the
interview:
1) Motivational Screening (20%)
Based on the information provided in the personal statement of the candidate:
a) Passion for woman’s health-to provide respectful care for a positive birthing experience.
b) Willingness to undergo the 18-month residential course at the designated SMTI
c) Willingness to serve as individual practitioners of midwifery care-low-risk pregnancies
and normal births as posted after the training

2) Aptitude assessment (20%) will be a part of interview process to ascertain spoken English language
proficiency and communication, technical knowledge, leadership and advocacy for client’s rights, and
team spirit.

14
7.5. ORGANIZATION OF THE PROGRAM

7.5.1 Distribution of the program in weeks (78 weeks):

First 12 months: 52 weeks

 Annual Leave +Casual Leave +Sick Leave +Public holidays =4 weeks

 Exam preparation and examination =2weeks

 Theory and practicum (skill lab & Clinical) =46weeks

Second six months: 26 weeks of internship

 Annual Leave +Casual Leave +Sick Leave +Public holidays =2 weeks

 Exam (competency assessment) =1 week

 Internship experience =23 weeks

7.5.2 Implementation of the curriculum

First 12 months (46 weeks)

Block classes- 3wks x 40hrs = 120hrs

Clinical Residency of 43wksx45hrs/week =1935 hrs

Total: 2055 hours

7.5.3 Distribution of the Courses for teaching (52 weeks =2055 hrs)

DETAILS

Block classes
3 weeks x 40hrs /week = 120 hours (Full theory block classes: Theory 90 hrs + skill lab 30 hrs)

Clinical residency
43weeks x 45 hrs / week = 1935 hrs (Theory-140 hours + Skills lab-65 hours + Clinical-1730 hours)
 140 hours of theory and 65 hours of skills lab to be integrated during clinical experience. Theory can be covered in the
form of faculty lecture, clinical rounds, clinical presentations, drug presentations etc First 35 weeks: 6hrs / week x 35
weeks=210 hours ( Theory- 140 + Skill lab-65hrs and Next 8 weeks:2-3 hrs/week may be used for revision.
 A small individual/group research project to be conducted during clinical postings applying the steps of research
process and written report to be submitted

15
 Total=230 Hrs (theory)+95Hrs(skills lab)+1730Hrs (clinical practice) = 2055 hrs

7.6. COURSE OF INSTRUCTION

S. No Courses/Modules Theory Practicum (Skill Areas of Clinical Postings

Lab (SL) + Clinical
Lab( CL))
I Module I: Foundations to Midwifery 90 20 SL +180 CL

1 Indian Healthcare system & Maternal and 10 20 CL

Neonatal Health (MNH) scenario

2 Professionalism and professional midwifery 18

practice
3 Woman centered continuity of midwifery 6 8 SL+40 CL
care & Respectful Maternity and Newborn Integrated clinical practice at
Care All maternity areas of the
4 Humanization of childbirth and the impact of 10 8 SL+ 20 CL hospital/
communication
5 Legal issues relevant to midwifery practice 6
6 Ethics in Midwifery 4 Integrated clinical practice at
All maternity areas of the
7 Education and counseling in midwifery 6 2 SL+ 20 CL hospital/
8 Community engagement and Research 30 2 SL+80 CL
 Community responsibility & leadership
and Research informed practice
II. Module II: Normal pregnancy, birth, 100 40 SL+ 980 CL
puerperium and care of newborn

1. Basic sciences applied to midwifery: 40 12 SL+210 CL Integrated clinical practice

Maternal, Fetal and Newborn Physiology,
Pharmacology & diagnostics and Infection
Control
2. Normal Pregnancy, Birth and Puerperium 50 22 SL+ 680 CL Antenatal OPD/ ward
Labour room / casualty
Postnatal ward / OPD
3. Care of the newborn 10
6 SL+90 CL SNCU/NICU / postnatal ward

III. Module III: Complex Care of woman and 40 35 SL+570 CL

care of compromised newborn
1. Perinatal psychological health 4 60 CL ANC Ward/Labour Room/ PNC
ward
2. Complex care of the woman 25 20 SL + 330 CL Antenatal OPD / ward/Obstetric
HDU/ICU

16
 Labour room /
casualty/maternity OT/Obstetric
HDU/ICU
Postnatal ward / OPD/ Obstetric
HDU/ICU
3. Care of the compromised newborn 8
10 SL + 130 CL NICU / Postnatal ward / OPD
4. Healthy families and communities 3 ANC OPD/Postnatal OPD /
5 SL+ 50 CL
ward / FP ward
Total =2055 hours 230 hours 95 SL+ 1730 CL
hours

7.7. CLINICAL PRACTICE

7.7.1 Clinical Residency experience (A minimum of 45 hrs/ week is prescribed, however, it is flexible with different
shifts and OFF followed by on call duty every week or fortnight)

7.7.2 Clinical postings

The students will be posted to the under mentioned clinical area during their training period

First 12 Clinical area Week/s

months S/
No
1 Antenatal (AN) OPD 6
2 Antenatal (AN) Ward 4
3 Labour Room 12
4 Postnatal (PN) Ward & OPD 4+1
5. NICU (SNCU) 2
6 OBS Casualty 1
7 OBS OT 1
8 OBS ICU 2
9 Family planning ward 1
10 PHC/CHC 4
11 MLCU 4
TOTAL 42

Next 6 months of Internship

S/ No Clinical area Week/s

1 AN OPD & Ward 3
2 PN OPD & Ward 3
3 Labour Room 6
4 NICU(SNCU) 2
5. OBS Casualty & ICU 3
6 OBS OT 1
7 PHC/CHC 3
8 Miscellaneous 1
TOTAL 22
17
1. TEACHING AND LEARNING
Teaching learning within the NPM curriculum draws on Experiential Learning theories. Experiential learning
recognizes that learning is an active process that occurs as students interact with authentic activities, experiences and
social encounters. The educational process is underpinned by respect, with educators modelling the respectful care
and communication that these graduates will engage in with women. The student is intentionally situated at the center
of learning and becomes directly involved in the process of constructing knowledge. As such, experiential learning
relies on experience, as the source material and thoughtful reflection to facilitate learning. Providing ‘real world’
context to activities and experiences aligns students learning to the types of practice and complexities they might
encounter as midwifery graduates. Motivation and engagement increase as students work with real-life situations that
require decision-making that reflect the nature of maternity care environments and promote autonomous roles that
need to be assumed upon completion of the program and called to lead midwifery care in MLCUs.

Experiential learning is also committed to minimizing the theory-practice gap that has been recognized as a
challenge in contemporary tertiary health care education. Experiential learning integrates practice with theory,
avoiding teaching and learning which occurs in silos. As part of the experiential learning pedagogy students will
engage in significant practice experience through midwifery practicums. Practicums will be organized to reflect a
diversity of clinical settings across the continuum of pre-conception, childbirth, to postpartum and will include hospital
and community settings. Students will also be required to engage in defined continuity of care experiences where they
follow women through their pregnancy, labour, birth and puerperium.

Complementing Experiential Learning in this program is Scenario-Based Learning (SBL) and reflective
practice. SBL uses scenarios which reflect realistic situations, for example they may be based on case studies, critical
incidents or narratives, which provide contextual material and/or learning triggers and provide an ideal environment
for exploring practice, complexities and encourage critical thinking, problem solving and decision-making skills. The
learning processes in SBL moves through phases that requires students to engage in the scenario, analyze the situation,
identify learning needs, construct knowledge, reflect and apply learning. Scenario based learning is best provided
through tutorials and flipped classroom, where students can access pre-tutorial readings and recorded lectures to
support the interactive nature of the learning.

A dedicated simulated environment will be developed to provide a safe learning environment where students
will have the opportunity through simulation workshops to develop midwifery skills, work in teams, explore scenarios
and problems, and practice clinical decision-making. Carefully designed simulation activities will also provide the
opportunity to develop communication skills relevant to the women’s needs and health problems, including interacting
with scenarios representing families from different demographic and cultural backgrounds, which is vital considering
India’s cultural and demographic diversity. Inter-professional learning may also be fostered through implementing
team simulation scenarios.

Reflective practice assists students to learn from experience, both positive and negative and to gain new
insights about themselves and practice. Gibbs cyclic model provides a six-stage approach to systematically reflect
on an experience or activity; including description, feelings, evaluation, analysis, conclusion and an action plan.

18
 Description(1) Feeling(2)

Action plan(6) GIBBS CYCLE Evaluation(3)

Conclusion(5) Analysis(4)

Experiential learning supported by scenario based learning and reflective practice will be integrated
throughout the curriculum in both theoretical and practice components. Teaching and learning arrangements will be
organized to encourage collaboration and interaction, examples of teaching modes include tutorials and group work,
online resources and lectures, smart classrooms, personal research and reflection, experiential workshops, journal club,
post clinical reviews.

8.1: Teaching and learning methods

Skills lab Clinical
Classroom
 Tutorials and workshop  Skill demonstration  Clinical practice under
 Lecture cum Discussion  Simulation supervision
 Experiential learning  Scenario based reflective  Independent clinical practice
 Self-directed learning learning  Bed side clinics
(Annexure III. Learning  OSCE (plan and conduction)  Reflective learning
resources)  Role play  Experiential learning
 Problem based learning  Drills  Case presentation
 Practice teaching  Microteaching –skill  Case studies/discussions
 Micro teaching demonstrations  Health talk
 Audio-video assisted  Videos  Clinical rounds/conference
teaching  Drug study and presentation
 Virtual learning-virtual  Microteaching –theory/skill
classroom demonstrations
 *Safe Delivery App/ any  Field visit/report
other apps as self-directed  Logbook (Annexure-II)
learning

19
 Example:*EdTech based learning may be incorporated throughout the curriculum by integration of Safe
Delivery App into the various teaching methodologies. The Safe Delivery App is a smartphone application that
provides direct and instant access to evidence-based and up-to-date clinical guidelines on BEmONC. The SDA
is used as a teaching and learning tool that covers 11 modules: (Infection Prevention, Post Abortion Care,
Hypertension, Active Management of Third Stage Labour, Prolonged Labour, PostPartum Haemorrhage,
Manual Removal of Placenta, Maternal Sepsis, Neonatal Resuscitation, Newborn Management, Low Birth
Weight)

8.2: Assessment methods

8.2.1 Continuous Formative Assessments (Internal Assessment)

 Seminar
 Self-assessment through reflective learning as well as peer review
 Written assignments (Case studies, Case presentation, Case report etc)
 Case study & Clinical presentation
 Group work
 Literature reviews
 Objective Structured Clinical Examination (OSCE)
 Practical assessments-teaching activities (health teaching sessions), simulation
 Written examination/Test papers-MCQs, short answers & essay type
 Competency Assessment
 Clinical performance/practice evaluation
 Quizzes
 Poster Presentations
 Online learning activities
 Class presentations including case studies
 Debates
 Peer Review
 Continuous assessment.

Midwifery practice experiences and reflection activities will be documented in a practice portfolio compiled over the
duration of the program. Feedback will be sought from women and midwives (preceptors) with whom students work.

20
1. EXAMINATION REGULATIONS

9.1: SCHEME OF EXAMINATION

Course/Paper Int. Ass. Ext. Ass. Total Duration (in

Marks Marks marks hours)
A. Theory
Paper I (Module 1) 25 75 100 3

Paper II (Module 2 & 3) 25 75 100 3

Theory Total 50 150 200

B. Practical

Midwifery 100 100 200

Practical Total 100 100 200

Grand Total 150 250 400

Note: The Theory and practical examination have to be conducted by the Respective examination board approved by
the Council

9.2 ELIGIBILITY FOR ADMISSION TO EXAMINATION

 Percentage of attendance in theory and practical before appearing for examination should be 90%.
 Candidate who successfully completes the necessary requirement such as logbook and clinical requirements
is eligible and can appear for the final exam.
 However, students should make up 100% of attendance for integrated practice experience and internship in
term of hours and activities before awarding the certificate

9.3. SUPPLEMENTARY EXAMINATION

 Failed candidates can appear for the supplementary examination after 6 weeks in the exam failed either
theory or practical only.
 Number of attempts – 3

9.4 EXAMINATION PATTERN (Theory & Practical)

Type of Exam Internal (formative assessment) External (summative assessment)

Theory 25 marks (tests, assignments, presentations) 75 marks (10 marks- MCQ, 30 marks- short
answers, 35 marks – essay / scenario)

Practical 100 marks (20 for clinical performance + 20 100 marks (40 in OCSE + 60 in Directly
for clinical assignments + 20 for OSCE+40 observed practical (DOP)
for DOP)

For practical examination maximum number of students per day = 10 students

21
9.4.1 Examiners for Practical examination

 A panel of three examiners: NPM educators – 2 (one internal and one external) and medical preceptor – 1(The
examiners as well as the medical preceptor must be involved in teaching the program and be familiar with the
curriculum)

9.4.2 Qualification of examiners

 NPM educator, M.Sc OBG nursing with 5 years of teaching and clinical experience after PG - dual role / M.Sc
OBG nursing with 5 years of experience as faculty with a minimum of 2 years midwifery clinical working
experience.
 Medical faculty/preceptor from Obstetrics and Gynecology, Pediatrics and Public Health with 3 years post PG
experience / consultant.

1. CERTIFICATION

A. Title – Nurse Practitioner in Midwifery (NPM)

B. A title is awarded upon successful completion of the prescribed study program, which will state that she/he
i. Has completed the prescribed course of Nurse Practitioner in Midwifery program for a period of 18
months
ii. Has completed 90% of the theoretical and 100% of the practical instruction hours before awarding
the certificate.
iii. Has passed (70% marks both internal and external together) in the theory and practical examination

C. Certification will be done by the Examination Boards as approved by the Council. The SNRC will register
NPM as an additional qualification.

22
 1. COURSE DETAILS/ MODULES

COURSE MODULE I: FOUNDATIONS TO MIDWIFERY

Theory: 90 Hours

Practicum: Skill Lab (SL)-20 Hours

Clinical (CL)- 180 Hours

Course Aim
This course will enable the students to develop a deep understanding of midwifery as profession and the role and scope
of the midwife in both the local and international context utilizing the principles of professional management,
leadership and research informed midwifery practice.

Course Description
Students will explore the history of midwifery in India; the Indian health care system, Maternal newborn health (MNH)
scenario in India, National Family Health Survey; the legal, regulatory and ethical frameworks and requirements of
midwifery practice, including code of ethics and professional conduct, jurisdictional laws, local policy and guidelines,
respectful behaviour, human rights, humanizing birth, shared decision making, confidentiality and privacy. Midwifery
models of care; global significance and the professionalism of midwifery along with the ICM essential competencies;
professional accountability and transparency; inter-professional collaboration and teams; teaching, supervision and
mentoring skills; personal and professional resilience; moral courage; clinical reasoning; self-care; and professional
audit are also included. There will be a specific focus on respectful and compassionate communication and cultural
competency. It will also include community responsibility and midwifery leadership. This course will also support
students to develop lifelong learning skills including evidence-based practice; critical thinking skills, critical appraisal;
research translation; reflective practice; documentation and record keeping.

Objectives:
1. Demonstrate professional accountability for the delivery of midwifery care as per INC standards that is
consistent with moral, altruistic, legal, ethical, regulatory and humanistic principles in midwifery practice.
2. Identify the role of midwifery philosophy and practice in transforming maternity care in India and globally
3. Describe the importance of RMNC and develop strategies to promote respectful and compassionate care
Demonstrate compassionate and effective communication skills for respectful and culturally competent
midwifery care
4. Apply principles of evidence-based practice, critical thinking and reflection to support autonomous midwifery
practice. Utilize the assessment and evaluation data to critically analyze and enhance midwifery practice
5. Explore how the midwife collaborates with the inter-professional health care team and value of respectful
teamwork
6. Describe the advocacy role of the midwife for women, families and communities
7. Identify and apply legal and ethical principles and provisions for midwifery practice
8. Describe the importance of communication, education and counseling of women and families to participate
effectively in midwifery care
9. Understand the role of the midwife as an agent of change for transformative practice
10. Analyse and apply principles of effective leadership, team building, negotiation and conflict resolution skills
11. Discuss appropriate management of midwifery resources and equitable access to midwifery care
12. Review the ethical principles and methodological approaches to research.
13. Utilize research to inform practice
 Competencies: (ICM)
1. Assume responsibility for own decisions and actions as an autonomous practitioner (1a)
2. Assume responsibility for self-care including personal safety and self-development as a midwife (1b)
3. Appropriately delegate aspects of care and provide supervision (1c)
4. Utilize research to inform practice (1d)
5. Uphold the fundamental human rights of individuals when providing midwifery care (1e)
6. Adhere to jurisdictional laws ethical, regulatory requirements, codes of conduct for midwifery practice (1f)
7. Facilitate women to make individual choices about care (1g)
8. Demonstrate effective interpersonal communication with women and families, health care teams, and
community groups (1h)
COURSE CONTENT:
Teaching
Hours Learning Assignment Methods of
Unit Content Learning
outcomes s Assessment
activities
I T- 10 Indian Healthcare system
CL-20 & MNH Scenario
 Build rapport Introduction
with students
 Vision of the NPM  Icebreakers
and educator and get-to-
course, overview and
 Identify the know your
previous expectations
activities
experience of  Accessing resources
student peers (online)
and working  Seminar, tutorial and
in groups working in groups
 Confidently
 Overview of course
begin their
journey as assessments, academic
NPM policies and
students procedures, group
 Articulate norms  Group
their seminar  Quiz
understandin  Tutorial on  Essay/Short
g of  Group work Maternit answers
becoming an
Indian health care system  Online lecture y care
NPM
 Describe the  Health care delivery  Self-directed services
system: National, learning by GOI
vision for the
new NPM State, District, and  Integrated
Village level with clinical
reference to MCH practice
 Review the  Trends of maternity
structure and care in India
function of  Maternity care services
health care
by GOI
system in
India.
 Describe the
provision of
maternity
care services

24
 Teaching
Hours Learning Assignment Methods of
Unit Content Learning
outcomes s Assessment
activities
exploring the
new initiative
and
guidelines
 Discuss
trends, issues
and
complexities
in relation to
maternity
care
provision in
India

Maternal and newborn  Discussion  Essay, short

health (MNH) scenario in and  Preparat answers and
 Explain the India experiential ion & MCQ
epidemiolog  Public Health for learning presenta  Observation
y of maternal midwives  Scenarios tion of reports
and neonatal  Epidemiological vital
health in aspects and magnitude  Self-directed statistics
India and of maternal and learning records
various neonatal health in  Observa
national India  Supervised tion &
health  Maternal and newborn practice in, implem
programs to health scenario in India HSC/ CHC entation
address the  Community audit and of
issues death case review national
 Issues of maternal and health
 Discuss the neonatal health: Age, program
Maternal and Gender, Sexuality, s at
newborn Psycho socio cultural HSC/P
health factors, gender HC/
scenario in disparities CHC
India  Women empowerment  Literatu
 Quality of Care in re
 Describe the MNH search
quality of on
care in MNH MNH
care

25
 Teaching
Hours Learning Assignment Methods of
Unit Content Learning
outcomes s Assessment
activities
II T-18  Demonstrate Professionalism and  Discussion  Self-  Essay,
understandin professional midwifery and study  Short
g of  Professionalism- experiential and self- answers
professionali meaning and elements, learning reading  MCQ
sm and accountability,  Self- directed of ICM  Assessment
exhibit visibility and ethics in and guided code of of
professionali midwifery practice learning Ethics assignment
sm in the  History of Midwifery  Tutorial group  Personal  Self-
midwifery  Current scenario: work philosop reflection
practice Midwifery in India  Self-reflection hy of and
 Introduction to  Application of midwife assessment
 Explain the philosophy of midwifery ry of learning
history of midwifery practice model of care practice needs in
midwifery,  Contemporary in clinical relation to
various midwifery practice practice ICM
midwifery  Models of midwifery competenci
care models care- including es
and the distinction between
scope of midwives and other
midwifery providers with
practice midwifery skills
 Midwife led care
 Apply the model, job description
midwifery  Access and barriers to
model of midwifery care,
care in  ICM competencies for
clinical basic midwifery
practice practice
 ICM global standards
 Describe the of midwifery practice
characteristic
 Scope of midwifery
s of
practice:
midwifery
 Roles and scope of
care that
Nurse practitioner in
promote
midwifery
physiological
birth process  Trends in Midwifery
 Autonomous role of
 Explore the
physical, midwife/NPM
social and  Role of Professional
cultural organizations
factors which (National & state
impact on midwifery
access to associations) and
midwife-led advocacy
care
 Contextualiz Inter-professional  Summative
e ICM collaboration and essay on the
competencies teamwork  Group lancet series
 Framework for quality
 Discuss discussion
autonomy maternal and newborn
and care
accountabilit  Integrality framework
y within the (Lancet series)
26
 Teaching
Hours Learning Assignment Methods of
Unit Content Learning
outcomes s Assessment
activities
context of  Review of scope of
midwife led practice and referral
care and pathways
continuity of  Communication and
care documentation.  Critical
 Discuss the reflection  Summative
role of Reflective practice and conversations reflective
national Clinical reasoning (groups of practice
midwifery three); cycle report
organizations  Reflective thinking scenario group
in terms of and practice work; group
advocacy  Bass model of holistic discussion
reflection
 Identify  Moral courage
importance  Critical thinking and
of inter-
Clinical reasoning
professional
collaboration
community
agencies and
institutions  Continuing  Formative
professional reflective
development in exercise
midwifery  Tutorial,
group work,
Scenario
based
Personal and professional learning, case
 Identify and resilience; self-care; review
reflect on human rights
critical
 Self-care,
practice
 Resilience
incidents
 Moral courage & Formative group
 Demonstrate
Ethical practice role play
self-
 Accountability for
reflection to
practice
recognise 
 Support services, Tutorial,
personal and debriefing group work,
professional Scenario
limitations based
 Define and learning, role
Apply Teaching, mentoring and play
critical supervision
thinking and
clinical  Teaching strategies
reasoning to appropriate to
care midwifery teaching
scenarios  Mentorship,
preceptorship
 Discuss  Clinical supervision
importance  Respectful care and
of supervision
maintaining
27
 Teaching
Hours Learning Assignment Methods of
Unit Content Learning
outcomes s Assessment
activities
continuing
midwifery
competence
and
professional
development.
 Formulate a
strategy for
self-care and
managing
personal
safety in
midwifery
practice

 Demonstrate
knowledge to
assume
responsibility
for decisions
and actions
as an
autonomous
practitioner

 Explore the
role of the
midwife as
preceptor/me
ntor.

 Demonstrate
understandin
g of this role
in midwifery
practice
III T- 6 Woman centered  Discussion  Evidence
SL-8  Describe the continuity of midwifery and based essay,
CL- 40 principles of care & Respectful experiential short
woman Maternity and Newborn answers and
learning
centered care MCQ.
and the care  Role play
 Relationship-based  Video -  Assessment
benefits to  Role
care & woman RMNC of clinical
women and
 Integrated play on performanc
their babies centeredness
RMC e with
 Define continuity of Clinical
midwife-led practice in Checklist
midwifery care
care and maternity  Self-
 Compassionate care reflection
midwifery ward,
continuity of  Introduce continuity of and
 Tutorial,
care care experience assessment
 Group work
 Scenarios of learning

28
 Teaching
Hours Learning Assignment Methods of
Unit Content Learning
outcomes s Assessment
activities
 Identify how requirements within  Self-directed needs in
midwife-led the program learning relation to
continuity of Respectful maternity and ICM
care affects newborn care (RMNC) competenci
maternity es
care,  What is RMNC
maternal and  Type of care expected
newborn for women and family
outcomes  Importance of RMNC
in improving quality of
 Link the care
practice of
woman  Clients’ rights for
centred care health care
to the  Client Privacy
provision of  Social accountability,
respectful Creating Social and
maternity Cultural Barrier Free
care Environment
 Develop  Behavior change
strategies to strategy for RMNC
promote
services
respectful
and  RMC for women in
compassionat MLCU’s
e maternity  RMC at all level of
care facilities
o Preconception
o During ANC
 Describe the o During labour
importance o During delivery
of RMNC o During postpartum
period
 Newborn care
integrated into RMC
 Respectful
communication-
bereavement, maternal
death, newborn death,  Exercise
IUD, still birth s
 RMC in complication
 RMC during
psychological
morbidity of women
postpartum  Self-
assessment
 RMC for Differently-
abled woman
 Role of NPM in
assuring RMNC in
MNH service

29
 Teaching
Hours Learning Assignment Methods of
Unit Content Learning
outcomes s Assessment
activities
 Review the Integrating cultural
principles of competence
cultural  Cultural competence
competence  Cultural safety
 Explore the  Cultural diversity
inequities
 Myths and taboos
faced by
women from related to childbirth
diverse
cultural and
hard-to-reach
communities
 Discuss
cultural
competence
within
context of
woman-
centered care

IV T-10  Articulate the Humanization of  Digital

SL-8 charter for childbirth and the impact records
CL-20 human rights of communication  MCQ, short
and the  Interactive answers
influence on  Humanization of workshop  Engagemen
midwifery childbirth  Tutorial t in
practice  Charter of human  Group work workshop
rights  Scenario and
 Describe  Respectful and based learning reflection
how compassionate  Lecture cum report
humanized communication and discussion
care can care  Evaluation
impact on the  Childbirth experience of teaching
woman’s  Woman centered plan for
childbirth language (communication  Role health
experience workshop) play education
and
communicati Communication
on  Channels and
techniques of  Assessment
communication of role
 Communicat  Culturally sensitive playing
e effectively communication
with women,  Team communication
family and  Information
professional technology tools in
colleagues support of
fostering communication
mutual
 Barriers to effective
respect and communication
shared

30
 Teaching
Hours Learning Assignment Methods of
Unit Content Learning
outcomes s Assessment
activities
decision  Communication
making to between woman and
enhance midwife to build
health woman’s confidence
outcomes and promote normal
 Recognize childbirth experience
barriers to
effective
communicati
on and
challenges
within
diverse
cultural
communities
 Discuss the
importance
of language
and
communicati
on in
promoting
normal birth
and building
women’s
confidence,
including
working with
pain in
labour
V T-6 Legal issues relevant to
midwifery
 Explain,  National legal  Discussion  Presenta  Assessment
framework for Medical and tion - of
legal and
Practice including experiential ethical presentation
regulatory learning
principles in National Health Policy and
 Scenarios legal
2017
midwifery  Case
practice  INC regulations & discussions
issues in
Practice standards for midwife
within the  Role play
ry
legal midwifery and its  Debate
framework of rationale  Panel
India o Policies and discussion
procedures
o Establishing standing
 Describe the orders and protocols
provision of  National Legal
maternity framework for
care services midwifery practice and
exploring the its implications
new initiative

31
 Teaching
Hours Learning Assignment Methods of
Unit Content Learning
outcomes s Assessment
activities
and  Adoption laws, MTP
guidelines act, Pre-Natal
Diagnostic Test
 Identify key (PNDT)Act, Surrogate
legislation mothers
governing  Scope and specifics of
the practice national MNH
of midwives Guidelines of the
MoH&FW
 Explain the  Professional conduct
types and
and accountability
elements of
consent to  Informed consent
health care  Record Keeping
 Apply  Confidentiality
beginning  Documentation
level
knowledge of
the law to
common
situations
encountered
within
midwifery
practice in
India
 Explore and
reflect upon
the nature of
ethics and
diverse moral
and ethical
outlooks
people hold

VI T-4 Ethics in Midwifery

 Ethics  Assign  Evaluate
 Explore and  Ethical principles  Tutorial ment on understandi
reflect upon  Shared decision  Group work ethical ng of the
the nature of making  Online lecture principl application
ethics and of es in of ethical
 Ethical decision  Scenario
the diverse midwife principles
making based learning
moral and ry and to situations
ethical  INC Code of ethics,  Case studies its encountered
outlooks  ICM codes of ethics importa in
people hold.  Professional boundary nce midwifery
 Describe  Midwifery Code of practice
globally ethics and its
accepted implications
ethical
principles
32
 Teaching
Hours Learning Assignment Methods of
Unit Content Learning
outcomes s Assessment
activities
underpinning  Ethical (bioethics)
ethical issues in maternal and
maternity neonatal care
health care
 Codes of moral
 Demonstrate
understandin behavior, human rights
g of the  Professional values
significance and professional
of the INC conduct
and ICM
code of
ethics and
code of
professional
conduct

VII T-6 Education and counseling  Assessment

SL-2  Discuss the in midwifery  Peer teaching-  Conduct of prepared
CL-20 principles  Principles of teaching women and a group education
and practice and learning family health materials
of health  Principles and practice education educatio
education of health education  Patient n
with women program
throughout the engagement
and family
childbearing cycle Exercise (Ex. for the
throughout
the  Assessment of discharge antenata
childbearing informational and planning for l women
cycle educational needs of postnatal care on
mothers and families at home) preparat
 Developing education ion of
materials labour
 Counseling & child-
 Active listening and birth
Counseling skills  Prepare
specific to educatio
 Apply the
reproductive health  Counseling n
counseling material
skills specific  Women and family sessions-Role
counseling during play s on
to relevant
reproductive breaking bad news
topic
and maternal
health

VII T-30 Community engagement

I SL-2 & research informed
CL- practice
80

33
T-4 A. Community
responsibility &  Essays,
leadership  Tutorial, Short
group work, answers,
 Identify key Midwifery leadership  scenario based MCQs
philosophical learning  Summative
Midwife’s roles online
concepts that continuous
underpin  Advocacy, moral resources assessment
advocacy in courage –
midwifery  Midwifery philosophy community
practice  Assertiveness developmen
 Identify key  Human rights t plan
theories of  Change theories
change  Agents of change
 Describe  Transformative care
transformative  Innovation
midwifery Leadership
practice
 Leadership
 Personality styles
 Demonstrate an  Team building,
understanding of Negotiation,
contemporary  Conflict resolution
 Respectful  Personality
leadership
communication quiz
 Identify  Emergency response,
elements community
underpinning development
effective team  Myer Briggs
building and personality style
negotiation skills
Identify strategies to
respond to
community needs
T-6 Management in MLCU
CL-  Describe role of  Management
40 NPM in  Definition, principles
leadership, and elements  Discussion  Exercise  Essay, short
management and  Management of (time, and s/ case answers and
supervision of material and experiential studies MCQ
maternal and personnel) MLCU/ learning
neonatal care in Maternity unit  Scenarios
various health and NICU  Case studies
 Role play
care settings  Team management  Observation
including  Soft skills
MLCUs  Transportation services
 Utilize advocacy for high risk mothers
skills and and newborn
cultural  Maintenance of
competence for Records & Reports
promoting  Nursing and midwifery
midwifery audit
education and
 Clinical audits –
midwife led MDSR (maternal death
continuum of
surveillance
care
34
  and response); CDR
(clinical data
repository)
 Infection prevention
protocols
 Quality assurance of
MNH services
 Quality assurance of
midwifery training
 Clinical supervision
 Introduction, definition
and objectives  Summative
 Principles and continuous
functions assessment
 Qualities of supervisor
– midwifery
 Responsibilities of
led unit
clinical supervisors
incorporate
 Discuss the  Access to resources
d into
sustainable and resource
development management community
goals o SDG plan
 Explore o Equitable distribution
equitable access of resources
to midwifery o Resource management.
care o Equity and rights,
 Review midwifery led
strategies for continuity of care units
effective o Environment concerns
management of
midwifery
resources

 Demonstrate
knowledge of
Midwifery led
care units
T-2 B. Research
 Compare and Informed  Tutorial  Essay/short
discuss of Practice  Group answers and
qualitative and work MCQ
quantitative Introduction to research  Online
research methodologies resources
paradigms  Introduction to
 Describe methodology
methodologies  Epistemology and
associated with ontology in research
these paradigms
 Overview of
qualitative and
quantitative research
paradigms

T-2  Discuss Research ethics, bias and

importance of research limitations  Tutorial  Essay/short
ethics in answers and
research.  History of MCQ
research ethics
35
  Demonstrate  National and  Group
knowledge of international work
contemporary codes of ethics
research ethics  Institutional ethics
guidelines. approval
 Identify areas of  Research ethics,
research bias and Academic
how this integrity
influences  Types of research
knowledge bias
production.  Research
Describe limitations
research
limitations and
restrictions

T-6  Differentiate and Quantitative &

CL- describe the qualitative research  Group work  Researc  Group
40 main  critique of h presentation
quantitative and  Overview of quantitative project on research
qualitative quantitative and research paper proposal methodolog
research qualitative  Development plan ies
methodologies methodologies of Research  Conduct
 Formulate a  Research questions in questions for of
research quantitative and quantitative research
question qualitative research research and
 Develop a  Data Collection and qualitative
quantitative Analysis research
research  Statistics
question  Preparing research
 Critically proposal
evaluate an  Practice challenges
example of  Research critique
quantitative  Use of critiquing tool
research
 Identify and
apply critical
research tools to
quantitative
research articles

T-4 Literature review  Critical

SL-2  Tutorial  Review analysis and
 Devise a  Literature search  Self-directed of Literature
literature search strategies study literatur review
based on o Literature search, data  Critique and es for
research base, keywords selection of research
questions. o Boolean operators papers project
 Identify key  Selection of relevant
words; employ literature
Boolean  Critical appraisal,
operators and analysis and synthesis
MeSH headings  Writing literature
 Identify and review,
select relevant formulating
literature recommendations

36
  Analyse and
synthesise
research
literature.
 Conduct a
literature review
T-4  Identify the Data Sources and  Tutorial  Literatu  Essay/short
different sources Evidence for midwifery  Self-directed re answers and
of Data and practice (EBMP) study search MCQ
Evidence for on
Midwifery  Facility/ District/ MNH
Practice State- available care
registers, HMIS,  Assessment
 Researc
DLHS  Evidence of
h study assignments
 Indian- NFHS, RHS, review
based
SRS, HMIS, DLHS, on area
AHS, Census,  Assessment
of work
MOHFW GOI of
(Eg. completed
guidelines WHO
 Global standards- research
Intrapart
WHO /ICM study
um presentation
recommendations, recomm
COCHRANE; State of and report
endation
Worlds Reports s or
 Evidence based LAQSH
Midwifery practice YA
 Data base search indicato
rs)
 EBMP-
Journal
club

T-2 Research dissemination  Presenta

 Discuss the and knowledge tion of
purpose of translation  Group work poster  Formative
research  Designing  Group poster and
dissemination  Purpose and methods posters work research
 Identify research of research (critique presentation
dissemination dissemination )
methods  Knowledge translation  Researc
 Apply and practice change h
knowledge symposi
translation um
techniques
(design poster)

 Design poster
based on
literature review
findings

37
 COURSE MODULE II: NORMAL PREGNANCY, BIRTH, PUERPERIUM AND CARE OF NEWBORN
{1. Basic Sciences applied to midwifery, 2. Normal pregnancy, birth & puerperium and 3. Care of newborn}

Theory: 100 Hours

Practicum:
Skills Lab-40 Hours
Clinical-980 Hours

Course aim

Drawing on the Council’s philosophy and ICM essential competencies for midwifery practice, the course aims
to enhance the Knowledge and skills to promote physiological birth and provide skilled, knowledgeable, respectful
and compassionate midwifery care to the woman and newborn in both community and institution. The review of
knowledge of basic sciences that include anatomy and physiology of reproduction and fetal development,
pharmacology & diagnostics and infection control supports the midwifery practice in facilitation of normal
physiological birth.

Course Description

This course module is designed to enable the NPMs to review the principles of related biological and
behavioral sciences and midwifery to promote physiological birth and provide respectful quality care that includes
anatomy and physiology of male and female reproductive system, conception, menstruation and ovulatory cycle;
normal physiological changes that occur in pregnancy, labour, birth and puerperium; fetal growth and development,
fetal circulation; normal neonatal physiology; development and pharmacology & diagnostics and infection control.
Antenatal care that includes assessment and screening, antenatal education and empowerment; Intrapartum care
that includes 1st, 2nd 3rd and 4th stage of labour, assessment of progress, supporting women in labour and birth,
promotion of physiological birth; working with pain with non-pharmacological and pharmacological pain relief,
assessment of fetus, assessment of perineal trauma, perineal suturing; active and expectant management of 3rd stage,
timely referral; and postnatal care that includes maternal care, transition to parenthood – mother, father and family,
promoting attachment, skin to skin, establishing breastfeeding, managing breastfeeding challenges, documentation,
reporting, community care are dealt in detail. It will address the knowledge and skills required to develop quality
practice skills care for the newborn and promote a healthy transition to life that includes immediate care of the newborn,
newborn assessment, essential newborn care; complete physical examination; newborn health needs; nutritional needs
of the newborn, skin to skin; breastfeeding; maternal newborn bonding; growth and development of the infant;
prophylactic measures; immunisaton; providing evidence based information to parents; consideration of cultural
norms; and respectful care to newborn.

Course objectives
1. Demonstrate professional accountability for the delivery of midwifery care as per the Council’s standards
that are consistent with moral, altruistic, legal and ethical and regulatory and humanistic principles in
midwifery practice
2. Discuss the anatomy and physiology of the female reproductive system and conception
3. Explain fetal and placental growth and development

38
 4. Describe the maternal physiological changes that are associated with pregnancy, labour and birth and
puerperium.
5. Assess and provide pre pregnancy care including counseling
6. Assess and provide care for women in the antenatal, intranatal and postnatal period including conduction of
normal deliveries
7. Assess and provide care for neonates
8. Describe the primary physiological adaptations that the newborn undergoes following birth and the
physiological basis of secure bonding and attachment.
9. Demonstrate sound knowledge of applied pharmacology and principles of prescribing
10. Identify and use medicines appropriately in midwifery, obstetric emergencies and complex situations as per
GoI guidelines
11. Implement infection control practices in maternal and newborn care facilities

Competencies: (ICM)

1. Adhere to jurisdictional laws, regulatory requirements, code of conduct for midwifery practice (1f)
2. Provide pre-pregnancy care (2a)
3. Determine health status of woman (2b)
4. Assess the fetal wellbeing (2c)
5. Monitor the progression of pregnancy (2d)
6. Promote and support health behaviors that improve their wellbeing (2e)
7. Provide anticipatory guidance related to pregnancy, birth, breastfeeding, parenthood, and change in the family
(2f)
8. Detect, manage, and refer women with complicated pregnancies (2g)
9. Assist the woman and her family to plan for an appropriate place of birth (2h)
10. Promote physiologic labour and birth (3a)
11. Manage a safe spontaneous vaginal birth and prevent complications (3b)
12. Provide care of the newborn immediately after birth (3c)
13. Provide postnatal care for the healthy woman (4a)
14. Provide care to healthy newborn infant (4b)
15. Promote and support breast feeding (4c)

39
 1. Basic sciences applied to midwifery
Theory: T-40 hours, Skill Lab: SL-12 hours, Clinical: CL-210 hours

A. Maternal, Fetal and Newborn Physiology

Teaching
Learning Methods of
Unit Hours Content Learning Assignments
outcomes Assessment
activities
1 T-3 Review of anatomy &  Discussion  Presentat  Essay,
SL-4  Review the physiology of human and ions/semi short
reproductive reproductive system experiential nars answers
system  Anatomy and learning  Demonst and
 Understand physiology of human  Self-directed ration – MCQ
the female reproductive system: learning female
hormonal  Hormonal cycles pelvis
cycle (ovarian  Female pelvis and Fetal and fetal
and uterine) skull (with feto-pelvic skull
relationships)
2 T-4  Understand Embryology and Fetal
SL-2 the process of growth and development  Tutorial  Foetal  Evaluati
fertilization  Fertilization and  Group work circulatio on of
and Implantation  Online n– the
conception  Embryological lecture schemati assignm
 Understand development  Self-directed c ent
placental  Placental development learning represent
development  Placental function; ation
and function blood brain barrier
 Demonstrate  Fetal development
knowledge of  Fetal circulation
fetal growth  Fetal nutrition
and
development
in early
pregnancy.
3. T-3  Recognize Physiological changes in
SL-2 physiological pregnancy  Tutorial  Quiz
changes in  Physiological changes  Group work  Educati
early in early pregnancy  Online onal
pregnancy including; lecture resourc
across the cardiovascular,  Self-directed e
body systems hematological, learning develop
 Understand endocrine, digestive, ment
the interaction respiratory, uterine,
of pregnancy renal, immune system
hormones musculoskeletal,
integumentary
 Hormones of
pregnancy
 Ongoing signs of
pregnancy

40
 B. Pharmacology and Diagnostics

Teaching
Learning Methods of
Unit Hours Content Learning Assignments
outcomes Assessment
activities
1 T-3 Review of
 Discuss the Pharmacology  Lecture  Quiz
role of  Group work
 Role of
pharmacology  Self-
in safe and pharmacology in safe
directed
effective and effective
study
midwifery midwifery practice
practice  Classification and
 Discuss factors schedule of drugs
that determine  Principles of safe
the safe use of drug administration
medicines  Regulation, safe use
 Describe the of medicines
regulation,  Pharmacokinetics
scheduling and and
classification pharmacodynamics
of medicines in Mechanisms of
India  Drug action/reaction
 Define  Drug absorption,
pharmacodyna  Drug distribution
mics and its  Metabolism and
role in excretion,
medication use  Principles of
pharmacokinetics and
 Understand the
principles of pharmacodynamics
pharmacokineti
cs

2 T-3  Understand Medicines in pregnancy  Lecture  Quiz

how and breastfeeding  Group work
medicine move  Blood brain barrier  Self-
s between the  Teratogens and its directed
blood and the effect study
placenta  Medicines and Birth
or breast milk defects
and factors that  Pregnancy risk and
affect this drug classification
movement  Advice to women
 Identify and family (including
important special precautions
considerations while taking
for the use of medicines)
medicines
during
pregnancy and
breastfeeding

41
 Teaching
Learning Methods of
Unit Hours Content Learning Assignments
outcomes Assessment
activities
 Identify
medicines
known to cause
birth defects
 Identify
medicines that
may adversely
affect
breastfeeding
 Explain the
prevention and
treatment(s) of
drug side
effects
3 T-4  Demonstrate an Commonly used  Scenarios  Drug  Case
understanding medicines and their side  Case study, presentati study
of the effects  Tutorial on &  MCQ
pharmacologic  Group work Case  Short
 Classification,
al basis of  Self- reports answers
action of Mechanism of action,
directed and
Dosage, Uses, Side
medicines used study Essays
effects
to manage
 Drugs use in
conditions in
pregnancy pregnancy, labour
 Describe the and breast feeding:
adverse effects Oxytocin,
associated with ergometrine,
medicines Misoprostol,
 Explain the analgesia
prevention and  Antibiotics
treatment(s) of  Antipyretics and
drug side  Anti-inflammatory
effects agents
 Demonstrate an  Antiemetic
understanding  Laxatives
of the  Vitamins,
pharmacologic  Antifungal
al basis of  Anthelminthic.
treatments used
in the
management of
pain
 Identify
specific
analgesic
medicines that
are not
recommended
for use during

42
 Teaching
Learning Methods of
Unit Hours Content Learning Assignments
outcomes Assessment
activities
pregnancy and
breastfeeding
4 T-10  Understand and Prescription and safe  Scenarios  Drug  Simulate
CL-90 implement the administration of  Case study dosage d OSCE
principles of medicine  Tutorial calculatio  MCQs
safe drug  Fundamentals of group work n  Short
administration prescribing  Simulation  Drug answers
 Administer the  Principles of workshop presentati and
correct drug prescribing and  Reflective on & Essay
treatment as factors influencing it Case  Case-
learning log
per regulations  Implications of reports study
and
 Understand wrong practices interactive analysis
medicine related to prescribing discussion/l
calculations (using case studies) earning
 Prescribe  Prescriptive role of  Experientia
permitted drugs Nurse Practitioners l/
for women as  Professional, legal  Clinical
per the and ethical issues placement
protocols relevant to (under the
prescribing practice
preceptorsh
o Process and steps of ip of
prescribing
medical
o Prescribing
 Integrated
competencies
Clinical
 List of drugs that can
be administered by practice in
nurse practitioner as maternal
approved by GoI neonatal
 Implications of areas
wrong practices  Writing
related to prescribing prescription
(using case studies)  Review of
literature-
 Side effects
laws and
(classification and
regulations,
management)
trends of
 Drug calculations
nurse
and the 8 rights of
prescribing
drug administration
practice
 Safe drug
administration
 Informed consent
 Documentation:
accurate and
complete records
5 T-3  Demonstrate Non Pharmacological  Scenarios  Demonst  Simulate
CL-40 understanding Therapy:  Case study ration of d OSCE
of Complementary  Tutorial various  MCQs
supplementatio therapies and group work complim  Short
n supplementation entary answers
therapies
43
 Teaching
Learning Methods of
Unit Hours Content Learning Assignments
outcomes Assessment
activities
 Identify non-  Vitamin during and
pharmacologic supplementation labor Essay
al principles of  Complementary
working with therapies
pain o Acupressure,
Acupuncture
o Yoga
o Reflexology
o Water birth

6 T- 3  Identify Technology and  Scenarios,  Essays,

SL-2 screening tools diagnostics  case study Short
CL-40 used to  Screening, use of  Tutorial Answers
determine risk ultrasound group work  Simulate
 Ferning  Simulation d OSCE
 Understand the  Speculum exam workshop
use of  Bishops score  Demonstrat
technology in  CTG- Clinical ion on
pregnancy and reasoning,
collection
labour  Vaginal smear
of various
 Consider the  Visual inspection
specimens
over use of with acetic acid
and specific
(VIA),
technology in tests
midwifery care  PAP smear
 Collection, treatment
 Demonstrate
of various specimens,
skills in
and preparation of
performing
them for
selected
Examination
diagnostic
/screening
procedures for
women

C. Infection Control

T-4 Infection  Explain Infection Control  Discussio  Review  OSCE

SL-2 Control the  National guidelines n and notes on /OSP
CL-40 infection and institutional experienti national E
control al guidelines
policy
policies learning
 Principles of  Games  Draw
prevention of  Demonstr from
 Demonstr
infection ation clinical
ate skills
 Standard precautions using IP experienc
in
for prevention of materials e and
infection
infections  Skill write
control demonstra
practices o Hand washing infection
tions -
o Use of protective control
attire infection
related
practices
44
  Explore o Processing of used to reach practice
and items/equipment expert standards
reflect on o Proper handling and level in IP
the role disposal of sharps  Videos
of NPM o Maintaining a clean  Clinical
environment practice
and
o Biomedical waste  Self-
health
disposal directed
team in
 National infection learning
infection control guidelines  Safe
preventio o Role of NPM and Delivery
n health team in App
infection prevention module
/control on IP

2. Normal Pregnancy, Birth and Puerperium

Theory: T-50 hours, Skill Lab: 22 hours, Clinical: CL- 680 hours

Teaching
Learning Assignment Methods of
Unit Hours Content Learning
outcomes s Assessment
activities
1 T-4  Identify and Chain of Referral system  Discussion  Writing  Essay,
CL-40 implement the  Review of Laws and and referral short
chain of regulations of India that experientia slip/note answers
referral system govern midwifery practice l learning  “Emerg and
 Existing chain of referral  Supervised ency MCQ
 Identify and system clinical referral”
apply policies  Limitations and possibilities practice action
and protocols of other health care cards in
required to providers the safe
stabilize  Policy and protocols for delivery
women and referral, range of strategies app
newborn for  Conditions requiring (SDA)
referral referral, when, where and
how to refer for each
condition
 Transport arrangements:
community resources,
advice to families and
referral note
 Follow up: feedback on
cases referred
 Records and reports on
referrals
2 T-4  Facilitate a Beginning the pregnancy  Discussion  Pre-  Evaluatio
SL-2 partnership2 journey and concepti n of skills

2
Note that in a partnership relationship between a midwife and a woman, both make equally essential (but different)
contributions. The woman defines who her family are and how they will be involved. Information is shared,
decisions are negotiated, and the woman makes decisions that are right for her. The midwife upholds the woman’s
decisions. See chapter on partnership in practice in Pairman et al textbook.
45
 Teaching
Learning Assignment Methods of
Unit Hours Content Learning
outcomes s Assessment
activities
with women  Pre pregnancy Care experientia on using
through  Review of Sexual l learning counseli checklist
continuity of development (Self  Demonstra ng
care Learning) tion  History  Assessme
 Explain the  Socio-cultural aspects of  Role play- taking nt of
significance of human sexuality (Self counsellin and clinical
pre pregnancy Learning) g assessm performa
care  Evidence based screening  Tutorial, ent of nce with
 Recognize for health problems such as group health using
birth as a diabetes, hypertension, work, status of checklist
normal life thyroid conditions, and  Case study women
event for chronic infections that  Assess  Evidence
women and impact pregnancy ment of based
their families  Pre-conception counseling nutrition essay
 Provide (including awareness al status
preconception regarding normal births) and
care for  Planned parenthood screenin
eligible  Genetic counseling (Self- g of
couples Learning) women
 Provide  Assess and confirm
information pregnancy
and develop
skills to
enable shared
decision
making in
midwifery
practice
 Understand
and advocate
for planned
parenthood
3 T-6  Respond Pregnancy assessment and  Discussion  Health  Essay,
SL-2 effectively to midwifery care during 1st and educatio short
CL-50 women’s Trimester experientia n answers
individuality,  Review of Normal l learning  Case and
lack of pregnancy  Demonstra presenta MCQ
knowledge  Review of Maternal tions tion  Assess
their social nutrition and malnutrition  Bed side  Bed side clinical
and cultural  Diagnosis of pregnancy – clinics clinic skills
contexts. signs and symptoms,  Case  Clinical using
 Explain the differential diagnosis, discussion Confere procedur
significance of confirmatory tests s nce e
antenatal care  Definition, nature,  Seminar  Antenat checklists
for the women objectives and importance  Nursing al  Assess
and family of antenatal care rounds history clinical
 Building partnership  Supervised taking performa
 Demonstrate with women following clinical and nce using
skills in RMC protocol practice in assessm rating
providing  Antenatal assessment: antenatal ent scale
antenatal care, History taking, physical OPD and  Draw a  OSCE/O
health examination, breast ward micro- SPE
education for examination, obstetrical and birth
pregnant pelvic examination plan
46
 Teaching
Learning Assignment Methods of
Unit Hours Content Learning
outcomes s Assessment
activities
women and (Leopold’s maneuvers),  Self-
continuity of laboratory investigation directed  Laborat
care  Identification and learning ory
 Promote management of minor investig
equity and discomforts of pregnancy  Skilled ations:
access to care  Antenatal care and Birth perform
during counseling (lifestyles in Attendant and
pregnancy pregnancy, nutrition, shared module interpret
 Recognize decision making, risky  Online - UPT,
birth as a behavior in pregnancy, lecture Hb
normal life counseling regarding sexual estimati
event for life during pregnancy etc)  Scenario on,
women and  Screening for antenatal based HIV/Sy
their families. anxiety learning philis
 Screening for family testing;
 Describe the violence urine
need for  Point of Care and One analysis
documentation Stop service during for
and record ANC albumin
keeping  Danger signs during and
pregnancy sugar
 Birth preparedness and  Assess
complication readiness ment of
(including promoting fetal
“Normalcy during well-
pregnancy”) being
 Childbirth preparation  Antenat
 Respectful care and al
compassionate counsell
communication ing
 Recording and reporting
 Clinical
procedures as per
the GOIs guideline
 Various models of
ANC and their
evolution
 GoI current model
of ANC provision
 Role of Doula /
ASHA’s
 Role of nurse
practitioner in
midwifery
4 T-5 Midwifery care during 2nd
SL-2  Demonstrate trimester of pregnancy  Case
CL-45 knowledge of  Tutorial, presenta  Quiz
midwifery  Education and management tion
of physiological changes  Group  Compete
practice work,  Bed side ncy
throughout the and discomforts of 2nd clinic
trimester based
2nd trimester  Online  Clinical assessme
 Maintain  Rh negative and Confere
lecture nt
woman prophylactic anti D nce
centered

47
 Teaching
Learning Assignment Methods of
Unit Hours Content Learning
outcomes s Assessment
activities
relationship-  Second trimester tests and  Scenario  Antenat  OSCE
based care health education based al
 Assess fetal  Interpreting screening learning history
growth and results taking
development  Health education on IFA,  Case study and
 Discuss calcium and vitamin D
 Simulation
assessm
management supplementation, ent
workshop
for existing glucose tolerance test,  Assess
disease or immunization etc ment of
pathology  Informed decision making fetal
 Facilitate  Antenatal assessment: well-
ethical abdominal palpation, fetal being
midwifery assessment, auscultate fetal  Antenat
practice heart rate -Doppler and al
promoting pinnards, counsell
maternal  Assessment of fetal well- ing
autonomy and being: fetal pattern ,
choice DFMC, biophysical profile,
Non stress test, cardio-
tocography, USG, Vibro
acoustic stimulation,
 2nd trimester antenatal care,
 Women centered
care
 Respectful care
and compassionate
communication
 Referral and
collaboration,
empowerment
 Ongoing risk
assessment
 Maternal Mental
Health
 Role of Doula /
ASHAs
5 T-5  Demonstrate Midwifery care during 3rd  Tutorial  Case  Quiz,
SL-3 knowledge of trimester of pregnancy  Group presenta (end of
CL-50 midwifery  Physiological discomforts work tion course
practice during 3rd trimester  Online  Bed side exam)
throughout the  Third trimester tests and lecture clinic  Compete
3rd trimester screening  Scenario  Clinical ncy
 Fetal engagement in late based Confere based
 Maintain pregnancy learning nce assessme
woman  3rd trimester antenatal  Case study  Antenat nt
centered education classes,  Simulation al
relationship-  Birth preparedness and workshop history
based care to complication readiness  Demonstra taking
develop birth  Health education on tion of and
plan exclusive breastfeeding birthing assessm
 Danger signs of position ent
pregnancy-   Draw a
recognition of micro-

48
 Teaching
Learning Assignment Methods of
Unit Hours Content Learning
outcomes s Assessment
activities
 Provide ruptured birth
antenatal and membranes plan
preparation for  Ongoing risk  Assess
birth and assessment ment of
breastfeeding  Cultural needs fetal
education to  Women centered well-
build each care being
woman’s  Respectful and  Antenat
confidence compassionate al
communication counsell
 Alternative ing
birthing positions-
women’s preferred
choices
 Role of Doula /
ASHA’s
6 T-5  Apply the Midwifery care during first  Discussion  Bed side  Essay,
SL-2 physiology of stage of labour and clinic short
CL-120 labour Review of experientia  Health answers
 Describe how  Normal labour and birth l learning educatio and
a midwife  Onset of birth/ labour  Bed side n MCQ.
builds a  Per vaginal examination (if clinics  Case  OSCE/O
woman’s necessary)  Case presenta SPE
confidence  Stages of labour discussion tion  Assessme
and provides  Organization of labor s nt of
respectful room-Triage,  Seminar  Clinical skills
cares for the preparation for birth  Simulation Confere using
women during  Positive birth  Video nce procedur
labour environment  Demonstra  Case e
 Encourage the  Respectful care and tions study checklist
role of birth communication  Plotting  Assess
companion  Supervised clinical
and
during labour First Stage: clinical performa
interpret
 Discuss the practice in ation of nce with
 Physiology of normal labour
effect of the labour partogra rating
 Monitoring progress of
midwife's (and ward ph scale
labour
other team
 Using Partograph  SBA,  Supervi
members) sed
language on  Pain relief in labour (non IMNCI,
clinical
the woman's pharmacological and NSSK
practice
emotional pharmacological) modules
well-being  Assessing and monitoring  LaQshya
 Discuss how fetal well being
guidelines
to maintain an  Psychological support-
environment Managing fear
for labour in  Activity and positioning for
which the labour
woman feels  Nutrition during labour
safe
 Care during 1st stage of
 Working
normal labour
effectively
 Positive childbirth
with pain
experience for
during labour
women
49
 Teaching
Learning Assignment Methods of
Unit Hours Content Learning
outcomes s Assessment
activities
 Birth companion
for labour
 Safe environment
for mother and
newborn to
promote bonding
 Role of Doula /
ASHA’s
 Evidence based
theories (eg:
becoming a
mother) and
practice in relation
to labour
interventions
7 T-5  Apply Midwifery care during second  Tutorial Clinical  Essays,
SL-2 knowledge of stage of labour  Group scenarios Short
CL-120 the physiology work answers
of birth to  Physiology (Mechanism of  Online  OSCE/O
midwifery labour) lecture SPE
 Signs of imminent labour
care  Scenario
 Discuss how  Intrapartum monitoring based
the midwife  Birth position of learning
provides care choice  Case study
and support  Warm compresses  Simulation
for the women  Vaginal examination (if Workshop
during birth to necessary)
enhance  Management-preparation
physiology and supporting birth
and promote  Psychological support
normal birth  Non directive coaching
 Role of Doula /
ASHA’s

8 T-5  Assessment Midwifery care during 3rd  Tutorial  Case  Essays,

SL-2 and care of the Stage of labour  Group study Short
CL-100 newborn work  Simulati answers
immediately  Physiology - placental  Online on  OSCE/O
following separation and expulsion, lecture SPE
homeostasis
birth.  Scenario
 Physiological management based
of third stage of labour learning
 Active management of third 
stage of labour
 Examination of placenta,
membranes and vessels
 Assess perineal, vaginal
tear / injuries and suture if
required
 Immediate perineal care
 Essential newborn care
(ENBC)
 Initiation of breast feeding
 Skin to skin contact
50
 Teaching
Learning Assignment Methods of
Unit Hours Content Learning
outcomes s Assessment
activities
 Vitamin K prophylaxis
 Newborn resuscitation

9 T-3  Discuss the Midwifery care during 4th  Tutorial  Essays,

SL-3 impact of Stage of labour  Group Short
CL-20 labour and work answers
birth as a  Observation, Critical  Online  OSCE/O
transitional Analysis and Management lecture SPE
of mother and newborn
event in the  Scenario
woman's life o Maternal assessment,
based
 Ensure observation fundal height,
learning
urine output, blood loss
initiation of  Case study
 Documentation and
breast feeding
Record of birth  Simulation
and adequate Workshop
latching  Breastfeeding and
latching
 Managing uterine cramp
 Alternative/complementa
ry therapies
 Role of Doula / ASHA’s
 Various childbirth
practices
 Safe environment for
mother and newborn to
promote bonding
10 T-8  Demonstrate Postpartum care/ Ongoing  Discussion  Seminar  Essay,
SL-4 integration of midwifery care of women and  Case short
CL-135 the role of Review of experientia studies answers
midwife in the  Normal Postpartum period l learning  Clinical and
care of woman  Physiology of puerperium  Demonstra presenta MCQ.
 Explore the tion tion  Assessme
 Post-natal assessment and
maternal
care- facility and home-  Simulation nt of
physiological s  Counsel skills
based care
changes  Bedside ing with
following  Perineal hygiene and care rounds/cli procedur
mothers
birth  Bladder and bowel function nics for
e check
 Minor disorders of list
 Understand breast
 Case  OSCE/O
the physiology puerperium and its feeding
discussion SPE
of lactation management –
and  Physiology of lactation and techniqu
composition  Role play
lactation management es and
of breast milk  Postnatal counseling and position
 Safe  Health
psychological support
 Demonstrate Delivery talk
 Normal postnatal baby App video
skill in caring  Postnata
blues and recognition of on feeding
for postnatal l
postnatal depression
women assessm
 Transition to parenthood ent
 Supervi
sed
51
 Teaching
Learning Assignment Methods of
Unit Hours Content Learning
outcomes s Assessment
activities
 Understand  Care for the mother from 72 clinical
homeostasis hours to 6 weeks after the practice
and nutritional delivery in
requirements  Cultural competence postnata
of the (Taboos related to l ward
newborn postnatal diet and and
OPD
practices)
 Evidence based practice
in relation to postnatal
and newborn care.
 Knowledge on Postpartum
family planning methods
 Follow-up

3. Care of Newborn
Theory: T-10 hours, Skill Lab: SL- 6 hours, Clinical: CL- 90 hours

Teaching
Assignment Methods of
Hours Learning outcomes Content Learning
Unit s Assessment
activities
1. T-2  Discuss the need for Family centered care  Tutorials  Group  Essay,
compassionate, family  Concept of and group discussi short
centered midwifery care Family centered work on on answers
of the newborn and how care  Scenarios family
this is provided  Partnership and centered
 Discuss how the woman cultural midwife
and family’s views and competency ry care
beliefs are respected  Respectful care
 Understand that actions and
and interventions communication
carried out on baby  Informed consent
need to be fully and shared
explained and informed decision making
consent obtained
2 T-2  Discuss preparation for Ongoing care of  Discussion  Case  Essay,
SL-4 newborn at birth newborns and presenta short
CL-30  Explain the midwife’s  Assessment and experiential tion/ answers
role in observing and management of learning Case and MCQ
assessing the newborn normal neonates  Demonstrati study  Assessmen
immediately after birth Review of: ons  Health t of skills
 Normal neonate –  Self- talk with
 Explore the physiological directed  Newbor procedure
physiological adaptions adaptation learning n check list
that the newborn  Newborn  Seminar assessm  Assessmen
undergoes following assessment and  Case ent t of
birth care discussion clinical
performan
52
 Teaching
Assignment Methods of
Hours Learning outcomes Content Learning
Unit s Assessment
activities
 Demonstrate skills in  Screening for  Safe ce with
caring for normal congenital Delivery rating
newborns in the anomalies App scale
presence of mother  Care of newborn module on
from 72 hours to newborn
6 weeks after the managemen
delivery (Routine t and risk
care of newborn) managemen
 Skin to skin t
contact  Supervised
 Thermoregulation clinical
 Infection practice in
prevention postnatal
(asepsis and hand ward /
washing) NICU /
Nursery
3 T-3  Identify the newborn at Risk identification  Tutorials  Case study
CL-30 risk and give relevant and referral and group
immediate care  Risk work
 Understand the process Identification and  Scenarios
to refer unwell referrals  Simulation
newborns  Minor disorders workshops
 Educate the mother and of newborn and  Online
family on prevention, their management lecture
recognition, and  Newborn
management of screening,
common newborn  Signs of distress
problems and risk
assessment,
 Identification of
complications,
management and
referral as per
IMNCI protocol
 Documentation
and record
 Health education
to the mother and
family about the
management of
common newborn
problems
4 T-2  Discuss the benefits of Nutritional needs of  Tutorials  Formative
SL-2 breastfeeding for the the newborn and and group quiz
CL-20 baby and mother establishing work  Competen
Understand the breastfeeding  Scenarios cy based
composition of breast  Breastfeeding  Simulation OSCE
milk.  Breast milk workshops  Summativ
composition  Online e exam
lecture
53
 Teaching
Assignment Methods of
Hours Learning outcomes Content Learning
Unit s Assessment
activities
 Discuss the  Benefits of
recommendation of breastfeeding for
exclusive breastfeeding the newborn and
for six months mother
 Explain how to help a  Lactation
mother succeed with the management:
first breastfeeding and Breast feeding
recognize if the baby is techniques and
breastfeeding well. positions, rest and
 Explain and nutrition for
demonstrate how to mother during
express breast milk and breastfeeding
storage  Exclusive
 Understand the BFHI breastfeeding
 Expression and
storage of breast
milk
 Signs of hunger
 Supportive
environment for
breastfeeding
 Baby Friendly
Hospital Initiative
(BFHI) guidelines
 Health education
to mother and
family on
breastfeeding
5 T-1  Understand the Immunization  Tutorials  Case  Demonstra
CL-10 midwife's role in  Immunization and group scenario te skill in
immunization  Importance of work - immunizat
immunization  Scenarios midwife ion of the
 Demonstrate skill in  Health education  Simulation 's role in newborn.
immunization of the to family on workshops immuni
newborn. current  Online zation
immunization lecture
schedule  Self-
directed
learning

54
 COURSE MODULE III: COMPLEX CARE OF WOMAN AND CARE OF COMPROMISED
NEWBORN

Theory: 40 hours
Practicum:
Skill lab: SL-35 hours
Clinical: CL- 570 hours

Course aim

This course will prepare the student to provide skilled, knowledgeable, compassionate and respectful
midwifery care across the continuum of childbirth for mothers facing deviation from normalcy, in both community
and institution. This course will examine the physiological impact of pre-existing health challenges and medical
disorders experienced during pregnancy as well as pathophysiological response to deviations from normal and
complications in the woman, fetus and newborn.
Course Description

This course will build on the knowledge obtained from the previous courses and will examine the
pathophysiological impact of nutritional deficiencies, pre-existing medical disorders and existing disease burden in
India as well as pathophysiological response to deviations from normal; including hypertensive, endocrine,
haematological, haemorrhagic, metabolic disorders and obstetric emergencies. This module is designed to enable the
NPMs to develop skills in identifying women with deviations from normal during the antenatal, intranatal and postnatal
period and abnormal newborns and provide specialized care for them. The NPMs would be able to implement the
national health programs with special reference to family welfare and women’s health. The module consists of
Perinatal Psychological Health, Complex care of woman and care of compromised newborn.

Course Objectives:

1. Assess and provide care for women in the antenatal, intranatal and postnatal period facing complications
2. Assess and provide care for neonates with problems
3. Identify deviations from normalcy, stabilize and transport women and neonates to the higher centers
4. Explain how common pre-existing health challenges interact with the physiological changes during pregnancy to
increase the risk of complications.
5. Explain the pathophysiological responses that occurs in the woman, fetus and newborn in response to deviations
from normal and obstetric emergencies
6. Understand the pathophysiology underlying common fetal and neonatal disorders, complications and congenital
abnormalities
7. Recognize and assess deviations from normal physiology during pregnancy, labour and birth and the puerperium
8. Plan and provide evidence-based and compassionate, woman-centred midwifery care for women experiencing
complications during the antenatal, intrapartum and postpartum period.
9. Demonstrate effective clinical skills and appropriate use of technology in the care of women with complications
and/or obstetric emergency

55
10. Understand the impact of complications on the psychological, social and cultural wellbeing of women and their
families and the importance of continuity of care.
11. Describe the legal responsibilities associated with complications during the antenatal, intrapartum and postpartum
period
12. Identify the need for referral and interprofessional collaboration in managing the care of women with complex
needs.
13. Recognize woman who experiences physical and sexual violence and partner abuse and provide appropriate
support and referral
14. Promote health of families and communities and provide family welfare services

Competencies (ICM)

1. Assess the health status, screen for health risks, and promote general health and well-being of women and
infants(1j)
2. Prevent and treat common health problems related to reproduction and early life(1k)
3. Recognize conditions outside midwifery scope of practice and refer appropriately(1l)
4. Detect, manage, and refer women with complicated pregnancies (2g)
5. Provide care to women with unintended or mistimed pregnancy (2i)
6. Detect and treat or refer postnatal complications in woman(4d)
7. Detect and manage health problems in newborn infant ( 4e)
8. Care for women who experience physical and sexual violence and abuse (1m)
9. Provide family planning services (4f)

1. Perinatal Psychological Health

Learning Learning Assignments

Unit Hours Content Assessment
Outcomes Activities

1. T-2  Describe Perinatal mental health  Tutorial  Online  MCQ,

CL-20 common disorders  Group resources Short
mental work on answers,
disorders  Perinatal mental  Scenario perinatal Essays
impacting on health based mental  Continuous
pregnancy  Perinatal anxiety and learning health assessment
 depression
Describe the  Reflective including
principles of  Severe mental practice case report
illness- psychosis
care for  Case study
women with  Borderline
mental personality disorder
disorders in  Comorbidity and
the perinatal complexity in mental
period health
 Explain the  Substance abuse and
impact of mental illness
anxiety and  Trauma informed
depression on care principles

56
 women and  Assessment and
their families screening,
 Describe the  EPND
tools and  ANRQ
process for  WEMWBS
psychological  Referral,
screening in management plans
the perinatal  Managing suicide
period risk
 Describe the  Psychopharmacology
management  Compassionate care
of mental and communication
disorders in
the perinatal
period
2. T- 1  Explore the Perinatal death, trauma
CL-20 impact of and grief  Tutorial  Journal  MCQ,
perinatal  Group club- Short
death and work perinatal answers,
 Post-traumatic stress
trauma on the  Simulation mental Essays
woman and disorder health
workshop
 Grief, debriefing,
her family  Scenario
 Demonstrate grief counselling based
a sound  Domestic violence, learning
understanding signs of abuse  Reflective
of the process practice
of grief and
the response
of the
midwife to
support
bereaved
families
3. T-1  Consider the Perinatal wellbeing  Tutorial  Group  Educational
CL-20 impact of  Group work- resource
postnatal  Transition, maternal work Scenario  Group
wellbeing
transition on  Simulation based presentation
perinatal  Mother-infant workshop learning
mental health attachment  Reflective
 Explain the  Circle of security practice
importance of  Personal mental  Supervised
mother infant wellbeing strategies clinical
attachment  Knowledge of practice
 Develop supports and services
strategies to and for women
promote
personal
wellbeing

1. Complex care of the woman

57
 Learning Learning
Unit Hours Content Assignments Assessment
Outcomes Activities

1 T-2  Demonstrate Principles of recognition  Tutorials Clinical  MCQ,

ability to and assessment of risk  Group scenarios- Short
detect discussion Women with answers
complications  The midwife within  Scenario complication , Essays
early, take own scope of practice based s
appropriate recognises and learning
action and assesses deviations  Role play
timely refer a from normal  E learning
woman for  Demonstrates effective
management clinical skills and
at higher level critical knowledge for
 Highlight the women with
midwives’ complications during
roles and
the pregnancy
responsibilitie
s in early (definition, signs and
diagnosis symptoms,
 Demonstrate management as per
skill in protocols and
undertaking a guidelines in place)
risk  Assessment skills and
assessment clinical judgment
and referral based on the adequate
 Discuss legal decision-making
and ethical framework
practice in  Documentation and
relation to follow up on her risk
complex carE assessment
 Discuss
 Law and ethics in
collaboration
relation to complex
and team work
in care
management  Effective
of complexity communication
 Collaboration, team
 Effective work and referral
communicatio
n,
collaboration,
team work and
referral

2. T-2  Assess women Complex care in case of  Discussion  Discussi  Assess

CL-30 with Miscarriage and post and on and ment of
miscarriage abortion care experiential experien clinical
and provide  Definition and learning tial perform
post abortion classification of  Demonstrat learning ance
care abortion ions  Demonst with
 Etiology, modes of  Case rations rating
termination of discussions  Case scale
pregnancy  Safe discussio
 Diagnostic evaluation Delivery ns

58
 Learning Learning
Unit Hours Content Assignments Assessment
Outcomes Activities

for abortion app

 Management of modules on
abortion post
 Post abortion care abortion
including care
psychological support
 MTP act
3. T-5  Demonstrate Recognition and  Tutorials  Health  Formati
SL-5 knowledge in Management of problems  Group assessme ve quiz,
CL-60 midwifery during Pre-pregnancy discussion nt, summat
practice to and Pregnancy  Scenario screenin ive final
recognise, based g and examin
assess and  Gender based Violence manage
learning ation
manage  Culture sensitivity  ment of
Role play  Essay,
deviations  Emotional abuse and  E learning high risk
short
from normal physical neglect  Clinical mothers
answers
physiology  Female genital practice and
during the  Presentatio  Health MCQ
mutilation
pregnancy ns educatio
 Demonstrate  High-risk pregnancy n
 Simulation  Assess
competencies  Review of  Case
workshops ment
to provide Complications during presentat
 Low dose skills
care during pregnancy (definition, ion
high using
pregnancy causes, signs and frequency /Case procedu
skill study re
symptoms, diagnosis
management and developmen checklis
t  Procedur t
complications) es to be
 Discussion
o Bleeding in early performe
and  Assess
pregnancy: experiential d clinical
 Abortion learning /assisted perform
 Ectopic pregnancy  Bedside per the ance
 Hydatidiform mole clinics log-book with
o Bleeding in late  Demonstrat rating
pregnancy: ion scale
 Antepartum  Simulation
 Safe  OSCE
haemorrhage(APH
Delivery
) – Placenta  Evaluat
app
previa, Abruption modules on ion of
placenta Hypertensio case
o Hyperemesis n etc study/c
gravidarum  Supervised ase
o Pregnancy induced clinical present
practice in ation
hypertension
antenatal
 Pre-eclampsia and
ward /
management OPD/
 Eclampsia Obstetric
o Multiple pregnancy IUC
o Oligo/Polyhydramnios

59
 Learning Learning
Unit Hours Content Assignments Assessment
Outcomes Activities

o Role of NPM in
managing Medical
conditions in
pregnancy
 Anemia in pregnancy
 Gestational diabetes
mellitus
 Cardiac disease
 Pulmonary disease
 Thyrotoxicosis,
 Epilepsy
 Sexually transmitted
diseases
 HIV/AIDS
 Rh incompatibility
 Infections in
pregnancy - urinary
tract infection,
bacterial, viral,
protozoal, fungal –
malaria, dengue, TB
o Intrauterine growth
restriction
o Premature rupture of
the membranes
o Prolonged rupture of
membranes
o Multiple pregnancy,
o Placental dysfunction
o Intrauterine fetal death
o Gynecological
disorders complicating
pregnancy
o Adolescent
pregnancy, elderly
primi gravida and
grand multipara
 Decision making for
management and
referral

4. T-5  Demonstrate Complex care in labour  Tutoria  Case  Formati

SL-5 knowledge in ls Presentat ve quiz,
CL- midwifery  Complications in  Group ion summat
100 practice to labour (definition, discuss  Bed side ive final
recognise and signs and symptoms, ion clinic

60
 Learning Learning
Unit Hours Content Assignments Assessment
Outcomes Activities

assess management as per  Scenari  Procedur examin

deviations protocols and o based es to be ation
from normal guidelines in place) learnin performe  OSCE
physiology  Preterm labour and g d/assiste  Essay,
during labour antenatal cortico-  Role d/ short
 Discuss steroid management play observed answers
malpresentatio  Induction and  E as per and
n during augmentation of labour learnin the log- MCQ
labour  Precipitate labour g book
 Demonstrate  Prolonged and  Clinica
competencies obstructed labour l
to provide  Fetal distress in labour, practic
care during e
 Malposition and
complications
malpresentations  Present
in labour ations
(definition, signs and
 Provide first symptoms,  Simulat
line measures management as per ion
to treat or protocols and worksh
stabilize guidelines in place) ops
identified  Transverse lie  Low
conditions  Oblique lie dose
 Explain timely  Breech high
refer for  Face frequen
management  Brow cy skill
at higher level  Compound develo
 Identify, Presentation pment
provide initial  Unstable lie  Discuss
management  Occipito- ion and
and refer posterior experie
women with positions ntial
problems  Rhesus learnin
during labour incompatibilit g
within the y  Bed
scope of  Document side
midwifery and keep clinics
practice. accurate  Demon
 Facilitate record stration
communicatio  Self-
n link between directe
the midwife, d
women and learnin
families. g
 Semina
 Collabora r
te with  Case
the discuss
obstetrici ion
ans in the  Simulat
managem ions
ent of
 Safe
obstetric
deliver
emergenc
y app
ies and
61
 Learning Learning
Unit Hours Content Assignments Assessment
Outcomes Activities

complicat module
ions s
 Ensure safe  Supervi
environment sed
for the mother clinical
and newborn. practic
e in
labour
room /
obstetri
c
casualt
y/Obste
tric
IUC,
operati
on
theatre
5. T-4  Recognise and Complex care during  Tutorials  Case  Formati
SL-4 respond birth  Group Presentat ve quiz,
CL-30 effectively to discussion ion summat
 Obstetric emergencies- 
emergencies  Scenario Bed side ive final
or urgent definition, signs and clinic examin
based
symptoms
situations learning  Procedur ation
 Demonstrate  Role of NPM in  Role play es to be  OSCE
managing the 
competencies  E learning performe Essay,
emergencies as per
to provide
protocols and  Clinical d/assiste short
care during practice d/ answers
complications guidelines in place
 Amniotic fluid  Presentatio observed and
of birth ns as per MCQ
 Seek for embolism the log-
 Simulation
appropriate  Obstructed labour book
workshops
help  Constriction ring,
 Low dose
 Collaborate ruptured uterus
high
effectively
 Cord prolapse frequency
with health
professional in  Vasa previa skill
 Shoulder dystocia developmen
managing the t
emergency  Uterine inversion role
of NPM  Discussion
 Timely refer and
for  Postpartum
hemorrhage: types, experiential
management learning
at higher level causes and
management  Bed side
 Provide clinics
appropriate o Manual removal of
placenta  Demonstrat
psychosocial ion
support to the o Bimanual
compression of  Self-
woman and directed
their families uterus
o Aortic compression, learning
o Uterine balloon  Seminar
tamponade  Case
 Vaginal and cervical discussion
62
 Learning Learning
Unit Hours Content Assignments Assessment
Outcomes Activities

inspection  Simulations
 Rapid initial  Safe
assessment and delivery
management of app
different shocks modules
 Blood transfusion  Supervised
 Pharmacology for clinical
emergency obstetric practice in
labour room
/ obstetric
casualty/Ob
stetric IUC,
operation
theatre
6. T-3  Demonstrate Interventions during  Tutorials  Formati
SL-2 knowledge complicated birth  Group  Case ve quiz,
CL-30 regarding the Forceps delivery discussion Presentat summat
need for  Indications and contra-  Scenario ion ive final
intervention indications based  Bed side examin
during birth  Preparation for learning clinic ation
 Demonstrate procedure  Role play Procedures OSCE
skills to assist  Dangers to mother and  E learning to be  Essay,
or perform child  Clinical performed/as short
intervention  Management of practice sisted / answers
during birth Forceps delivery  Presentatio observed as and
when required vacuum extraction ns per the log- MCQ
for emergency  Indications and contra-  Simulation book
care indications workshops
 Counsel and  Preparation for  Low dose
support procedure high
women (and  Dangers to mother and frequency
families) with child skill
complications  Management of developmen
and vacuum extraction t
emergencies Caesarean section  Discussion
 Types e.g. elective or and
emergency experiential
 Indications and contra- learning
indications
 Pre-operative care
 Procedure (role of the
midwife)
 Post-operative care
Episiotomy, perineal and
cervical lacerations;
suturing
 Destructive delivery /
embryotomy
 Pharmacology for
surgical conditions,
document and keep
accurate record
63
 Learning Learning
Unit Hours Content Assignments Assessment
Outcomes Activities

7. T-1  Demonstrate Complex care during the  Tutorials  Formati

SL-2 knowledge of third stage of labour  Group  Case ve quiz,
CL-30 the deviations discussion Presentat summat
from normal  Complications of third  Scenario ion ive final
during the stage -definition, signs based  Bed side examin
third stage of and symptoms learning clinic ation
labour.  Management as per  Role play  Procedur  OSCE
 Demonstrate protocols and  E learning es to be
competencies guidelines in place  Clinical performe
to provide practice d/assiste
care during  Clinical d/
complications presentation observed
of the third  Simulation as per
stage of labour workshop the log-
 Low dose book
high
frequency
skill
developmen
t
 Discussion
and
experiential
learning
 Bed side
clinics
 Demonstrat
ion
 Self-
directed
learning
 Seminar
 Case
discussion
 Simulations
 Safe
delivery
app
modules
Supervised
clinical practice
in labour room /
obstetric
casualty/Obstetr
ic IUC,
operation
theatre
8. T-2  Identify, Complex care during the  Preparati  Essay,
CL-50 provide initial puerperium on of short
management  Discussion health answers
and refer and talk and
women with MCQ.
64
 Learning Learning
Unit Hours Content Assignments Assessment
Outcomes Activities

postnatal (Recognition and experiential  Clinical

problems Management of postnatal learning presentat  Assess
within the problems)  Bedside ion-plan ment of
scope of Review of: clinics & report skills
midwifery  Self- with
practice.  Physical examination, procedu
directed
identification of learning re
 Develop deviation from normal  Seminar check
rapport with  Review of puerperal  Case list
the women complications and its discussio
and families n
management
for continuity
o Puerperal pyrexia  Supervis
of care ed
o Puerperal sepsis
clinical
o Urinary practice
complications in
o Secondary postnatal
Postpartum ward /
hemorrhage postnatal
o Vulval hematoma OPD /
obstetric
o Breast
casualty/
engorgement operatio
including n theatre
mastitis/breast  Safe
abscess, feeding Delivery
problem App
o Thrombophlebitis module
on
o DVT
Sepsis
o Uterine sub  Discussi
involution on on
o Vesico vaginal variety
fistula (VVF), of case
Recto vaginal studies
fistula (RVF) /simulati
on
o Postpartum blues /
scenario
psychosis s to
 Decision making about practice
management and decision
referral making
 Clinical procedures as
per the guidelines
9 T-1  Demonstrate Resuscitation of the  Experiential  OSCE
SL-2 knowledge woman learning
and ability to  Reflection
manage basic  Basic life-saving  Role play
life-saving skills-adult CPR  E-learning
skills and  Simulation
adult CPR workshop

65
 Learning Learning
Unit Hours Content Assignments Assessment
Outcomes Activities

 Low dose
high
frequency
skill
developmen
t

1. Care of the Compromised Newborn

Teaching and Assignments

Ho Learning outcomes Content Learning Assessment
Unit urs activities

1. T-1  Discuss the Context of neonatal care  Tutorials  Critical

SL- scope of in India and the approach  Group reflecti
2 midwifery of different models of discussion on
practice in care newborn care  Scenario  Evidenc
of the based learning e based
 Newborn mortality -
compromised  Reflection review/
newborn major causes in India report
 Describe the  Models of newborn
Indian context care in India – NBCC;
for newborn care SNCUs; NICU
and the different  Home based newborn
level of care program
interventions  History taking and
 Discuss Indian physical examination
contribution in of newborn
meeting the  Identification of high-
sustainable risk
development  Adequate
goals (SDGs) documentation and
 Appreciate the record keeping
importance of  Civil Rights and Vital
bonding in case Statistics (CRVS)
of a  Birth notification and
compromised Birth registration
newborn  Information to parents
 Communicate on importance of
respectfully and registering births
compassionately  Issuance of birth
with the mother notification and
and her family Linkage to a birth
despite complex registration point
situation of care
 Understand the
importance of
evidence-based
practice in
improving the
66
 Teaching and Assignments
Ho Learning outcomes Content Learning Assessment
Unit urs activities

quality of care
provided
2 T-2  Demonstrate Care of Compromised  Tutorials  Clinical Formative
SL- knowledge to neonate during birth  Group presentati quiz,
2 detect discussion on summative
complications of  Needs of pre-term  Scenario  KMC final
the newborn and low birth weight based learning  Newborn examination
infants (definition,
early, take  Reflection assessme ; OSCE
signs and symptoms of
appropriate  Clinical nt
common health  Essay,
action and timely practice  Newborn
refer at higher problems and short
complications;  Seminar resuscitati
answers
level presentations ons
 immediate and and
Distinguish
ongoing treatment and  Simulation  Procedure MCQ
normal variation workshops s to be
in newborn management)
 Complications at  Low dose high performed
 Assess
appearance and frequency /assisted /
behaviour from birth affecting the ment of
skill observed
those indicating neonate (definition, skills
development as per the
pathologic signs and symptoms of with
common health  Discussion log-book
procedu
conditions
problems and and re
 Discuss experiential
complication at complications; check
immediate and learning list
birth affecting
the newborn ongoing treatment and
management);  Demonstration  Assess
respiratory distress, ment of
birth injuries,  Self-directed clinical
hypothermia and learning perform
hyperthermia, newborn ance
sepsis; recognize the  Seminar with
need for suction/ rating
ventilation; perform  Case scale
basic resuscitation of a discussion
new-born baby using  Safe delivery
appropriate equipment; app video on
calculation of drug newborn
dose and resuscitation,
administration of newborn
specified drugs; management
arrange referral and/or and low birth
transfer as needed weight
module
 Supervised
clinical
practice in
NICU / PN
ward / well
baby clinic
3 T-1  Demonstrate Compromised newborn  Tutorials Formative
CL- knowledge to with infection  Group  Clinical quiz,
20 detect discussion presentati summative
complications of  Neonatal infection  Scenario on final
the newborn (definition, signs and based learning  KMC
symptoms of common
67
 Teaching and Assignments
Ho Learning outcomes Content Learning Assessment
Unit urs activities

presenting an health problems and  Reflection  Newborn examination

infection, take complications;  Clinical assessme ; OSCE
appropriate immediate and practice nt
action and timely ongoing treatment and  Seminar  Newborn  Essay,
refer at higher management) presentations resuscitati short
level  Sepsis, meningitis,  Simulation ons answers
pneumonia, etc  Procedure and
workshops
  MCQ
Demonstrate Diarrhea Respiratory  Low dose high s to be
competencies to Infections, Pus or frequency performed
provide care for lesions/eyes, Red foul /assisted /  Assess
skill
the sick newborn smelling umbilicus, observed ment of
development
and discuss skills
Abdominal distension,  Discussion as per the
with
his/her condition Swollen limb or joint and log-book
and prognosis  Pemphigus procedu
experiential
 Collaborate neonatorum, re
learning
effectively with Omphalitis, check
health list
Neonatorum tetanus  Demonstration
professional in  Care of infants born of
managing the  Assess
HIV-positive mother;  Self-directed ment of
newborn ARV prophylaxis learning
situation (national PMTCT clinical
guideline) perform
 Seminar ance
 Symptoms and
treatment of with
 Case rating
withdrawal from discussion
maternal drug use scale
 Safe delivery
 Prevention of mother- app video on
to-child transmission newborn
of infections such as resuscitation,
HIV, hepatitis B and C newborn
 Calculation of drug management
dose and and low birth
administration of weight
specified drugs module
 Document and keep  Clinical
accurate record practice in
 Protocols for screening NICU / PN
for infectious ward / well
conditions baby clinic

4. T-1  Demonstrate Compromised newborn  Tutorials  Formati

CL- knowledge to with metabolic disorder  Group ve quiz,
20 detect discussion summat
complications of  Metabolic disorders  Scenario ive
the newborn (definition, signs and final
based learning
symptoms of common
presenting a  Reflection examin
health problems and
metabolic  Clinical ation
disorder, take complications; their  Essay,
practice
appropriate immediate and
ongoing treatment)  Seminar short
action and timely presentations answers

68
 Teaching and Assignments
Ho Learning outcomes Content Learning Assessment
Unit urs activities

refer at higher  Jaundice, Inborn errors  Simulation and

level of metabolism, workshops MCQ
 Demonstrate  Hypo-glycaemia  Low dose high
competencies to  Baby of diabetic frequency  Assess
provide care for mother skill ment of
the sick newborn  Phenylketonuria development skills
and discuss  Immediate  Clinical with
his/her condition identification and care practice procedu
and prognosis to the sick neonate  Seminar re
 Calculation of drug presentations check
dose and  Simulation list
 Discuss
administration of workshops
metabolic 
disorders of the specified drugs;  Low dose high Assess
 Document and keep frequency ment of
newborn clinical
accurate record skill
 Protocols for screening development perform
for metabolic ance
conditions with
rating
scale

5 T-1  Demonstrate Compromised newborn  Tutorials  Formati

SL- ability to detect with abnormal condition  Group ve quiz,
2 complications of discussion summat
CL- the newborn  Scenario ive
20 presenting a  Abnormal conditions based learning final
metabolic of the newborn  Reflection examin
(definition, signs and
disorder, take  Clinical ation;
appropriate symptoms of common  Essay,
practice
action and timely health problems and
complications; their  Clinical short
refer at higher presentations answers
level immediate and and
ongoing treatment),  simulation
 Demonstrate workshops MCQ
competencies to  Cerebral dysfunction /
irritation / hemorrhage  low dose high
provide care for frequency  Assess
the newborn with  Congenital and ment of
genetic malformations skill
abnormal development skills
condition and  Muscle-skeletal with
discuss his/her disorders; Soft tissue procedu
condition and abnormalities re
prognosis  Chromosomal check
 Discuss abnormalities list
abnormal  Haemolytic and
conditions of the hemorrhagic diseases  Assess
newborn of the newborn ment of
 Immediate clinical
identification and care perform
to the sick neonate ance
 calculation of drug with
dose and rating
administration of scale
specified drugs;

69
 Teaching and Assignments
Ho Learning outcomes Content Learning Assessment
Unit urs activities

document and keep

accurate record
 protocols for screening
for congenital
abnormalities
6. T-1  Discuss the Global public health  Tutorials  Group  Formati
SL- implementation action in neonatal and  Group work- ve quiz,
2 of the IMNCI in childhood care discussion Clinical summat
CL- the context of  Scenario condition ive
40 India  Integrated based learning and final
 Describe management of  Reflection managem examin
midwifery’s neonatal childhood
 Clinical ent as per ation
contributions in illness (IMNCI) IMNCI  OSCE
practice
improving Three components:  Clinical
community and presentations
family health  Capacity building of  simulation
practices; health workers workshops
promote health  Health system  low dose high
education strengthening and frequency
 Demonstrate improving community skill
competencies in and family practice development
providing care  Cost- effective strategy  Risk
for the newborn which can improve assessment
within midwifery child survival
practice
(In Indian context main
focus on capacity building
and less attention on
system strengthening or
improving community
practices)

7 T-1  Demonstrate Feeding in compromised  Tutorials  Demonstr  MCQ,

SL- ability to detect newborn  Group ate Short
2 feeding discussion competen Answer
Feeding problems of the
CL- complications of  Experiential cies in s/
30 the compromise newborn feeding Essays
learning
newborn  Calculation of fluid  Reflection compromi  OSCE/
 Discuss the requirements  Clinical sed OSPE
different modes newborn
 Promote EBM practice
of feeding a whenever possible and  seminar
compromised appropriate / formula presentations
newborn feeds / tube feeding  simulation
 Maintain the bonding workshops
 Provide adequate care  Low dose high
for the mother in case frequency
of weaning; skill
development

• Group discussion

70
 1. Healthy families and Communities

Unit Hour
s Learning Assignmen
Learning Outcomes Content ts Assessment
Activities

1 T-1 Public Health  Tutorials,  Role  Develop a

SL-2  Discuss the approach: Information, group play- public
scope of Education and discussion SBCC health
midwifery Communication (IEC)  Scenario- action and
practice in based learning implement
public health to  Community  role play that
Mobilization
promote healthy  e-learning includes
communities  Development SBCC
 Demonstrate committee in
knowledge of Primary Health Care
principles of Services  Clinical
epidemiology,  Community practice
sanitation, Diagnosis
community  Situational Analysis
diagnosis and  Health
vital statistics or Education/Promotion
records in , incl. guidance and
community- counseling/ social
based and behavior change
midwifery communication
(SBCC)
 Apply the principles
of community
mobilization to
promote maternal,
newborn and child
health
 Conduct a
comprehensive
assessment of
maternal and
newborns, including
their families, at
community level.

2 T-1  Explore the role Family planning  Tutorials,  Formative

SL-3 and group quiz,
CL- responsibilities  Planned Parenthood, discussion summative
30 of the midwife  Impact of early  Scenario- final
towards social frequent childbearing based learning examinatio
norms on family  Definition and  Role play n
planning history of FP  e-learning  OSCE
 Demonstrate national and
knowledge of international
national  Legal and Rights
aspect of FP  clinical
standards,
protocols and practice,
regulations in seminar
presentations;
71
Unit Hour
s Learning Assignmen
Learning Outcomes Content ts Assessment
Activities

the provision of  Socio-economic,  simulation

quality family cultural, religious workshops:
planning beliefs  low dose high
services,  myths, frequency
including misconceptions and skill
referral for custom which affect development
advanced clients’
management  Acceptance of FP
 Demonstrate  Health education and  Discussion
knowledge of counseling in family and
different family planning using experiential
planning Balanced learning
methods, Counselling Strategy
including (BCS)  Demonstratio
emergency  Male and n
contraception Community Leaders
 Demonstrate involvement in
competencies in  Self-directed
family planning learning
providing  Human rights aspects
differentiate of FP adolescents
counselling on  Supervised
/youth friendly clinical
FP to woman services for FP
/man/couple, practice in PN
 Create a safe, secure ward / PN
adolescent girl / and effective
boy OPD/ FP
counselling space ward /
 Various family PHC/CHC/H
planning methods SC
method of
administration, mode
of action, advantages
and disadvantages,
effectiveness, side
effects, indication
and contradictions,
complications, client
instruction
 Create a safe, secure
and effective
counselling space
 Collaborate with key
stakeholders in
providing midwifery
and family planning
care in the
community
3 T-1  Demonstrate Gender related issues in  Tutorials,  Group  MCQ,
competencies in SRHR group work- Short
CL- mainstreaming discussion Situati Answers
20 Gender in the  Definition of Gender  Scenario- on  Long
midwifery  Gender prescribed based learning analysi Essays
practice roles  Critical s
 Human rights and reflection
Legal frameworks –
72
Unit Hour
s Learning Assignmen
Learning Outcomes Content ts Assessment
Activities

 Integrate international,  Role play of

concepts of regional and national  e-learning women
gender-based  Situation of the girl in the
violence and child and the status society
sexual and of women in society and
reproductive  Gender based obstetri
health in violence c
managing  Concept of obstetric violenc
childbearing violence e
families  Root causes, effects
 Provide (physical,
compassionate psychological and
care and legal sexual)
guidance o  Effects of gender
survivors of related issues on
GBV; if SRHR
required direct  Gender inequalities
to protection in reproductive
centers/shelters health issues
 Strategies to
overcome gender-
based violence
 Advocacy for equal
opportunities for
men and women
 Family Protection
Centers for abused
individuals
 Special courts for
abused people
 Gender sensitive
health
services/provisions
including family
planning
 Male involvement in
SRH issues

73
 1. ANNEXURES

ANNEXURE – I
ROLES AND RESPONSIBILITIES OF THE NPMs
The unique and major role of NPMs is promoting the health of women and childbearing families. The NPMs
 Work with women to promote self-careand the health of women, infants and families
 Respect and treat women with human dignity and as persons accorded full human rights
 View pregnancy as a normal physiologic life event
 Monitor the physical, psychological, spiritual and social well-being of the woman and her immediate family
throughout the childbearing cycle
 Provide the woman with personal culturally appropriate advice, education, counselling, support and
antenatal care
 Provide respectful maternity care
 Render continuity of care to women from pre pregnancy, antenatal, during labour, childbirth and
immediately postpartum and ongoing support during the postnatal period
 Establish rapport in order to develop self-confidence in the woman to give birth and adapt to her new family
dynamic
 Minimise unnecessary technological interventions during childbirth
 Identify the onset of complications, give emergency care and refer women and or newborns who require
obstetrical or other specialist attention
 Focus on health promotion and disease prevention throughout the child bearing cycle.
ANNEXURE –II

CLINICAL LOGBOOK FOR NPM (PROCEDURAL COMPETENCIES/ SKILLS)

S.N Specific procedural competencies/skills Performs Date & signature of the

independently/Performs faculty
collaboratively with
doctor/ Assists doctor in
procedures
(P/PC/A)*
1 ANTENATAL CARE
1.1 Health assessment of antenatal woman: History taking, P
Physical examination and obstetrical examination
1.2 Urine pregnancy test P

1.3 Estimation of hemoglobin using sahli’s hemoglobinometer /true P

Hb-P
1.4 Preparation of peripheral smear for malaria P
1.5 Urine testing for albumin and sugar P
1.6 Point of care HIV test P
1.7 Point of care syphilis test P
1.8 Preparation of mother for USG P

74
S.N Specific procedural competencies/skills Performs Date & signature of the
independently/Performs faculty
collaboratively with
doctor/ Assists doctor in
procedures
(P/PC/A)*
1.9 Perform USG PC
1.10 Kick chart / DFMC (daily fetal movement count) P
1.11 Preparation and recording of CTG / NST/ CST P

1.12 Preparation/Assisting woman for antenatal investigations- A

amniocentesis, cordocentesis, Chorionic villus sampling
1.13 Antenatal counseling- diet & exercise P
1.14 Administration of TT/Td-P P
1.15 Prescription of iron and folic acid tablets
1.16 Prenatal counseling and care of general and vulnerable groups P
such as adolescent pregnant mothers
2 INTRANATAL CARE
2.1 Identification, assessment and admission of woman in labour P
2.2 Perform CTG PC
2.3 Vaginal examination during labour including Clinical P
pelvimetry
2.4 Plotting and interpretation of partograph P
2.5 Preparation for delivery – physical and psychological P
2.6 Setting up of the delivery room / unit P
2.7 Pain management during labour-non-pharmacological P
2.8 Conduction of normal delivery P
2.9 Episiotomy only if required and repair P
2.10 Essential newborn care P
2.11 Active management of third stage of labour P
2.12 Examination of placenta P
2.13 Care during fourth stage of labour P
2.14 Initiation of breast feeding and lactation management P
2.15 Assessment and weighing of newborn P
2.16 Administration of Vitamin K P
3 POSTNATAL CARE
3.1 Postnatal assessment and care P
3.2 Perineal / episiotomy care P
3.3 Breast care P
3.4 Postnatal counseling-diet, exercise & breast feeding P
3.5 Postpartum family planning P
4 NEWBORN CARE
4.1 Assessment of newborn including gestational age P
4.2 Baby bath P
4.3 Kangaroo Mother Care P
4.4 Identification of minor disorders of newborn and their P
management
4. 5 Neonatal immunization- Administration of BCG, Hepatitis B P
vaccine-P

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S.N Specific procedural competencies/skills Performs Date & signature of the
independently/Performs faculty
collaboratively with
doctor/ Assists doctor in
procedures
(P/PC/A)*
5 CARE OF WOMAN WITH COMPLICATIONS/HIGH RISK MOTHER
5.1 Identification of antenatal complications- pre- eclampsia, P
anemia, Antepartum hemorrhage
5.2 Glucose challenge test / Glucose Tolerance test P
5.3 Administration of MgSo4 P
5.4 Identification of fetal distress and its management P
5.5 Preparation of woman for emergency / elective caesarean A
section and assisting in caesarean
5.6 Prepare the mother and perform vacuum delivery when P
favourable
5.7 Vacuum delivery PC
5.8 Diagnosis of malpresentations and malpositions P
5.9 Diagnosis and management of cord presentation/cord prolapse P &PC
5.10 Early diagnosis of preterm labor P
5.11 Prepare assess suitability for and conduct breech delivery when P
favorable
5.12 Breech delivery PC
5.13 Infection prevention during labor and newborn care P
5.14 Diagnosis and management of prolonged labour P
5.15 Prepare and perform low forceps operation P
5.16 Forceps operation A
5.17 Manual removal of the placenta PC

5.18 Diagnosis and initial management of PPH- Bimanual P &PC

compression of uterus, Balloon tamponade for atonic uterus,
Aortic compression for PPH, Application of anti-shock
garment, prescription and administration of fluids and
electrolytes through intravenous
5.19 Repair of perineal and vaginal tears (upto II degree) P
5.20 Repair of perineal and vaginal tears (above II degree) PC
5.21 Identification and first aid management of obstetric shock P
5.22 Manage obstetric shock PC
5.23 Diagnosis and management of puerperal sepsis P &PC
5.24 Management of breast engorgement P
5.25 Management of thrombophlebitis P &PC
6 HIGH RISK NEWBORN
6.1 Identification of highrisk newborn P
6.2 Neonatal resuscitation P
6.3 Assisting in neonatal diagnostic procedures A
6.4 Feeding of high risk newborn –EBM(spoon/paladai) P
6.5 Insertion/removal/ feeding - Naso/oro gastric tube P
6.6 Administration of medication – oral / parenteral PC
6.7 Neonatal drug calculation P

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S.N Specific procedural competencies/skills Performs Date & signature of the
independently/Performs faculty
collaboratively with
doctor/ Assists doctor in
procedures
(P/PC/A)*
6.8 Oxygen administration P
6.9 Care of neonate in incubator / warmer/ventilator P
6.10 Neonatal intubation / ventilator PC
6.11 Care of neonate on phototherapy P
6.12 Assist in exchange transfusion A
6.13 Organizes different levels of neonatal care P
6.14 Transportation of high risk newborn P

7 FAMILY WELFARE
7.1 Family planning counseling P
7.2 Distribution of temporary contraceptives – condoms, OCP’s, P
emergency contraception
7.3 Insertion and removal of Interval IUCD P
7.4 Insertion and removal of PPIUCD/PAIUCD P
7.5 Preparation of the woman for Postpartum sterilization P
7.6 Prepare and assist in tubectomy A
8 OTHER PROCEDURES
8.1 Prepare and assist for D&C / D&E operations A
8.2 Perform Manual Vacuum Aspiration P &PC
8.3 Post abortion care P
8.4 Post abortion family planning services P
8.5 Post abortion counseling P
8.6 Pre-conception nutritional assessment, screening HIV,Cervical P
cancer
8.7 Preconception counseling and care P
8.8 Pap smear P
8.9 Visual inspection with acetic acid / iodine P
8.10 Counseling on breast self-examination P
8.11 Conduction of maternal and perinatal death audit PC
8.12 Maintenance of registers P
8.13 Maintenance of records P

* When the learner is found competent to perform the skill, the faculty/trainer will sign it.
Learners: are expected to perform the listed skills/competencies many times until they reach level 3 competency,
after which the faculty signs against each competency.
Faculty/Trainers: Must ensure that the signature is given for each competency only after they reach level 3.
 Level 3: competency denotes that the leaner is able to perform that competency without supervision
 Level 2: Competency denotes that the learner is able to perform each competency with supervision
 Level 1 :competency denotes that the learner is not able to perform that competency/skill even with
supervision

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 ANNEXURE-III

CLINICAL REQUIREMENTS FOR NPM PROGRAM

S.N. Clinical requirement Date Signature of the

Faculty/Preceptor

1 Antenatal assessment and care- 70

2 Postnatal assessment and care– 70
3 Assessment of labour using partograph – 40
4 Per vaginal examination if required – 20
5 Witnessing Conduction of birth - 10
6 Conduction of delivery (independent)–40
7 Assisting conduction of abnormal/assisted delivery – 15
8 Placental examination-10
9 Episiotomy and suturing if indicated – 10
10 Insertion of Interval IUCD – 5
11 Insertion of PPIUCD /PPIUCD– 5
12 Newborn assessment – 25
13 ENBC-25
14 Newborn Resuscitation – 5
15 Kangaroo Mother care – 5
16 Antenatal care study – 1
Diagnosis:
17 Postnatal care study- 1
Diagnosis:
18 Newborn care study- 1
Diagnosis:
19 Clinical presentation – 4
 Antenatal :
 Intra natal :
 Postnatal :
 Newborn :
20 Health talk
 Antenatal - Topic:
 Post-natal - Topic
 Newborn – Topic:
 Family welfare – Topic:

78
 S.N. Clinical requirement Date Signature of the
Faculty/Preceptor

21 Counseling mothers &family members

1.
2.
22 Bed side clinics – 2
1.
2.
23 Clinical Seminar/ Clinical Conference
Topic:

24 Drug study, presentation and report – 1

Drug:
25 Visits –report
 Peripheral health facility

26 Project/ Journal Club: Evidence based midwifery practice

(Individual/Group ) -1
Topic:
27 Continuity of Care experiences 15

Signature of the Program coordinator

ANNEXURE-IV
CLINICAL EXPERIENCE DETAILS FOR NPM PROGRAM

Area of posting Clinical Condition Number of days Signature of

care given Faculty/Preceptor

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Signature of the Program coordinator
ANNEXURE V

LEARNING RESOURCES

GOI Guidelines (MNH)

 LaQshya- Labour Room Quality Improvement Initiative Guideline
 Guidelines for standardization of labour rooms at delivery point
 Dakshata: Empowering Providers for Improved MNH Care during Institutional Deliveries
 SBA-Guidelines for Antenatal Care and Skilled Attendance at Birth by ANMs/LHVs/SNs ,Hand book and
trainers Guide
 IMNCI training modules,photo and chart booklets
 NavjatShishu Suraksha Karyakram guidelines
 Routine Immunization Handbook for Health Workers
 Postpartum FP handbook for Service Providers
 IUCD reference manual for medical officers and nursing personnel
 PPIUCD reference manual
 Operational guidelines: Introduction of Haemophilus influenza b (Hib) as Pentavalent Vaccine in Universal
Immunization Program of India
 Use of antenatal corticosteroids in preterm Labour
 Facility based IMNCI(F-IMNCI)(Participants manual and Chart booklet)
 Guidance note on use of Uterotonics during labour
 Vitamin K prophylaxis at birth(in facilities)
 National guideline for calcium supplementation during pregnancy
 National guideline on management of Hypothyroidism duringPregnancy
 National Guidelines for Diagnosis & Management of Gestational Diabetes Mellitus
 Screening for Syphilis during pregnancy
 National guidelines Respectful newborn care-Child Health Division, MoHFW
 Guidance for Mentoring and support visit-DAKSHATA
 Guideline on midwifery services in India-2018

Other resources

 WHO Report on Strengthening quality midwifery care and midwifery education

 The Lancet Series 2014, 2018 - Midwifery Quality Maternal and Newborn Care (QMNC) Framework
 ICM Essential Competencies for midwifery Practice (2019)
 WHO midwifery educator competencies
 Safe delivery app

ANNEXURE VI
ICM STATEMENT ON MIDWIFERY AND MODEL OF CARE

Midwifery care is provided by an autonomous midwife in collaboration with the maternity care team. Midwifery
competencies (knowledge, skills and attitudes) are held and practised by midwives, educated through a pre-service/pre-
registration midwifery education programme that meets the ICM global standards for midwifery education.
The ICM’s definition of midwifery reflects its core statement of philosophy and model of care the key points of
which follow.
 Pregnancy and childbearing are usually normal physiological processes

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  Pregnancy and childbearing is a profound experience, which carries significant meaning to the woman, her
family, and the community.
 Midwives are the most appropriate care providers to attend childbearing women.
 Midwifery care promotes, protects and supports women's human, reproductive and sexual health and rights,
and respects ethnic and cultural diversity.
 It is based on the ethical principles of justice, equity, and respect for human dignity.
 Midwifery care is holistic and continuous in nature, grounded in an understanding of the social, emotional,
cultural, spiritual, psychological and physical experiences of women.
 Midwifery care is emancipatory as it protects and enhances the health and social status of women, and
builds women's self confidence in their ability to cope with childbirth
 Midwifery care takes place in partnership with women, recognising the right to self-determination, and is
respectful, personalised, continuous and non-authoritarian.
 Ethical and competent midwifery care is informed and guided by formal and continuous education,
scientific research and application of evidence.

ICM Model of Midwifery Care (ICM 2014).

 Midwives promote and protect women’s and newborns’ health and rights.
 Midwives respect and have confidence in women and in their capabilities in childbirth.
 Midwives promote and advocate for non-intervention in normal childbirth.
 Midwives provide women with appropriate information and advice in a way that promotes participation and
enhances informed decision-making.
 Midwives offer respectful, anticipatory and flexible care, which encompasses the needs of the woman, her
newborn, family and community, and begins with primary attention to the nature of the relationship between
the woman seeking midwifery care and the midwife.
 Midwives empower women to assume responsibility for their health and for the health of their families.
 Midwives practice in collaboration and consultation with other health professionals to serve the needs of the
woman, her newborn, family and community.
 Midwives maintain their competence and ensure their practice is evidence-based.
 Midwives use technology appropriately and effect referral in a timely manner when problems arise.
 Midwives are individually and collectively responsible for the development of midwifery care, educating
the new generation of midwives and colleagues in the concept of lifelong learning.

ANNEXURE VII

REFERENCES

1. Government of India (2018) Guidelines on Midwifery Services in India, Ministry of Health and Family Welfare
Government of India and National Health Mission, India
2. Miller S, Abalos E, Chamillard M, Ciapponi A, Colaci D, Comandé D, Diaz V, Geller S, Hanson C, Langer A,
Manuelli V, Millar K, Morhason-Bello I, Castro CP, Pileggi, VN, Robinson N, Skaer M, Souza, JP, Vogel, JP &
Althabe, F (2016). ‘Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful
maternity care worldwide.’ The Lancet, 388(10056): 2176-2192.
3. Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife-led continuity models versus other models of care for
childbearing women. Cochrane Database of Systematic Reviews 2016, Issue 4. Art. No.: CD004667. DOI:
10.1002/14651858.CD004667.pub5
4. ICM 2013 International Confederation of Midwives Global Standards for Midwifery Education (2013) accessed
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guidelines_ammended2013.pdf
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https://www.internationalmidwives.org/our-work/policy-and-practice/essential-competencies-for-midwifery-
practice.html

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6. Renfrew M, McFadden A, Bastos M, Campbell J et al. (2014) Midwifery and quality care: findings from a new
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15. Australian Nursing and Midwifery Accreditation Council (ANMAC) 2014 Midwife accreditation standards,
ANMAC, Canberra accessed July 15th 2019 at
https://www.anmac.org.au/sites/default/files/documents/ANMAC_Midwife_Accreditation_Standards_2014.pdf
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22. Finlay, L. (2008). Reflecting on 'Reflective practice'. 1st ed. [ebook] The Open University. Available at:
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practice-PBPL-paper-52.pdf [Accessed July 12th 2019]

DR. T. DILEEP KUMAR,

President, INC

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