Independent Nurse Midwifery Pracctitioner

INDEPENDENT
NURSE
MIDWIFERY
PRACTITIONER
MS. RACHANA JOSHI
Assistant Professor
Sumandeep Nursing College
SVDU
Ms. Rachana Joshi, Sumandeep
Nursing College, SNC

“ I know I make a difference. I do as much
as I can- to help, make each birth as loving,
gentle, peaceful, empowering, connecting
and celebratory as possible. With the threat
of Pitocin, epidurals, it is not necessarily an
easy thing, but it is the best I can do.”
Ms. Rachana Joshi, Sumandeep Nursing College, SNC

Independent Midwives:
Independent Midwives are fully qualified
registered nurse-midwives to utilize their
knowledge, skills, judgment and authority
in the provision of primary women's
health services while maintaining
accountability for the management of
patient care in accordance with midwifery/
nursing council of one’s own country

Reasons to focus on Midwives:

Midwives provide comprehensive maternal and
newborn care:

effective use of professional
midwives at the primary
health care level
Reduction in maternal
morbidity and mortality.

 Midwives work at the community level- She knows
cultural practices - the referral of women to
appropriate healthcare settings for birth- reducing
maternal morbidity and mortality in the process.

 Lack of infrastructure and skilled staff for
providing emergency care, 50% of CHC and
30% of FRUs do not have an anesthetist and
Obstetrician

Does India have midwives?
Who is a midwife in India?
Auxiliary Nurse Midwife (ANM), Multi Purpose Worker Female (MPWF)
Community based midwives
Diploma and Degree holders in general nursing and midwifery Institution
based nurse-midwives.
Currently there are no fully qualified specialized midwives.
Midwifery is not understood in India and the policy on midwives has not caught the
attention of the policy makers fully due to complex reasons.
Reforms are needed to improve the ongoing training of teachers.
There is a need to recognize midwifery as a separate profession both in the medical and
the nursing profession and there is a need to link midwifery practice and teaching.

GNM and B Sc course should be modified as follows:
First year common for
nursing and midwifery
From 2nd year have
separate streams for
nursing and midwifery.
There could be fewer seats
for midwifery for only
those students who wish.
E.g. Nsg. School with
admission capacity of 50
there will be 35 nursing
stream students and 15
midwifery stream
students.
Nursing stream students
will get only the RN
registration and midwifery
students will only get RM
registration.
If any one want to do both
they will have to do one
more year of training in
the respective field. Then
they will get RN RM
registration.
By doing this both RN and
RM training will be of 3
years instead of 3.5 years
but for those who want
both RN & RM the
training will be 4 years.

MIDWIFERY MODEL OF CARE

Four Cs:
 Core concept
 Context (overview)
 Content
 Compensation (Benefits)

CORE CONCEPT
“..pregnancy and birth are normal life processes.”

CONTEXT
Monitor
Well being
Education
↓Technological
Interventions
Referral
Services
Midwifery Model of Care

CONTEXT
The Midwives Model of Care includes:
 Monitoring the physical, psychological, and social
well-being of the mother throughout the childbearing
cycle
 Providing the mother with individualized education,
counseling, prenatal care, and postpartum support
 Minimizing technological interventions
 Identifying and referring women who require
obstetrical attention

The application of
this woman-
centered model of
care
to reduce the
incidence of birth
injury, trauma,
and Cesarean
section.

What do nurse-midwives do?
They help women to give birth in hospitals,
birthing centers, and at home…
But that’s not all !!!!

What Else do Nurse-Midwives Do?
*Nurse-midwives are trained not only to attend births, but to
provide prenatal and postpartum care.
*Nurse-midwives are trained to provide prenatal, labor and birth,
and postpartum care… as well as primary care services to women
throughout the lifespan--adolescence, pre-baby, post-baby, all the
way through menopause, and beyond!
*Nurse-midwives are not limited to reproductive issues--they are
trained to be competent in general primary care of women! They can
treat common ailments and disorders, perform comprehensive
physical exams, order medications and laboratory/diagnostic tests,
and provide comprehensive health and wellness education!
*Nurse midwives also provide treatment of partners for sexually
transmitted infections…
*They can also provide normal newborn care for the first 28 days
of a baby’s life.

Midwife-Led Care….
Believes: That pregnancy and birth is a normal physiological
process for women, not a disease or illness.
 Promotes: sensible, love and continuous partnership with
women and their families for health care decisions
 Provides: Individualized woman and family-centered care,
education, and empowerment to make care choices
 Is based on: Midwifery Model of care &
Evidence-based care

Benefits of Midwifery Care
*Reduced use of pain meds and epidural anesthesia
*Reduced episiotomies
*Increased chance of normal vaginal delivery
*Shorter hospital stays for hospital birth experiences
*Increased breastfeeding rates

At a hospital…
At home...
At a birth center…
Choices, choices….
Where can I have
my baby?

Midwives and doctors each have unique roles in caring for women! The
focus of a physician or obstetrician is often on disease; the focus of
a midwife is on “normal” (on health and wellness).
While midwives focus on wellness and normal pregnancy, not every
pregnancy is normal! Nurse-midwives are expected to “consult,
collaborate or refer” with/to physicians and other health care team
members when complications arise (ACNM, 1997).
Additionally, physicians can take advantage of the midwife’s expertise in
“normal”….
Care of women should be a team effort!
Frequently asked questions…
How do midwives and doctors work together?

So what qualities do Midwives really
need?
• You need to have a passion for
women’s health, pregnancy and
birth
• Excellent communication skills –
listening, understanding,
counselling, supporting,
empathy…and many more
• You need to understand
childbearing from different
social cultural contexts
• Dedication!

WHAT WE CAN PROVIDE IN MIDWIFERY PRACTICE
PACKAGE FOR INDEPENDENT PRACTICE
Access to a
midwife 24
hours a day,
7 days a
week.
Two midwives
alternatively
provide women
centred
antenatal, intra
& postnatal
care.
Antenatal care
in privacy.
Continuity of
care
throughout
labour either at
home or
hospital or
referral to an
obstetrician if
necessary.
Postnatal
care up to
six weeks.
Knowledge
able
breastfeedi
ng support

STANDARDS REQUIRED FOR THE
PRACTICE OF MIDWIFERY
Standard- I = Midwifery care
is provided by Qualified
Practitioners.
Standard- II =Midwifery care
occurs in safe environment
within the context of the
family, community & a system
of health care

Standard- III = Midwifery care
supports individual rights & self-
determination within boundaries
of safety
Standard- IV = Midwifery care is
comprised of knowledgeable, skill
& judgment that foster the
delivery of safe, satisfying &
culturally competent care
Standard- V = Midwifery care is
based on knowledge, skills &
judgement which are reflected in
written practice guidelines.

Standard- VI =Midwifery care is
documented in a format that is
accessible and competent.
Standard- VII = Midwifery care is
evaluated according to an established
programme for quality management
that includes a plan to identify &
resolve problems.
Standard- VIII = Midwifery care may
be extended beyond the set
competencies to incorporate new
procedures that improve care for
women and their families.

CHALLENGES FOR
INDIAN MIDWIVES
*Rights & Responsibilities
* Health care system should be
integrated to midwifery services
* Standards to be set
* Ensure care , collaboration,
consultation & referral

Challenges for
law regulation
Educational
challenges
Challenges for
research
activities
Challenges for
policy makers.
Develop a
Midwifery
practitioner
course
Salary Structure
Develop nursing
network

INDIAN NURSING COUNCIL (INC)
 Initiatives of INC
♦ Developed PhD Nursing curriculum.
♦ Developed Minimum Standards for Nursing
Practice.
♦ Developed ‘Nurse Practitioner in Midwifery’
♦ Developed different nursing speciality programmes
for 1-year Post Basic - Emergency and Trauma,
Cardiothoracic, Neo-Natal, Operation Room,
Orthopaedic, Critical Care, Oncology, Psychiatric,
Neuro Sciences, Geriatric and Nurse Midwifery
Practitioner

 SBA module of MOHFW (Ministry of Health and Family
Welfare)
 Use of selected life saving drugs and intervention
approved by MOHFW
 Integrated Management of Neonatal and Childhood
Illnesses (IMNCI) module for basic health workers
 Strengthening of advanced skills in midwifery practice
in M.Sc. nursing curriculum.
 Society of Midwives’ India and Academy of Nursing
Studies are contributing for improvement in midwifery
education and practice.

INC’s midwifery Practitioner Program of one year
The INC approved 11
month course for
Nurse practitioner in
midwifery for staff
nurses (RN & RM)
should be
implemented by all the
states.
Gujarat has started implementation of the course since September
2009. These trained midwives will provide quality maternal and
newborn services in hospitals and also be clinical instructors for
students persuing midwifery thus contributing to the quality of
pre-service education.

Creating dedicated posts of midwives in
institutions:
These trained midwives should be posted
in labour rooms and not rotated to other
departments or specialties.
For example the Government of Gujarat has
proposed, 100 posts of dedicated midwives in
CHCs and District Hospitals wherever there
are no obstetricians available.
These midwives will be dedicated to the labour
room and the maternity sections.
They would be given higher salary.

NRHM
Under NRHM, the main strategy of the
government for reduction of MMR
focuses on institutional deliveries.
The govt. has recently changed policy
to allow staff nurses and ANMs to
initiate treatment of pregnancy related
complications, including intravenous
fluids and injectable oxytocics,
antibiotics and magnesium Sulfate.

INTERNATIONAL
CONFEDERATION OF
MIDWIVES
(ICM)
 ICM is a federation of midwifery associations.
 Representing countries across the globe. The ICM
works closely with the World Health Organization
 All United Nations agencies, and governments in
support of safe motherhood and primary health care
strategies for the world’s families.
 ICM takes the leadership role in development of the
definition of the midwife, and midwifery scope of
practice (the essential competencies).

INTERNATIONAL
CONFEDERATION OF
MIDWIVES
(ICM)
ICM also promotes standards and guidelines that
define the expected structure and context of midwifery
pre-service education programs; provides guidance for
the development of regulations for midwifery practice;
and assists countries to strengthen the capacity of
midwifery associations and to develop leaders of the
midwifery profession worldwide.

SOCIETY OF
MIDWIVES INDIA
(SOMI)
Society of Midwives, India (SOMI) is a formally
constituted membership based national level
professional organization of Registered Midwives.
which was registered with the Registrar of Societies,
Hyderabad on 22 November, 2000.
SOMI works with the midwives all over India
conducting programs especially to improve the skills
and knowledge of nurse-midwives.

CAMT
Training (CAMT) project in collaboration with Sweden
International Development Agency (SIDA) in four states
Andhra Pradesh, Gujarat ,West Bengal and Tamil Nadu.
CAMT as the part of a major project on “Developing Inter-
Institutional Collaboration between Institutions in India and
Sweden for improving Midwifery Services in India supported
by SIDA”
with a view to be the technical resource centre in
strengthening midwifery teaching & service in the state.

Seniors Juniors
Professional Midwifery Education
and Training Programme (PMET)
Ms. Rachana Joshi, Sumandeep Nursing
College, SNC

Fernandez Hospital
Unit I (1996)
High Risk Pregnancy
Unit II (2011)
Evita Fernandez
Hyderabad, INDIA Ms. Rachana Joshi, Sumandeep Nursing
College, SNC

Fernandez Hospital
HYDERABAD, India
1948 to 2012
2 beds to 220 beds unit
Ms. Rachana Joshi, Sumandeep Nursing
College, SNC

 Fernandez Hospital is committed to helping women.
 To meet this objective the hospital began a
Professional Midwives Education and Training
(PMET) Programme to produce a cadre of competent,
confident and skilled midwives.
 This special taskforce would help deliver simple safe,
affordable care to low risk mothers in the community.
Ultimate aim is to reduce maternal mortality and
morbidity.
 first pilot group deliver 400 babies during 2010-11.roup
of eight midwives helped

Fresh Batch of PMETS

Academy for Nursing Studies and
Women’s Empowerment Research Studies
(ANSWERS)
ANSWERS is a non-profit professional organization
founded by a group of nurses led by
Dr.Prakasamma, a public health specialist.
ANSWERS was established in 1991 and registered in
1994 in Hyderabad, Andhra Pradesh to take up
independent research and training programmes
and improve quality of health care.
The organization is involved in research, training,
information and service in nursing, midwifery,
public health and women’s empowerment.

Midwifery Today in our Country…..

Dr.Manju Chhugani
 She is M.Sc.(Nursing), Ph.D., is Associate Professor on Faculty of
Nursing, Jamia Hamdard University.
 She is researcher and trainer, and versatile leader in the field of
nursing and midwifery with 20 years of extensive hands-on
experience in the area of maternal and child health and university
teaching.
 She holds an office with the Society of Midwives (India), Central,
and works tirelessly to achieve safe motherhood in India, working
with various International NGOs like UNICEF, UNFPA and the
Centre for Development and Population Activities (Cedpa).
 She is also a member of Global Alliance for Nurses and Midwives
and a member of Midwifery Research Advisory Network.

Lina Duncan
 is from the UK and has been a midwife since 1999, having trained
in the US and the Philippines with 1000 births. Her training was
100% Midwifery Model of Care approach. Since attending many
high-risk women and babies in the Philippines she has set up a
company along with her colleagues and has been working in India
since 2008. Her company Justlink Health Services provides a
variety of pregnancy and birthing services to women across
Mumbai and Pune, including high-risk situations such as malaria
and anaemia in pregnancy.
 Lina and her colleagues plan to train midwives using an
apprenticeship style in all sectors of society that will strive to work
under the Midwifery Model of Care and in Mother-Baby friendly
circumstances. Ms. Rachana Joshi, Sumandeep Nursing College, SNC

Mrs. Uma
Handa
 Has BSc and an MSc in Nursing with specialization in
obstetrics and gynecology.
 She has worked in the field of nursing since 1974, in nursing
educational institutions in both the conventional and distance
system, as well as in national and international health agencies.
Countries in which she has worked include Sri Lanka, UK,
Bangladesh and South Africa (University of Namibia—
UNAM).
 Her present goal is to promote independent midwifery practice
in India to encourage mothers to go through natural childbirth
and so that unnecessary medical and surgical interventions can
be prevented.

Dr. Vijaya Krishnan
 Dr. Vijaya Krishnan is a Certified Professional Midwife
(CPM), co-founder and Director of Healthy Mother
Wellness & Care and the leading official Lamaze
Certified Childbirth Educator (LCCE) in India.
 She has completed her Midwifery education from the US
and is the co-founder of Healthy Mother centre, India's
first Natural Birth Center based on Scientific Midwifery
Model of Care
 Dr. Vijaya is the only Indian to be awarded the Certified
Professional Midwife certification by the North American
Registry of Midwives.

Healthy Mother
is India's most trusted, Midwife-led
maternal, newborn and infant care
provider. care model is universally
practiced in the UK, many states of the
US, and in Europe.
They believe pregnancy and birth are
normal, physiological life events in
mothers' lives. They need to be
celebrated, supported and respected,
rather than subjected to "assembly line"
hospital protocols, which view them as
patients and birth as risky "disease".

Mrs. Geeta Saxena, Midwife:
 Mrs. Geeta Saxena doing independent midwifery
practice in Delhi , associated with one of the
Hospital setting. She manages all antenatal,
intranatal and postnatal cases.
 If any complications arise than she refer the client
to obstretician..

ANNAPURNA CLINIC
MIDWIFERY LED CLINIC
 Independent Midwifery led Clinic
run by Choithram College of
Nursing faculty under the Guidance
of Dr. Usha Ukande (Principal ,
Choithram college of nursing ,SOMI
Indore Chapter President, NRSI
President.

 Daily checkups of antenatal and postnatal women.
 Fruitful Advices, guidelines and instructions to clients
 TT vaccinations.
 Topics tat covered….
 Introduction on Healthy Parenting,
 Garbh Sanskar,
 Fetal development month by month
 Natural birthing techniques (Lamaze technique)
 Yoga in Pregnancy : Demonstration of Exercises
(During Antenatal & Postnatal period)
 Breast feeding
 Queries on Pregnancy

A woman’s body is created to
give birth,
labour and delivery is not a
sickness that needs to be
suppressed
or medicated.

Human Rights in Childbirth
Birthing women have a fundamental human
right to choose the circumstances in which
they give birth.

"Midwives see birth
as a miracle and only
mess with it if
there's a problem;
doctors see birth as a
problem and if they
don‘t mess with it,
it's a miracle!”
“Trust that the
body that started
the process can
finish it…”

CONCLUSION
The strong voices of powerful midwives,
working close to government & civil
society institutions & major external
entities committed to improving maternal
& newborn health status, have realized
the goal of achieving IMP
Midwives many strengths and
contributions have not been fully utilised
to meet today’s health care needs.

THANK
YOU

Independent Nurse Midwifery Pracctitioner

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