INTRODUCTION TO

MIDWIFERY &
OBSTETRICAL
NURSING

PREPARED BY:
MADHURI PRAKASH.R
 Obstetrics word came from a Latin word
OBSTETRIX means MIDWIFE.
Midwifery, as known as obstetrics, is a health
science and health profession that deals
with pregnancy, childbirth, and the postpartum
period(including care of the newborn),besides
sexual and reproductive health of women
throughout their lives.
 Terminology
Midwifery is the knowledge necessary to perform the
duties of midwife.
Obstetrics is that branch of medicine, which deals
with the management of pregnancy, labour and
puerperium.
Gynaecology is that branch of medical science,
which treats diseases of the female genital organs.
Reproduction means process by which a fully
developed offspring of its kind is produced.
 Pregnancy is a state of carrying fetus inside the
uterus by a woman from conception to birth.
Gestation means pregnancy.
Gravidae is state of pregnancy irrespective of its
duration.
Multipara refers to woman who has given birth more
than once
Nullipara is the woman who has not given birth
before.
Primigravidae is a woman carrying first pregnancy.
Multigravidae is a woman carrying pregnancy more
than once.
 Healthy women are the key to the health of any
nation, primarily because of their vital role in co-
creating healthy infants and co-caring for the family.
Providing health care to women is not only a health
issue but a matter of human rights issue.
In womens life childbirth is a special event.
A mother will never forget a midwife who delivered
her baby; and who was with the woman during
childbirth, which is the very essence and identity of a
midwife.
Hence a midwife is an obvious catalyst in providing
safe motherhood in the fabric of our society.
 This presentation sets out the situation of Indian
midwifery in three sections:
1. Midwifery in India before independence.
2. Midwifery in independent India
3. Present and future of midwifery in India
 Midwifery in India before
independence
In ancient India, care of women and
practice of midwifery were totally in the
hands of indigenous village dais.
These indigenous dais, not only helped
during childbirth but also acted as
consultants for any condition of the
mother related to birth.
When medical missionary women from
England came to India, the first striking
observation they made was that, since dais
were unable to deal with difficult
deliveries and pregnancies, the maternal
and neonatal mortality were very high.
 The first training school for dais was started in 1877
by Miss Hewlett, an English missionary of the
Zenana Missionary Society.
However, the training of dais was not taken up by
Government of India (GoI) till 1900 when a fund was
established by Lady Curzon to improve the
conditions of childbirth in the country.
But before that, in 1872, a handful of Indian
Christian nurses were trained for two years at Delhi.
In 1899 the Zenana Bible and Medical Mission
started the training of nurses, but until 1893 there was
no generally accepted scheme of training in the
hospitals.
 In 1918 with the help of Dufferin Fund, Lady
Reading Health School was established to train
Auxiliary Nurse Midwives (ANMs).
In 1926 the Madras Registration of Nurses and
Midwifes Act was passed to promote the role of
a registered midwife for service during
childbirth.
In 1936 Dufferin fund sanctioned grant to a
number of Dufferin hospitals to build hostels,
supply teaching materials and employ qualified
sisters in nursing schools.
Thus Dufferin fund helped in raising the
standards of nursing and midwifery in India.1
In fact prior to independence, midwifery
training started as a separate course, in India.
Young girls at the middle school level (8th)
were selected to undergo this training.
 Midwifery in independent India
In 1946, the Bhore Committee laid stress on the need
for qualified midwives, health visitors, and the
training of dais.
In 1955, the Shetty Committee recommended the
training of Auxiliary Nurse Midwife (ANMs) in
health centers for maternal and child health services,
provided there were adequate health visitors to
supervise them.
In 1959 Bishoff, a technical Consultant supported the
training of two types of nursing personnelANM and
General Nurse Midwife (GNM Nursing- 3 years and
Midwifery- 1 year).
 In 1947, the first step the Indian Nursing Council
took after its inception was to combine the nursing
and the midwifery courses into a single course.
The course was designed to be of three and a half
years duration, with the entry qualification being 10th
class.
In 1975 the Kartar Singh Committee recommended
shortening the two year course of ANM to one and a
half years and entry after class 10th.
These ANMs were designated as female health
workers. They were specially trained in midwifery
and child health care services. GoI also invested
heavily in the training of dais.
 Present and future of midwifery
in India
The presence of a skilled midwife at birth is the single
most important factor for achieving safe motherhood
(WHO).
The number of midwives available as per population is
an important indicator of the maternal health status in a
country.
The maternal health status of women and maternal
mortality are closely related to the presence of trained
attendants at birth.
As the percentage of births attended by trained
personnel goes up, the maternal mortality ratio goes
down.
 In India there are the following
cadres of midwives:
1. The trained nurse midwife (RN, RM): Who has
undergone a diploma (Diploma in General Nursing
and Midwifery), which is of three and a half years
duration. Or A degree nurse who has done B.Sc.
(Honors) Nursing, which is of four years duration.
2. The ANM, who is designated as the Multi-purpose
health worker (female), is registered as a midwife.
Presently, this is a two years course with entry
classification being 12th class.
India has a huge cadre of ANMs who are educated
and trained in Midwifery.
 3. Skilled Birth Attendant (SBA) refers exclusively
to people with midwifery skills (e.g. doctors, nurses,
midwives), who have been trained to get proficiency
in the skills necessary to manage normal deliveries,
and to diagnose, manage, or refer complications to all
levels of health care settings.
Midwifery skills are defined as a set of cognitive and
practical skills that enable the individual to provide
basic health care services throughout the natal
continuum period and also to provide prompt actions
in emergencies including life saving measures, when
required.4
 Need for midwifery as a
profession in India

1. To achieve safe motherhood

2. 2. To avoid duplication of services
3. 3. To give health education
4. 4. To participate in countrys concern i.e. maternal
and child welfare
5. 5. To get status and recognition in the society
 TRENDS IN THE MIDWIFERY AND
OBSTETRICAL NURSING
Changes in social structure, variations in family
lifestyle: It has altered health care priorities for maternal
and child health nurses. Today, client advocacy, an
increased focus on health education, and new nursing roles
are ways in which nurses have adapted to these changes.
Cost Containment
Cost containment refers to systems of health care delivery
that focus on reducing the cost of health care by closely
monitoring the cost of personnel, use and brands of
supplies, length of hospital stays, number of procedures
carried out, and number of referrals requested.
 Expanded roles for nurses
Increasing nursing responsibility for assessment and
professional judgment and providing expanded roles
for nurse practitioners, such as the nurse-midwife.
Family Centered Care
More natural childbirth environment where partners,
family members may remain in a homelike
environment, and participate in the childbirth
experience
By adopting a view of pregnancy, childbirth as a
family event, nurses can be instrumental in including
family members in care and consult family members
about a plan of care and provide clear health teaching
so that family members can monitor their own care
 Access to Health Care
Strong predictors of access to quality health care include having
health insurance, a higher income level, and a regular primary care
provider or other source of ongoing health care. Use of clinical
preventive services, such as early prenatal care, can serve as
indicators of access to quality health care services. The objectives
selected to measure progress in this area are:
Increase the proportion of persons with health insurance.
Increase the proportion of persons who have a specific source of
ongoing care.
Increase the proportion of pregnant women who begin prenatal
care in the first trimester of pregnancy
 Shortening Hospital Stays
Women who have begun preterm labor stay in the hospital while
labor is halted and then are allowed to return home on medication
with continued monitoring.
Routine hospital stay for mothers and newborns after an
uncomplicated birth is now 2 days or less.
Short-term hospital stays require intensive health teaching by the
nursing staff and follow-up by home care or community health
nurses.
Increased Use of Alternative Treatment Modalities
There is a growing tendency to consult alternative forms of
therapy, such as acupuncture or therapeutic touch, in addition to,
or instead of, traditional health care providers. Nurses have an
increasing obligation to be aware of complementary or alternative
therapies.
 Increased Use of Technology
The field of assisted reproduction (e.g.,
in vitro fertilization), seeking
information on the Internet, and
monitoring fetal heart rates by Doppler
ultra sonography are other examples.
In addition to learning these
technologies, maternal and child health
nurses must be able to explain their use
and their advantages to clients.
Otherwise, clients may find new
technologies more frightening than
helpful to them.
 Technological Advances As the
technology has revolutionized and
increasingly sophisticated computers in
todays world, it has become necessary
for the nursing personnel to have
thorough knowledge of the new
technology being used.
Due to this advancement, the hands
on care of the client is reduced, so also
is the, quality nursing care.
Today foetal monitoring has
progressed from the use of fetoscope to
electronic foetal monitors. It can be
used both, directly and indirectly.
 Maternal and Child Health
Indicators
Birth rate: The number of births per 1,000 population.
Fertility rate: The number of pregnancies per 1,000
women of childbearing age.
Fetal death rate: The number of fetal deaths (over 500
g) per 1,000 live births.
Neonatal death rate: The number of deaths per 1,000
live births occurring at birth or in the first 28 days of
life.
 Infant Mortality Rate: The number of deaths per
1,000 live births occurring at birth or in the first 12
months of life.
Childhood Mortality Rate: The number of deaths
per 1,000 population in children, 1 to 14 years of age.
The Maternal mortality rate (MMR) is the annual
number of female deaths per 100,000 live births from
any cause related to or aggravated by pregnancy or its
management (excluding accidental or incidental
causes).
 Maternal morbidity rate: Any departure, subjective or
objective, from a state of physiological or psychological
well-being.(during pregnancy, childbirth and the
postpartum period up to 42 days or 1 year).
Perinatal mortality: The World Health Organization
defines perinatal mortality as the "number of stillbirths
and deaths in the first week of life per 1,000 total births,
the perinatal period commences at 22 completed weeks
(154 days) of gestation and ends seven completed days
after birth"
 FERTILITY RATES
The total fertility rate (TFR), sometimes also
called the fertility rate, absolute/potential
natality, period total fertility rate (PTFR) or total
period fertility rate (TPFR) of a population is the
average number of children that would be born to a
woman over her lifetime if:
1. She were to experience the exact current age-
specific fertility rates (ASFRs) through her lifetime,
and
2. She were to survive from birth through the end of
her reproductive life.
 LEGAL AND ETHICAL PRINCIPLES IN
THE PROVISION OF HEALTH SERVICES
1. Informed decision making.
Patients or individuals who require health care
services have right to make their own decision about
the opinions for treatment or other related issues. The
process of obtaining permission is called informed
consent.
 The health care provider should disclose the
following details:
1. The individual is currently assessed health status
regarding the general or reproductive health.
2. Reasonably accessible medical, social, and other
means of response to the individuals conditions
including predictable success rates, side effects and
risks.
3. The implications for the individuals general, sexual
and reproductive health and lifestyle declining any of
the options or suggestions.
4. The health providers reasoned recommendation for
a particular treatment option or suggestion.
 Autonomy:
Autonomous persons are those who, in their
thoughts, work, and actions, are able to follow norms
chosen of their own without external constraints or
coercion by others.
It is to be noted that autonomy is not respect for
patients wish against good medical judgement.
Simply put, a health provider can refuse a treatment
option chosen by the patient, if the option is of no
benefit to the patient.
 Surrogate decision makers:
Surrogate decision makers[ parents, caregivers,
guardians] may take the decision if the affected
individuals ability to make a choice is diminished by
factors such as extreme youth, mental processing
difficulties, extreme medical illness or loss of
awareness.
 privacy and confidentiality
A patients family, friend or spiritual guide has no
right to medical information regarding the patient
unless authorized by the patients. The following
points of confidentiality are to be kept in mind:
health care providers duties to protect patients
information against unauthorized disclosures.
Patients right to know what their health care
providers think about them.
Health care providers duties to ensure that
patients who authorize releases of their confidential
health related information to others, exercise an
adequately informed and free choice.
 Competent delivery services:
Every individual has a right to receive treatment by a
competent health care provider who knows to handle
such situations quite well. According to the laws,
medical negligence is shown when the following 4
elements are all established by a complaining party.
A legal duty of care must be owed by a provider to
the complaining party.
 Breach of the established legal duty: of care must
be shown, which means a health care provider has
failed to meet the legally determined standards of
care.
Damage must be shown.
Causation must be shown.
Safety and efficacy of products:
Health care providers are responsilble for any
accidental or deliberate use of products that differs
from their approved purposes or methods of use, for
instance, the dosage level for drugs. Look for the
drug contraindications, drug expiry, damage of
diluted sterilization solvents etc.
 PRE-CONCEPTION CARE &
PLANNING FOR PARENTHOOD
Preconception care is the provision of biomedical,
behavioural and social health interventions to women
and couples before conception occurs.
It aims at improving their health status, and reducing
behaviours and individual and environmental factors
that contribute to poor maternal and child health
outcomes.
Its ultimate aim is to improve maternal and child
health, in both the short and long term
 Even if preconception care aims primarily at
improving maternal and child health, it brings
health benefits to the adolescents, women and
men, irrespective of their plans to become
parents.
 NEED FOR PRECONCEPTION CARE

reduce maternal and child mortality

prevent unintended pregnancies
prevent complications during pregnancy and delivery
prevent stillbirths, preterm birth and low birth weight
prevent birth defects
prevent neonatal infections
prevent underweight and stunting
prevent vertical transmission of HIV/STIs
lower the risk of some forms of childhood cancers
 Areas addressed by the
preconception care package
Nutritional conditions
Tobacco use &Psychoactive substance use
Genetic conditions
Environmental health
Infertility/sub-fertility
Interpersonal violence
Too-early, unwanted and rapid successive pregnancies
Sexually transmitted infections (STIs)
Vaccine-preventable diseases
Female genital mutilation (FGM)
Mental health
Preconception care for all women of childbearing age should include:
Access to good quality health care for all adolescents Vaccination
(e.g., rubella and hepatitis B vaccine)
Essential nutrition for girls and women and work to combat eating
disorders (obesity prevention), including the administration of folic
acid supplements
Preventive medical consultations, risk assessment, and psychological
counseling (e.g., prevention of psychotropic substance abuse, risk
behaviors)
Family planning, including the promotion of planned, adequately
spaced pregnancies
Detection and treatment of sexually transmitted infections, especially
HIV/AIDS
Treatment of chronic diseases (e.g., diabetes, hypothyroidism,
malaria, tuberculosis, and Chagas disease).
 Role of nurse in midwifery &
obstetric care
Midwife:
A midwife is a health care professional who provide
health care services for women including
gynecological examinations, contraceptive
counselling, prescriptions, and labor and delivery
care. Midwife provides expert special care during
labor, delivery and after birth so that midwife unique.
Various roles and responsibilities of a midwife have
presented in the below:
Care giver:
Midwives provide high quality antenatal and
postnatal care to maximize the womens health during
and after pregnancy, detect problems early and
manage or refer for any complications.
Coordinator:
Midwives coordinate care for all women. Coordinator
ensures holistic, voluntary and social services for
pregnant women when appropriate so that every
womens birth experience regardless of risk factor.
 Leader:
The role of leader is to plan, provide and review a
womens care, with her input and agreement, from the
initial antenatal assessment through to the postnatal
period. Midwifes leading role reduces admission to
hospital and results in significantly less intervention
during birth.
Communicator:
As a communicator, the midwives understand that
effectiveness of communication. It helps to develop trust
relationship with pregnant women and family members.
The midwife has to communicate effectively with
pregnant women and family members as well as others
so that they can share their all problems.
 Manager:
Manager is a great role for midwife. Midwives manage
all the circumstances where appropriate and can
recognize and refer women to obstetricians and other
specialists in a timely when necessary.
Educator:
As an educator, midwives provide high quality,
culturally sensitive health education in order to promote
healthy, helpful family life and positive parenting.
Counselor:
Midwives provide information and counsel pregnant
women on prenatal self care including nutrition, hygiene,
breastfeeding and danger sings in pregnancy and
childbirth.
 Family planner:
They also counsel people as a family planner. They provide all
information about all kind of family planning methods and help
couple to take decision.
Adviser:
Midwives give advice on development of birth plan and promote the
concept of birth preparedness. They also give advice during
complicated situation so that it will help them to take decision.
Record keeper:
Record keeping is an integral part of midwifery practice. It helps
making continuity of care easier and enabling identify problem in
early stage.
Supervisor:
Supervising and assisting mothers during antenatal period, monitoring
the condition of the condition of the fetus and using their knowledge
to identify early sings complication.
 https://www.um.edu.mt/__data/assets/pdf_file
/0018/147033/midwiferyeduc.pdf
http://ecommons.aku.edu/cgi/viewcontent.cgi?
article=1004&context=jam