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Midwife Means

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    ROLE OF MIDWIFERY PRACTICE

    INTRODUCTION

    Midwife means with woman or in France wise woman. The midwife is recognized worldwide as being

    the person who is alongside and supporting women during birth. However the midwife also has a key rolein promoting the health and well being of childbearing women and their families before conception,

    antenatally and postnatally, including family planning.

    If chosen as the primary care gives for pregnancy the role of the midwife will take place, of an

    obstetrician. For instance UK, approximately 75% of the prenatal care is performed by midwives for all

    low risk mothers and obstetricians only see high risk patients.

    ACTIVITIES OF A MIDWIFE

    The midwife has diverse and complex functions:

    1. A midwife is a highly trained expert and carries out clinical examinations, provide health andparent education and support the mother and her family throughout the child bearing prices to

    help them adjust to their parental role.

    2. Provides sound family planning information and advice.3. She diagnoses pregnancies and monitor normal pregnancies to carry out examination necessary

    for the monitoring of the development of normal pregnancies.

    4. She give advice regarding personal hygiene and nutrition to the pregnant mother, and caresthroughout pregnancies and first six weeks of birth.

    5. Care for and assist the mother during labour and monitors the condition of the foetus by theappropriate clinical and technical means.

    6. Conducts spontaneous deliveries including where required an episiotomy and in urgent cases ofbreech delivery.7. To recognize the warning signs of abnormality in the mother or infant which necessities referral

    to a qualified medical doctors absence, in particular, the manual removal of placenta, possibly

    followed by manual examination of the uterus.

    8. To examine and care for the newborn infant, to take all initiatives, which are necessary in case ofneed and to carry out where necessary immediate resuscitation.

    9. To care for and monitor progress of the mother in the post-natal period and to give all necessaryadvice to the mother on infant care to enable her to ensure the optimum process of the newborn

    infant.

    10.To carry out the treatment prescribed by a medically qualified doctors.11.To maintain necessary records.12.Midwife teaches about pregnancy , the process of labor, birth and recovery, and parenting skills,

    this can promote significant improvement in maternal and infant health.

    13.She plans care with each woman in labor that is tailored to meet her specific needs andexpectations.

    14.Puts the care plan into practice and evaluate the care given to measure its effectiveness.

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    15.She is a skilled professional providing continuous care for several months and assists in criticaldecision making regarding appropriate care in pregnancy, labor and the post-partum period.

    16.Plays important role in disaster and complex humanitarian emergencies at the periphery of thehealth care system where there are no doctors.

    17.The midwife should develop partnership with the woman from the beginning of her pregnancy.This requires a social rather than medical model of maternity care, endorsing the involvement ofthe woman and her partner in decision making and requiring the woman to be able to voice her

    needs and wishes freely.

    18.The midwife should strive to build a relationship of mutual trust and create an environment inwhich expectations , wishes, fears, and anxieties can be readily discussed. This requires good

    communication skills.

    19.She should provide emotional and psychological care to woman during labor. The attitude andreactions to childbirth vary considerably and are influenced by different social, cultural and

    religious factors. For a multigravida, the previous experiences of birth will also be important.

    20.The midwife should forward as an advocate to support the woman in unknown and unfamiliarsituations and people ; greater pain than expected or the effect of analgesic pain than expected or

    the feeling of vulnerability, loss of personal identity and powerfulness.

    Many women anticipate labor with mixed feeling of fear and excitement . They may be apprehensive

    about entering an unknown and perhaps threatening hospital environment and concerned about

    relinquishing her personal autonomy and identity. Alternatively, expectations of labour may be unrealistic

    and may be unfulfilled leading to feeling of disappointment, failure or loss .In these situations the

    midwife should support the mothers.

    Basic role:

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

    case manager and educator.

    1. Care giver

    The midwife understands and facilitates normal childbearing and provides the adequate care to the

    mother and the baby, spreads health and well-being to women and their families

    2. Client advocate

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

    basic rights .

    3.Researcher

    The midwife is a good researcher and does not implement interventions with a sound base on evidenceand can critically evaluate the evidence-base for midwifery knowledge .She goes through various studies

    and conduct studies to provide the best care to the mother and child.

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    4.Manager

    A midwife quickly comprehends the range of normal maternal, fetal and neonatal well-being practice,

    diagnoses factors that may adversely affect maternal or fetal well-being, locates appropriate

    assistance or intervention while providing continued family support ,manages skilled emergency

    interventions and assists during bereavement

    5.Educator

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

    women and their communities

    Expanded role

    As trends in maternal and child health care changes , so do the roles of maternal and child health nurses.

    Many nurses with a specified number of years of direct patient care, education programa are certified in

    their speciality . In addition, maternal and child health nurses function in a variety of advanced practice

    roles.

    1.Clinical Nurse Specialist

    Clinical nurse specialist are nurses prepared at the masters- degree level who are capable of acting as

    consultant in their area of expertise, as well as serving as role models, researchers, and teachers of quality

    nursing care. Example of areas of specialization are neonatal, maternal , child and adolescent health care ,

    childbirth education, and lactation consultation.

    2.Case Manager

    A case manager is a graduate level nurse who supervises a group of patients from the time they enter a

    health care setting until they are discharged from the setting, or ina seamless care system, into their homes

    as well, monitoring the effectiveness, cost and satisfaction of their health care. Case management can be a

    vastly satisfying nursing role, because if the health care setting is seaming or one that follows people

    both during an illness and on their return to the community, it involves long-term contacts and lasting

    relationships.

    3. Women health nurse practitioner

    A women health nurse practitioner is a nurse with advanced study in the promotion of health and

    prevention of illness in women. Such a nurse plays a vital role in educating women about their

    bodies and sharing with them methods to prevent illness, in addition, they care for women with

    illness such as STDs offering information and counseling them about reproductive life planning.

    They play a large role in helping women remain well so that they enter pregnancy in good health

    and maintain their health through out life.

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    4. Family Nurse Practitioner

    A FNP is an advanced practice role that provides health care not only to women but to total families. In

    conjunction with a physician, an FNP can provide prenatal care for a women with an

    uncomplicated pregnancy. The FNP takes the heath and pregnancy history, performs physical and

    obstetric examination, orders approximate diagnostic and laboratory tests and plans continued

    care throughout the pregnancy and for the family afterwards. FNPs then monitor the family

    indefinitely to promote health and optimal family functioning.

    5.Neo-natal Nurse Practitioner

    A neonatal nurse practitioner(NNP) is an advanced practice role for nurses who are skilled in the care of

    newborn, both well and ill. NNPs may work in level1, level2 or level3 newborn nurseries;

    neonatal follow-up clinics or physician groups. They also transport ill infants to different care

    settings. The NNPs responsibilities include managing and carrying out patient care in INC ,

    conducting normal newborn assessment and physical examination and providing high-risk follow

    up discharge planning.

    SCOPE OF MIDWIFERY PRACTICES

    Paramount to the practices of any health care provider is an awareness of the individual professional

    scope of practice. Understanding and adhering to ones scope of practice of recipient of health care

    practices, as well as in the safe- guarding of health care professionals themselves. For, instance, a person

    with a broken bone will not seek care from a psychologist. The prevention of such inappropriate and

    potentially dangerous scenarios is the very reason why defining ones scope of practice is vital to the

    wellbeing of individuals seeking health care . In midwifery education , students learn from the start oftheir training that safety is vital to offering quality midwifery care, and understanding ones scope of

    practice is a large part of achieving this.

    The scope of midwifery nursing practices is the range of roles , functions, responsibilities and activities

    which a registered nurse is educated, competent and has authority to perform.

    IMPORTANT CONSIDERATIONS IN DETERMING THE SCOPE OF MIDWIFERY PRACTISES

    A. COMPETENCE:Competence is the ability of the registered nurse r registered midwife to practice safety and effectivety,

    fulfilling his/her professional responsibilities within her scope of practice.

    A competent professional midwife possess many attributes.these include practical and technocal skills,

    communication and interpersonal skills, organizational and managerial skills, the ability to practice safely

    and effectively utilizing evidence , the ability to adapt a problem solving approach to care utilizing critical

    thinking , the ability to perform as part of a multidisciplinary team demonstrating a professional attitude,

    accepting responsibility and being accountable for once action.

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    B. ACCONTABILITY AND AUTONOMY:Accountability is the fullfillment of a formal obligation to disclose to referent others the purpose,

    principles, procedures, relationships, result, income and expenditures for which one has authority. In the

    course of his/her professional practice, a nurse or a midwife must be prepared to make explicit rationale

    for decisions in the make explicit the rationale for decision in the context of legislation, professional

    standards and guidelines, evidence based practice and professional and ethical conduct.

    Accountability cant be achieved unless the nurse or midwife has autonomy to practice . Nurse are

    autonomous in midwifery . This means that they have the freedom to make discretionary and binding

    decisions in accordance with their scope ofpractise. Authority is the legitimate power to fulfill a

    responsibility.

    C. CONTINUING PROFESSIONAL DEVELOPMENTContinuing professional development encompasses experiences, activities, and process that contribute

    towards the development of a midwife as a health care professional. This means, it is a lifelong process of

    learning, both structured and informal.

    Continuing education is a vital component of continuing professional development and takes place after

    the completion of the pre-registration education programme for midwives and nurse. It consists of

    planned learning experiences that are designed to augment the knowledge, skills and attitude of a

    registered nurse or registered midwife, for the enhancement of midwifery practices , patient care

    education, administration, and research.

    D. SUPPORT FOR PROFESSIONAL NURSING AND MIDWIFERY PRACTICEInorder for the midwives to practice completely and to realize these potential in the interest of quality

    patient care; certain supports need to be in place. This includelocal and national guidelines, policies andprotocol that have been developed collaboratively with practicing nurses and midwives, and with

    reference to legislation and research- based literature.

    E. DELEGATIONDelegation is the transfer of authority by a nurse midwife to another person to perform a particular role.

    Each registered midwife is accountable for his/her own practice. The midwife is accountable for his/ her

    own practice. The midwife who is delegating is accountable for the decision to delegate . This means that

    the delegate function is appropriate and that support and resourses areavailable to the person to whom the

    role has been delegated. The miwife is accountable for carrying out the delegated role in an appropriate

    manner.

    THE PRINCIPLES TO BE KEPT IN MIND WHILE DELEGATING ROLES

    The nurse midwife must ensure that the primary motivation for delegation is to serve the interestof the patient.

    The midwifery must ensure that the delegation is appropriate with reference to the definitions andphilosophies of nursing or midwifery as appropriate .

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    The nurse or midwife must take the level of experiences , competence, role and scope of practiceof the person to whom the role is being delegated into account.

    The nurse or midwife must not delegate to junior colleagues , tasks and responsibilities beyondtheir skill and experiences.

    The midwife must ensure appropriate assessment , planning, implementation and evaluation ofdelegate role.

    The midwife must communicate the role in a manner understandable to the person to whom it isbeing delegated.

    The midwife must communicate the role in a manner understandable to the person to whom it isbeing delegated.

    The midwife must decide on the level of supervision and feedback necessary.The Nurse to whom a particular role has been delegated should take account of the following

    principles.

    - The nurse or midwife must consider if it is within their scope of practice . If the delegatedrole is beyond the current scope of practice. If the delegated role is beyond the current scopeof practice of the nurse or midwife need to consider the appropriateness of this delegation.

    - The midwife must acknowledge any limitations of competence.- The nurse or midwife must provide appropriate feedback to the delegator.

    6. EMERGENCY SITUATION

    Nothing in this document will be constructed as preventing a nurse midwife from taking appropriate

    action in the case of an emergency . The best interest of the patient must be served by appropriate nursing

    or midwifery intervention in emergency situations.

    PRINCIPLES OF DETERMING THE SCOPE OF PRACTICE

    The following principles are the basis for making decisions with regard to the scope of practice for an

    individual nurse/midwife.

    The primary motivation for expansion of practice must be best interest of patient and promotionand maintenance of the best quality health services for the population.

    Expansion of practice must be made in the content of the definition of nursing midwifery and thevalues that underpin midwifery practice.

    Expansion of practices must only be made with due consideration to legislation , national policy,local policy and guidelines. If necessary at local level, appropriate protocols and guidelines

    should be devised and appropriate supports put in place.

    In determining the scope of practice the midwife must make a judgement as to whether she iscompetent to carry out the role function.

    The midwife must take measures to develop and maintain the competence necessary forprofessional practice . The midwife must acknowledge any limitation of competence.

    Expansion of practice must be based on appropriate assessment , planning, communication andevaluation.

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    The midwife who is delegating a particular role function is accountable for the decision todelegate . This means that the delegated role is appropriate and that, support and resources are

    available to the person to whom it has been delegated.

    The individual midwife is accountable for her practice. This means that she is accountable fordecision and determines the scope of practice.

    INDEPENDENT NURSE MIDWIFE

    PRACTITIONER

    Definition

    Independent midwives are fully qualified midwives who have chosen to work outside the National Health

    Scheme in a self employed capacity. The legal role of a midwife encompasses the care of women and

    babies during pregnancy, birth and the early weeks of motherhood.

    Usually one midwife gives care to a woman her family through out a pregnancy. Having established a

    trusting relationship , the same midwife would care for the woman and her baby and support afterwards.

    Research have shown that many women till want this type of midwifery care and that it help women to

    cope with the challenges of labor and the transition to parenthood. In recent times, health advisers and

    government policy makers have promoted independent midwives style of care as the Gold Standard to

    which the National Health Scheme(NHS) should aspire to independent midwives are currently working

    to ensure that all women can assess gold standard care in the future.

    Working place

    A pregnant women is entitled to choose where she wants to have her baby. Midwives can work with

    women at : Home, Hospital, In separate midwifery aid units ,Private birth centers.

    Mode of Duties

    Independent midwives have more freedom to practice individualized care compared to those working

    with the NHS, who can be restricted by guidelines and protocols.

    Independent midwives are regulated by the Nursing and Midwifery Council. They are subjected to the

    same supervision as NHS midwives are required to keep up to date with their practices and are only

    allowed to act within their sphere of competence as midwives.

    For instance, there are currently approximately 150 independent midwives in U.K. They often work in

    partnership or have close connection with other independent nurse midwives, enabling them to provide

    seamless care to the women who use their services.

    The independent midwives form relationship of trust with pregnant women, which then help women to

    feel safe and supported when they go into labor. Many independent midwives have become very

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    experienced and in areas of child birth; that within the NHS are usually dealt with by obstetric

    management . These include breech birth, twins and vaginal birth after caesarean . The majority of births

    attended by independent midwives at any stage during pregnancy , no matter how close you are to your

    due date. Some will give free consultations to women who are considering all their birthing options.

    Practicalities to be aware1. Cost: Independent midwife charge for their services. The amount will depend on the living

    status and the type of services they offer.

    2. Place of Birth: Most of the midwives attend birth at home. There are a small number ofindependent midwife services in U.K. with their own centers. If a women is planning

    hospital birth or need to be transferred to hospital , she can do so and a midwife can

    accompany her if so she designs.

    3. Independent midwifes have the same referral rights as NHS midwives and are able toarrange a consultant appointment or hospital admission if required.

    Professional Autonomy of a Midwife

    The midwife is responsible for all care unless she makes a referral to mother to another healthprofessional.

    Any guidelines and policies should have been developed and approved by midwifery afterprocess of consultation.

    Principles

    The National Nursing , midwifery and Health visiting practice(UKCC) describes seven guiding principles

    which establish autonomous midwifery philosophy and values in relation to expected outcomes of

    midwifery programmes:

    A.Provision of Women centered care

    Every woman expects to be treated as though she is special and important .Although at times maternity

    units and community workloads can be busy, individual women wants midwives to be there for them , not

    for someone else.It is essential that midwives have an understanding of social , cultural and context

    differences so that they can respond to the needs of women and their families in a variety of care setting

    and priorities and manage work appropriately. Of particular importance is working with families to draw

    up a plan of care and support and then evaluate and modify that care as circumstances.

    B. Ethical And Legal Obligations

    The practice of a midwife is controlled by law, under the Nurses Midwives and Health Visitors Act and

    Midwives Act. Midwives also need to be familiar with other Acts of Parliament and Statutory Instruments

    that impact on their practice. The code of professional conduct sets requirements for the behavior of

    midwives and nurses in relation to such things as confidentiality, respect and personal responsibility for

    ethical choices. For example, midwives may find themselves expected to care for women who have

    decided to terminate their pregnancy. Even though the midwife have objection regarding it, she cannot

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    refuse to provide care for the woman. Counselling services are normally provided for women and staff

    facing ethical dilemmas and stressful situations.

    C. Respect for Individuals And Communities

    Society is composed of people from many cultures, ethics, and religious backgrounds. Midwifery care

    must be provided in a non-discriminatory way without prejudice; Where midwives find they dont have

    the skill or expertise to provide effective care for individuals or groups then need to seek assistance. In

    areas where there are number of residents who dont speak the local language, link workers or an

    interpreting service can be more appropriate than asking another family member; especially a child, to

    communicate between the woman and the midwife.

    D. Quality and Excellence

    Individual midwives should strive for continuous improvement and excellence in midwifery practice. To

    protect the health and well-being of mother and babies , supervision of midwives is enshrined in statute.

    Clinical governance has more recently been established to assure the quality of all the health services

    provided by an individual NHS Trust and has many principles that mirror statutory supervision ofmidwives. Auditing of standards and discussion of difficult maternity care scenarios are ways in which all

    professional groups can work together to improve the quality of services. Involvement of mother in

    evaluating care and suggestion for areas that need improvement have become even more important in

    contributing to become even more important in contributing to quality and excellence in the maternity

    services.

    E.The changing nature and context of Midwifery Practices

    Midwives need to be flexible and also become change agents when necessary. Theu need to adapt to new

    technologies to improve the quality of care, providing quality care and there by developing their existing

    skills and identify changes needed.

    F.Evidencebased Practice and learning

    The practitioners of midwifery should have evidence for effective care and not assume that all research is

    of value but that it must be critically analysed. It intends to foster the use of sysytematic reviews such as

    effective care in pregnancy and childbirth.

    G.Life-long Learning

    Midwife should adapt a style of learning complex and problem solving skills and become expert

    practitioners with upto date knowledge of informations. Midwives also need to grasp opportunities to

    learn from each other by observing , discussing different ways of practicing and where necessary seeking

    out an education or training event.

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    The Independent Nurse midwifery management processes

    Regardless of the practice setting, the nurse midwife care encompasses four aspects of management:

    1.Independent Management

    Nurse midwife are responsible and accountable for the management decision they make in caring for the

    patient. Nurse midwife provides independent management when they sysytematically obtain or update a

    complete and relevant database for assessment of the patients health status. This includes the history the

    physical examination results, the laboratory data. On the basis and interpretation of this findings, nurse

    midwives accurately identical problems and diagnosis and implement a plan of action.

    2.Consultation

    When nurse midwives identify problems or complication they seek advice from another member of the

    health care team often a physician. When they retain independence management responsibility for the

    patient while seeking advice, this is called consultation, may centre on an ongoing health problems, a non

    obstetrical , time limited problem that arises during pregnancy. After consultation the nurse midwife and

    the women discuss the recommendations if any and modify the plan of care accordingly. In this process

    nurse midwife retain responsibility for decision.

    3.Co management or collaborative care

    One out come of consultation may be the decision to shift to co management or collaborative care. This

    usually occurs if part of the womens care is related to an ongoing medical or gynecological complication

    beyond the scope of the nurse midwives practice. In this situation the nurse midwife and the physician

    collaboratively treat the patient.

    The range of services provided:

    Pre-pregnancy advice Advice about birth options Childbirth education classes Continuous midwifery care during pregnancy Preparation for and attendance at births in an appropriate environment of the parents choice. Postnatal care following birth at home, birth centre or hospital. Separate postnatal care for women who want private midwifery care for this period only or who

    are discharged home early from hospital

    Lactation consultancy Referral to and advice about other health professional such as medical and natural health

    practitioners, eg obstetricians, paediatricians, GPs , chiropractors, osteopaths, naturopaths ,

    homeopaths

    Some midwives have a special interest and expertise in supporting women in special areas suchas vaginal birth after caesarean section(VBAC), breech births, water births and postnatal

    depression.

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    Independent practice Midwife in India

    In India 1,00,000 women die every year due to pregnancy related cause (GOI 2005). Over 50 million

    women suffer from malnutrition in India. Morbidity due to pregnancy is 18 times higher in developing

    countries and IMR is 7 times higher in developing countries. Risk to a woman of dying from pregnancy

    related causes: developed countries 1: 4000 to 10,000 where as in India it is 57/1000. IMR in developedcountries 1 in 5000 to 10,000 and in India 64/1000.

    Major contributing factors for these problems are:

    Lack of skilled health care

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

    Nurse midwives are available at the first level of referral but are unskilled for the level of

    management required to supervise at-risk deliveries.

    Poor utilization of midwifery skill.

    Lack of a supportive policy environment

    In order to improve this conditions, the Nursing Council (INC), the parent body of the nursing councils

    in the country, has rolled out a series of initiatives, many of which are in the early implementation stage,

    while the rest have been forwarded by INC for approval to the Union Health ministry.

    Aimed to ease the impact of the shortage of gynecologists in community health centres, INC performed

    a pilot study for the Independent Nurse Practitioner Project in Infant Mortality Rate(MMR) in West

    Bengal at SSKM Hospital female medical and surgical wards. The project provided an 18 months training

    in midwifery, besides an additional training in emergency obstetric care to candidates who have

    completed their BSC in nursing and have two to three years of experience in OB-GYN wards to take care

    of ANMs in rural sectors. These nurses were called independent nurse as they were trained to prescribe

    medicines following approved protocols and take decisions independently in absence of gynecologists.

    The result of the pilot study has been submitted to health ministry and the government of India examined

    the protocol to extent this project all over India. The GOI response to the challenge:

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

    Phase 1

    Funded under the India-Australia Training and Capacity Building Project (IATCBP) asThe Specialist Midwifery Sub-Project.

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

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    Development of new cadre

    Consensus building Development phase Implementation phase

    Consensus building

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

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

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

    Development phase

    Step 4: Base-line data collected

    Step 5: Development of code of ethics

    Step 6: Development of practice standards

    Step 7: Development of a framework for service standards

    Implementation phase

    Step 8: Development of clinical guidelines

    Step 9: Development of curriculum framework

    Step 10: Writing the curriculum

    Step 11: Development of assessment tools

    Step 12: Piloting selected modules and assessment

    Step 13: Review and revision

    Outcomes

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

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

    To decrease maternal and infant mortality and morbidity in the rural and tribal areas of India byproviding quality ob and gynae services through NP placed in CHCs.

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    Training & placement of Independent Nurse Midwife Practitioner Course

    Duration: 18 months (including 6 months internship) Eligibility/ Qualifications

    o B. Sc. Nursing, 2 years experience (at least one year in midwifery)o Age: < 45 yrs

    Placement: CHC / PHC with facilities for supporting the role & function of new cadre Post: convert one post of staff nurse to NP in Midwifery

    Salary: equivalent to principal nursing school Mode of Offer: Full-time only Proposed Course Locations: Colleges of Nursing and Medical Colleges in Calcutta (West Bengal)

    and Indore (Madhya Pradesh)

    Proposed Intake for the First 2 years: First year: 6 each from training location Second year: Intake to be reviewed based on the experience of the initial intake Professional Recognition and Accreditation: INC

    Responsibilities & practice

    o Promotion of health of women throughout their life cycle with special focus on women duringchildbearing years and their new babies.

    o Provide autonomous care to women prior to & during pregnancy, during & after childbirth, careof newborn & assume responsibility and accountability for their practice.

    o Practice within the existing peripheral health system consisting of birth attendants, ANMs,nurses, doctors & specialists

    o NP will be posted at a facility where no obstetricians are posted or availableJob description

    Promote health of women before pregnancy through education and counseling for healthy familylife including planning for pregnancies.

    Promote health of women during pregnancy through: Quality, technically advanced antenatal care to women with normal pregnancy Early detection of risk situations and management that commensurate with their level of

    competence

    Management of minor disorders of pregnancy Referrals as required

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    Regulations of practice

    INC Act (1947) amended to allow INC to: Regulate the practice of the NP in midwifery according to the code of ethics License the NP to practice independently (as per practice standards) Authorize & be responsible for preparing, approving & implementing the curriculum

    Code of ethics & practice standards are key for licensing & regulation of NPTEACHING INSTITUTIONS

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

    programs in nursing having parent/ affiliated Govt. Hosp. facilities of maternity, neonatal and

    pediatric units. Or Other non-Govt. nursing teaching institution offering diploma or degree

    programs in nursing having parent Hosp. facilities of maternity, neonatal and pediatric units

    The institution conducting this course should have a 50 bedded parent hospital having mother and

    neonatal units,Case load of minimum 500 deliveries per year, 8-10 level II neonatal beds,

    Affiliation with level III neonatal bed

    The number of seats available depend on the number of deliveries conducted in the parent

    institutions ie,10 students for minimum 500 deliveries per year

    20 students for minimum 1000 deliveries per year

    STAFFING PATTERN

    1. Full time teaching faculty

    Ratio 1:5

    Qualification: M. Sc. Nursing with Obstetrics and Gynaec/Community/Pediatrics

    Specialty

    Nurse practitioner in midwifery with B. Sc. nursing Experience: Minimum 3 years

    2.Guest faculty - multi-disciplinary in related specialties

    Distribution of the Course:

    1. Teaching: Theory & Clinical practice 42 weeks

    2. Internship 4 weeks

    3. Examination 2 weeks

    4. Vacation 2 weeks

    5. Public holidays 2 weeks

    ------------------

    52 weeks

    Curriculum

    Theory

    Clinical Nursing-I

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    (Inclusive of foundation courses) 90 Hrs

    Clinical Nursing II- 90 hrs

    Paper III

    (i) Supervision & Management 30 Hrs

    (ii) Clinical Teaching 30 Hrs

    (iii) Elementary Research & Statistics 30 Hrs

    TOTAL 270 Hours

    Practical

    Integrated Clinical Practice 1410 Hrs

    Internship 160 Hrs

    Total 1570 Hrs

    Clinical Experience

    Maternal and neonatal care Services 38 weeks Antenatal OPD including Infertility clinics

    /Reproductive medicine, Family welfare and

    post partum clinic / centre 6 weeks

    Antenatal and Postnatal ward 4 weeks Labour room 8 weeks Neonatal Intensive Care Unit 4 weeks Obstetric/Gynae operation Theatre 4 weeks Gynae ward 2 weeks Paediatric OPD/under five clinic 2 weeks Paediatric ward 2 weeks CHC,PHC,SC 6 weeks Total practical hours 38 weeks (1410 hrs) Internship - 4 weeks in community

    Institutions conducting NP Course

    Gujarat:o Ahemdabado Barodao Bhavnagar: under process

    PROPOSED CADRE OF NURSE MIDWIFE PRACTITIONERS

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

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

    1.

    2.

    3.

    4.

    Staff Nurse Midwife

    Practitioner

    Chief nurse Midwife

    Practitioner

    Senior nurse midwife

    practitionerNurse Midwife

    Practitioner

    10,000-15,200

    8000-13,500

    6500-10,000

    5500-9000

    4

    6

    30

    3016

    12.02 lakh

    14.76 lakhs

    50.07 lakhs

    43.43 lakhs

    Research findings

    1. Health CareSeeking Practices of Pregnant Women and the Role of the Midwife in Cape Town,South Africa

    Naeemah Abrahams rn, rm, mphil, Rachel Jewkes mbbs, msc, mfphm, md, Zodumo Mvosocsc (hon), mphil(Journel for Midwifery & womens health, volume 46, issue 4, pageno:240-247)

    ABSTRACT

    The objective of this study was to investigate the health-seeking practices of pregnant women in

    a periurban area in Cape Town, South Africa. This qualitative study was based on 103 minimally

    structured in-depth interviews of 32 pregnant women. Most women were interviewed on several

    occasions, and a group discussion was held with women. The interviews were taped, transcribed,

    analyzed ethnographically, and, if necessary, translated into English. Antenatal care attendance

    was influenced by a number of factors, including women's knowledge of the role of antenatal

    care, perceived health needs, booking systems, nurse-patient relationships, economics, child care,

    and transport. The expected benefits were weighed against the anticipated costs before decisions

    about seeking care were made. The findings highlight the importance of women's perceptions of

    quality of care in influencing their health seeking practices. The study suggests that considerably

    more attention needs to be given to this aspect of maternity services.

    http://onlinelibrary.wiley.com/doi/10.1016/S1526-9523(01)00138-6/full#fn2http://onlinelibrary.wiley.com/doi/10.1016/S1526-9523(01)00138-6/full#fn2http://onlinelibrary.wiley.com/doi/10.1016/S1526-9523(01)00138-6/full#fn2http://onlinelibrary.wiley.com/doi/10.1016/S1526-9523(01)00138-6/full#fn3http://onlinelibrary.wiley.com/doi/10.1016/S1526-9523(01)00138-6/full#fn3http://onlinelibrary.wiley.com/doi/10.1016/S1526-9523(01)00138-6/full#fn4http://onlinelibrary.wiley.com/doi/10.1016/S1526-9523(01)00138-6/full#fn4http://onlinelibrary.wiley.com/doi/10.1016/S1526-9523(01)00138-6/full#fn4http://onlinelibrary.wiley.com/doi/10.1016/S1526-9523(01)00138-6/full#fn4http://onlinelibrary.wiley.com/doi/10.1016/S1526-9523(01)00138-6/full#fn3http://onlinelibrary.wiley.com/doi/10.1016/S1526-9523(01)00138-6/full#fn2
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    2.Childbirth as healing: three women's experience of independent midwife care

    M Milan

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

    Abstract

    This article sets out to demonstrate that, for some women, childbirth may be experienced as healing and

    life-changing. The author works as an independent midwife. Interviews with three ex-clients were

    analysed, and the common themes identified and grouped. The three women had negative memories of

    the birth of their first child, but all birthed their second babies at home. The quality of care received was

    described as empowering, reassuring and emotionally supportive. Practical inputs such as listening

    presence, information, referrals, touch, were all identified as facilitative. The women framed their

    perception of the changes which had occurred in terms of reassessment of themselves and their

    capabilities in the light of the achievement of the birth experience.

    Conclusion

    The role of midwife is very important. Every midwife should know the scopes of midwifery practices

    and the role played by independent nurse midwife practitioner in the society, to provide the best and safe

    care for the mother and the child.

    REFERENCE

    1. Varney Helen, Kriebs M Jan, Varneys Textbook of Midwifery , All India Publishers andDistributors,2005, IVth edition, Page no: 3-4

    2. Henderson Christine, Myles midwifery , A textbook of Midwifery , published by Davis KarleneDame,2004, 13

    thedition, page no: 433-434

    3. Wrong L Donna, Hockenberry J Marilyn, Perry E. Shannor, Lowermilk Leonard Dietra,Maternity Child nursing Care, published library of congress, 2006, 3

    rdedition, page no:299-300

    4. http://scholar.google.co.in/scholar?q=independent+midwife&hl=en&as_sdt=2%2C55. http://scholar.google.co.in/scholar?hl=en&q=role+of+midwife&btnG=Search&as_sdt=2%2C5&a

    s_ylo=&as_vis=0

    http://scholar.google.co.in/scholar?q=independent+midwife&hl=en&as_sdt=2%2C5http://scholar.google.co.in/scholar?q=independent+midwife&hl=en&as_sdt=2%2C5http://scholar.google.co.in/scholar?hl=en&q=role+of+midwife&btnG=Search&as_sdt=2%2C5&as_ylo=&as_vis=0http://scholar.google.co.in/scholar?hl=en&q=role+of+midwife&btnG=Search&as_sdt=2%2C5&as_ylo=&as_vis=0http://scholar.google.co.in/scholar?hl=en&q=role+of+midwife&btnG=Search&as_sdt=2%2C5&as_ylo=&as_vis=0http://scholar.google.co.in/scholar?hl=en&q=role+of+midwife&btnG=Search&as_sdt=2%2C5&as_ylo=&as_vis=0http://scholar.google.co.in/scholar?hl=en&q=role+of+midwife&btnG=Search&as_sdt=2%2C5&as_ylo=&as_vis=0http://scholar.google.co.in/scholar?hl=en&q=role+of+midwife&btnG=Search&as_sdt=2%2C5&as_ylo=&as_vis=0http://scholar.google.co.in/scholar?hl=en&q=role+of+midwife&btnG=Search&as_sdt=2%2C5&as_ylo=&as_vis=0http://scholar.google.co.in/scholar?q=independent+midwife&hl=en&as_sdt=2%2C5

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