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SUBMITTED ON 06 /11/2013

The role of a midwife whether she practices in hospitals, health centers, or
domiciliary conditions has been recognized as one of the most rewarded job.
Her function carries great responsibilities and demands, specific knowledge
and skills. They play a central role in health care delivery- promotion,
prevention, treatment and rehabilitation, in areas of great health needs,
especially in remote areas. The midwife may practice in any setting
including the home, the community, hospitals, or in any other maternity
services. In all settings the midwife remains responsible and accountable for
the care she provides.
According to ICM membership (International confederation of midwives) and
joint study group of maternity care and WHO, the term midwife id defined as

A midwife is a person who, having been

regularly admitted to a midwifery educational
program duly recognized in the country in which it is
located has successfully completed the prescribed
course of studies in midwifery and has acquired the
requisite qualification to be registered and or legally
licensed to practice midwifery.

Care of women during pregnancy, childbirth, and postnatal period.

Serve as a guardian of normal birth alert to possible complications.
Treat complication due to miscarriage and unsafe abortion.
Pregnancy advices and health education.
Newborn care.

Recognizing and addressing problems in the women and newborn

before, during and after child birth.
Assist women to successfully breast feed.
Refer women and new born to higher level of care.


A nurse clinician is a registered nurse who has gotten the needed
special training that enable him/her to be able to perform numerous of
the duties of a physician.
The nurse clinician uses advanced clinical nursing skills to assess, plan,
implement and evaluate patient care for patient in a specialty area.
Coordinate and handles administrative duties associated with clinical
operations and patient scheduling.
Facilitates patient flow and patient education. Refers patient for further
care or services.
Ensure the supply needed for the operations of clinic.
Maintains required documents and record.
Clinical nurse specialists are advanced practice nurse who hold a master or
doctorate degree in a specialized area of nursing practice. Clinical nurse
specialist provide direct patient care, serve as expert consultants for nursing
staff, and takes an active hand in improving health care delivery systems.
WHNP focuses on the primary health care needs of women across the
lifespan from adolescent through menopause and beyond, with an emphasis
on reproductive gynecological health. she will be a specialist in the field of
womens health addressing a range of womens health issues ,including
normal pregnancy, prenatal management, family planning, well women
health care, uro-gynecology, aesthetic and menopause.


Certified nurse midwife are licensed health care practioner educated in the
two disciplines of nursing and midwifery. They provide primary health care
to women of childbearing age including prenatal care, labour and delivery
care, care after birth, gynecological exam, newborn care, assistance with
family planning decisions, preconception care, menopause management
and counseling in health maintenance and disease prevention.
Meet the health care needs of the family by providing health assessments,
direct care, guidance, teaching or counseling as particular around family self
care. The family nurse consultant typically works collaboratively with family
primary care, Physicians and other professional within the health care
system. The family health care consultant may follow families in a variety of
setting such as school, homework place or hospital depending upon the
client needs.
The nurse consultant will practice autonomously at an advanced level
in the delivery of high quality, safe and effective care.
The nurse consultant role blends a significant proportion to direct,
higher level clinical care with education, research, management and
The nurse in this role will focus on the delivery and maintenance of
clinical excellence, provide an expert consultancy service to patient
and colleague.
Plan, implement and evaluate evidence based care, contribute to the
development of services by taking an active role in generating and
disseminating knowledge across the organization.
They undertake research in a specialist area that focuses on improving
outcomes and experiences for patient and families.
Facilitate and provide education and training to staff and students.
Nurse researchers are scientists who study various aspects of health
illness and health care.

By designing and implementing scientific studies, they look forward to

improve health, health care services and health care outcomes.
Nurse researcher identifies research question, design and conduct
scientific studies, collect and analyze data and report their findings.
Many nurse researchers teach in academic or clinical setting and often
write article and research report for nursing, medical and other
professional journal and publications.
Nurse educationalist is a person who is a specialist in the theory and
method of nursing education.


The midwife works in partnership with women, on her own professional
responsibility, to give women the necessary support, care and advice
during pregnancy, labour and the postpartum period to facilitate birth
and to provide care for the new born.
The midwife has an important role in health and wellness promotion
and education for the women, her family and the community.
The midwifery practices involve informing and preparing the women
and her family for pregnancy, birth, breast feeding and parenthood and
include certain aspect of womens health, family planning and infant
well being.
The midwives play an important role in providing essential health care and
emergency health care.
Essential obstetrical care:
Intends to provide the basic maternity services to all pregnant women
Early registration of pregnancy (within 12-16 weeks)
Provision of minimum three antenatal checkups by ANM or medical
officer to monitor progress of pregnancy and to detect any risk or
complication so that appropriate care including referral could be done
in time.

Provision of safe delivery at home or in the institution.

Provision of three postnatal checkups to monitor the postnatal recovery
and to detect complication.
It is more relevant for Assam, Bihar, Rajasthan, Orissa, Uttar Pradesh and
Madhya Pradesh as most of the deliveries in these states are conducted at
home in unclean environment causing high maternal morbidity and
mortalility rate.
Emergency obstetric care
Complications associated with pregnancy are not always predictable; hence
emergency obstetric care is an important intervention to prevent maternal
mortality and morbidity. Main emphasis is on 5 major problems which cause
maternal mortality- hemorrhage, sepsis, unsafe abortion, hypertensive
disorder and obstructed labour which can be treated at a well staffed, well
equipped health facility. There are mainly three levels on emergency
obstetric care-primary, secondary and tertiary

Primary level
Care would be provided in the community, birth center public
maternal unit and private hospitals or in combination.
E.g. Women would receive all her antenatal care in the community, labour
and child birth would be in hospitals.
Secondary level
Provide additional care during the antenatal, labour and birth and
postnatal period for women and babies who experience complications and
who have clinical needs for referral or transfer
Tertiary level
These services provide multidisciplinary specialist team for women and
babies with complex and or rare feto-maternal needs who require access to
specialist services.
These services provide multidisciplinary specialist team for women and
babies with complex and or rare feto-maternal needs

According to W.H.O the emergency obstetric care is provided by giving

emphasis on three main aspects

The care provided at health center, large or small, include capabilities for
Obstetric first aid
Administration of antibiotics, oxytocin and anticonvulsant.
Basic emergency obstetrical care
Along with obstetrical first aid

Manual removal of placenta

Removal of retained products following miscarriage or abortion
Assisted vaginal delivery, preferably with vacuum extractor
Newborn care

Comprehensive emergency obstetric care

This include all the basic function given above plus,

The cesarean section

Safe blood transfusion
Care of sick and low birth weight newborns including resuscitation
Family planning services

Three phases are included

P h a s e IIIIII

The nurse midwife plays an important part in all areas of womens health
care. The scope of midwife can be explained through their role in the
following field namely;

Adolescent girl care

Preconception care
Maternal care
Newborn care


Various services/program/yojana are developed aiming at improving the
nutritional and health status of adolescent girls and promoting self
development, awareness of health, hygiene, nutrition, family welfare and
management. It is well recognized that these program when provided could
significantly improve the health and nutritional status of women and
children and promote the decision making capabilities of women. The
midwife should be aware of these yojana and some of them include
Sabala yojana
It is also known as Rajiv Gandhi scheme of empowerment of adolescent
girls. The proposal intend to empower adolescent girls of age group 11 18
years with spotlight on educating girls, development in their dietary and
health, and upgrading diverse skill like home talent, life skill and vocational

talents. It targets outfitting girls on family benefit, health sanitation and

information and direction on current public facilities along with targeting
girls who are out of schools.
Kishori sakti yojana
It is for addressing the needs of self development, nutrition and health
status, literacy and numerical skills, vocational skills etc of adolescent girls.
Swawlamban yojana
At Swawlamban yojana scheme, funded by department of women and child
development of Rajasthan state government, they train 30 women and
adolescent girl in readymade garment skills within 2 months, from Monday
to Friday two hours every day.
Poorak poshaahar yojana
In order to improve the nutritional status the Poorak poshaahar scheme
provides supplementary nutrition to the children between six month and six
year of age, pregnant and lactating women and adolescent girls. The
beneficiaries of this scheme are identified by the anganwadi workers and
the distribution of the supplementary nutrition is done.
Nutritional program for adolescent girls
To address the problem of under nutrition among adolescent girl and
pregnant women and lactating mother, the planning commission in the year
(2002-2003) launched the nutritional program for adolescent girl. Under this
project 6 kg of food grains were given to under nourished adolescent girl,
pregnant and lactating mother. Eligibility is determined on the basis of their
Kasturba Gandhi balika vidyalaya scheme
Provide educational facilities for girl belonging to SC, ST, minority
communities and families below the poverty line in educationally backward


Preconception care is the care that the women receive before she gets
pregnant. It involves finding and taking care of any problem that may affect
the women and her baby later. By taking action on health issue before
pregnancy, any future problem to the mother can be prevented. When a
couple is seen and counseled about pregnancy, its course and outcome well
before the time of actual conception is called preconception counseling.
Objective is to ensure that women enter pregnancy with an optimal state of
health which would be safe both to herself and the fetus. The three aspects
included in the preconception care are educational, informational and
Education should be provided on ideal age of pregnancy. Patient with
medical condition should be educated about the effect of disease on
pregnancy. The couple should be educated about avoiding the hazardous
working environment. Women should be urged to stop smoking, taking
alcohol and abusing drug. Couple should be also educated to do life style
Preconception care include helping to assess and identify
Nutritional status: supplement of folic acid or supplementation of
micronutrients such as iron, iodine and folic acid
Pre existing medical condition: treatment of conditions such as obesity,
diabetes, epilepsy, hypothyroidism and hypertension.
Infectious diseases: vaccination against rubella, varicella, hepatitis B;
screening for HIV/AIDS and other sexually transmitted infections
Family planning for appropriate timed pregnancy
Drugs used are verified and changed if required
Maternal health is optimized.
It is the science of improving a population by controlled breeding to increase
the occurrence of desirable heritable characteristics. Its a belief to improve
the qualities of human species or a human population, especially by means
of discouraging reproduction by persons having genetic defect or presumed
to have inheritable undesired traits(negative eugenics) or encouraging

reproduction by persons presumed to have inheritable desirable

traits(positive eugenics). This process is mainly done through genetic
Genetic counseling
Genetic counseling is seeked by couples with
A family history of genetic condition, birth defect, chromosomal
Two or more pregnancy looses.
A child with known inherited disorder.
Women who is pregnant or plan to become pregnant at 35 years of age
or older.
People related by blood who want to have children.
Genetic screening include
Screening of inherited genetic disease.
Prenatal diagnosis of chromosomal or genetic disease.
Management of inherited genetic disease prevention eliminating the
casual factor or by secondary prevention (terminating the affected
During antenatal period
Antenatal care
Antenatal care is the care of the women during pregnancy. The primary aim
of antenatal care is to achieve at the end of pregnancy a healthy mother
and a healthy baby.

During the first antenatal visit the midwives should

Take health history
Physical examination
Laboratory examination
1. Complete urine analysis
2. Stool examination
3. Complete blood count, including Hb estimation
4. Serological examination
5. Blood grouping and RH typing



6. Chest X-ray
7. Pap test
8. Gonorrhea test if needed
On subsequent visit
Physical examination (weight gain, blood pressure)
Laboratory test should include urine examination, hemoglobin
Iron and folic acid supplement and medication as needed
Immunization against tetanus
Group or individual instruction on nutrition, family planning, self care,
delivery and parenthood.
Referral services, where necessary.
Antenatal advices on Diet
Rest and sleep
Dental care
Care of breast
Smoking and alcohol
General advice

During intranatal period

Child birth is a normal physiological process, but the midwives should be
able to deal with complications that may arise. Septicemia may result from
unskilled and septic manipulation. Tetanus neonatrum can occur from use of
unsterilized instruments. The need for effective intranatal care is therefore
The emphasis is on clean hand and fingernails, clean surface for
delivery, clean cutting and care of cord, keeping the birth canal clean
by avoiding harmful practices.
Thorough sepsis should be maintained.
Delivery should be done with minimum injury to infant and mother.
The midwife should be ready to deal with any complications that arise
during pregnancy.

Rooming in should be practiced.

During postnatal period
It is the care of the mother after delivery
Provide care for the rapid restoration of the mother to optimum health.
Check adequacy of breast feeding
Women and her family should be encouraged to tell their health care
professional about any change in mood emotional state and behavior
that are outside of the womens normal pattern.
At each postnatal visits parents should be offered information and
advice to enable them to
Assess their babies general condition
Identify sign and symptoms of common health problem seen in
Contact a health care professional or emergency service if required.

Immediate care

Neonatal assessment
General appearance

Head circumference should be around 33- 35.

Chest circumference should be 30.5 33.
Assess anterior and posterior fontanels
Temperature should be 36.5 -37 degree Celsius
Heart rate should be 120- 160
Breathing should be 30-60 breath/second.
Assess for apgar score
Assess for reflexes.

A study was conducted to assess the scope and practice among staff nurse
in Gujarat and the study revealed that the scope is limited as compared to
international standards of midwives. Their right to practice was not legally
defined, but they were not specially prohibited from practice. As a

consequence the staff nurse faced loss of skills as their practice was
restricted. The clinical midwifery education of nursing and midwifery
student was marginalized because the education of medical students was
given priority, and the students got only exposed to restricted practice of
staff nurse.
The midwife is a person who has undergone a prescribed training and has
been certified by a statutory body appointed by a national government to
undertake the responsibility of giving the necessary care and advice to
women during pregnancy, labour and postnatal period. In this topic the
various position handled by the midwife and their role in providing care to
the mother and child is discussed.


1. Kaminio Rao. The text book of midwifery obstetric for nurses. 1 st

edition. Elseiver. Page no. 17.
2. D.C.Dutta. Text book of obstetrics. 6th edition. New central book
publisher. Page no 105.
3. M.C. Gupta. Text book of preventive and social medicine. 3 rd edition.
Jaypee. Page no. 534.
4. Chris Henderson. Mayes Midwifery-A text book of midwives. 13 th
edition. Baillierra Tindall publisher