INTRODUCTION TO

MIDWIFERY &
OBSTETRICAL
NURSING

PREPARED BY:
DEBALINA GHOSH
P G TUTOR
• 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.
• Gynecology 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.
• Gravida 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.
• Primigravida is a woman carrying first pregnancy.
• Multigravida 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 women’s 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. 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 personnel ANM 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. To avoid duplication of services
3. To give health education
4. To participate in country’s concern i.e. maternal and child
welfare
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
today’s 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 individual’s conditions including
predictable success rates, side effects and risks.
3. The implications for the individual’s general, sexual and
reproductive health and lifestyle declining any of the
options or suggestions.
4. The health provider’s 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 patient’s
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 individual’s
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 patient’s 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 patient’s
information against unauthorized disclosures.
•  Patient’s right to know what their health care providers
think about them.
•  Health care provider’s 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,
behavioral and social health interventions to women and
couples before conception occurs.
• It aims at improving their health status, and reducing
behaviors 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 women’s 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 women’s birth
experience regardless of risk factor.
• Leader: 
• The role of leader is to plan, provide and review a women’s
care, with her input and agreement, from the initial
antenatal assessment through to the postnatal period.
Midwife’s 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.
 REFERENCE

• https://www.um.edu.mt/__data/assets/pdf_file/0018/
147033/midwiferyeduc.pdf
• http://ecommons.aku.edu/cgi/viewcontent.cgi?
article=1004&context=jam