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INTRODUCTION OF
MIDWIFERY AND
REPRODUCTIVE HEALTH
*Midwifery is defined as the art of assisting
woman at childbirth.
*The word is synonymous with obstetrics,
which is defined as a branch of medicine that
deals with pregnancy and childbirth.
*Obstetric IS a branch of medicine that deals
with parturition ,is most ancient medical art.
*The term obstetric is derived from the Latin
word for midwife, is of recent introduction,
until the late 19th century the word midwifery
was generally used.
*1.1 Definition of Midwifery

*Midwifery (mid means ‘with’ and wif

means ‘wife’ or women): obstetrics deals
with that branch of medicine providing
care for parturition (childbirth), its
antecedents (pregnancy) and sequels
(postnatal).
 *Contd…
*The subject of midwifery is divided into 3
parts; prenatal, natal and postnatal care.
Prenatal care: This includes the study of
maternal condition, physiological changes
and other necessary topics from
conception to term. This includes
physiology of conception, fetal and
placental development, physiological
changes, minor and major problem of
pregnancy and their management.
 *Contd…
Intranatal care: This includes the initial
of labour, delivery of baby and placenta,
management of complications during
labour and delivery and care of baby and
mother throughout 1-2 hours of delivery.
Post natal care: This includes the part of
the following delivery after 1-2 hours to 42
days of child birth. In this part we have to
study the physiological changes after
delivery, minor and major disorder during
puerperium.
*Definition of Midwife
*A midwife is a person who having been
regularly admitted to a midwifery
educational programme duly recognized in
the country in which it is located, has
successfully completed the prescribed
course of studies in midwifery, has
acquired the requisite qualifications to be
registered and/or legally licensed to
practice midwifery.
 *1.3History of Midwifery
*The history of midwifery is a long and
interesting one. Women of all ages and
countries have done noble work as
midwives throughout the countries.
*Until the end of 16th century, midwifery
was practiced entirely by women. Men
could be severely punished for attending
women in childbirth.
*In the 17th century, male midwives began
to take up midwifery.
 *Contd…
*By the middle of 18th century, the number of
male midwives have increased.
*During the 19th century, several hospitals
began to train midwives and to issue
certificates.
*In 1972, a definition of the midwife was
developed by the International Confederation
of Midwives (ICM), which is adopted by the
International Federation of Gynaecology and
Obstetric (FIGO) followed by the World Health
Organization (WHO) in 1992.
 *Contd…
*The function of midwifery is recorded at the end
of 16th century.
* The first book on Midwifery was published in 1513
AD in Germany.
*This book was later translated into English in 1540
AD.
* However, in those days, even in Europe the
literacy rate of women was almost nil.
*Therefore the so called midwifes could not make
used the book and the work of midwifery was
carried out merely by experience and perhaps by
trial and error methods.
 *Contd…
*The first person to practice the modern art of
obstetrics was a French Surgeon named Ambroise
pare.
*At the end of 16th century, he opened a school on
Paris.
*In 18th century, formal instruction on midwifery
was started in Edinburgh.
*In Nepal, births were attended by experienced
person. They were called sudeni, TBA or Ajee and
who were called upon if the spontaneous birth was
delayed.
 *Contd…
*These sudeni pass on their knowledge and
skills to their own family members such as
daughter, sisters,etc.
*However training for these midwives was
started by Nepal Red Cross Society and
Woman’s Organization.
*Then, it is given by Department of health
Service and training section of health
department (NHTC).
 *Contd…
*In 1928 AD (1985 BS) first group of ladies
were sent to India (Allahbad) for 18 months
midwifery training in Rana period namely
Vidyawati Kansakar, Radha Devi Malakar,
Dharma Devi Kansakar, Bishnu Devi Rai, who
upon returning worked at Bir hospital.
*Then 2nd lot, 2 ladies (Dr. Uma Devi Das and
Rukmini Charan Shrestha) were sent to India
on 1952AD (2009BS) for 3 ½ yrs nursing
course with 1 year internship.
 *Contd…
*After then, on 1953 AD, 3rd lot ladies were
sent to Delhi for midwifery training. After
establishment of the Maternity Hospital
Thapathali, midwifery training began in
Nepal.
*In curriculum of TU, CTEVT, KU, NAMS and
BPKIHS, midwifery is included in the 3 years
programme on PCL nursing programme.
Midwifery is considered as absolute necessity
for nurses working in any area, urban or rural.
 *Contd…
*Midwifery is main component of ANM
curriculum. In 1977, the Bachelor of
midwifery started. The first 2 batches of
nurses comprised a total of 22 nurses.
*Under affiliation of Purbanchal University,
Bachelor of Midwifery was started from 2002.
Nowadays, the NHTC provide training to
nurse on essential obstetric care, Midwifery
refresher training, emergency, management
etc and WHO provide training guidance for
nurses.
*Safe motherhood and NFHP in
collaboration with Family Health
Division of DoHS providing SBA,
CAC and PAC training for
different level of health workers
in Nepal.

*Contd…
 *1.2 Midwifery Terminology
*Neonatology: means branch of medicine dealing
with neonate (newborn). Neonatal period is 4
weeks of infant's life after birth.
*Reproduction: means process by which a fully
developed offspring of its kind is produced.
*Genetic (of origin): means study of heredity and
its variation.
*Pregnancy: is state of carrying fetus inside uterus
(womb) by a woman from conception to birth. Baby
inside uterus is called fetus.
*Gestation: means pregnancy. Duration of
normal pregnancy is 280 days (from 1st day of
last menstrual period) or 40 weeks or 9
calendar months and 7 days.
*Gestational age: is the duration of gestation
from 1st day of last menstrual period.
Gestational age is expressed in completed
days or completed weeks.
*Trimester: of pregnancy of 3 months period.
*first trimester: is 12 weeks period from 1st
day of last menstrual period.
*Second trimester: Is second three months
from 13 to 28 weeks.
*Third trimester: is third three months of 29 to
40 weeks.
*Labour (delivery): means process of
childbirth.
*Natal: means ‘of birth’.
*Antenatal or prenatal: means before births.
*Intranatal or natal: means during birth.
*Postnatal: means after birth.
*Maternal: relates to state of reproduction in a
woman (pregnancy, childbirth and postnatal period
up to 42 days).
*Perinatal: is the period from 28 weeks of pregnancy
(or 1000 gm and above fetus) to 7th days of birth
(early neonatal life). In view of increased survival of
very low birth weight babies by improved perinatal
care. Extended perinatal period means period from
22nd weeks of pregnancy (or 500gm and above fetus)
to 7th days of life ( as per WHO, 1976)
*Gravida: is pregnant state irrespective of its
duration.
*Para: refers to state of a woman who has
given birth to a baby at or after the age of
viability i.e. 22 weeks.
*Primigravidae: is a woman carrying first
pregnancy.
*Multigravidae: is a woman carrying
pregnancy more than once.
*Primiparae: is a woman who delivered once
of a fetus or fetuses at or after the age of
viability (22 weeks).
*Multiparae: is a woman who delivered more
than one fetus or fetuses at or after the age
of viability.
*Nulliparous: is a woman who has not given
birth to fetus at or after the age of viability.
*Expected date of delivery (EDD): this is
calculated by adding 9 calendar months and 7
days to first day of last menstrual period
provided menses are regular and normal 28
days cycle. This is called Naegele’s Rule.
*Maternal and child health (MCH): related to
the health of mother during pregnancy,
childbirth and postnatal period and that of
child up to 5 years.
*Birth: is complete expulsion or extraction of
a fetus weighing 500 gm.
*Live birth: is complete expulsion or
extraction of a product of conception,
breathe or show any other ‘evidence of life’
birth is considered live born.
*Abortion: an expulsion or extraction of
products of conception weighing less than 500
gm before viability (22 completed weeks of
gestation), whether or not the abortion was
spontaneous or induced. Previously abortion is
taken as termination of pregnancy before 28
weeks.

*Embryo: is early fetus up to 8 weeks of

pregnancy.
*Fetus: is intrauterine baby from 9-40 weeks
pregnancy.
*Immature fetus: 500 gm or less than 1000
gm (less than 28 weeks).
*Premature fetus/preterm: 28 weeks to less
than 37 completed weeks (less than 259
days).
*Term: pregnancy 37 completed week less
than 42 completed weeks (259 to 293 days)
*Post term: is pregnancy of 42 completed
weeks or more (293 days or more).
*MTP: is medical termination of pregnancy.
This is procured legal abortion done as a
health measure to protect a woman against
death and disease due to criminal abortion.
*Birth weight: the first weight of an infant
within first 60 completed minutes after birth
*Birth time: In hour and minutes the time of
completed expulsion of baby from birth canal.
*Low birth weight: is baby weighing less than
2500 gm(up to and including 2499gm).Full
size baby weigh 2500gm or more.
*Intrauterine growth retardation :(IUGR) is
baby with lower weight than gestational age
(below 10th percentile of weight curve).
 *1.6 Ethics in Midwifery
Code of Ethics:
A code of ethics is a public declaration of the
beliefs and values of a profession and the
members of that profession.
This code makes public the goals, values and
morals of those who call themselves
“midwives”.
 *ICM Code of Ethics in Midwifery
Regulations
*The Code of ethics in Midwifery that defined
the moral context of Midwifery in meeting
the needs of women came from the ICM
Board of Management during the mid 1980s.
*The ICM International Code of Ethics for
Midwives was revised and re-confirmed at
the meeting of the International Council in
May 1999, in Manilla, The Philippines.
*A code of ethics is not a dry dusty
piece of paper, it is a living
breathing embodiment(a very good
example) of the spirit of midwifery
and we are the ones that make it
not only live, but sing and dance
with the joy of itself.

*Continue
 *Aims of ICM(International
Confederation of Midwives)

*To improve the standard of care are provided

to women, babies, and families throughout
the world through the development,
education, and appropriate utilization of the
professional midwife .
*The code acknowledges women as persons
with human rights, seeks justice for all people
and equity in access to health care, and is
based on mutual relationships or respect, trust
and the dignity of all members of society.
 *The code in Midwifery
1)Midwives Relationships
a. Midwives respect a women’s informed right
of choice and promote the women’s
acceptance of responsibility for outcomes of
her choice.
b. Midwives work with women ,supporting their
right to participate actively in decisions
about their care and empowering women to
speak for themselves on issues affecting the
health of women and their families in their
culture/society.
 *continue
c. Midwives support and sustain each other in
their professional roles.
d. Midwives ,together with women, work with
policy and funding agencies to define
women’s needs for health and ensure that
resources are fairly allocated considering
priorities and availability.
e. Midwives work with other health
professionals, consulting and referring as
necessary when need for care exceeds the
competencies of the midwives
 *continue
f. Midwives recognize the human
interdependence within their field of
practice and actively seek to resolve
inherent conflicts.

g. The midwives has responsibility to her or

him as a person of moral worth including
duties of moral self respect .
 * 2)Practice of midwifery:-
a. Midwife provide care for women and
childbearing families with respect for
cultural diversity while also working to
eliminate harmful practices with in those
same culture.
b. Midwife encourage realistic expectation of
child birth by women within their own
society with the minimum expectations
that no women should be harmed by
conception or childbearing.
c. Midwife use their professional knowledge to
ensure safe birthing practices in all
environments and culture.
d. Midwives respond to the psychological
,physical ,emotional, and spiritual needs of
women seeking health care, whatever their
circumstances.
e. Midwives act as effective role models in health
promotion for women throughout their life cycle
for families and for other health professionals.
f. Midwifes actively (achieve) seek personal,
intellectual and professional growth throughout
their career, integrating (join) this growth into
their practice.
3)The professional responsibility of midwives
a. Midwives hold in confidence client
information in order to protect the right to
privacy and use judgment in sharing the
information
b. Midwives are responsible for their decisions
and actions and are accountable for the
related outcome in their care of women.
c. Midwives may refuse to participate in
activities for which hold deep moral
opposition .
 *continue
d.Midwives understand the adverse
consequences that ethical and human
rights,voilations have on the health of
women and infants. and will work to
eliminate these violation.
e.Midwives participate in the
development and implementation of
health polices that promote the health
of all women and childbearing families.
4)Advancement of midwifery knowledge
a. Midwives ensure that the advancement
of midwifery knowledge is based on
activities that protect the rights of
women as person
b. Midwives develop and share midwifery
knowledge through a variety of process such
as peer review and research.
c. Midwives participate in the formal
education of midwifery students and
midwives.