Lecturer

Muna Abdirahman yasin

Introduction of midwifery
Chapter One
Objectives

By the end of the session the students will be able to.

• understand the definition of midwifery
• To describe the care that midwife provide to the
mothers and newborn.
• To determine the principles of midwifery and cultural
awareness
• To distinguish qualified midwife and traditional birth
attendance (TBA )
• To understand the responsibility of midwifery
• to list the roles of midwife
Definition

• Midwife is recognized as a responsible and

accountable professional who works in partnership
with women (definition of. international
confederation of midwives (ICM) world health
organization (WHO) international federation of
gynecology and obstetrics( FIGO) )
• A midwife is a trained health professional who
helps healthy women in early pregnancy, during
labor, delivery, and after birth of
newborn(postpartum)
History of midwifery

Although the midwifery were slow to grow, they proved to be

enduring
The word midwife is meaning “with women”

In a ancient time midwifery had both technical and magical

aspects

During the 15th and 16th century midwives were burnt because of
the people perception of them as being companions of the devil.

in early Greeks and roman times midwives were the caregivers

to women during their monthly cycle
Cont..
Midwives used herbs and potion routinely before the
discovery of modern day medicine
In 1925,mary Breckinridge established frontiers nursing
service.
In 1928, the first professional organization for nurse-
midwives began establishment of American Association
of nurse-midwives
In 1955, the American college of nurse-midwives
chartered.
Between the 1970-1980’s midwifery began to grow
rapidly
What is midwife and who then is a midwife

According to WHO{2013}midwifery encompasses

care of women during pregnancy, labor and
postpartum period as well as care of newborn
International confederation of midwives{2014} state
that a midwife is a person who has acquired requisite
qualifications to be registered and legally licensed to
practice midwife and uses the title ‘midwife’ and who
demonstrates competency in the practice of
midwifery
Categories of midwifery profession

During the 1970’s there were three categories of

midwives:
• Granny midwives
• Lay midwives
• Traditional birth attendants
Formal education has improved aspects of midwifery
and classified them into two main categories
• Certified nurse-midwife
• Direct entry midwife
Role of midwife

Promote health and self care to expectant mother,

infant , and families
Serves as an advocate for women e.g. cultural
sensitivity
Focuses on health promotion and disease preventions
Respect for human dignity and women as person with
full human rights and autonomy's of women

Although all midwives attend births in hospital they

may also work in homes clinics, communities and
maternal units.
Principles of midwife

To being primary care providers midwifery care is

shaped by five basic principles
• Continuity of care
• Informed choice
• Community-based
• choice of birth sitting and
• evidence informed practice
Continuity of care

• A woman’s relationship with their pregnancy care

providers is vitally important.
• Not only are these encounters the vehicle for
essential lifesaving health services, but a family’s
experiences with caregivers can empower and
comfort or inflict lasting damage and emotional
trauma. The midwifery approach starts in the
relationship through which they work with women
a reciprocal partnership getting to know and trust
each other over time.
Cont..
continuity of midwifery care, provided by team and
caseload midwife based on 15 trials involving 17,674
women, found benefits in maternal and neonatal
health outcomes with the continuity of midwifery
care model.
INFORMED CHOICE

Working in partnership with means working together to

support childbearing women to make decisions about
their own care. Midwives recognize the woman as the
primary decision-maker for the course of her care. They
support the woman’s rights to make informed choices,
and support thoroughly informed decision-making by
‘providing complete, relevant, objective information in
a non-authoritarian, supportive manner.
defines informed choice as a ‘collaborative information
exchange between a midwife and woman that supports
woman decision-making.
Cont..
informed choice decision making does not result from one, time-
limited conversation. It may continue over several weeks or months
of a pregnancy, and be revisited during several visits with the
midwife.
•The process should therefore be seen as a circle rather than a list. In
describing this process with people who are making decisions at the
end of life, Gowanda (2014) talks about different levels, giving
information, providing consumer choices, or interpretive
conversations in which much of the care provider’s time is spent
listening.
Cont..
In order to do informed choice well, the woman needs
to have enough time to fully explore each topic.
Midwifery appointments tend to be thirty to forty-five
minutes long, for most of the pregnancy. This is for
the dual purpose of both supporting relationship-
building between the woman, their family, and the
midwifery team, and enabling informed choice
decision making.
Cont..
Finally, it is important to recognize that while we
profess to offer choice and support women in making
decisions, the agenda is ultimately set by the birthing
culture in which we live and work, the services
available, and the expectations created by those
services. The knowledge, values, language and style
of the midwife and other professionals will also
influence and inform interactions with the woman,
and ultimately, the decisions she makes.
COMMUNITY-BASED

Midwives were traditionally community-based

meaning that they were both part of and understood
the communities and life circumstances of those they
served. Community-based services still exist in many
developing countries but have been reduced and
limited in many parts of the worldwide. most
midwives practice out of community-based (rather
than hospital-based) clinics. The ability of midwives
to practice independently, outside the hospital setting,
creates an important conceptual (and political)
separation from the medical model of care
CHOICE OF BIRTH SETTING

The ability to provide choice of birth place is key to the

midwifery model of care, as it is intrinsically linked to informed
choice, and to the principle of providing true woman-centered
care, which focuses on the needs and desires of the childbearing
woman and her (self-defined) family.
Midwives provide information needed for the woman to make
an informed choice about the appropriate setting for her, in
which to give birth. Because the midwife is able to provide
evidence-informed care in any setting, the woman is then free to
make that decision based on her own needs and vision for her
birth.
Cont..
The availability of options where midwives may practice fully,
be they at home, in birth centers or in midwifery-supportive
maternity care units in hospitals, has helped move midwifery
and the re-development of midwifery skills and knowledge
forward.
Systems and protocols for consultation and referral and
respectful relationships with other professionals and birth
workers are essential components of safety in this regard. The
development of the appropriate care pathway, including the
provision of different places of birth is critical to effective
midwifery.
EVIDENCE-INFORMED PRACTICE

Finally midwives are committed to evidence-

informed practice. Evidence-informed practice uses
evidence to identify the potential benefits and risks of
any clinical decision. This means that the midwives
must commit to continually developing and sharing
midwifery knowledge. They must attend continuing
education opportunities in the field of midwifery and
obstetrics
 difference between qualified midwife and
traditional birth attendance (TBA)

• traditional birth attendants (TBAs) provided delivery care

throughout the world prior to the development of organized
systems of medical care. In 2016, an estimated 22% of
pregnant women delivered with a TBA, mostly in rural or
remote areas that lacked formal health services.
• Still active in many developing countries specially rural
they provide care, including support and advice, to women
during pregnancy and childbirth. Even though they
generally have no formal training and are not recognized as
medical practitioners, TBAs enjoy a high societal standing
and many families seek them as health care providers.
Cont..
• Midwives have the ability to perform physical
exams, prescribe medications, and order laboratory
tests.
• They are also able to provide prenatal care,
gynecological care, labor and birth care to help with
multiple stages of the life cycle.
• Their education and skill allow midwives to
counseling to women of all ages and provide health
education.
 cont..
Although midwives have many skills, here are the most common
ones
•Continuity of care
•Comprehensive Care
•Identify and assess during all stages of pregnancy
•To use judgment, skill and intuition in competent assessment and
response
•Appropriate equipment and treatment
•Medical consultation, collaboration, and referral
 Role and responsibilities

A midwife is a health care professional who provides health care services

for women including gynecological examinations, contraceptive
counseling, prescriptions, labor and delivery care. The midwife provides
expert specialized care during labor, delivery and after birth so that
midwife unique.
Eleven Various roles and responsibilities of a midwife have presented
here.
1. Caregiver:
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.
Cont..
2. 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.
3. Leader:
The role of a 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.
Cont..
4. Communicator:
As a communicator, the midwives understand the effectiveness of
communication. It helps to develop a 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.
5. Manager:
The manager is a great role for the midwife. Midwives manage all the
circumstances where appropriate and can recognize and refer women
to obstetricians and other specialists at a time when necessary.
Cont..
6. Educator:
As an educator, midwives provide high quality, culturally sensitive health
education to promote healthy, helpful family life, and positive parenting.

7. Counselor:
Midwives provide information and counsel pregnant women on prenatal
self-care including nutrition, hygiene, breastfeeding, and danger signs in
pregnancy and childbirth.

8. Family planner:
They also counsel people as a family planner. They provide all
information about all kinds of family planning methods and help couples
to take decisions.
Cont..
9. Adviser:
Midwives advise on the development of the birth plan and
promote the concept of birth preparedness. They also advise on a
complicated situation so that it will help them to take decisions.

10. Record-keeper:
Record keeping is an integral part of midwifery practice. It helps
to make the continuity of care easier and to enable identify
problems in an early stage.
Cont..
11. Supervisor:
Supervising and assisting mothers during the antenatal
period, monitoring the condition of the fetus and using
their knowledge to identify early signs of complications.
Difference between midwife and doctor

•One of the main differences between a midwife and a doctor is the

type of education they receive. An obstetrician is a doctor that
specializes in pregnancy and birth. He or she has gone to medical
school many years and is trained to do surgery. Obstetricians don’t
attend home births. A small few attend births at birth centers.

•A midwife is trained in all things related to pregnancy and birth,

but does not go a long time to medical school. Although midwives
don’t carry the title of doctor, they are no less competent to provide
care for pregnancy and birth. In fact, countries where midwifery
care is the norm have the best outcomes for both moms and babies.
Cont..
• Midwives specialize in low and moderate risk
pregnancies in healthy women. Midwives only refer
women to physicians when there is a problem, and
they do not perform C-Sections. Some midwives
attend homebirths, and some only work in hospitals
Different Models of Care

•There are two general models of care for pregnancy and birth. One is the
midwifery model of care and the other is obstetrical management.

•Under the midwifery model of care, pregnancy and childbirth are considered
normal events, not medical ones. The focus is on preventative care during
pregnancy.

•Prenatal appointments with midwives are generally longer. Midwives take a

lot of time to answer questions and talk about nutrition.

•The use of the midwifery model of care has been proven to reduce the
likelihood of C-Section and other intervention, including the use or forceps
and vacuum. The midwifery model follows a “wait and see” approach during
labor and birth. This means that medical interventions are not used unless
there is a medical necessity for them.
Cont..
•Obstetrical, or medical management, tends toward more
intervention in order to have more “control” over labor and
delivery. A care provider who operates mainly under this model
is likely to use many interventions during labor, such as Pitocin
to speed up labor. Using many interventions during labor when
they aren’t needed leads to more Cesarean births.
• Generally, midwives practice the midwifery model of care and
obstetricians tend to take more of a management approach.
However, there are exceptions. It’s important to note when
you’re choosing a midwife or doctor that not all midwives
practice the midwifery model of care and not all doctors use a
lot of intervention.
what the people believes about midwife

The word “midwife” has many different connotations

depending on perspective of the people around the
world. Some belief midwives as healers and helpers.
Some belief them as skilled and wise. Some see them as
agents of women’s empowerment. However because of
the history of midwifery and its relationship with class-
perception many see midwives as uneducated, old
primitive women.

Before hospital birth was normalized “granny” or

“traditional” midwives were largely responsible for
attending births which typically took place in the home.
Thanks for Attention