2. MIDWIFERY - SOLUTION TO INDIA'S MATERNAL HEALTH CHALLENGES?
This section provides information on why midwifery could be a solution, the various midwifery programmes implemented by different Indian states, and the NPM programme.
2a. Importance of Professional Midwifery Midwives are healthcare professionals who specialize in providing care for childbearing women through pregnancy, labour, childbirth, and the immediate postpartum period. The Lancet Series on Midwifery documents how midwives trained to international standards safeguard public health by providing quality obstetric care to women and newborns, and how a full package of midwifery services—including family planning—can prevent 83% of all maternal deaths, stillbirths, and newborn fatalities in countries with low human development [1].
The midwifery model of care prioritizes physiological childbirth and respectful maternity care. It acknowledges that pregnancy and labour are not diseases that require treatment and that most women, with the right support, can go through the birthing process without complications. A midwife fully trained to international standards, who meets the level of competencies set by the International Confederation of Midwives, can provide preventive healthcare, promote normal birth, detect complications, provide referrals, and carry out emergency measures.
2b. History of Midwifery Programmes in India
State
Project
Current Status
West Bengal
(2002/ 2011)
India-Australia Training and Capacity Building project”. In 2002, the first course of 18 months training in Nurse Practitioner Midwifery started under the India–AusAID project, based on curriculum developed by INC. Twelve posts of NPM sanctioned by the State Government. Total two batches of training conducted.
In 2011, West Bengal implemented the One Year Post Basic Diploma in Nurse Practitioner in Midwifery. Training was stopped after two batches.
Twelve candidates posted in PHCs and BPHCs.
Andhra Pradesh, West Bengal, Gujarat and Tamil Nadu
Began with the NPM course in two states (WB & Gujarat); then five CAMT centres were established in four States with a 12-month training course. Fifteen senior faculty underwent a three-month advanced tutor course, some of which was in Sweden. In Gujarat, training of NPM for one
year led to a separate cadre of NPM equal to Matron class 3.
Even though visibility for midwifery increased, the initiative was not
scaled up.
Telangana
(2011/2014/2017)
In 2011, the Professional Midwifery Education and Training programme was conducted by Fernandez Hospital.
In 2014, Fernandez Hospital was accredited to initiate the Post basic Diploma in NPM with 10 seats.
In 2017, the Government of Telangana initiated a tripartite partnership between State Government, UNICEF and Fernandez Hospital to train nursing students in midwifery using 18 months course based on ICM competencies. A total 126 posts of midwives created by the State
Government.
Training is on-going
This has been stopped
Training is on-going
Madhya Pradesh
(2016)
Eighteen months training on midwifery, based on ICM competencies was conducted for four nurses at a private institute, Choitram Hospital. This did not involve the state government.
Not sure
2c. Introduction of Professional Midwifery in India Professional midwives, trained to ICM standards, are specialized healthcare professionals who can offer evidence-based, high-quality, respectful maternal care. With increasing global research showing that health systems equipped with professional midwives deliver better health outcomes, the Government of India announced the Guidelines on Midwifery Services [2] in December 2018. In addition, they also released a Guidance Note and a Scope Of Practice for Educators and Practitioners (All three documents are attached below). These guidelines were developed with an aim to establish a professional midwifery cadre within the public healthcare system.
The focus of the Nurse Practitioner in Midwifery programme is to train professional midwives who are skilled, knowledgeable, and can provide compassionate, cost-effective, and women-centred healthcare services related to maternal, reproductive, and newborn care. The Guidelines on Midwifery Services cover areas such as education, regulation, integration of NPMs with the public health system, career progression, and certification.
Existing Registered Nurse-Midwives (RN/RMs) will train to be Nurse Practitioners in Midwifery through an additional 18-months of post-basic training in midwifery. The goal is to create around 86000 nurse practitioners in midwifery and establish 8000 MLCUs at LaQshya certified public facilities. This is planned to be implemented through a cascade training model, at National Midwifery Training Institutes (NMTIs) and State Midwifery Training Institutes (SMTIs). The National Midwifery Educators (NMEs) will train at NMTIs, and setup the State Midwifery Training Institutes (SMTIs) to train Nurse Practitioners in Midwifery (NPMs). After their training, the NPMs in turn will be deputed to set up and run MLCUs in smaller district facilities.
References
[1] Likis FE. The Lancet Series on Midwifery: A Momentous Opportunity to Improve Maternal and Newborn Health. J Midwifery Womens Health. 2014 Sep-Oct;59(5):477-8. doi: 10.1111/jmwh.12259. PMID: 26226186. https://pubmed.ncbi.nlm.nih.gov/26226186/
[2] MoHFW, Ministry of Health and Family Welfare. 2018. Guidelines on Midwifery Services in India 2018. https://www.nhm.gov.in/New_Updates_2018/NHM_Components/RMNCHA/MH/Guidelines/Guidelines_on_Midwifery_Services_in_India.pdf
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