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A Seminar On Role and Scope of Midwifery Practices
A Seminar On Role and Scope of Midwifery Practices
AND SCOPE OF
MIDWIFERY
PRACTICES
SUBMITTED TO SUBMITTED BY
MRS.JESMI JOHN MRS.LEKSHMI P
SENIOR LECTURER 1ST YEAR MSC NURSING
JOSCO COLLEGE OF NURSING JOSCO COLLEGE OF NURSING
SUBMITTED ON 06 /11/2013
INTRODUCTION
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.
DEFINITIONS
According to ICM membership (International confederation of midwives) and joint study group
of maternity care and WHO, the term midwife id defined as
NURSE CLINICIAN
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.
NURSE CONSULTANT
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 activities.
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 RESEARCHER
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
Nurse educationalist is a person who is a specialist in the theory and method of nursing
education.
SCOPE OF MIDWIVES IN HEALTH CARE AND THE COMMUNITY
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.
Intends to provide the basic maternity services to all pregnant women through
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.
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
preterm birth
preterm labour management including care including kangaroo mother care,
antenatal corticosteroid essential 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.
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
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.
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 weight.
Provide educational facilities for girl belonging to SC, ST, minority communities and families
below the poverty line in educationally backward block.
PRECONSUPTION CARE
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 eugenics.
Educational
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 modifications.
Informational
Eugenics
Genetic counseling
MATERNAL CARE
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.
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 indispensible.
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.
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 babies
Contact a health care professional or emergency service if required.
NEWBORN CARE
Immediate care
Neonatal assessment
General appearance
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.
CONCLUSION
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.
BIBLIOGRAPHY
Textbook
1. Kaminio Rao. The text book of midwifery obstetric for nurses. 1st 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. 3rd edition. Jaypee. Page no.
534.
4. Chris Henderson. Mayes Midwifery-A text book of midwives. 13th edition. Baillierra
Tindall publisher
Internet
5. www.midwiferycouncil.health
6. www.nursingtimes.net
7. Nursingcareers.nhsemployer.org
8. www.nfpa.org
9. www.midwiferyjournal.com