AMANDEEP KAUR

NURSING DEMONSTRATOR
IONURC, GOINDWAL SAHIB, PUNJAB
MIDWIFE
A midwife is a person who , having been
regularly admitted to a midwifery
educational program, duly recognized in the
country in which it is located , has
successfully completed the prescribed course
of studies in midwifery and has acquired the
requisite qualification to be registered and /
or legally licensed to practice midwifery.
OBSTETRICS IS CONCERNED PRINCIPALLY
WITH THE PHENOMENA AND MANAGEMENT
OF PREGNANCY, LABOR, AND THE
PUERPERIUM UNDER NORMAL AND
ABNORMAL CIRCUMSTANCE
 Midwifery is as old as the history of human
species. Archeological evidence of a woman
squatting in children supported by another
woman from behind demonstrates the
existence of midwifery in 5000 BC.
 Hippocrates (460 BC), the father of
scientific medicine, organized trained and
supervised midwives. Hippocrates believed
that the fetus had to fight its way out of the
womb and the membranes. The efforts of
Hippocrates were not appreciated by the
midwives.

 Aristotle (384-322 BC), the father of
embryology, described the uterus and the
female pelvic organs. He also discussed the
essential qualities of the midwife
 Soranus, in the second century, was the first to
specialize in obstetrics and gynecology. His
book was used for 1.500 years. He used a
vaginal speculum, advised on cord care, and
wet nursing.

 Leonardo da Vinci (1452-1519), made
anatomical drawings of pregnant uterus.

 Vesalius in 1543, opened the full term
pregnant uterus on a lower animal, extracted
the fetus, and demonstrated uterus as a single
chamber organ.
 Ambroise Pare (1510-1590), laid the
foundations of modern obstetics. He
performed internal podalic versions and
skillfully delivered woman. He was the first
to deliver a woman in bed instead of the
birthing-stool. He also sutured perineal
lacerations. Ambroise Pare founded a school
for midwife trained by Pare, attended the
ladies of the French court.

 Juius Caeser Aranzi WROTE THE FIRST
BOOK FOR Italian midwives, which ran
seventeen editions. He advised cesarean
secton for contracted pelvis. He described
the raw placental surface and initiated the
study of uterine sepsis.
 The French king louis XIV in 1663, employed a
Paris surgeon to attend one of his mistresses in
labor, and pleased with the result the king honored
the surgeon with the title “accouters”(a person
who assists women in childbirth).
 Mauriceau in 1668, published a treatise an
midwifery.
 Chamberlen in 1675, designed obstetric forceps.
 William Smellie (1697-1763), is called the father
of British midwifery. He explained labor to be a
mechanical process and described pelvimetry,
cephalometrt and forceps delivery of the after
coming head of a breech. The chair of midwifery
was founded in 1726 in the University of Edinburgh.
 John Leake(1972), replaced the obstetric
stool by special delivery beds.

 Charles White in 1773, stated that puerperal

fever was infectious. He used lime as
disinfectant, and clean linen, isolation,
adequate ventilation and sitting posture to
facilitate drainage.

 Fielding ould(1710-1789), described the

mechanism of normal labor and performed the
first episiotomy.

 Gordonin 1795, described puerperal sepsis as

a wound contamination of placental site.
 Laennec in 1816, invented a stethoscope.
 Francois in1818, first recognized fetal
heart sounds in the pregnant uterus.
 James Young Simpson in 1847, used
chloroform first in obstetrics for
anesthesia.
 Florence Nightingale in 1862, organized a
small training school in connection with
King’s College Hospiatl where she conducted
training for midwives.
 Semmelweiss in 1861, demonstrated the
cause of puerperal sepsis and suggested
preventive measures.
 Louis Pasteur in 1879, wrote a thesis on
puerperal sepsis demonstrating the presence
of streptococci in the lochia, blood and in
fetal cases in the peritoneal cavity.
 Spencer and Ballantyne promoted the
concept of antenatal care for pregnant
woman.
 France Mauriceau, A France obstetrician,
first reported cesarean section in 1668.
 Porro performed sub-total hysterectomy in
1876.
 Max Sanger in 1882, first sutured the
uterine walls.
 In 1912, Kronig introduced lower
segment vertical incision and it was
popularized by De Lee (1922).
 Munro Kerr in 1926 introduced the
present technique of lower segment
cesarean operation and popularized
it.
 MIDWIFERY A SEPARATE PROFESSION
 ENTRY IN MIDWIFERY PRACTICE-A DEGREE IN
MIDWIFERY FROM UNIVERSITY
 INDEPENDENT NURSE MIDWIFERY PRACTICE
 MIDWIFERY MODEL OF CARE AND REJECTION
OF MEDICAL MODEL OF CARE
 EPIDURAL ANALGESIA IN LABOUR
 POSITIONS DURING SECOND STAGE OF
LABOUR
 BIRTHING CENTRES- THE MIDWIFE LED
BIRTHING UNIT
 TEAM MIDWIFERY PRACTICE
 FAMILY CENTERED MIDWIFERY PRACTICE
 WOMEN FRIENDLY SERVICES
 COMPLEMENTARY AND ALTERNATIVE MEDICINE
 NATURAL CHILBIRTH
 EVIDENCE BIRTH
 MIDWIFERY A SEPARATE PROFESSION
MANY COUNTRIES HAVE TAKEN UP MIDWIFERY
AS A SEPARATE PROFESSION LIKE NURSING
PROFESSION.

 ENTRYIN MIDWIFERY PRACTICE-A DEGREE IN

MIDWIFERY FROM UNIVERSITY-
TO MAKE THEM MORE COMPETENT AND HELP
THEM TO PERFORM HIGH QUALITY OF
MATERNAL & CHILD HEALTH CARE

 INDEPENDENT NURSE MIDWIFERY PRACTICE

 MIDWIFERY MODEL OF CARE AND REJECTION OF
MEDICAL MODEL OF CARE
 MIDWIFERY MODEL IS MORE WOMEN CENTERED,
PERSONALIZED CARE PROVIDED BY MIDWIVES.
MIDWIVES BELIEVE THAT PREGNANCY &
CHILDBITH NORMAL PHYSIOLOGICAL
PHENOMENA & NOT PATHOLOGICAL AS IN
MEDICAL MODEL.
 EPIDURAL ANALGESIA IN LABOUR
IT PROVIDE BETTER PAIN RELIEF IN LABOUR

 POSITIONS
DURING SECOND STAGE OF LABOUR
UPRIGHT OR SITTING POSITION IS GOOD FOR
CHILDBIRTH & LITHOTOMY POSITION HAS BEEN
BANNED
 A midwife must be able to give the necessary
supervision, care and advice to women during
pregnancy , labour and postpartum period.
 They should be able also to conduct deliveries on
her own responsibility and to care for the
newborn and the infant. This care includes
a. preventive measures
b.detection of abnormal condition in the mother
and child
c. procurement of medical assistance and
execution of emergency measures in the
absence of medical help.
 She performs an important task of counseling and
education not only for the women but also within
the family and community.
 The work should involve antenatal education
preparation for parenthood and extends to
certain areas of gynecology, family planning
and child care.
 She may practice in hospitals , clinic, health
units , domiciliary conditions or any other
service.
 Treat complications due to miscarriages and/or
unsafe abortions
 Recognizing and addressing problems in the
women and newborn before, during and after
childbirth.
Offering general health information, including
reproductive health care and planning.
Assisting women to successfully breast feed.
Referring women and new born for higher level of
care when complications arise beyond their scope of
practice and capabilities. The principal objective of
the midwifery profession is.
 Each midwife should uphold the dignity and honors
of the profession and accept its self-imposed
disciplines. Midwives provides quality and culturally
acceptable care to help keep women and newborns
safe.
 In countries with strong midwifery services ,
midwives play an important
preventative role by offering immunizations,
health education , family planning information
and promotion on many aspects of healthy
lifestyles.
 Midwives can also foster a dialogue with female
community leaders about the needs of pregnant
women and ways of mobilizing support for them.
 Although TBAs do not have the training to deal
with life – threatening problems, their
cooperation can be very helpful in convincing
families of the benefits of professional care,
early referral or institutional delivery when
complications arise or seen likely.