SEMINAR ON HISTORICAL REVIEW AND CONTEMPORARY

PERSPECTIVES IN MIDWIFERY
Introduction
The study of child bearing is the study of a process that has taken place
throughout human history. Child bearing is a normal and natural occurrence, yet
it involves a complex series of events that may occur in a precise order to
ensure success. It involves many risks but it also provides many rewards to the
individual, to the family, and to the society as a whole.
Maternity nursing focuses on the care of the child bearing women and their
families through all stages of pregnancy and childbirth, as well as the first 6
weeks after birth
OBSTETRICS
Obstetrics is derived from the Latin word "obstetrex" meaning midwife.
Obstetrics deals with the branch of medicine providing care for parturient
(childbirth) and sequels (parturition).
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
Historical review of obstetrics
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.
There are also references in the Bible. In Exodus 1:15, it is recorded that the
king of Egypt spoke to Shiprah & Puah, the two midwives, who helped Hebrew
women when they give birth. These two midwives are the first midwives found
in the literature. Through the centuries, midwifery, the art of assisting women in
childbirth has grown fulfilling its meaning "with women" at birth.
EARLY DEVELOPMENT IN INDUS VALLEY
The development of obstetrics and gynecology possibly started in the Indus
valley where civilization was flourishing 5 millennia ago. The knowledge of
medicine spread from the Indus Valley, west to the middle East and east
onwards across India. Even though obstetrics may have started in the Indus
valley, Aurignacian art in which is represented by paintings of animals and by
status was carried out in Europe and depicted drawing and status of interest to
gynecology.
Egypt (6000-1200BC)
1. In the most Muslim countries and in Egypt women were attended only by
women. Men were excluded from places where women where laboring.
2. Women squatted either on the ground or brick to deliver. The earliest
known records are found in the Egyptian papyruses.
3. The Ebers papyrus (1500BC) a comprehensive payrus scroll dealing
primarily with obstetrics and gynecology documents practices relating to
abortion: augmentation of labour, disease peculiar to women and methods
of treatment.
4. In Egypt, the womens urine was used to water wheat and barleys corns. If
the plants grew rapidly, pregnancy was confirmed: if the barley grew
faster than the wheat the fetus was a female
MESOPOTAMIA (4000-331BC)
The practice of medicine in Mesopotamia began either simultaneously
with that of Egypt or soon after the code of Hummurabi, the famous ruler
of old Babylonian. Dynasty was one of the first codes to regulate practice
of medicine.

GREEK AND ROME

Greek medicine was dominated first by Greek God as Apollo, Diana,
Mercury and then by the writings of Hippocrates , A Greek physician
named 'Soranus' known as the " Father of Obstetrics "wrote his
gynaecology book in Greek and described that fetus could take up various
positions in the uterus. He is the best known for podalic version.
Soranus gave one of the earliest full description of uterus and also
described on fertilization.
Gabrelious Falloppuis was an Italian who described the fallopian tube
connecting the ovaries to the uterus.
Arestotle (384-322BC)
The father of embryology described the uterus and female pelvic organs.
He also discussed essential qualities of the midwife. From the 5th to 15th
century period of decline of Romen Empire, untrained midwives
controlled the practice of midwifery.
EUROPEAN DEVELOPMENTS
Renaissance art became the forerunner of the new scientific age. Artists
such as Leonardo Da Vinci (1452- 1519) and Michelangelo
Buonarroti(1475-1564) did human dissections and accurately illustrated
every aspects of the human body.Leonardo Da Vinci made anatomical
drawings of pregnant uterus
 In 1953, the first book on midwifery was printed in Germany, based on
the teachings of Soranus. During this period doctors were rigidly
excluded from labour rooms and midwives assisted women in labour
Ambroise Pare (1510-1590) laid the foundations of modern obstetrics.
He was the first to deliver a women in bed instead of birthing tools. His
contribution to the science of obstetrics was perhaps the turning point that
shifted the responsibility of the management of pregnancy and birth from
midwives to trained physician.
The Hotel Dieu in Paris was the 5th century onwards, the most
famous maternity unit in Europe and therefore in the world. It helped to
spread the knowledge of midwifery widely.

17th century
• The development of the obstetrics forceps was a major break through in
17th century. Instruments to assist delivery had been used for centuries
but were mainly for extracting dead fetus.
• The possibility of constructing obstetrics forceps suggested by Jacon
Rueff about 1554.
• Chamberlen family is usually credited with the invention and
development of the instrument to save the lives of countless number of
infant and mothers.
• Peter Chamberlin invented in 1598.William Harvey (1578-1657),
discoverer of the circulatory system developed Embryology.
• Francosis Mauriceau (1637-1709) was the first to observe that puerperal
fever was epidemic. He described a mechanism for breech extraction and
may have been the first to advocate delivery in bed rather that on birthing
stool
The 17th and 18th centurires were known as "age of enlightment

19th century
Gynaecology developed separately from midwifery Ephraim Mc Dowell
(1771-1830) in 1809 performed an ovariotomy on Mrs. Crawford,
Kentucky. His success led to an unsurge of interest in gynecological
surgery.
James Mario Sims (1813-1883) carried out first successful
repair of fistula in 1849 and introduced sims speculum and Sims
position for gynecological examination.
The first abdominal hysterectomies were carried out by A.M. Health and
Charles Clay of Manchester in 1843.
The discovery of anesthesia in the19th century is of major importance to
obstetrics. Scientists viewed it as an end to pain: moralists declared it the
work of the devil and a violation of scripture. The arguments continued
 for several years and finally ceased when Victoria delivered prince
Leopold after receiving chloroform.
Many techniques , procedures , and clinical findings used in modern
practices is proposed by Europeans such as Braxton Hicks Contractions
(John Braxton Hicks), Hegars signs (Alfred Hegar), Nageles rule (Franz
Nagele)
Kroning in 1912 introduced lower segment vertical incision and it was
popularized by De Lee (1922).
Munro Kenri in 1926 introduced the present technique of lower segment
caesarian operation and popularized it.

DEVELOPMENT IN UNITED STATES

• During the 19th century, obstetrics were greatly influenced by William
Dewees . He brought into practice the lithotomy position for delivery,
insisted on relieving pain during labour and advocated judicious use of
forceps. He is considered as the "Father of American Obstetrics“
• The American Medical Association founded in 1847 established a section
on obstetrics women's disease and children in 1873.
• Early in the 20th century, a need for newborn nurseries appeard. By mid
century hospital delivery had steadily increased.
• The Sheppard-Towner Act of 1921 was the first federal legislation to
provide funds for state programs in maternal and child helath .
• In 1935, came the social security Act, which provided grants for health
and welfare programs.
• In 1964, the maternity and infant care projects were begun by the public
health services department of health education and welfare. The most
significant contributions of the projects for the professional have been the
emphasis on early prenatal care, a humanizing approach to public clinics
and utilization of health team as a functional unit.

DEVELOPMENT OF MIDWIFERY IN INDIA

• In ancient India, the untrained 'dias' (maids) belonging to the lower
community were mostly responsible for conducting deliveries. This
system leads to various complications and increased maternal and infant
deaths. Those were the days when more than 2 lakh women used to die
due to childbirth or related facts and diseases.
• By considering the above facts, non-official organizations introduced the
training scheme for the dais for safe delivery.
 • In 1903, the Victoria Memorial 'Scholarship Fund for training of dais
was established. During this period there were 200 per thousand maternal
deaths as reported by public Health Commission in 1930
• The number of doctors, nurses and midwives were very few and they
were available only in a very few cities and towns. Majority of deliveries
during that time was taking place in rural areas in most unhygienic way.
The umbilical cords were cut by any available bamboo or wooden strip
often sharpened by rubbing the end on the floor of the room where the
delivery used to take place.

• To alleviate certain aspects of such miseries "The Lady Dufferin Fund"

fund was founded by Queen Victoria in 1885 and established "Zenana
Hospitals". In 1940-there were about 400 Dufferin Hospital all over the
British India. Significant contributions were made by the medical
missionaries.

• Maternal and child health services were first organized in India in 1912
by a committee of "The Lady Chemsford League" which collected funds
for child welfare and established demonstration on all India bases. In
1931," Indian Red Cross Society" started maternity centers in different
parts of the country through its Maternal and child Welfare Bureau“ The
constitution of India directs the state to record improvement in the public
health as one of its primary duties

In post- independence period

The Union Government has created a post of an adviser MCH at the Directorate
General Of Health Services to look after such services in the union.
International Organization like WHO and UNICEF, also began to help the
nations in improving MCH services.
 During the first five year plan, more than 200 MCH centers were started
in different states with the help of Union Government and International
Organization.
 During the second five year plan, MCH services were integrated with the
services of primary health centers. More staff such as public health
nurses, lady health visitors and midwives, dais etc were trained and
appointed. The training programme of dais was taken up as a regular
measures.
 During the late sixties, the government of India realized that the children
and women of childbearing age contributes of the total population and are
vulnerable groups. As such as Union Ministry of Health and family
planning(1969) introduced the following schemes.
• Immunization of infants and preschool age children against diphtheria,
Pertusis and tetanus.
• Immunization of expectant mother against tetanusProphylaxis against
nutritional anemia of mother and child.
• Prophylaxis against blindness in children caused by vitamin A deficiency.
All these programmes are continuing since 1969. It is said that MCH
scheme under family planning has been re-emphasized since 1977 along
with the change in the name of the Department from family welfare.
Since 1992, the special programme of Child Survival and safe
Motherhood(CSSM)
• New maternal and child health care which now also being described as
reproductive and child helath.
• The health organization on India at that has 2 main branches.
o One was for administration of medical relief and maintenance of
associated institutions under the direction of the Director General of the
Indian Medical Services at the center and surgeon General of Civil
Hospitals in the States.
o Preventive health services were under the direction of public health
commissioner at the center and sanitation Commissioner in the states.

The All Institute of Hygiene and Public health was established in

1930 with the aid of Rockfeller foundation and provided programs of
study in Maternal and Child Health.
In 1943, the government appointed a committee called Bhore Committee
to survey the existing health conditions and to formulate a comprehensive
plan for health administration. The staff of each unit including among
other members, one institutional nurse, four midwives and four trained
dais.
Programs for training dais and auxiliary nurse midwives (ANM's) started
on this report.

DEVELOPMNT OF MIDWIFERY EDUCATION

By the early 1800's schools of nursing were being established throughout
Europe. In 1860, Florence Nightingale founded ST.Thomas School of
Nursing In London. She advocated the training of a "better class" of
women as nurses and midwives to provide services to women.
In 1872, the obstetrical society of London began issuing certificates to
qualified midwives.
 In 1881, Rosalind Paget, one of Miss Nightingale's Ladies " founded the
midwives Institute now the Royal college of Midwives to register
midwives and promoted a bill to ensure proper education and control.
In 1902, the English Midwives Act was passed. The act also brought
Central Midwives Board, a statutory body controlling the training and
practice of midwives

DEVELOPMENT IN UNITED STATES

In 1762 William Shippen, a pupil of Smellie and Hunter established a
school for midwifery in Philadelphia and became part of the University of
Pennsylvania and the curriculum became known as obstetrics.

In India
Post independence , the Government gave more emphasis to national
health programmes . For the same reason, more attention was given to the
establishment of medical colleges and nursing/midwifery colleges and
schools. Many medical colleges, nursing and midwifery schools and
colleges were built during the early 1960s. A series of small but positive
initiatives have taken place to strengthen midwifery as a profession. In
November 2000, the Society of Midwives in India (SOMI) was formed to
develop a separate identity and provide a collective strength to the
profession in India by 2009.
• In 1871, the government General Hospital at Madras was started with the
first school of nursing for midwives with four students. Many nursing
schools were started in different states of India between 18th and 19th
century mostly by mission hospitals, which trained Indians as nurses
• Fernandez Hospital began a Professional Midwifery Education and
Training (PMET) Programme in 2011 to produce a cadre of competent,
confident and skilled midwives. This special taskforce would help deliver
simple safe, affordable care to low risk mothers in the community. Their
aim is to reduce maternal mortality and morbidity.
In 2014, the Indian Nursing council granted 10 seats to start Post Basic
Diploma in Nurse Practitioner Midwifery (NPM) to Fernandez School of
Nursing. The first batch started in November 2018
CONTEMPORARY PERSPECTIVES
The contemporary view of childbearing recognizes that childbearing is a
special, miraculous, and yet normal part of life. Pregnant woman have special
health care needs but with proper education and preparation, childbearing can
and should be a positive experience .
The contemporary view of childbearing has resulted in shifts in the delivery of
care. While most women continue to receive medical supervision during
pregnancy, the focus has changed from illness-based model to wellness based
model
In contemporary maternity nursing, more and more of the care takes outside the
traditional hospital setting. Maternity nurses are routinely employed in schools
and clinics and are increasingly working in the home, where traditional
maternity nursing care is modified and adapted to be responsive to the needs of
today's child bearing families.

Goals Of Contemporary Midwifery Nursing

In keeping with the contemporary viewpoint that child bearing is a normal
process, maternity nursing should focus on the positive, wellness-based goals.
The maternity nurse works to-
1) Emphasize the naturalness of pregnancy as a normal part of mature
human development.
2) Promote the highest level of wellness possible for the expectant mother,
the unborn infant, and the family unit throughout all stages of pregnancy,
labour and delivery, and the immediate post delivery period.
3) Prepare and educate all expectant mothers so that they can be active,
well-informed participants in care throughout the entire childbearing
process from conception to delivery.
4) Establish a supportive care environment that makes childbearing a
positive experience and encourages the development of wholesome
relationship between mother and newborn and within the entire family
unit.
Conclusion
Midwifery has survived and thrived in past decades dramatically. It would seem
that it is still recognized as an important occupation, highly valued by women.
The rise of science as authoritative knowledge, the involvement of everyone and
the influence of medicine on childbirth have all had impact on the status of
midwifery and the control of midwives.
BIBLIOGRAPHY
 MIDWIFERY AND OBSTETRICAL NURSING, NIMA BHASKAR,
3RD EDITION, EMMES MEDICAL PUBLISHERS, PAGE NO: 2-7
 www.slideshare.net
 www.scribd.com