INDEPENDENT NURSE MIDWIFERY PRACTITIONER

Midwifery term is used to describe the activities of health care providers who are experts in
the women health care including prenatal care to expectant mothers, attending at birth and
providing post-partum care to mother and her infant. Practitioners of midwifery are known as
midwives.

DEFINITION

Independent midwifery practice enables registered nurse midwives to utilize their knowledge
skills, judgement and authority in the provision of midwifery practice package and primary
women's health services while maintaining accountability for the management of patient care
in accordance with midwifery standards laid down by the midwifery or nursing council of
their country. Independent should not interpreted to mean alone, as there are clinical
situations when any prudent practitioner would seek the assistance of another qualified.

MIDWIFERY PRACTICE PACKAGE FOR INDEPENDENT PRACTICE

1. Access to a midwife 24 hours a day, 7 days a week.

2. Two midwives available alternatively and provide women centered antenatal, intrapartum
and post-natal midwifery care.

3. Antenatal care in privacy.

4. Continuity of care throughout labour.

5. Post-natal care up to 6 weeks.

6. Knowledgeable breast-feeding support.

STANDARDS REQUIRED FOR THE PRACTICE OF MIDWIFERY

Midwifery practice as conducted by midwife is the independent management of women's
health care, focusing particularly on pregnancy, child birth the post-partum period care of
new born, family planning and gynaecological needs of women. Midwives provide
consultation, management, collaborative management or referral as indicated according to
standards of midwifery practice.

In India as such standards of midwifery practice act are not developed to do independent
midwifery practices which are one of the essential requirements. American college of nursing
midwives has defined eight standards of practice.

Standard - 1

Midwifery care is provided by qualified practitioners Midwifery should be registered.

Shows evidence of continuing competency as required by certification agency or council.

It is in compliance with the legal requirements of the jurisdiction where the midwifery
practice occurs.

Standard-II

Midwifery care occurs in a safe environment within the context of the family, community and
a system of health care.

Demonstrates a safe mechanism for obtaining medical consultation, collaboration and

referral.

Uses community services as needed.

Demonstrates knowledge of the medical, psychological, economical, cultural and family

factors that affect care.

Demonstrates appropriate techniques for emergency management including arrangements for

emergency transportation.

Promotes involvement of support persons in the practice settings.

Standard-III

The midwives practices in accordance with the philosophy and the code of ethics of the
professional body provides clients with a description of the scope of midwifery services and
information regarding the client's rights and responsibilities.

Provides clients with information regarding services when requested or when care required is
not within the midwife's scope of practice.

Provides client with information regarding health care decisions and the state of science
regarding these choices to allow for informed decision making.

Standard-IV

Midwifery care is comprised of knowledge, skills and judgement that foster the delivery of
safe satisfying and culturally competent care.

The midwife collects and assesses client care data, develops and implement individualized
plan of management and evaluates outcome of care.

Demonstrates the clinical skills and judgements described in the basic midwifery practice.

Practices in accordance with standards.

Practices in accordance with service or practice guidelines that meet the requirements of the
particular institution or practice settings.

Standard-V

Midwifery care is based upon knowledge, skills, and judgment which are reflected in written
practice guidelines.

Midwife describes the parameters of services for independent and collaborative midwifery
management and transfer of care when needed.
Establish practice guidelines for each specialty area which may include, but is not care of the
child bearing family and new born care.

Includes the following information in each specialty area

a) Client selection criteria

b) Parameters and methods for assessing health status.

c) Parameters for risk assessment.

d) Parameters for consultation, collaboration and referral.

e) Appropriate interventions including treatment, medications and or devices.

Standard-VI

Midwifery care is documented in a format that is accessible and competent.

The midwife uses records that facilitate communications and institutions.

Provides prompt and complete documentation of evaluation, course of management and

outcome of care..

Promotes documentation system that provides for confidentiality and transmissibility of

health records.

Maintain confidentiality in verbal and written communications.

Standard-VII

Midwifery care is evaluated according to an established programme for quality management

that includes a plan to identify and resolve problems.

The midwife participates in programme of quality management for the evaluation of practice
within the setting in which it occurs.

Provides for a systemic collection of practice data as a part of a programme of quality,

management.

Seeks consultation to review problems, including peer review of care.

Acts to resolve problems identified.

Standard-VIII

Midwifery practice may be extended beyond the set competencies to incorporate new
procedure that improve care for women and their fames.

The midwife identifies the need for new procedure taking into consideration consumer
demand, standards for safe practice and availability of other qualified personnel.

Ensures that there are no institutional, state or council statures, regulations or laws that would
constrain the midwife from incorporation of the procedure into practice.

Reports the incorporation of this procedure to the authority. In respect to provide standardized
practice independently, the nurse midwife has to meet required education, experience,
advanced skills and competency.

Challenge for Indian midwives

Independent midwifery practice is one of the measures and challenges to assist in reduction
of maternal death. Indian profession of midwifery is facing challenges to make this dream
reality. The challenges are

1. Practice challenges

Following recommendations can be made by midwifery Professional body such as TNAI to

health care system administrators and policy makers and other regulatory bodies to ensure
that practice structures are to be designed to provide the best health care possible by making
the midwifery model of care readily available to women.

Midwives should be recognized as independent practitioners with the rights and

responsibilities regarding scope of practice, authority and accountability that all independent
by share.

Health organizations should use to allow quality and standard based midwifery care.

Midwives should ensure case consultation collaboration and referral provided to a woman
without interruption and for overall benefits.
2. Challenges for law regulation

The regulation and credential of midwives are challenging. Developing laws and regulations
would permit full access to independent midwifery services while protecting the public and
unnecessarily limited midwives with the scope of practice can be avoided. For this: -

State regulators should enact laws which are based on entry to practice standards on
successful completion of midwifery educational programme.

Health care system should develop privileging and credentialing mechanisms for midwives
that are consistent with the professional standards, recognize midwifery as distinct from other
health care professions and recognize established process that permits midwives to build
upon competencies within their statutory scope of practice.

3. Educational challenge

The current evolution of health care challenged educators to continue to develop quality
midwives to meet the challenging demands of health care system. Following points can be
taken as challenges.

Direct entry midwife programme to create a new category of professional midwife. These
midwives will work exclusively for maternal care.

The midwifery profession should identify, develop and implement mechanism to recruit
midwives who reflect Indian population with their competencies

It is needed to develop categories of midwives as per their expertise in their midwifery.

4. Challenges for research activities

It is required to continually grow and evolve in order to provide evidence-based midwifery

practice which will help to practice independently.

Analysis of midwifery practice in view of consumers or women who receive care.

5. Challenges for policy makers

Some of the most pressing issue regarding midwifery go beyond the current scope of
regulatory bodies, professional associations, educators and practitioners. Policy makers are to
be convinced for the importance of independent practice. Research efforts have found that
midwifery makes a positive contribution to the health of women and babies.

RESEARCH ABSTRACT

Background

In India, nursing regulation is generally weak, midwifery coexists with nursing, and 88% of
nursing and midwifery education is provided by the private health sector. The Indian health
system faces major challenges for health care provision due to poor quality, indeterminate
regulatory functions and lack of reforms.

Methods

We undertook a qualitative investigation to understand midwifery and nursing education, and

regulatory systems in India, through a review of the regulatory Acts, and an investigation of
the perceptions and experiences of senior midwifery and nursing leaders representing
administration, advocacy, education, regulation, research and service provision in India with
an international perspective.

Results

There is a lack of importance accorded to midwifery roles within the nursing system. The
councils and Acts do not adequately reflect midwifery practice, and remain a barrier to good
quality care provision. The lack of required amendment of Acts, lack of representation of
midwives and nurses in key governance positions in councils and committees have restrained
and undermined leadership positions, which have also impaired the growth of the professions.
A lack of opportunities for professional practice and unfair assessment practices are critical
concerns affecting the quality of nursing and midwifery education in private institutions
across India. Midwifery and nursing students are generally more vulnerable to discrimination
and have less opportunities compared to medical students exacerbated by the gender-based
challenges.

Conclusions
India is on the verge of a major regulatory reform with the National Nursing and Midwifery
Commission Bill, 2020 being drafted, which makes this study a crucial and timely
contribution. Our findings present the challenges that need to be addressed with regulatory
reforms to enable opportunities for direct-entry into the midwifery profession, improving
nursing education and practice by empowering midwives and nurses with decision-making
powers for nursing and midwifery workforce governance.

SUMMARY

So far we discussed about NP and midwives, its different aspect and their responsibilities.

CONCLUSION

Hope it was clear, if you have any doubt you can ask now. Thank youREFERENCE

Bibliography

Basher P. Shabeer, Khan Yasheen S. "A concise text book of advanced nursing practice",
EMMESS Medical Publishers, first edition 2012, page no. 694-698.

Net reference

http://www.who.int/hrh/nursing_midwifery/films/en/.

https://www.nursing.org
AAFP. (2008). Guidelines on the Supervision of Certified Nurse Midwives, Nurse
Practitioners and Physician Assistants. Retrieved March 5, 2009, from American Academy of
Family

WWW.independentnurse.co.uk

Mayra K, Padmadas SS, Matthews Z (2021) Challenges and needed reforms in midwifery
and nursing regulatory systems in India: Implications for education and practice. PLoS ONE
16(5): e0251331. https://doi.org/10.1371/journal.pone.0251331