Midwifery Initiative in

AP:

Building Tomorrow’s
Professionals
 Background
• AP is one of the larger state with 9 lac PW registrations and 8 lac
annual deliveries
• Govt. of AP has made significant progress in achieving key maternal
and child health indicators
• In this process, AP also reported increased in C-section rate, over
crowding of secondary and tertiary facilities and over medicalization
• State has faced the challenges in ensuring respectful maternity care,
improving the access to quality health services and availability of
trained resources

To address these issues, GoAP has planned to build a strong Midwifery Cadre
 Introduction
Launch of Guidelines on Midwifery Services by Govt. of
India – Partners Forum 2018

• Followed by launch – Sensitization meeting with PS – Health, CHFW and all

stakeholders
• Govt. of AP has decided to roll out the program by creating a cadre
of midwifery practitioners in public health hospitals
• AP has formed State Midwifery Task Force – So far 3 Technical
Advisory Group (TAG) meetings conducted for policy decisions
• Unicef and Fernandez Foundation are providing technical support
in implementation of program since inception
 Planning
• Developed state level roadmap for midwifery initiative
• DME after conducting the assessments in all 10 CoNs –
Guntur CoN and Tirupati CoN are identified as State
Midwifery Training Institutes (SMTIs)
• Skill labs and training infrastructure strengthened with
10.25 lac for each SMTI
• A budget of approx. 8.6 Cr got approved in ROPs of
2021-24 for two batches
• 6 midwifery educators selected as per GoI guidelines
and trained for six months at NMTI, Hyderabad
 Contd..
Midwives Requirement Forecast in Public Facilities
34 facilities (600-1200 42 facilities (1200- 10 facilities (>6000 Total Midwives
Name of the state
deliveries/year) 6000 deliveries/year) deliveries/year) Required
@ 8 NPMs @ 16 NPMs @ 32 NPMs
Andhra Pradesh 272 672 320 1264

• Action plan with clear timelines framed for implementation

• Unicef also upgraded skill lab of SMTI Tirupati with 38 mannequins
• Lay out plans for 2 MLCUs designed and submitted by Unicef
• Subsequently other 8 Colleges of Nursing are also being strengthened to SMTIs –
10.25 lacs budget per institute released for same
 Implementation
• First state in the country to have GO for Midwifery
[GO Ms. No. 205] released by Govt. of AP
• GO clearly outlines implementation guidelines including
certification by State Nursing Council under DME
• Applications were called for 60 NPM trainees from in-service SNs
• 2 state level sensitization webinars were organized to orient on concept of Midwifery
and scope of practice
• Formed NPM selection committee with representatives from CHFW, DME, CoNs, Unicef
& FF
 Contd..
• Out of 139 applied 60 were selected as NPMs by conducting
theory, OSCE and interview

• Selected NPMs allotted SMTIs based on their preferences

provided

• Budget of 94.8 lacs per SMTI released to for initiation of

NPM training

• 1 Program cum Data Assistant recruited exclusively for

Midwifery program and placed at both SMTIs

• Midwifery Program launched by CHFW AP on 17th Feb 2022

– 2 NPM batches training initiated
 Implementation
• As per GO, State Nursing Council conducting assessments
to give formal permission to conduct the course and
provide certification
• On the eve of International Midwifery Day 2023 – Dist.
Collector has inaugurated MLCU at GGH Tirupati
• Series of sensitization workshops organized by
Unicef and FF for ObGs on concept of Midwifery,
collabrative care, AN &
Intranatal exercises and
Optimal birthing
positions
 Contd..
• 7 MEs were selected and trained for 6 months at NMTI, Banglore and posted at 2 SMTIs
• 18 months theory and practical exams conducted by Nursing Division - Board of
Examinations under DME for 2 batches
• Supplementary exams were also conducted by board and declared the results of 60 NPMs
• All 60 Midwives were posted in 13 high delivery load hospitals in a batch of 4-6
midwives
Midwifery Posters – Birth Positions and Exercises
 Monitoring and Mentoring
• Monitoring for the quality of training is ensured by periodic visits
by officials from State, Unicef and FF
• International Midwifery Educators visit SMTIs on regular basis for
mentoring and handholding of MEs
• Regular workshops like MOMS, Optimal Birthing Position,
Episiotomy workshops etc., were organised for NPMs
 Guidance Notes on Midwifery in AP
CHFW launched guidance notes on Optimal Birthing Positions and
Operationalising on State Midwifery Training Institute on Nov’23.
 IEC Package of Midwifery Services

Safe Motherhood ANC Flipbook Post Natal Counselling Flipbook HR Pregnancy Flipbook

Trimester wise – Child Birth classes

content

Video demonstrating AN Exercises 5 posters and 2 Short videos on

promotion of Normal Deliveries
 Sensitisation Visits at Midwifery Sites
• After posting of 60 midwives – a team comprising of members from
O/o CHFW, UNICEF and FF including NME have visited facilities for
sensitisation of staff on Midwifery

• 9 out of 13 facilities completed sensitization

• Sensitization meeting conducted for Medical Superintendents, HoD

ObG, Obstetricians, Midwives ,Nurses and other maternity staff

• SOPs ,guidelines on optimal birthing positions and Midwifery

Advocacy videos were shared

• Demonstration of exercises and optimal birthing positions in Labour

• Challenges addressed (Shift duties, Initiating Midwifery OP,

Childbirth education classes)
 Impact of Midwifery in AP
Oct’23 to Dec’23

No. of Antenatal mothers No. of mothers risk No. of childbirth classes No. of mothers supported
assessed-6786 categorized- 888 taken- 5783 during birth- 1218

No. of mothers birthed in No. of postnatal mothers No. of newborns No. of newborns
No. of perineal suturing assessed- 1271 resuscitated- 61
alternate positions-1218 assessed- 2511
done-414
 Uptake of Midwifery OP Services
• Midwifery OP units successfully being run by Midwifery
Educators and NPM trainees independently
• All hospitals providing Midwifery practices to initiate
midwifery OP services to PW with no high risk
conditions
3000
2593 2545 2488
2500
(75%) (98%)
2000 1901
1705
1500 1277 (75%)
1000

500

0
Oct-23 Nov-23 Dec-23

Midwifery OPD Childbirth education classes

Clinical Outcomes - Reduction of C-section rates
100 Aug’ 2023 to Dec’ 2023
90
Normal Births LSCS
80
70 59% 60% 62%
60%
60 56
%
50
40
44%
30 41% 40% 40% 38%
20
10
Midwifery Services Introduced
0
Aug-23 Sep-23 Oct-23 Nov-23 Dec-23
 Percentage of births without Episiotomy
80%

70% 68%

60%
55%
50% 46%
40%

30%
29% 28% 27%
20%

10%

0%
Oct-23 Nov-23 Dec-23

Births by Doctors & Nurses without episiotomy

Births by Midwives without episiotomy
 Clinical Outcomes –
Midwifery Births and Birthing Positions
n=4402

Upright All Fours

3618(82%)
1(0.1%)

Left Lateral Squatting

772(18%) 11(0.9%)
 Challenges

• Had to repeat selection process as 9 out of 60 were non willing after selection

• Placing all 60 selected NPMs at SMTIs by issuing deputation orders

• General transfers during the training program

• Despite the orientation webinar – resistance in joining NPM course

• Clearing the uncertainties among the NPM trainees

• Ensuring the quality of training by MEs

• Maintaining the positive learning environment at SMTIs

 Way Forward
• Process of registration as Professional Midwives by State Nursing Council is in
progress as mandated in GO
• Establishment of 10 Midwifery Led Care Units (MLCUs) at identified High
Delivery Load facilities – Budget of 6 lac per MLCU approved and sent.
• 19 in-service SNs selected as MEs and are being trained at Fernandez
Foundation - NMTI, Hyderabad
• Operationalizing 5 more SMTIs in Govt. Nursing Colleges
• Midwifery cadre and Career Progression Pathway for the NPMs and Midwifery
Educators – (Draft prepared)
• Provision of performance based incentives for midwives – Budgets approved in
ROP 2024-26
 Testimonial Thank You!!

A small body of determined spirits fired by an unquenchable faith

in their mission can alter the course of history!
-Mahatma Gandhi