BSC SEM 6 UNIT 1 MIDWIFERY / OBSTETRIC AND GYNECOLOGY NURSING- I
UNIT 1 Introduction to midwifery
📘 Introduction to Midwifery.
🔹 Definition of Midwifery:
Midwifery is a health science and profession that deals with pregnancy, childbirth, postpartum care, and the care of newborns. It focuses on normal reproductive processes and provides skilled, evidence-based care to women and babies.
According to the International Confederation of Midwives (ICM), “A midwife is a person who, having been regularly admitted to a midwifery educational program, is duly recognized, and who has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery.”
🔹 Scope of Midwifery Practice:
Antenatal care (ANC): Monitoring and supporting the health of the mother and fetus.
Intranatal care: Skilled assistance during labor and delivery.
Postnatal care (PNC): Care of the mother and newborn after birth.
Newborn care: Resuscitation, breastfeeding support, and growth monitoring.
Family planning counseling and services.
Health education and promotion.
Referral in case of complications.
🔹 Goals of Midwifery:
Ensure safe motherhood.
Promote normal birth with minimal medical intervention.
Reduce maternal and neonatal morbidity and mortality.
Support women emotionally, physically, and psychologically during childbirth.
Empower women through education and informed decision-making.
🔹 Role of the Nurse-Midwife:
Monitor maternal and fetal well-being.
Identify high-risk pregnancies and refer when necessary.
Conduct safe deliveries in hospitals, homes, or birthing centers.
Educate mothers on nutrition, hygiene, breastfeeding, and immunization.
Provide emotional and psychological support.
Maintain documentation and legal records.
🔹 Qualities of a Good Midwife:
Compassion and empathy.
Clinical competence and confidence.
Communication and counseling skills.
Decision-making and emergency handling.
Respect for women’s dignity and cultural values.
🔹 Midwifery in Public Health:
Integral part of Reproductive and Child Health (RCH) programs.
Supports national goals such as reducing Maternal Mortality Ratio (MMR) and Infant Mortality Rate (IMR).
Works under schemes like Janani Suraksha Yojana (JSY) and LaQshya.
🔹 Midwifery and Legal/Ethical Aspects:
Must follow legal obligations in birth registration, consent, and reporting.
Must adhere to ethical principles like confidentiality, autonomy, and non-maleficence.
Should follow INC and WHO guidelines for midwifery practice.
🔹 Recent Trends in Midwifery:
Introduction of Nurse Practitioner Midwife (NPM) programs in India.
Focus on respectful maternity care (RMC).
Use of technology in ANC/PNC – telehealth, mobile apps.
Skilled Birth Attendants (SBA) training programs.
📚 History of Midwifery in India.
Midwifery in India has evolved over centuries—from traditional practices by dais (traditional birth attendants) to modern evidence-based care provided by skilled nurse-midwives. This history is marked by a gradual transition from informal, experience-based caregiving to formal, professional education and regulatory systems.
🔸 1. Ancient Period (Before British Rule)
In ancient India, childbirth was traditionally managed by Dais, experienced women in the community.
Dais learned skills informally through observation and experience; there was no formal training.
They assisted in home births using herbal remedies, massages, and cultural rituals.
Ayurveda also mentioned childbirth management and maternal care, as seen in texts like Charaka Samhita and Sushruta Samhita.
🔸 2. Colonial Period (British Rule – 18th to mid-20th century)
British rulers recognized the high maternal and infant mortality rates and introduced midwifery training programs.
Dai Training Programs were initiated in the late 19th century to improve traditional birth practices.
In 1908, the first formal midwifery course for women began in Madras (Chennai).
Lady Dufferin Fund (1885) was established to promote women’s healthcare, especially in maternal and childbirth services.
Missionary hospitals and British-established maternity homes began training nurses in midwifery.
🔸 3. Post-Independence Period (After 1947)
After independence, India took serious steps to improve maternal and child health, including formalizing and professionalizing midwifery.
a. Establishment of INC (1947):
The Indian Nursing Council (INC) was established in 1947 to regulate nursing and midwifery education.
Midwifery became a part of general nursing and auxiliary nurse-midwife (ANM) training.
b. Auxiliary Nurse Midwife (ANM) Program (1950s):
Launched in rural areas to provide maternal and child health services.
ANMs were trained in antenatal, intranatal, and postnatal care along with family planning and immunization.
c. National Health Programs:
1960s–1980s: Various national programs such as the Maternal and Child Health (MCH) Program, Family Planning Program, and Reproductive and Child Health (RCH) programs involved midwives actively.
Trained birth attendants (TBAs) and ANMs played a major role in reducing maternal and infant mortality.
🔸 4. Modern and Recent Developments (2000–Present)
a. Skilled Birth Attendant (SBA) Training (2005):
Government launched SBA training for ANMs, staff nurses, and LHVs to ensure safe deliveries.
Emphasis on institutional deliveries under programs like Janani Suraksha Yojana (JSY).
b. National Health Mission (NHM) (2013):
Strengthened maternal health through facility-based and community-based midwifery services.
c. Midwifery-Led Care Units (MLCUs) and Nurse Practitioner in Midwifery (NPM):
2018 onward: The Ministry of Health and Family Welfare (MoHFW) and INC, supported by WHO, started introducing Midwifery-Led Care Units (MLCUs).
Nurse Practitioner in Midwifery (NPM) programs were launched to train professional midwives as per international standards.
Aim: Provide Respectful Maternity Care (RMC) and reduce unnecessary medical interventions like C-sections.
🔸 Key Milestones in Indian Midwifery:
Year
Milestone
Ancient
Dai system and Ayurvedic childbirth practices
1885
Lady Dufferin Fund initiated
1908
First midwifery training in Madras
1947
Indian Nursing Council established
1950s
ANM training launched
1970s–80s
MCH and Family Planning integration
2005
Skilled Birth Attendant (SBA) training began
2018
Launch of Midwifery-Led Care Units
2019–Present
Nurse Practitioner in Midwifery (NPM) training program
🔸 Challenges in the History of Midwifery in India:
Shortage of trained midwives.
Low awareness of midwifery-led care among the population.
Cultural preference for traditional birth practices in rural areas.
Medicalization of childbirth and reduced autonomy of midwives.
Limited institutional support for advanced midwifery roles.
🔸 Current Scenario (As of 2025):
India is working toward meeting SDG targets by promoting midwifery.
National Midwifery Training Institutes (NMTIs) are being established.
Midwives are being trained to:
Lead birth units,
Conduct normal deliveries,
Support women emotionally and culturally during childbirth.
The role of midwives is being revived as independent professionals contributing to maternal and neonatal safety.
📌 Current Scenario: Midwifery in India.
Midwifery in India is undergoing a major transformation to align with global standards of Respectful Maternity Care (RMC) and Universal Health Coverage (UHC). The Indian government, in collaboration with the World Health Organization (WHO) and Indian Nursing Council (INC), is establishing Midwifery-Led Care Units (MLCUs) and training Nurse Practitioners in Midwifery (NPMs) to reduce maternal and neonatal mortality and promote normal, safe childbirth.
🔹 1. Introduction of Nurse Practitioner in Midwifery (NPM) Program
Launched in 2018–2019 by the Ministry of Health and Family Welfare (MoHFW) and Indian Nursing Council (INC) with technical support from WHO.
Aimed at producing midwives who are competent, autonomous, and internationally aligned.
Trained NPMs can:
Lead normal deliveries
Provide antenatal and postnatal care
Identify complications and refer appropriately
Promote family planning, breastfeeding, and newborn care
🔹 2. Midwifery-Led Care Units (MLCUs)
Being set up in selected district hospitals and medical colleges.
Offer normal birthing services in a respectful, non-interventionist environment.
Led by NPMs, with backup support from obstetricians in case of complications.
Goal: Reduce unnecessary C-sections and improve women’s birth experience.
🔹 3. National Midwifery Training Institutes (NMTIs)
6 National Midwifery Training Institutes (NMTIs) and State Midwifery Training Institutes (SMTIs) have been identified and operationalized.
These institutes follow international midwifery curricula.
Each NPM receives 18 months of residential training including simulation, mentorship, and clinical practice.
🔹 4. Government Policies and Strategic Support
The National Health Policy 2017 recognized midwifery-led care as a cost-effective model to reduce maternal mortality.
Aligns with WHO’s Global Strategic Directions for Nursing and Midwifery (2021–2025).
LaQshya program under NHM focuses on quality of care in labor rooms and MLCUs.
🔹 5. Respectful Maternity Care (RMC)
A key focus of the current midwifery model.
Midwives are trained to:
Support women’s rights, dignity, and informed choice
Provide compassionate and evidence-based care
Minimize unnecessary interventions in labor
🔹 6. Challenges Still Faced
Issue
Description
❌ Shortage of trained NPMs
Still in early phase, limited number of certified midwives
❌ Resistance from existing health providers
Some obstetricians resist sharing autonomy with midwives
❌ Limited awareness
Many communities unaware of midwifery-led care models
❌ Infrastructure gaps
Need for more MLCUs with adequate equipment and privacy
🔹 7. Current Achievements (2024–2025 Highlights)
Over 100 NPMs trained and posted across India.
MLCUs are functional in multiple states including Kerala, Maharashtra, Tamil Nadu, and Gujarat.
Government is planning to scale up NPM training and open MLCUs in all districts by 2030.
NPMs now play a key role in reducing MMR and IMR, and promoting normal vaginal deliveries.
📘 Transformative Education for Relationship-Based and Transformative Midwifery Practice in India
🔹 Introduction:
Transformative midwifery education in India is a paradigm shift from traditional, task-oriented training to a more woman-centered, relationship-based, and holistic approach. It aligns with global efforts led by WHO and ICM (International Confederation of Midwives) to build a cadre of competent, autonomous, and compassionate midwives who provide Respectful Maternity Care (RMC).
🔹 What is Transformative Education in Midwifery?
Transformative education refers to an approach that:
Goes beyond skill acquisition, focusing on attitude, values, ethics, and empowerment.
Develops critical thinking, clinical reasoning, and leadership.
Encourages self-awareness, emotional intelligence, and interpersonal relationships.
Promotes evidence-based and woman-centered midwifery practice.
🔹 Key Features of Transformative Midwifery Education in India:
Feature
Description
🌱 Competency-Based Curriculum
Based on ICM Essential Competencies (2019) and INC framework. Focuses on skills, knowledge, and attitude.
🧠 Critical Thinking & Clinical Decision Making
Midwives are trained to assess, plan, and respond confidently in normal and emergency birth scenarios.
❤️ Relationship-Based Care
Prioritizes trust, empathy, and communication between midwives and women.
🤝 Respectful Maternity Care (RMC)
Emphasis on dignity, privacy, consent, and informed choices for women during childbirth.
🧍 Woman-Centered Approach
Birth is seen as a natural, empowering experience, not just a clinical event.
📈 Reflective Practice & Continuous Learning
Midwives are encouraged to reflect, grow, and stay updated with current evidence.
🔹 Implementation in India:
✅ 1. National Midwifery Training Institutes (NMTIs):
Central hubs for transformative education and mentorship.
Mentors are experienced national and international midwifery educators.
✅ 2. Nurse Practitioner Midwife (NPM) Program:
18-month residential program to produce skilled, autonomous midwives.
Follows a global standard midwifery curriculum.
Focus on relationship-building, communication, and respect for women’s autonomy.
✅ 3. Collaborations:
Supported by WHO, UNFPA, Jhpiego, and other international agencies.
Technical assistance provided to design curriculum, build faculty, and monitor quality.
🔹 Core Principles of Relationship-Based Midwifery Practice:
🤱 Partnership with Women: Women are active decision-makers in their care.
💬 Effective Communication: Listening, empathy, and shared decision-making are central.
🫂 Continuity of Care: The same midwife supports the woman through pregnancy, labor, and postpartum.
🧘 Emotional and Psychological Safety: Addressing fear, stress, and trauma through compassionate care.
🙏 Cultural Sensitivity and Respect: Adapting care based on the woman’s beliefs, background, and needs.
🔹 Benefits of Transformative Education and Relationship-Based Midwifery:
Benefit
Impact
✔️ Empowered Midwives
Confident, autonomous practitioners
✔️ Empowered Women
Women feel respected, safe, and informed
✔️ Improved Maternal Outcomes
Lower MMR and IMR, fewer interventions like C-sections
✔️ Increased Trust
Between community and healthcare system
✔️ Better Birth Experience
Emotionally positive, physically safe childbirth
🔹 Challenges in Implementation:
Shortage of trained midwifery educators and mentors.
Resistance from the medical hierarchy and existing health workforce.
Need for policy and legal recognition of independent midwifery practice.
Requirement of scaling up infrastructure and awareness.
🔹 Way Forward:
Policy reforms to recognize midwifery as an independent profession.
Investing in midwifery education, mentorship, and career pathways.
Public awareness campaigns to promote trust in midwifery-led care.
Expanding MLCUs and NPM programs to all districts.
📘 National Health Programs Related to RMNCH (Reproductive, Maternal, Newborn, Child, and Adolescent Health)
🔹 Introduction to RMNCH
RMNCH stands for Reproductive, Maternal, Newborn, Child, and Adolescent Health. It is a comprehensive approach launched by the Government of India to improve the health and survival of women, infants, children, and adolescents. It aligns with the goals of reducing MMR, IMR, NMR, and improving overall health and nutrition outcomes across the life cycle.
🔹 Key National Health Programs Related to RMNCH
✅ 1. Reproductive and Child Health (RCH) Program – Phase I & II
Launched: 1997 (RCH-I), 2005 (RCH-II)
Aim: To provide integrated and need-based reproductive and child health services.
Services included:
Family planning
Safe motherhood
Immunization
Prevention of RTIs/STIs and adolescent reproductive health
✅ 2. Janani Suraksha Yojana (JSY) – 2005
A safe motherhood scheme under National Health Mission (NHM).
Provides cash incentives to promote institutional deliveries among poor pregnant women.
Special focus on BPL families, SC/ST communities, and high-focus states.
📘 Current Trends in Midwifery and Gynecology Nursing (2025).
Midwifery and gynecology nursing are undergoing rapid transformation in India and globally due to advancements in clinical practices, education, technology, policy reforms, and women-centered care models. The focus is shifting from merely managing childbirth and women’s diseases to providing holistic, respectful, evidence-based, and empowering care to women across their life stages.
🔹 1. Midwifery-Led Continuum of Care
🌸 Description:
Emphasizes a continuity of care model where the same midwife (or team) provides care throughout antenatal, intranatal, and postnatal periods.
✅ Benefits:
Builds trust and strong relationships with the woman
Reduces medical interventions and C-section rates
Improves maternal and neonatal outcomes
🔹 2. Nurse Practitioner in Midwifery (NPM) Program
🌸 Description:
Launched in India to create a new cadre of autonomous, skilled midwives.
Trained to manage normal pregnancies and childbirth independently.
Based on ICM (International Confederation of Midwives) standards.
✅ Benefits:
Strengthens respectful maternity care
Reduces burden on obstetricians
Increases access to skilled birth attendants in rural areas
🔹 3. Midwifery-Led Care Units (MLCUs)
🌸 Description:
MLCUs are being established in district hospitals and medical colleges.
Provide non-interventionist, natural birthing environments managed by midwives.
✅ Benefits:
Encourages normal vaginal deliveries
Empowers women through choice and dignity
Reduces unnecessary use of anesthesia and surgical births
🔹 4. Respectful Maternity Care (RMC)
🌸 Description:
RMC is now a global standard focusing on:
Informed consent
Privacy and confidentiality
Freedom from abuse and discrimination
Emotional support during labor
✅ Benefits:
Improves woman’s birth experience
Reduces trauma and postpartum depression
Encourages facility-based deliveries
🔹 5. Technological Integration in Gynecological Care
🌸 Examples:
Use of telemedicine for follow-up consultations
Electronic fetal monitoring during labor
Mobile apps for ANC and menstrual health tracking
Colposcopy and hysteroscopy advancements for early diagnosis
✅ Benefits:
Timely care access
Early diagnosis of cancers and gynecologic disorders
Saves time and resources, especially in remote areas
🔹 6. Focus on Adolescent Reproductive Health
🌸 Description:
Through programs like RKSK, adolescent girls are educated on:
Menstrual hygiene
Nutrition and anemia prevention
Safe sex practices
Contraceptive choices
✅ Benefits:
Reduces teenage pregnancy
Empowers young girls with reproductive rights
Promotes long-term health-seeking behavior
🔹 7. Integration of Family Planning and Contraceptive Services
🌸 New Initiatives:
Long-acting reversible contraceptives (LARC) like Antara injection
Postpartum IUCD (PPIUCD) inserted within 48 hours of delivery
Emergency contraception education and availability
✅ Benefits:
Prevents unwanted pregnancies
Promotes birth spacing
Reduces maternal and infant mortality
🔹 8. Evidence-Based and Holistic Nursing Practice
🌸 Description:
Nurses are trained to use research-based interventions in both midwifery and gynecology.
Integration of alternative therapies like:
Breathing techniques
Yoga for pregnancy
Aromatherapy during labor
✅ Benefits:
Increases quality and safety of care
Promotes natural labor progression
Reduces dependency on medication
🔹 9. Focus on Preventive and Early Detection in Gynecology
🌸 Strategies:
Pap smear tests for cervical cancer screening
HPV vaccination for adolescent girls
Awareness about breast self-examination
PCOS and infertility counseling
✅ Benefits:
Early diagnosis of diseases like cancer, PCOS, endometriosis
Improves women’s quality of life
Reduces disease burden on the healthcare system
🔹 10. Education and Training Reforms in Nursing
🌸 Updates:
Emphasis on simulation-based learning, OSCEs, and competency-based training
Launch of B.Sc. Midwifery as an independent program in India
Faculty development programs for midwifery educators
✅ Benefits:
Produces confident, skilled, and compassionate midwives
Keeps nursing workforce updated with global standards
Prepares nurses for leadership and autonomy
🔹 11. Gender Sensitivity and Women Empowerment in Care
🌸 Description:
Focus on gender-inclusive language, addressing violence against women, and mental health support
Midwives and nurses play a key role in counseling and legal referrals.
✅ Benefits:
Ensures equitable, safe, and culturally sensitive care
Builds trust and safety for all women
🔹 12. Global Collaborations and WHO Guidelines
🌸 Description:
India is working closely with:
WHO
UNFPA
Jhpiego
ICM
Aligning national programs with WHO’s Global Strategic Directions for Nursing and Midwifery (2021–2025)
✅ Benefits:
Promotes universal health coverage
Encourages global learning and knowledge exchange
Strengthens the profession of midwifery and gynecology nursing
📘 Respectful Maternity and Newborn Care (RMNC)
(For Nursing and Midwifery Students – 2025 Updated)
🔹 Introduction
Respectful Maternity and Newborn Care (RMNC) is a human rights-based, woman-centered approach to providing care during pregnancy, childbirth, and the postnatal period—extending to the newborn. It ensures that every woman and baby receives compassionate, dignified, evidence-based, and non-discriminatory care throughout the continuum of childbirth.
🔹 Definition:
RMNC is defined as care that maintains the dignity, privacy, and confidentiality of the woman and newborn, ensures freedom from harm and mistreatment, and enables informed choice and continuous support during labor and childbirth. – WHO, 2016
🔹 Core Components of RMNC:
For the Mother:
Dignified and respectful communication
Privacy and confidentiality
Freedom from abuse or coercion
Informed consent and decision-making
Equity and non-discrimination
Supportive companionship during labor
Freedom of movement and birth position
Pain relief and emotional support
For the Newborn:
Immediate skin-to-skin contact
Early initiation of breastfeeding
Delayed cord clamping (after 1–3 mins)
Prevention of hypothermia
Gentle handling and minimal separation from mother
Timely identification and management of complications
🔹 Importance of RMNC:
Benefits to Women & Newborns
Benefits to Healthcare System
Prevents trauma and abuse
Builds trust in public health
Reduces maternal mortality
Improves institutional delivery rates
Promotes early bonding
Reduces legal and ethical violations
Encourages breastfeeding
Increases service utilization
Reduces postpartum depression
Enhances patient satisfaction
🔹 Global and National Initiatives Supporting RMNC:
🌍 WHO (World Health Organization):
Introduced “Standards for improving quality of maternal and newborn care in health facilities”.
Emphasizes Respectful Maternity Care (RMC) as a universal right.
🇮🇳 In India:
LaQshya Program (2017):
Labour Room Quality Improvement Initiative.
Focuses on ensuring safe and respectful childbirth.
National Midwifery Initiative:
Trains Nurse Practitioners in Midwifery (NPMs) to offer dignified, non-interventionist birthing services.
RMNCH+A Strategy (2013):
Incorporates RMC in all maternal and newborn health interventions.
JSSK (Janani Shishu Suraksha Karyakram):
Provides cashless, dignified maternal and newborn care in public facilities.
🔹 Nurses’ and Midwives’ Role in Promoting RMNC:
Role
Action
👩⚕️ Advocate
Speak up against disrespectful practices
🧠 Educator
Provide antenatal education on rights and choices
🫂 Supporter
Offer emotional support and birth companionship
📋 Documenter
Ensure informed consent and legal recordkeeping
🤝 Facilitator
Respect birth preferences, positions, and comfort
⏱️ Responder
Identify early signs of distress in mother or newborn
🔹 Common Violations of RMNC (To be Prevented):
Verbal or physical abuse
Performing procedures without consent (e.g., episiotomy)
Neglect or abandonment during labor
Shaming women for their choices
Separating newborns from mothers without medical need
Discriminatory behavior based on caste, age, economic status, etc.
🔹 Challenges in Implementing RMNC:
Shortage of trained, empathetic staff
Overcrowding and lack of privacy in labor rooms
Cultural insensitivity and hierarchical systems
Lack of awareness of rights among women
🔹 Way Forward:
Training and sensitization of all healthcare providers.
Strict monitoring and audits of labor rooms.
Involving community in demanding respectful care.
Empowering women through health literacy.
Promoting midwifery-led care models across India.
📘 Midwife-Led Care Units (MLCUs)
(For Nursing & Midwifery Students – Updated 2025)
🔹 Introduction:
Midwife-Led Care Units (MLCUs) are specialized units within hospitals or maternity centers where trained midwives (especially Nurse Practitioners in Midwifery – NPMs) provide comprehensive, respectful, and evidence-based care to low-risk pregnant women throughout labor, delivery, and the postnatal period—with minimal medical intervention.
MLCUs are part of India’s national strategy to reduce maternal and neonatal mortality and to improve the quality of childbirth services, particularly under the LaQshya program and the National Midwifery Initiative.
🔹 Definition:
A Midwife-Led Care Unit (MLCU) is a healthcare setting managed and run by midwives that offers a safe, respectful, and natural birthing experience for women with low-risk pregnancies, emphasizing minimal medical interventions and continuous emotional support.
🔹 Types of MLCUs:
Alongside MLCUs (AMUs)
Located next to obstetric units in hospitals
Quick referral in case of complications
Suitable for district and referral hospitals
Standalone MLCUs (SMUs)
Located outside hospitals, in community settings
Suitable for rural and primary health settings
Offers midwife-only care for low-risk deliveries
🔹 Objectives of MLCUs:
Promote natural childbirth and reduce unnecessary interventions (e.g., C-sections).
Improve maternal and newborn health outcomes.
Provide Respectful Maternity Care (RMC).
Enhance women’s autonomy and decision-making during childbirth.
Increase the availability and visibility of skilled midwifery care.
🔹 Core Services Provided in MLCUs:
Services
Description
🩺 Antenatal care
Counseling, risk screening, and pregnancy monitoring
👶 Intranatal care
Monitoring labor, assisting vaginal delivery, emotional support
🧷 Postnatal care
Monitoring of mother and newborn, breastfeeding support
📈 Referral system
Immediate transfer to obstetrician/doctor in case of complications
🗣️ Health education
Nutrition, hygiene, contraception, danger signs, etc.
🔹 Key Features of an MLCU:
Run by trained Nurse Practitioners in Midwifery (NPMs).
Home-like, calm environment for birthing.
Use of non-pharmacological pain relief (e.g., massage, music, water therapy).
Support for birth companions during labor.
Provision for emergency referral and backup care by obstetricians.
Emphasis on informed consent, freedom of movement, and birth position choices.
🔹 Benefits of MLCUs:
For Women
For Health System
Respectful, dignified care
Reduces burden on OB-GYNs
Fewer interventions (e.g., C-section)
Cost-effective care
Better birth satisfaction
Strengthens midwifery as a profession
Increased breastfeeding rates
Improves maternal and newborn outcomes
Lower rates of postpartum depression
Encourages facility-based births
🔹 MLCUs in India – Current Status (as of 2025):
Pilot MLCUs established in 11 states, including:
Tamil Nadu, Kerala, Maharashtra, Gujarat, Uttar Pradesh, Rajasthan, Odisha, and Madhya Pradesh.
National Midwifery Training Institutes (NMTIs) are training midwives to staff MLCUs.
Supported by Ministry of Health and Family Welfare (MoHFW), INC, and WHO.
LaQshya program and RMNCH+A strategy promote MLCU integration into district hospitals.
🔹 Eligibility Criteria for Women to Deliver at MLCU:
Singleton pregnancy
Cephalic presentation
Gestational age: 37–42 weeks
No major complications (e.g., PIH, GDM, anemia < 9 g/dL)
No history of cesarean section or obstructed labor
🔹 Challenges in MLCU Implementation:
Challenge
Description
🚫 Resistance
From doctors or staff uncomfortable with midwife-led autonomy
🧑🏫 Training gaps
Shortage of skilled NPMs and midwifery educators
🏥 Infrastructure
Need for dedicated MLCU spaces in crowded hospitals
📣 Awareness
Low public awareness about MLCU benefits
⚖️ Policy
Need for legal and regulatory support for independent midwifery
🔹 Way Forward:
Scale-up NPM training programs across India.
Establish MLCUs in every district hospital and CHC.
Include midwifery care in insurance schemes and maternity benefit programs.
Promote community awareness and education on respectful birthing.
Develop strong referral linkages for high-risk pregnancies.
📘 Birthing Centers (Birth Centres)
🔹 Introduction
A Birthing Center (also called Birth Centre) is a healthcare facility specially designed to provide natural, safe, and family-centered childbirth experiences, primarily for low-risk pregnancies. It is typically midwife-led, homelike in setting, and focused on minimal medical intervention during labor and delivery.
🔹 Definition
A Birthing Center is a freestanding or hospital-attached facility where healthy pregnant women with low-risk pregnancies can give birth in a natural, respectful, and supportive environment under the supervision of trained midwives, with backup support from medical professionals if needed.
🔹 Key Characteristics of Birthing Centers:
Feature
Description
🏡 Home-like environment
Calm, private, and non-clinical setting (soothing lighting, music, space to walk, birthing pool, etc.)
👩⚕️ Midwife-led care
Managed and run primarily by skilled nurse-midwives or NPMs
💊 Minimal intervention
Avoids routine use of C-section, epidurals, or induction unless medically necessary
👨👩👧 Family involvement
Allows birth companions and promotes family support
💖 Woman-centered approach
Respects woman’s choice of birth position, pain relief methods, and privacy
🧳 Short stay
Women are usually discharged within 6–24 hours after normal birth
🚑 Referral linkages
Ties with nearby hospitals for emergencies and high-risk referrals
🔹 Types of Birthing Centers
Freestanding Birthing Centers
Located outside hospital premises
Staffed by midwives with tie-ups for hospital referral
Suitable for normal low-risk births
Alongside Birthing Centers (within hospitals)
Attached to hospitals with quick access to doctors
Combines midwife-led care with medical backup
Home Birth Services with Birthing Unit Backup
Midwives provide home birth services and refer to centers if needed
🔹 Eligibility Criteria for Birthing Center Delivery:
Healthy woman with singleton, cephalic presentation
Term pregnancy (37–42 weeks)
No history of cesarean section or complications
No existing medical or obstetric high-risk conditions
Willingness for natural birth without routine interventions
Breastfeeding support, newborn care, early discharge, follow-up visits
🗣️ Health education
Family planning, newborn danger signs, postpartum hygiene
🔹 Benefits of Birthing Centers:
For Women & Family
For Health System
Respectful and comfortable experience
Reduces overcrowding in hospitals
Reduced interventions (e.g., C-section)
More cost-effective than hospital delivery
Empowered and informed choices
Focuses on midwifery and skilled birth attendants
Lower stress and anxiety
Promotes community-based care models
Early discharge with safety
Reduces burden on tertiary hospitals
🔹 Birthing Centers in India: Current Scenario (2025)
The concept is gaining popularity due to:
Urban maternal preferences for non-hospital births
Government-supported Midwife-Led Care Units (MLCUs)
Increasing awareness about natural birthing practices
✳ Examples in India:
Fernandez Hospital (Hyderabad) – Natural Birth Centre
Sitaram Bhartia Institute (Delhi) – Midwife-based birthing care
Birthvillage (Kochi) – Freestanding birthing center
State-run Birthing Huts and MLCUs in public hospitals under LaQshya Program
🔹 Challenges in India:
Challenge
Explanation
🚧 Low awareness
Most people unaware of birthing centers as an option
🧑⚕️ Shortage of midwives
Need for more trained NPMs and midwifery educators
⚖️ Policy gaps
Lack of separate legal status or regulation for birthing centers
💰 Affordability
Private birthing centers may be expensive for lower-income groups
🏥 Emergency management
Referral systems not always robust in rural areas
🔹 Role of Nurse-Midwives in Birthing Centers:
Provide holistic, evidence-based maternity care
Offer emotional support and manage pain naturally
Ensure informed consent, freedom of choice, and woman’s autonomy
Educate about postnatal care, danger signs, family planning
Identify risks early and initiate referrals when needed
📘 Water Birth
🔹 Introduction:
Water birth is a method of childbirth where a woman spends the final stages of labor, and sometimes the actual delivery of the baby, in a birthing pool filled with warm water. It is based on the belief that water provides a relaxing, soothing, and less painful environment for both the mother and the baby.
Water birth is a key practice in natural and midwifery-led childbirth, particularly in birthing centers and Midwife-Led Care Units (MLCUs).
🔹 Definition:
A water birth is the process of giving birth in a pool of warm water, where the laboring woman delivers the baby in water or uses water during labor to manage pain and improve comfort.
🔹 Purpose and Philosophy:
Natural birth experience with minimal interventions.
Pain relief through hydrotherapy.
Enhancing freedom of movement and relaxation.
Providing a gentle transition for the newborn from amniotic fluid to water.
🔹 Stages Where Water Can Be Used:
First Stage of Labor – Most common; for pain relief and relaxation.
Second Stage (Pushing & Birth) – Some women also choose to deliver in water.
Third Stage (Placenta Delivery) – Usually done outside water, but can be done in water under guidance.
🔹 Ideal Candidates for Water Birth:
Healthy pregnant women with:
Low-risk singleton pregnancy
Gestational age of 37–42 weeks
Cephalic presentation
No complications (e.g., preeclampsia, gestational diabetes, bleeding)
Well-informed and motivated women choosing natural childbirth.
🔹 Contraindications for Water Birth:
Not Recommended If
Reason
High-risk pregnancy
Fetal or maternal complications
Multiple pregnancy
Risk of preterm birth and complications
Breech presentation
Increased risk during vaginal delivery
Meconium-stained liquor
Higher risk of aspiration
Epidural anesthesia
Movement restriction
Premature labor
Increased risk of infection and complications
🔹 Benefits of Water Birth:
For Mother
For Baby
Natural pain relief
Gentle birth environment
Reduced need for epidurals or drugs
Reduced birth trauma
Shorter labor duration
Smoother transition from womb to world
Less perineal trauma
Maintains temperature stability
Improved relaxation and comfort
Reduces crying and stress response
Enhances sense of control
Early initiation of bonding and breastfeeding
🔹 Equipment Needed:
Birthing pool (deep and wide enough for full immersion)
Immediate readiness for emergency transfer if complications arise.
Midwife must be trained in water birth and neonatal resuscitation.
🔹 Water Birth in India – Current Status (2025):
Gaining popularity in urban birthing centers and private hospitals.
Offered at selected natural birthing centers in:
Hyderabad (Fernandez Hospital)
Delhi (Sitaram Bhartia)
Kochi (Birth Village)
Being encouraged in some Midwife-Led Care Units (MLCUs) under National Midwifery Initiative.
Not yet widely adopted in public sector due to infrastructure and training gaps.
🔹 Challenges in India:
Challenge
Explanation
🚫 Limited awareness
Many women are unaware of this option
🧑⚕️ Lack of training
Few midwives are certified in water birth
🏥 Infrastructure gaps
Public hospitals often lack birthing pools
📜 No standard guidelines
Need for uniform policies across India
😟 Safety concerns
Misconceptions about infection and drowning risk
📘 Lotus Birth
🔹 Introduction:
Lotus birth, also known as umbilical non-severance, is a natural childbirth practice in which the umbilical cord is not cut after birth. Instead, the umbilical cord and placenta remain attached to the newborn until they naturally dry, separate, and fall off—usually within 3 to 10 days after birth.
It is based on the belief that allowing the cord and placenta to separate naturally offers spiritual, emotional, and health benefits to the baby.
🔹 Definition:
Lotus birth is the practice of leaving the umbilical cord uncut after delivery, keeping the placenta intact and attached to the baby until the cord naturally detaches on its own.
Named after Clair Lotus Day, who promoted this practice in the 1970s.
🔹 Philosophy Behind Lotus Birth:
Emphasizes natural separation of the newborn from the placenta.
Sees the placenta as a sacred and life-giving organ that should be honored.
Belief that the baby transitions gently from womb to world with minimal trauma.
Encourages bonding, calmness, and immune support.
🔹 Procedure of Lotus Birth:
After birth, the baby is placed on the mother’s chest (skin-to-skin contact).
The umbilical cord is left unclamped and uncut.
The placenta is delivered naturally (within 30–60 minutes).
The placenta is washed, dried, and wrapped in clean cloth or herbs.
The baby is kept close to the placenta, and both are handled carefully.
The cord dries and detaches on its own (between 3 to 10 days).
🔹 Care of the Placenta in Lotus Birth:
Step
Description
🧼 Cleaning
Gently rinse the placenta with sterile water
🌿 Drying
Pat dry and allow to air dry or gently wrap in gauze
🧂 Preserving
Often packed with natural herbs (lavender, salt, rosemary) to prevent odor or decay
🔁 Daily care
Change cloth regularly, inspect for odor or signs of infection
🔹 Benefits Claimed by Supporters of Lotus Birth:
For the Baby
For the Mother & Family
Gentle and gradual transition
Promotes sacred bonding experience
Reduced stress and trauma
Enhances spiritual satisfaction
Better immune support
Increases maternal mindfulness
Continued blood flow from placenta (for a few minutes)
Encourages slower pace in postpartum period
🔹 Medical Perspective & Risks:
🔍 Evidence-based Perspective:
While delayed cord clamping (1–3 minutes) is scientifically proven to benefit the newborn (improved iron stores, oxygenation), extended non-severance (Lotus birth) has limited scientific evidence.
⚠️ Potential Risks:
Risk
Explanation
🦠 Infection
Dead tissue (placenta) can be a source of bacterial growth
❌ Limited handling
Baby’s mobility is restricted due to attached placenta
😟 Misinterpretation
May delay seeking care if infection or neonatal issues arise
🔬 No proven long-term benefit
Unlike delayed clamping, lotus birth has not shown measurable health improvements
🔹 Nursing and Midwifery Responsibilities in Lotus Birth:
Respect mother’s choice if informed and eligible.
Ensure the baby is stable post-delivery before proceeding.
Maintain strict hygiene for placenta and umbilical area.
Educate the family on signs of infection: foul odor, fever, redness, swelling.
Provide guidance on gentle handling, bathing, and feeding.
Maintain accurate documentation and report abnormalities immediately.
🔹 Guidelines and Policy Status in India (2025):
Not officially recommended by Indian health authorities (MoHFW, INC).
Accepted only under informed parental request and low-risk deliveries.
Midwives/nurses must adhere to infection prevention protocols.
WHO does not endorse lotus birth but supports delayed cord clamping (1–3 minutes).
📘 Essential Competencies for Basic Midwifery Practice (As per ICM – International Confederation of Midwives)
🔹 Introduction:
The International Confederation of Midwives (ICM) has developed a global framework of Essential Competencies for basic midwifery practice. These competencies define the minimum knowledge, skills, and professional behavior that every midwife must demonstrate to ensure safe, effective, and respectful care for women, newborns, and families throughout the childbirth continuum.
🔹 Purpose of ICM Competency Framework:
Guide midwifery education, practice, regulation, and policy globally.
Ensure standardized quality care irrespective of setting or country.
Align midwifery training with WHO standards and Sustainable Development Goals (SDGs).
🔹 Four Main Categories of Essential Competencies:
Category
Description
A. General Competencies
Professional behavior, communication, ethics, documentation
B. Pre-pregnancy and Antenatal Care
Counseling, assessments, early risk detection
C. Care During Labour and Birth
Support during normal labor, managing emergencies
D. Ongoing Care of Women and Newborns
Postpartum, newborn care, family planning, breastfeeding
🔸 A. General Competencies
These include cross-cutting competencies applicable across all stages of care:
Assume responsibility and accountability for midwifery practice.
Facilitate women-centered care that is ethical, respectful, and culturally appropriate.
Use effective communication and counseling skills.
Promote and protect human rights, confidentiality, and informed consent.
Apply evidence-based practice in decision-making.
Collaborate with other health professionals as needed.
Use appropriate documentation and record-keeping.
🔸 B. Competencies Specific to Pre-pregnancy and Antenatal Care
Midwives must be able to:
Provide pre-pregnancy counseling and family planning services.
Confirm pregnancy and establish gestational age.
Monitor fetal and maternal well-being during antenatal visits.
Educate about danger signs, birth planning, and emotional support.
🔸 C. Competencies Specific to Care During Labour and Birth
Midwives should be able to:
Monitor and support the physiological process of labor.
Promote freedom of movement, choice of birth position, and non-pharmacological pain relief.
Facilitate normal vaginal delivery.
Identify, manage, or refer complications (e.g., prolonged labor, hemorrhage).
Provide emotional support and involve a birth companion.
Ensure immediate newborn care (warmth, clearing airways, early breastfeeding).
Practice delayed cord clamping and active management of third stage of labor.
🔸 D. Competencies Specific to Ongoing Care of Women and Newborns
Midwives are expected to:
Monitor mother and newborn in postpartum period for at least 6 weeks.
Support early and exclusive breastfeeding.
Provide family planning counseling and services.
Educate mothers on hygiene, nutrition, mental health, and newborn care.
Detect and manage postpartum complications (e.g., sepsis, depression).
Support parenting and bonding with the newborn.
Maintain continuity of care and link with community-based services.
🔹 ICM’s Underlying Principles in Competency Framework:
Principle
Focus
🔹 Woman-centered care
Respect for dignity, autonomy, informed choice
🔹 Continuity of care
Throughout pregnancy, birth, postpartum
🔹 Partnership with women
Empowering and involving women in decisions
🔹 Evidence-based practice
Using current research and clinical guidelines
🔹 Cultural safety and equity
Addressing social determinants and respectful care
🔹 Importance of ICM Competencies in India:
Forms the basis of training Nurse Practitioners in Midwifery (NPMs).
Incorporated into National Midwifery Initiative curriculum.
Helps India achieve LaQshya goals, SDG 3 (Good Health & Well-being), and reduce MMR/IMR.
Empowers midwives to work autonomously with legal and professional recognition.
📘 Universal Rights of Childbearing Women
🔹 Introduction:
Every woman has the right to respectful, safe, and dignified care during pregnancy, childbirth, and postpartum. The Universal Rights of Childbearing Women were first outlined by the White Ribbon Alliance and are endorsed by WHO, UNFPA, and other global health agencies. These rights aim to eliminate disrespect and abuse in maternity care and ensure Respectful Maternity Care (RMC) for all women, regardless of age, caste, class, religion, or socio-economic status.
🔹 What Are Universal Rights of Childbearing Women?
These rights are based on human rights principles and apply in all childbirth settings—hospitals, birthing centers, or homes.
They include:
🔟 The Ten Universal Rights of Childbearing Women:
No.
Right
Description
1️⃣
Right to be treated with respect and dignity
Every woman must be treated politely, kindly, and with compassion—free from abuse, harassment, or humiliation.
2️⃣
Right to information, informed consent, and refusal
Women must be given complete information about procedures and allowed to make their own choices.
3️⃣
Right to privacy and confidentiality
Personal health information and physical privacy must be protected at all times.
4️⃣
Right to non-discrimination
Women must not be treated differently based on age, race, caste, religion, education, marital status, or economic condition.
5️⃣
Right to timely healthcare and highest attainable health standards
Women must have access to skilled care without delay and be referred if complications arise.
6️⃣
Right to be free from harm and ill-treatment
No woman should experience physical, emotional, or verbal abuse or unnecessary medical interventions.
7️⃣
Right to liberty, autonomy, self-determination, and freedom from coercion
Women should have control over their body and health decisions, including the choice of birth position or pain relief.
8️⃣
Right to companionship during labor and childbirth
Women have the right to have a birth companion (e.g., husband, mother, or friend) present.
9️⃣
Right to continuous care and support
Continuous emotional and physical support must be available from trained midwives or nurses.
🔟
Right to make complaints and receive redress
Women must be allowed to file complaints and seek justice if their rights are violated.
🔹 Why Are These Rights Important?
Benefit
Explanation
🩺 Improves outcomes
Reduces maternal and neonatal mortality and complications
💖 Builds trust
Encourages women to seek institutional care
🧠 Reduces trauma
Protects mental health and postpartum well-being
👩⚖️ Promotes justice
Prevents discrimination and abuse in care
🌍 Supports global goals
Aligns with SDGs, especially Goal 3 (Health & Well-being) and Goal 5 (Gender Equality)
🔹 Examples of Violations (That Must Be Prevented):
Slapping or shouting at a woman in labor
Performing episiotomy without consent
Denying pain relief or not allowing a birth companion
Mocking or discriminating against unmarried or adolescent mothers
Ignoring a woman’s call for help during labor
🔹 Role of Nurses and Midwives in Upholding These Rights:
Role
Responsibility
👩⚕️ Care provider
Offer respectful, non-judgmental care
📢 Advocate
Speak up against abuse or mistreatment
🧠 Educator
Teach women about their rights
📋 Documenter
Maintain proper informed consent and patient records
🤝 Collaborator
Work with doctors, ASHAs, and family for holistic care
🚨 Reporter
Report violations or unsafe practices immediately
📘 Sexual and Reproductive Health (SRH)
🔹 Introduction:
Sexual and Reproductive Health (SRH) refers to the state of physical, emotional, mental, and social well-being in all matters related to the reproductive system and sexuality. It is not merely the absence of disease but includes the right to safe, respectful, and informed choices regarding sexual and reproductive functions.
It is a fundamental human right, central to the health and development of individuals, families, and communities.
🔹 Definition (WHO):
“Reproductive health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and its functions and processes.” – World Health Organization (WHO)
🔹 Components of Sexual and Reproductive Health (SRH):
Domain
Description
🧠 Sexual Health
Healthy, respectful, and consensual sexual relationships; freedom from violence, coercion, and discrimination
🤰 Reproductive Health
Safe pregnancy, childbirth, and family planning services
🧪 Prevention & treatment of STIs/RTIs
Including HIV/AIDS, syphilis, gonorrhea, chlamydia
👶 Fertility & Infertility Care
Counseling and support for conception or contraception
🩺 Safe Abortion Services
Where legal, with counseling and post-abortion care
💬 Adolescent Reproductive Health
Menstrual hygiene, sex education, and protection from early pregnancy
👩⚕️ Cervical and breast cancer screening
Early detection and treatment of reproductive cancers
🔹 Principles of SRH:
Informed Choice & Consent
Equity and Non-Discrimination
Confidentiality and Privacy
Gender Sensitivity
Comprehensive and Lifelong Approach
Right to Information and Access to Services
🔹 Importance of SRH:
Benefit
Explanation
💉 Prevents unwanted pregnancies
Access to contraceptives and education
🧬 Controls population growth
Supports sustainable development
👩⚕️ Reduces maternal and infant mortality
Through antenatal care and skilled delivery
💖 Empowers women
By giving control over their reproductive choices
🧑⚕️ Prevents STIs and cancers
Through screening and timely treatment
🧠 Promotes mental and social health
Reduces stigma and increases autonomy
🔹 SRH Services in India:
Offered under Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCH+A) approach through:
Family Planning Services (Mala-N, IUCDs, Antara injection)
Adolescent Health Program (RKSK)
Safe abortion services under MTP Act
STI/RTI Clinics (Suraksha Clinics)
Anemia Mukt Bharat, WIFS
Menstrual Hygiene Scheme (MHS)
Maternal and Child Health (MCH) Clinics
🔹 Barriers to SRH in India:
Barrier
Impact
🚫 Lack of awareness
Leads to unprotected sex, unsafe abortions
😷 Cultural taboos
Restrict access to sex education and services
❌ Gender inequality
Limits decision-making in reproductive matters
🧒 Early marriage
Increases maternal risks and dropouts
🏥 Limited rural access
Few trained providers and facilities
🔹 Nursing Role in SRH Promotion:
Role
Responsibility
👩⚕️ Educator
Provide sexual and reproductive health education in schools, clinics, and community
🧠 Counselor
Offer emotional support and non-judgmental counseling to adolescents, couples
🩺 Service provider
Assist in family planning, maternal health, STI screening, and safe abortion care
SDG 5 – Achieve gender equality and empower women and girls
UNFPA Mission – “Delivering a world where every pregnancy is wanted, every childbirth is safe, and every young person’s potential is fulfilled.”
📘 Sexual and Reproductive Health Rights (SRHR)
🔹 Introduction:
Sexual and Reproductive Health Rights (SRHR) are a set of human rights that protect every individual’s freedom to make informed choices about their sexuality and reproduction, free from coercion, violence, and discrimination. These rights ensure access to safe, respectful, and quality sexual and reproductive healthcare.
SRHR is an integral part of human rights, gender equality, and public health.
🔹 Definition (UNFPA):
“Sexual and reproductive health rights refer to the basic rights of all individuals to decide freely and responsibly on matters related to their sexual and reproductive lives, and to have access to information, education, and services to do so.”
🔹 Core Components of SRHR:
🔹 1. Right to Life and Health
Every individual has the right to life and to the highest attainable standard of physical and mental health, including reproductive health.
🔹 2. Right to Information and Education
Everyone has the right to accurate, evidence-based information about sexuality, contraception, safe abortion, menstruation, and fertility.
🔹 3. Right to Decide Freely and Responsibly on Reproductive Matters
Includes the right to:
Decide if and when to have children
Choose contraceptive methods
Access infertility care
🔹 4. Right to Privacy and Confidentiality
Individuals have the right to seek SRH services without being judged, disclosed, or violated.
🔹 5. Right to Access SRH Services
Access to:
Family planning
Antenatal and postnatal care
Safe abortion (where legal)
STI/RTI treatment
HIV services
🔹 6. Right to Be Free from Violence and Discrimination
Protection from:
Sexual violence or coercion
Female genital mutilation (FGM)
Child marriage
Forced sterilization
🔹 7. Right to Autonomy and Bodily Integrity
The right to make decisions about one’s own body, including sexual and reproductive choices.
🔹 8. Right to Equality and Non-Discrimination
All individuals should enjoy equal SRH rights regardless of gender, age, marital status, caste, religion, sexual orientation, or disability.
🔹 Importance of SRHR:
Importance
Explanation
🌍 Human rights
Protects dignity and freedom of choice
🧠 Empowerment
Especially for women, adolescents, and LGBTQ+
💉 Health improvement
Reduces maternal mortality, STI rates, and unsafe abortions
🧑🏫 Education and awareness
Increases responsible decision-making
⚖️ Gender justice
Promotes equity in health and social participation
🔹 Examples of SRHR Violations:
Denying access to contraception
Forcing a woman to continue or terminate a pregnancy
Marrying girls before legal age (child marriage)
Performing medical procedures (e.g., sterilization) without consent
Withholding sexual health education in schools
Discriminating against unmarried women or LGBTQ+ in health settings
🔹 National and Global Frameworks Supporting SRHR:
🌍 Global:
International Conference on Population and Development (ICPD) – 1994
Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW)
Sustainable Development Goals (SDGs) – especially Goal 3 and Goal 5
🇮🇳 India:
Reproductive and Child Health (RCH) Program
Adolescent Health Program (RKSK)
MTP Act (Medical Termination of Pregnancy Act)
POSH Act (Protection from Sexual Harassment)
Pocso Act (Protection of Children from Sexual Offences)
Rights under Article 21 of the Indian Constitution (Right to life and dignity)
🔹 Role of Nurses and Midwives in Promoting SRHR:
Role
Responsibilities
🧠 Educator
Provide comprehensive sexuality education (CSE)
👩⚕️ Service provider
Offer family planning, STI testing, antenatal/postnatal care
💬 Counselor
Support decision-making with empathy and respect
📣 Advocate
Promote SRHR awareness in community and policy levels
🚨 Safeguarder
Identify and report rights violations (e.g., abuse, coercion)
🧾 Documenter
Maintain confidentiality and ethical care practices
🔹 Challenges in SRHR Implementation (India & Globally):
Challenge
Explanation
🚫 Cultural taboos
Reluctance to discuss sex and reproductive choices
🙍 Gender inequality
Limited autonomy for women and girls
👩🎓 Lack of education
Myths and misconceptions about SRH
🏥 Rural access
Limited services in remote areas
❌ Legal restrictions
Limited access to safe abortion in some countries
📘 INC/MoHFW Regulations in Midwifery Practice (India – 2025)
🔹 Introduction:
Midwifery education and practice in India are governed by two main authorities:
🏛 Indian Nursing Council (INC) – A statutory body under the Government of India, responsible for setting standards of nursing and midwifery education, training, and registration.
🏥 Ministry of Health and Family Welfare (MoHFW) – The national ministry that formulates health policies, implements programs, and strengthens public health services across India, including midwifery and maternal care.
Together, these bodies ensure that midwifery is safe, standardized, evidence-based, and aligned with global guidelines.
🔹 A. Indian Nursing Council (INC) Regulations
✅ 1. INC Act, 1947
Empowers INC to regulate nursing and midwifery education across India.
Approves syllabi and curricula for:
ANM
GNM
B.Sc. Nursing
Nurse Practitioner in Midwifery (NPM)
✅ 2. Regulations on Education Standards
INC prescribes:
Admission criteria
Course duration
Clinical hours
Internship requirements
Examination and evaluation standards
✅ 3. Registration and Licensing
All practicing midwives must be registered with:
State Nursing Councils, and
Comply with INC-recognized registration guidelines
✅ 4. Nurse Practitioner in Midwifery (NPM) Program – 2018 Onward
Developed in partnership with MoHFW and WHO.
Produces skilled, independent midwives aligned with ICM (International Confederation of Midwives) standards.
NPMs trained in:
Antenatal care
Normal labor and delivery
Postnatal care
Family planning and newborn care
18-month residential program with simulation and clinical practice.
✅ 5. Code of Ethics & Professional Conduct
INC publishes ethical codes covering:
Respect for human dignity
Informed consent
Confidentiality
Accountability
Non-discrimination
🔹 B. Ministry of Health and Family Welfare (MoHFW) Regulations & Initiatives
✅ 1. National Midwifery Initiative (NMI) – 2018
Aimed to establish a professional midwifery cadre in India.
Components include:
Midwife-Led Care Units (MLCUs)
National Midwifery Training Institutes (NMTIs)
Deployment of NPMs in hospitals and birthing centers
✅ 2. LaQshya Program (2017)
Labour Room Quality Improvement Initiative
Ensures safe and respectful intrapartum care
Promotes midwife-led birthing services in public facilities
✅ 3. RMNCH+A Strategy (2013)
Framework covering Reproductive, Maternal, Newborn, Child and Adolescent Health
Ensures free, high-quality antenatal care to all pregnant women on the 9th of every month.
Midwives play a role in:
Screening
Counseling
Referrals
✅ 5. Skilled Birth Attendant (SBA) Guidelines
MoHFW trains ANMs, LHVs, and staff nurses as Skilled Birth Attendants.
Aims to:
Ensure safe and clean deliveries
Identify and manage obstetric complications
✅ 6. Maternal Death Review Guidelines
Midwives must report and document maternal deaths.
Purpose: Identify systemic gaps and improve service delivery.
✅ 7. Standard Treatment Guidelines (STGs) for Midwives
Issued by MoHFW for:
Antenatal care protocols
Normal labor management
Management of postpartum hemorrhage
Newborn resuscitation
Family planning and contraception
🔹 Collaborative Roles of INC and MoHFW:
Area
Responsibility
📚 Education
INC develops midwifery curriculum and standards
🏥 Program Implementation
MoHFW deploys midwives under national health missions
📋 Regulation
INC registers and monitors licensed midwives
🛡️ Quality Assurance
MoHFW ensures MLCU quality through LaQshya
🤝 Global Alignment
Both work with WHO and ICM to modernize midwifery
📘 Ethical Issues in Maternal and Neonatal Care
🔹 Introduction:
Maternal and neonatal care involves some of the most sensitive and emotionally intense moments in healthcare. Nurses, midwives, and doctors are often faced with complex ethical dilemmas when providing care to pregnant women, mothers, and newborns—especially in situations involving risk, consent, rights, and life-or-death decisions.
Understanding and respecting ethical principles is essential to ensure safe, dignified, and equitable care for both mother and baby.
🔹 What Are Ethical Issues?
Ethical issues refer to situations where moral principles like autonomy, justice, beneficence, and non-maleficence may conflict or be challenged in clinical decision-making.
🔹 Key Ethical Principles in Maternal and Neonatal Care:
Principle
Description
🔹 Autonomy
Respect the mother’s right to make informed decisions
🔹 Beneficence
Do good for both mother and baby
🔹 Non-maleficence
Do no harm to mother or baby
🔹 Justice
Provide fair and equal care to all
🔹 Confidentiality
Keep patient information private
🔹 Informed Consent
Obtain voluntary, informed agreement before procedures
🔹 Common Ethical Issues in Maternal and Neonatal Care:
1. Informed Consent vs. Emergency Situations
When a mother is unconscious or in labor and unable to give consent, should the healthcare provider intervene to save her or the baby?
Balancing life-saving care vs. consent becomes a dilemma.
2. Maternal Autonomy vs. Fetal Well-being
A mother refuses a C-section that could save the fetus.
Whose life takes priority—mother’s autonomy or fetus’s right to life?
3. Adolescent Pregnancy
Ethical concerns arise when providing care to a minor, especially around:
Consent
Sexual abuse reporting
Confidentiality vs. parental rights
4. Confidentiality in Sensitive Situations
A woman wants to keep her pregnancy or abortion private.
Health workers must balance confidentiality with legal obligations (e.g., in rape, minor age, or abuse cases).
5. Gender-Based Discrimination
Refusing care or treating patients differently based on gender, caste, marital status, or number of daughters already born is unethical.
Midwives must promote non-judgmental care.
6. Respectful Maternity Care (RMC) Violations
Ethical issues occur when:
Women are verbally or physically abused in labor rooms.
Procedures like episiotomy are performed without consent.
Mothers are denied a birth companion or privacy.
7. Refusal of Newborn Treatment by Parents
In certain cultural or religious groups, parents may refuse life-saving neonatal treatment.
Ethical dilemma: respecting parental beliefs vs. baby’s right to life.
8. End-of-Life Decisions for Neonates
In cases of extreme prematurity or congenital anomalies, decisions on:
Resuscitation
NICU admission
Withdrawal of life support
must be made ethically and compassionately.
9. Abortion and Termination of Pregnancy
Health workers may face moral conflict while providing abortions.
Ethically, care must be non-judgmental, legal, and based on informed consent under the MTP Act.
10. Resource Allocation and Equity
Ethical concern arises when beds, medicines, or staff are limited, especially in public hospitals.
Every woman and baby has the right to fair access to quality care.
🔹 Nurse & Midwife Responsibilities in Ethical Practice:
Role
Action
📋 Educator
Explain rights, procedures, and options clearly to women/families
🧠 Counselor
Support ethical decision-making without bias
📢 Advocate
Stand up for patient rights and dignity
🛡️ Protector
Maintain privacy, confidentiality, and safe environments
📖 Documenter
Record informed consent and incidents accurately
⚖️ Policy Follower
Adhere to INC Code of Ethics, hospital policies, and legal acts
White Ribbon Alliance – Universal Rights of Childbearing Women
Indian MTP Act, POCSO Act, JJ Act
LaQshya Guidelines for Labour Room Care
📘 Adoption Laws in India.
🔹 Introduction:
Adoption is a legal process by which a child who is biologically unrelated to a couple or individual becomes their permanent and lawful child. It gives the adopted child the same legal rights as a biological child, including inheritance.
Adoption laws in India aim to protect the best interest of the child, ensure legal safety for adoptive families, and prevent child trafficking or illegal adoptions.
🔹 Key Objectives of Adoption Laws:
Provide orphaned, abandoned, or surrendered children with a loving and stable family.
Ensure adoption is legal, transparent, ethical, and in the child’s best interest.
Protect the rights of the biological, adoptive parents, and the child.
🔹 Legal Framework Governing Adoption in India:
India has two sets of laws for adoption, based on the religion of the adoptive parents:
✅ 1. Hindu Adoption and Maintenance Act (HAMA), 1956
📌 Applicable to:
Hindus, Buddhists, Jains, Sikhs (not to Muslims, Christians, Parsis, or Jews)
📌 Features:
Covers domestic adoption only
Allows adoption of one male and one female child
Married couple must adopt with consent of spouse
Unmarried, widowed, or divorced individuals can also adopt
Child must be:
Below 15 years of age
Not previously adopted
Not already having adoptive parents
📌 Legal Outcome:
Child becomes legal heir and member of adoptive family
Adoption is irrevocable
✅ 2. Juvenile Justice (Care and Protection of Children) Act, 2015 (JJ Act)
📌 Applicable to:
All Indian citizens, regardless of religion
NRIs and foreign nationals (through CARA guidelines)
📌 Features:
Covers adoption of orphans, abandoned, or surrendered children
Governed by CARA (Central Adoption Resource Authority)
Child must be:
Declared legally free for adoption
Registered with Specialised Adoption Agency (SAA)
📌 Adoptive Parent Criteria:
Married couples, single women, and single men (with restrictions)
Must be physically, mentally, emotionally stable
Age difference between child and adoptive parent: minimum 25 years
Married couples must be in a stable marriage for at least 2 years
🔹 Role of CARA (Central Adoption Resource Authority)
An autonomous body under MoWCD (Ministry of Women and Child Development)
Regulates and monitors all legal adoptions in India
Maintains online adoption system – CARINGS (Child Adoption Resource Information and Guidance System)
Authorizes Specialised Adoption Agencies (SAAs)
🔹 Types of Adoption Recognized in India:
Type
Description
👨👩👧 In-country Adoption
Adoption by Indian citizens residing in India
🌍 Inter-country Adoption
Foreign nationals or NRIs adopting from India
🧓 Relative/Kinship Adoption
Within family (allowed under HAMA, JJ Act)
🧺 Step-parent Adoption
Legal procedure to adopt spouse’s child from previous marriage
🔹 Legal Procedure of Adoption (under JJ Act & CARA):
Registration with a Specialised Adoption Agency (SAA) or online via CARINGS portal.
Home Study Report (HSR) by social worker.
Matching process: Prospective parents are shown profiles of legally free children.
Acceptance of a child and signing of Memorandum of Agreement.
Pre-adoption foster care (optional).
Court procedure for legal adoption order.
Post-adoption follow-up and support by agency for 2 years.
🔹 Rights of the Adopted Child:
Treated as a biological child
Full right to inherit property
Right to name, identity, care, education, and protection
Right to know biological origin (in special cases, when of age)
🔹 Nurses’ and Midwives’ Role in Adoption Process:
Role
Responsibility
🧠 Educator
Provide accurate information about adoption laws and procedures
📋 Counselor
Offer emotional support to biological and adoptive families
🧒 Child advocate
Ensure child’s health, nutrition, vaccination, and emotional well-being
🤝 Facilitator
Collaborate with SAAs and child welfare committees
🚨 Reporter
Report abandoned or at-risk children under the JJ Act
🔹 Legal Provisions Against Illegal Adoption:
Sale or trafficking of children is a criminal offense.
Adoption through unauthorized sources (e.g., hospitals, NGOs without CARA approval) is illegal.
Penalty under IPC and JJ Act includes imprisonment and fines.
🔹 Challenges in Adoption in India:
Challenge
Explanation
⏳ Delays in process
Due to legal formalities and documentation
😟 Social stigma
Especially for adopting girl children or special needs
📜 Awareness gaps
Among rural population and single parents
🛑 Black market adoptions
Illegal baby selling by unregistered agencies
📘 Medical Termination of Pregnancy (MTP) Act – India
🔹 Introduction:
The Medical Termination of Pregnancy (MTP) Act is a legal framework in India that allows for the safe and legal abortion of a pregnancy under specific conditions. Originally enacted in 1971, and amended in 2021, the Act ensures that women have access to legal, safe, confidential, and timely abortion services while preventing unsafe and illegal abortions.
🔹 Purpose of the MTP Act:
To reduce maternal mortality and morbidity due to unsafe abortions.
To provide reproductive rights and choice to women.
To regulate when, how, and by whom abortion can be legally performed in India.
🔹 Important Updates: MTP (Amendment) Act, 2021
Aspect
Before Amendment
After 2021 Amendment
Gestational age limit
Up to 20 weeks
Increased to 24 weeks for special categories
Who can approve?
1 doctor (up to 12 weeks), 2 doctors (12–20 weeks)
1 doctor (up to 20 weeks), 2 doctors (20–24 weeks)
Special cases for 24 weeks
Not allowed
Allowed for survivors of rape, incest, minors, and other vulnerable women
Abortion beyond 24 weeks
Not permitted
Permitted in case of fetal abnormalities with approval from a Medical Board
Privacy clause
Not clearly stated
Confidentiality ensured – identity of woman must not be revealed except to legal authorities
🔹 Who Can Perform MTP?
Only a Registered Medical Practitioner (RMP) with the following qualifications:
At least 1 year of experience in gynecology and obstetrics
Trained under MTP guidelines
Working in a government-approved hospital or clinic
Nurses, ANMs, and midwives are not permitted to perform MTP but may assist and provide pre/post-abortion care.
🔹 Permissible Conditions for Abortion Under MTP Act:
Risk to woman’s physical or mental health
Substantial fetal abnormalities
Pregnancy due to rape or incest
Failure of contraception (only for married and now unmarried women too, as per 2021 amendment)
Mental trauma or socio-economic burden
🔹 Time Limit for Termination:
Gestation Age
Who Can Approve
Legal Conditions
🕒 Up to 20 weeks
1 RMP
On request if criteria are met
🕓 20–24 weeks
2 RMPs
Only for special categories (rape survivors, minors, differently-abled)
🕔 Beyond 24 weeks
Medical Board approval
Only in case of fetal anomaly (incompatible with life)
🔹 Medical vs Surgical Abortion:
Type
Description
Applicable Up To
💊 Medical Abortion
Use of pills (Mifepristone + Misoprostol)
Up to 9 weeks (63 days)
🔪 Surgical Abortion
Dilation and curettage (D&C) or vacuum aspiration
After 9 weeks and up to 24 weeks depending on case
🔹 Rights and Protections Under the MTP Act:
Confidentiality: Identity and details of the woman must be kept private.
Consent:
For adult women (18+), only the woman’s consent is needed.
For minors (<18) or mentally ill persons, guardian’s consent is required.
Legal immunity: Doctors acting in good faith under the Act are protected from legal consequences.
🔹 Penalties Under the Act (For Illegal Abortions):
Offense
Punishment
Unqualified person performing MTP
Imprisonment up to 7 years
Performing abortion without woman’s consent
Imprisonment for up to 10 years
Breach of confidentiality
Fine and imprisonment up to 1 year
🔹 Role of Nurses and Midwives in MTP Services:
Role
Responsibility
🧠 Educator
Provide education on legal abortion, contraception, and reproductive rights
👂 Counselor
Offer non-judgmental support and emotional care
💉 Clinical Assistant
Assist the doctor during MTP procedures
🩺 Post-abortion care
Monitor for bleeding, infection, and emotional support
🗂️ Record-keeper
Maintain confidentiality and proper documentation
📣 Advocate
Support women’s access to safe and legal abortion services
🔹 Programs Supporting MTP Services in India:
RCH Program (Reproductive and Child Health)
RMNCH+A Strategy
Safe Abortion Services (SAS) under NHM
Mission Parivar Vikas
📘 Pre-Natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994
🔹 Introduction:
The PNDT Act was enacted to prevent female feticide and regulate the use of prenatal diagnostic techniques (like ultrasound) that were being misused to determine the sex of the fetus, often leading to sex-selective abortions.
In 2003, it was amended and renamed as the PCPNDT Act (Pre-Conception and Pre-Natal Diagnostic Techniques Act) to include regulation from the pre-conception stage itself.
🔹 Full Name:
The Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection) Act, 1994, amended in 2003.
🔹 Purpose of the Act:
Prohibit sex selection before or after conception.
Regulate the use of diagnostic techniques (ultrasound, amniocentesis, etc.).
Prevent misuse of such techniques for determining fetal sex.
Improve the child sex ratio in India.
🔹 Why Was the Act Needed?
Issue
Impact
📉 Declining sex ratio
Due to widespread sex-selective abortions
🧪 Misuse of technology
Ultrasounds being used to determine fetal sex
⚖️ Lack of regulation
Clinics operating without licenses or documentation
❌ Violation of women’s and unborn girls’ rights
Pressure on mothers to abort female fetuses
🔹 Key Provisions of the PCPNDT Act:
✅ 1. Ban on Sex Selection
Sex determination and sex selection is prohibited at any stage—before or after conception.
✅ 2. Regulation of Diagnostic Techniques
Ultrasound, amniocentesis, chorionic villus sampling, and other diagnostic techniques can only be used for:
Detecting genetic abnormalities
Sex-linked disorders
High-risk pregnancies (e.g., maternal age >35, family history)
✅ 3. Mandatory Registration
All genetic clinics, laboratories, and ultrasound centers must:
Be registered under the Act
Display a board: “Sex determination is a punishable offence.”
Maintain records of all procedures and pregnancies
✅ 4. Prohibition of Advertisement
No person or clinic shall advertise sex determination tests, even indirectly.
Punishable with fine or imprisonment.
✅ 5. Responsibilities of Healthcare Professionals
Doctors, radiologists, sonologists, and staff must:
Not reveal the sex of the fetus
Maintain complete Form F records
Report violations and cooperate with authorities
🔹 Offences and Penalties Under the Act:
Offence
Penalty
Conducting or assisting sex selection
❌ Up to 3 years’ imprisonment + ₹10,000 fine (1st offence); 5 years + ₹50,000 fine (repeat offence)
Advertising sex determination
❌ Up to 3 years’ jail + fine
Failure to maintain records
❌ Punishable under the Act
Using unregistered equipment or centers
❌ Leads to sealing of the clinic and license suspension
🔹 Role of Appropriate Authorities:
Appointed at state, district, and sub-district levels to:
Monitor and regulate centers
Conduct inspections
Seize equipment or records
Initiate legal action
🔹 Nurses’ and Midwives’ Role Under PCPNDT Act:
Role
Responsibility
📢 Advocate
Educate the public about girl child rights and the law
📝 Record-keeper
Assist in maintaining correct documentation (e.g., Form F)
🚨 Reporter
Report illegal sex selection practices if witnessed
🧠 Educator
Inform pregnant women about legal and health aspects of prenatal diagnostics
🙋 Supporter
Protect and counsel women facing family pressure for sex-selective abortion
🔹 Impact of PCPNDT Act:
Helped in improving the child sex ratio in some states.
Increased awareness among healthcare professionals.
Encouraged legal use of prenatal tests for genuine medical conditions.
However, implementation gaps remain in rural and urban-private setups.
📘 Surrogate Mothers
🔹 Introduction:
A surrogate mother is a woman who agrees to carry and deliver a baby on behalf of another person or couple, known as the intended or commissioning parents. Surrogacy is used when a woman is medically unable to conceive or carry a pregnancy but wants to have a biological child.
India has legalized altruistic surrogacy under specific guidelines to protect the rights of all parties, especially the surrogate mother and the child.
🔹 Definition:
A surrogate mother is a woman who voluntarily agrees to become pregnant and give birth to a child for another couple or person, who will become the child’s legal parent(s) after birth.
🔹 Types of Surrogacy:
Type
Description
✅ Traditional Surrogacy
The surrogate is genetically related to the child. Her own egg is fertilized with the intended father’s sperm (less common and not permitted in India).
✅ Gestational Surrogacy
The surrogate is not genetically related to the child. An embryo created from the intended parents’ egg and sperm is implanted in her uterus. (Legal in India)
🔹 Types Based on Payment:
Type
Description
❌ Commercial Surrogacy
The surrogate is paid beyond medical expenses – now banned in India.
✅ Altruistic Surrogacy
The surrogate is not paid except for medical and insurance coverage – only this is legal in India.
🔹 Legal Framework in India: Surrogacy (Regulation) Act, 2021
The Surrogacy (Regulation) Act, 2021 governs surrogacy practices in India to:
Prevent exploitation of surrogate mothers
Protect the rights of the child and intended parents
Ensure ethical and safe practices
🔹 Key Provisions of the Surrogacy Act, 2021 (India):
✅ 1. Only Altruistic Surrogacy is Allowed
No monetary benefit to the surrogate, except:
Medical expenses
Insurance for 36 months
✅ 2. Eligibility Criteria for Intended Parents
Must be Indian citizens
Married couple: Woman aged 23–50, man aged 26–55
Widow or divorcee woman (aged 35–45) can also be a single parent
Must not have any biological, adopted, or surrogate children
✅ 3. Eligibility Criteria for Surrogate Mothers
Must be a close relative (sister, cousin, sister-in-law)
Married woman aged 25–35 with at least one biological child of her own
Allowed to act as a surrogate only once in her lifetime
Must undergo medical and psychological screening
Requires written informed consent
✅ 4. Surrogacy Authorization
Must be conducted in a registered surrogacy clinic with a certificate of eligibility.
Requires approval from the appropriate authority and surrogacy boards.
✅ 5. Ban on Commercial Surrogacy
Any form of payment, advertising, or third-party arrangement for surrogacy is illegal.
✅ 6. Rights of the Child Born via Surrogacy
Considered the biological child of the intended parents
Has full legal rights, including inheritance
Cannot be abandoned due to deformity or gender
✅ 7. Punishments for Violations
Engaging in commercial surrogacy, sex selection, exploitation = jail term of 5 years and fine up to ₹10 lakh
🔹 Ethical Considerations:
Concern
Explanation
🤱 Surrogate exploitation
Risk of poor women being forced into surrogacy for money
🧬 Genetic identity
Confusion regarding biological links and parenthood
❌ Abandonment of child
Rejection of child with disabilities or undesired gender
🛡️ Emotional impact
On surrogate and her family
⚖️ Legal disputes
Conflicts over parental rights or breach of contract
🔹 Role of Nurses and Midwives in Surrogacy:
Role
Responsibility
🧠 Counselor
Provide psychological and emotional support to surrogate and intended parents
👩⚕️ Caregiver
Monitor surrogate’s health, antenatal care, and childbirth
📋 Educator
Explain legal rights, informed consent, and medical process
🚨 Observer
Ensure no exploitation or coercion is occurring
🗂️ Documenter
Maintain confidential records and care plans
👩⚖️ Advocate
Promote ethical and respectful maternity care for the surrogate
📘 Roles and Responsibilities of a Midwife in Different Settings (Hospital / Community)
🔹 Introduction:
A midwife is a trained healthcare professional who provides comprehensive care to women during pregnancy, labor, delivery, and the postpartum period, as well as to newborns and sometimes even adolescents and families. A midwife’s role extends from clinical practice to community service, depending on the setting.
🔹 Core Philosophy of Midwifery:
Promote natural, respectful, and woman-centered birth
Ensure safe motherhood and newborn care
Empower women and protect reproductive rights
🔹 Key Settings Where Midwives Work:
🏥 Hospital/Institutional Setting
🏘️ Community/Public Health Setting
Let’s explore the responsibilities in each:
🏥 A. Roles and Responsibilities of a Midwife in a Hospital Setting