Abdirahman Ibrahim Abdirahman

Clinical Specialist-RN, BSc, MPH-Kampala

University

Orientation to midwifery
Chapter 1
introduction to Basic midwifery

ABDIRAHMAN
IBRAHIM

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Midwifery
Midwifery is the health science and health profession that
deals with pregnancy, childbirth, and the postpartum
period (including care of the newborn), in addition to the
sexual and reproductive health of women throughout their
lives. A professional in midwifery is known as a midwife

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 A midwife
A midwife is a person who, having been regularly admitted to
a midwifery educational programme, recognized in the
country in which it is located, has successfully completed the
prescribed course of studies in midwifery and has acquired the
requisite qualifications to be registered and/or legally licensed
to practice midwifery.

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She must be able to give the necessary supervision, care and
advice to women during pregnancy, labour and the
postpartum period, to conduct deliveries on her own
responsibility and to care for the newborn and the infant.
This care includes preventative measures, the detection of
abnormal conditions in mother and child, the procurement of
medical assistance and the execution of emergency measures
in the absence of medical help.
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 Types of midwife
1. Registered midwife
2. Enrolled midwife
3. Auxiliary
4. Skilled midwife
5. TBA (traditional birth attendance)
6. Nurse midwife tutor
 Registered midwife

• There education last about 3 to 4 or more years in nursing

school and lead university or post graduate university degree
they have full range of midwifery skills
 Enrolled midwife
• Also called nurse technician or associate midwife there
education last 3 or 4 years and lead to have common
midwifery skills
 Auxiliary midwife
• Called assistance midwife some secondary school training a
period on the job training may be included basic midwifery
skills
 Skills birth attendance
• Profionals such as midwife doctor or nurse who has been
educated and the training to proficiency in the skills needed to
manage normal and communicate pregnancy
 TBA rational birth attendance
• Mainly on the job training
 Nurse midwife tutor
• Individual prepared to provide basic education or post
graduate training for nurse midwife
History of midwifery

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History of midwifery
The word midwife is derived from middle English (mit wif)

meaning with women .

Formerly, midwives did not undergo any formal education but they

were women who had experiences as far as child was concerned

In ancient times, midwifery had both technical and magical aspects

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cont

In early Greeks and Roman times midwives were the caregivers
to women during their monthly cycle
Midwives used herbs and potions routinely before the discovery
of modern day medicine.
In 1925 Mary Breckinridge, established frontier nursing service.
In 1928 the first professional organization for nurse midwives
began with the establishment of American Association of Nurse-
Midwives.
In 1955 the American college of nurse-midwifery was chartered
Between 1970-1980’s midwifery began to grow rapidly.

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In many African countries midwifery is often incorporated into
nursing curricular and is not provided as a separate programme,
some, such as Burundi and Rwanda, did develop specialist
midwifery programmes. In the late 1960, concern for the high
level of maternal mortality in Africa a number of others countries,
such as Zambia open professional midwifery schools for
registration as a midwife.

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 CHALLENGES IN GLOBAL
MIDWIFERY FOR THE 21ST CENTURY

Midwives originating from the West will hold very different

perspectives of childbirth and midwifery practice compared with
colleagues from other countries, especially those classified as less and
least developed (WHO 2007).

Midwives worldwide aim to provide a safe environment for birth.

However, countless women in today’s world are forced to experience

childbirth, not as a fulfilling experience, but as one fraught with fear

and danger.
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In the 21st century, a majority of women still cannot dissociate birth from
death.
Consequently, midwives are challenged to play a leading part in making
childbirth safer.
130 million babies born worldwide each year, it is estimated that almost
8 million die before their first birthday, 4 million in the first month of life
(WHO
2006).

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The Millennium Development Goals (MDGs) include efforts to improve

the health of both women and children, particularly in the context of

poverty and disease.

Making pregnancy safer challenges not only health professionals, but also
technical experts, including water engineers, road builders,
telecommunication experts and vehicle mechanics.

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CONTRASTS AND INEQUALITIES

It has been stressed that one of the most striking measurable contrasts
between industrialized and developing countries becomes evident in
examining maternal mortality ratios. The 2005 estimates confirm the
highest figures in sub-Saharan Africa followed by South Asia .
Globally, the maternal mortality ratio (MMR) reduction has proceeded
on average by 1% between 1990 and 2005. MMR, as a key indicator
for MDG 5, needs to decrease at a much faster rate if this goal is to be
met (WHO 2007).

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On a global scale, it is estimated that every minute of every day, a
Woman dies of pregnancy-related complications; the massive death
exceeds half million each year (WHO 2008a); 99% of these deaths
occur in developing countries, figures varying considerably.
Motherless newborns are between 3 and 10 times more likely to die
than those whose mothers survive (UNICEF 2008a).

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 MATERNAL DEATHS
The International Classification of Diseases, Injuries and Causes of Death

(ICD9) defines a maternal death as:

the death of a woman while pregnant or within 42 days of termination

of pregnancy, irrespective of the duration and the site of the

pregnancy, from any cause related to or aggravated by the pregnancy

or its management but not from accidental or incidental causes.

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The maternal mortality rate (MMR) for any year is expressed as the
number of deaths attributed to pregnancy and childbearing per 1000
registered total births, or more commonly as the number of deaths
per 100,000 maternities.

Maternal deaths occurring more than 42 days after pregnancy or

childbirth are no longer included in the figures, in line with the
international definition of maternal deaths.

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Causes of maternal death

Main causes
In developing countries, maternal death is the second most common
cause of death after HIV/AIDS. There are five main obstetric causes
of maternal death worldwide:
haemorrhage, infection, unsafe abortion, hypertensive
disorders and obstructed labour (WHO 2008a). Haemorrhage
accounts for around a quarter of deaths globally.

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However, the leading cause of death tends to vary with the region.

In many countries, adolescent mothers are twice as likely to die as

other pregnant women (WHO 2008a)

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 Predisposing factors
Maternal death is influenced by numerous factors.

The reasons why women die have been described as ‘many layered’
(AbouZahr & Royston 1991).

These layers include social, cultural and political factors that determine
crucial issues including the status of women, women’s health and
fertility, and their ‘health-seeking behaviour’. Failures in healthcare
systems and transportation add to the problems.
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One of the issues confronting an estimated 100–140 million
women and girls each year is female genital mutilation (FGM)
10% of the world population, 63% of all HIV infections are evident
there (UNAIDS/WHO 2006). Linkage between HIV and maternal
mortality has been established in the region

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 Maternal morbidity

Morbidity is less easily measurable.

It is estimated that of the 136 million women who give birth each
year, 20 million suffer pregnancy-related illness (WHO 2008a).

The term ‘severe acute maternal morbidity’ (SAMM) has recently

entered obstetric literature; several definitions include the concept of

“near-miss’ and a situation where Pregnancy related complications

lead to the failure of body organs.

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.

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Horrific injuries such as obstetric fistulae , stigmatizing women in
their families and communities, have been described as one of the
most visible indicators of the massive gaps in maternal healthcare
between the developing and developed world (WHO 2006b).
Other morbidities include anaemia, infertility and depression.

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 Millennium Development Goals (MDGs)

 The Millennium Development Goals (MDGs) are a set of eight

interdependent goals aimed at reducing poverty and improving the quality

of life, particularly of the rural poor, and represent a global partnership
resulting from the Millennium Declaration at the UN’s Millennium
summit of 2000.

 193 United Nations member states and at least 23 international

organizations agreed to achieve these goals by the year 2015.

 The MDGs are internationally considered as benchmarks of the progress a

country is making towards sustainable development.

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8 Millennium Develop Goals (MDG)
[Link] extreme poverty and hunger
 A person dies of hunger every 3.5 seconds
 A billion people live on less than $1 a day

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2. Achieve Universal Primary Education for Children

100 million children are not in school

70% of those children are girls

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[Link] Gender Equality and Empower Women
 Empowered women:
 become leaders in their communities
die less often in childbirth
have healthier and better educated children

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4. Reduce Child Mortality
Every 3 seconds a child under 5 dies
Most can be prevented by:
 Clean water
 Sanitation
 Improved nutrition
 Medical treatment

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5. Improve Maternal Health
Half a million women die annually from
complications of pregnancy and child birth
In some parts of world, women have a 50-50
chance of surviving a pregnancy

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6. Combat HIV/AIDS, Malaria, TB, and Other Diseases
Needs are for
Health education
Proper sanitation
Access to clean water
Mosquito nets
Inexpensive medications

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[Link] Environmental Sustainability
Clean water and
Sanitation
Work together to save lives
Create productive societies

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8. Create a Global Partnership for Development
 Fair trade systems
 Increased international aid
 Debt relief for developing countries

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Ethics and midwifery practice

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 Introduction
Ethics is now recognized as a major part of both midwifery education
and practice; it permeates all professional relationships.

Many childbearing women are no longer willing to be passive recipients

of care; they expect to be fully informed of all aspects of their care so
that they, rather than the professionals, make informed decisions, thereby
retaining their autonomy and control. Knowledge of ethics will enable
midwives to have a clear understanding of issues related to their practice
and, in particular, of their role in empowering women to achieve a
pleasurable, fulfilling experience of childbirth.
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Definition
Ethics is basically moral philosophy, or at least the vehicle by
which we transport moral philosophy into practical, everyday
situations.

Ethics deals with the “rightness” or “wrongness” of human

behavior.

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There are three levels to ethics:
1. Meta-ethics involves the deeper philosophy of
examining everything in abstract; for instance, what we mean by
‘right’ and ‘wrong’. In everyday situations.

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 cont
2. Ethical theory aims to create mechanisms for problem

solving, much as mathematicians created formulae for solving

problems related to their field.

3. Practical ethics, as the term suggests, is the active part

where the work of the moral philosophers is put into practice. It is

also the area on which this chapter will generally concentrate.

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 The purpose and aims of the Code

The purpose of the Code is to guide nurses and midwives in their day-to-
day practice and help them to understand their professional responsibilities
in caring for patients in a safe, ethical and effective way.
• Support and guide nurses and midwives in their ethical and clinical
decision making, their on-going reflection and professional self-
development;
• Inform the general public about the professional care they can expect
from nurses and midwives;
• Emphasise the importance of the obligations of nurses and midwives to
recognise and respond to the needs of patients and families;
• Set standards for the regulation, monitoring and enforcement of
professional conduct.
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 All registered nurses and midwives in each area of practice
(clinical, education, research, administration or management)
should adhere to the Code’s principles, values and standards of
conduct.
Nursing and midwifery students should become familiar
with the Code and its supporting documents as part of their
education.

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The structure of the
Code

The Code is based on five principles. They govern:

• Respect for the dignity of the person
• Professional responsibility and accountability
• Quality of practice
• Trust and confidentiality
• Collaboration with others.

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cont
Each principle underpins the Code’s ethical values and related
standards of conduct and practice and guides the relationships
between nurses, midwives, patients and colleagues. The ethical
values state the primary goals and obligations of nurses and
midwives. The standards of conduct and professional practice
follow on from these values and show the attitudes and behaviors
that members of the public have the right to expect from nurses
and midwives.

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Code of Professional Conduct and Ethics for
Registered Nurses and Registered Midwives

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PRINCIPLE 1
Respect for the dignity of the person
Values

1. Nurses and midwives respect each person as a unique

individual.

2. Nurses and midwives respect and defend the dignity of every

stage of human life.

3. Nurses and midwives respect and maintain their own dignity

and that of patients in their professional practice.

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4. Nurses and midwives respect each person’s right to self-
determination as a basic human right. In respecting the right to self-
determination, the requirement of informed consent is key.

5. Nurses and midwives respect all people equally without

discriminating on the grounds of age, gender, race, religion, family
status, sexual orientation, disability (physical, mental or intellectual)
or membership of the Traveller community.

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PRINCIPLE 2
Professional responsibility and
accountability
Values
1. Nurses and midwives are expected to show high standards of
professional behaviour.
2. Nurses and midwives are professionally responsible and
accountable for their practice, attitudes and actions including
inactions and omissions.
3. Nurses and midwives recognise the relationship between
professional responsibility and accountability, and their
professional integrity.
4. Nurses and midwives advocate for patients’ rights.
5. Nurses and midwives recognise their role in the appropriate
management of healthcare resources.
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 PRINCIPLE 3
Quality of practice

Values
1. Nurses and midwives who are competent, safety-conscious and who
act with kindness and compassion, provide safe, high-quality care.
2. Nurses and midwives make sure that the healthcare environment is safe
for themselves, their patients and their colleagues.
3. Nurses and midwives aim to give the highest quality of care to all
people in their professional care.
4. Nurses and midwives use evidence-based knowledge and apply best
practice standards in their work.
5. Nurses and midwives value research. Research is central to the nursing
and midwifery professions. Research informs standards of care and
ensures that both professions provide the highest quality and most cost-
effective services to society.
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PRINCIPLE 4
Trust and confidentiality

Values
1. Trust is a core professional value in nurses’ and midwives’
relationships with patients and colleagues.
2. Confidentiality and honesty form the basis of a trusting
relationship between the nurse or midwife and the patient. Patients
have a right to expect that their personal information remains
private.
3. Nurses and midwives exercise professional judgment and
responsibility in circumstances where a patient’s confidential
information must be shared.

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PRINCIPLE 5
Collaboration with others
Values
1. Professional relationships with colleagues are based on mutual
respect and trust.
2. Nurses and midwives share responsibility with colleagues for
providing safe, quality healthcare. They work together to achieve the
best possible outcomes for patients.
3. Nurses and midwives recognise that effective and consistent
documentation is an integral part of their practice and a reflection of
the standard of an individual’s professional practice. They support the
ethical management of the documentation and communication of care.
4. Nurses and midwives recognise their role in delegating care
appropriately and in providing supervision.

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 Thank U

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