UNIT-I

INTRODUCTION
The word derives from Old English mid, "with," and wif, "woman," and thus originally meant
"with-woman," that is, the person who is with the woman (mother) at childbirth.

Obstetrics word came from a Modern Latin obstetricus, "pertaining to a midwife," which has the
root word obstetrix, "midwife,"

Terminology

• Midwifery is the knowledge necessary to perform the duties of midwife.

• Obstetrics is that branch of medicine, which deals with the management of pregnancy,
labor and puerperium.

• Gynecology is that branch of medical science, which treats diseases of the female genital
organs.

• Reproduction means process by which a fully developed offspring of its kind is produced

• Pregnancy is a state of carrying fetus inside the uterus by a woman from conception to
birth.

• Gestation means pregnancy.

• Gravidae is state of pregnancy irrespective of its duration.

• Multipara refers to woman who has given birth more than once

• Nullipara is the woman who has not given birth before.

• Primigravidae is a woman carrying first pregnancy.

• Multigravidae is a woman carrying pregnancy more than once.

Definition:

1. Midwifery, is a health science and health profession that deals with pregnancy, childbirth,
and the postpartum period (including care of the newborn), besides sexual and
reproductive health of women throughout their lives.

2. Obstetrical nursing, also called perinatal nursing, is a nursing specialty that works with
patients who are attempting to become pregnant, are currently pregnant, or have recently
delivered. Obstetrical nurses help provide prenatal care and testing, care of patients
experiencing pregnancy complications, care during labor and delivery, and care of
patients following delivery. Obstetrical nurses work closely with obstetricians, midwives,
and nurse practitioners.
 3. According to ICM membership (International confederation of midwives) and joint study
group of maternity care and WHO:
“A midwife is a person who, having been regularly admitted to a midwifery educational
program duly recognized in the country in which it is located has successfully completed the
prescribed course of studies in midwifery and has acquired the requisite qualification to be
registered and or legally licensed to practice midwifery”.

The role of a midwife whether she practices in hospitals, health centers, or domiciliary
conditions has been recognized as one of the most rewarded job. Her function carries great
responsibilities and demands, specific knowledge and skills. They play a central role in health
care delivery- promotion, prevention, treatment and rehabilitation, in areas of great health needs,
especially in remote areas. The midwife may practice in any setting including the home, the
community, hospitals, or in any other maternity services. In all settings the midwife remains
responsible and accountable for the care she provides.

 Healthy women are the key to the health of any nation, primarily because of their vital
role in co-creating healthy infants and co-caring for the family.

 Providing health care to women is not only a health issue but a matter of human rights
issue a.

 In women’s life childbirth is a special event.

 A mother will never forget a ‘midwife’ who delivered her baby; and who was ‘with the
woman’ during childbirth, which is the very essence and identity of a midwife.

 Hence midwife is an obvious catalyst in providing safe motherhood in the fabric of our
society.

SCOPE OF MIDWIVES IN HEALTH CARE AND THE COMMUNITY

 The midwife works in partnership with women, on her own professional responsibility, to
give women the necessary support, care and advice during pregnancy, labour and the
postpartum period to facilitate birth and to provide care for the new born.
 The midwife has an important role in health and wellness promotion and education for
the women, her family and the community.
 The midwifery practices involve informing and preparing the women and her family for
pregnancy, birth, breast feeding and parenthood and include certain aspect of women’s
health, family planning and infant well being.

The midwives play an important role in providing essential health care and emergency health
care.

Various roles and responsibilities of a midwife have presented in the below:

 • Care giver: Midwives provide high quality antenatal and postnatal care to maximize the
women’s health during and after pregnancy, detect problems early and manage or refer
for any complications.

• Coordinator: Midwives coordinate care for all women. Coordinator ensures holistic,
voluntary and social services for pregnant women when appropriate so that every
women’s birth experience regardless of risk factor.

• Leader: The role of leader is to plan, provide and review a women’s care, with her input
and agreement, from the initial antenatal assessment through to the postnatal period.
Midwife’s leading role reduces admission to hospital and results in significantly less
intervention during birth.

• Communicator: As a communicator, the midwives understand that effectiveness of

communication. It helps to develop trust relationship with pregnant women and family
members. The midwife has to communicate effectively with pregnant women and family
members as well as others so that they can share their all problems.

• Manager: Manager is a great role for midwife. Midwives manage all the circumstances
where appropriate and can recognize and refer women to obstetricians and other
specialists in a timely when necessary.

• Educator: As an educator, midwives provide high quality, culturally sensitive health

education in order to promote healthy, helpful family life and positive parenting.

• Counselor: Midwives provide information and counsel pregnant women on prenatal self
care including nutrition, hygiene, breastfeeding and danger sings in pregnancy and
childbirth.

• Family planner: They also counsel people as a family planner. They provide all
information about all kind of family planning methods and help couple to take decision.

• Adviser: Midwives give advice on development of birth plan and promote the concept
of birth preparedness. They also give advice during complicated situation so that it will
help them to take decision.

• Record keeper: Record keeping is an integral part of midwifery practice. It helps making
continuity of care easier and enabling identify problem in early stage.

• Supervisor: Supervising and assisting mothers during antenatal period, monitoring the
condition of the condition of the fetus and using their knowledge to identify early sings
complication.

Midwifery in India before independence

• In ancient India, care of women and practice of midwifery were totally in the hands of
indigenous village ‘dais’.
 • This indigenous dais not only helped during childbirth but also acted as consultants for
any condition of the mother related to birth.

• When medical missionary women from England came to India, the first striking
observation they made was that, since dais were unable to deal with difficult deliveries
and pregnancies, the maternal and neonatal mortality were very high.

• The first training school for dais was started in 1877 by Miss Hewlett, an English
missionary of the Zenana Missionary Society.

• However, the training of dais was not taken up by Government of India (GoI) till 1900
when a fund was established by Lady Curzon to improve the conditions of childbirth in
the country.

• But before that, in 1872, a handful of Indian Christian nurses were trained for two years
at Delhi.

• In 1899 the Zenana Bible and Medical Mission started the training of nurses, but until
1893 there was no generally accepted scheme of training in the hospitals.

• In 1918 with the help of Dufferin Fund, Lady Reading Health School was established to
train Auxiliary Nurse Midwives (ANMs).

• In 1926 the Madras Registration of Nurses and Midwifes Act was passed to promote the
role of a registered midwife for service during childbirth.

• In 1936 Dufferin fund sanctioned grant to a number of Dufferin hospitals to build hostels,
supply teaching materials and employ qualified sisters in nursing schools.

• Thus Dufferin fund helped in raising the standards of nursing and midwifery in India.1 In
fact prior to independence, midwifery training started as a separate course, in India.
Young girls at the middle school level (8th) were selected to undergo this training.

Midwifery in independent India

• In 1946, the Bhore Committee laid stress on the need for qualified midwives, health
visitors, and the training of dais.

• In 1955, the Shetty Committee recommended the training of Auxiliary Nurse Midwife
(ANMs) in health centers for maternal and child health services, provided there were
adequate health visitors to supervise them.

• In 1959 Bishoff, a technical Consultant supported the training of two types of nursing
personnel ANM and General Nurse Midwife (GNM Nursing- 3 years and Midwifery- 1
year).

• In 1947, the first step the Indian Nursing Council took after its inception was to combine
the nursing and the midwifery courses into a single course.
 • The course was designed to be of three and a half years duration, with the entry
qualification being 10th class.

• In 1975 the Kartar Singh Committee recommended shortening the two year course of
ANM to one and a half years and entry after class 10th.

• These ANMs were designated as female health workers. They were specially trained in
midwifery and child health care services. GoI also invested heavily in the training of dais.

Present and future of midwifery in India

• The presence of a skilled midwife at birth is the single most important factor for
achieving safe motherhood (WHO).

• The number of midwives available as per population is an important indicator of the

maternal health status in a country.

• The maternal health status of women and maternal mortality are closely related to the
presence of trained attendants at birth.

• As the percentage of births attended by trained personnel goes up, the maternal mortality
ratio goes down.

In India there are the following cadres of midwives:

• 1. The trained nurse midwife (RN, RM): Who has undergone a diploma (Diploma in
General Nursing and Midwifery), which is of three and a half years duration. Or a degree
nurse who has done [Link]. (Honors) Nursing, which is of four years duration.

• 2. ANM, who is designated as the Multi-purpose health worker (female), is registered as

a midwife.

• Presently, this is a two years course with entry classification being 12th class.

India has a huge cadre of ANMs who are educated and trained in Midwifery

• 3. Skilled Birth Attendant (SBA) refers exclusively to people with midwifery skills
(e.g. doctors, nurses, midwives), who have been trained to get proficiency in the skills
necessary to manage normal deliveries, and to diagnose, manage, or refer complications
to all levels of health care settings.

• Midwifery skills are defined as a set of cognitive and practical skills that enable the
individual to provide basic health care services throughout the natal continuum period
and also to provide prompt actions in emergencies including life saving measures, when
required.

Need for midwifery as a profession in India

 1. To achieve safe motherhood

2. 2. To avoid duplication of services

3. 3. To give health education

4. 4. To participate in country’s concern i.e. maternal and child welfare

5. 5. To get status and recognition in the society

TRENDS IN THE MIDWIFERY AND OBSTETRICAL NURSING

Changes in social structure, variations in family lifestyle: It has altered health care
priorities for maternal and child health nurses. Today, client advocacy, an increased focus
on health education, and new nursing roles are ways in which nurses have adapted to
these changes.

Cost Containment :Cost containment refers to systems of health care delivery that focus
on reducing the cost of health care by closely monitoring the cost of personnel, use and
brands of supplies, length of hospital stays, number of procedures carried out, and
number of referrals requested.

Expanded roles for nurses : Increasing nursing responsibility for assessment and
professional judgment and providing expanded roles for nurse practitioners, such as the
nurse-midwife.

Family Centered Care

- More natural childbirth environment where partners, family members may remain in
a homelike environment, and participate in the childbirth experience
- By adopting a view of pregnancy, childbirth as a family event, nurses can be
instrumental in including family members in care and consult family members about
a plan of care and provide clear health teaching so that family members can monitor
their own care
• Access to Health Care

Strong predictors of access to quality health care include having health insurance, a
higher income level, and a regular primary care provider or other source of ongoing
health care. Use of clinical preventive services, such as early prenatal care, can serve as
indicators of access to quality health care services.

The objectives selected to measure progress in this area are:

- Increase the proportion of persons with health insurance.

- Increase the proportion of persons who have a specific source of ongoing care.
- Increase the proportion of pregnant women who begin prenatal care in the first
trimester of pregnancy
 Shortening Hospital Stays

- Women who have begun preterm labor stay in the hospital while labor is halted and
then are allowed to return home on medication with continued monitoring.
- Routine hospital stay for mothers and newborns after an uncomplicated birth is now 2
days or less.
- Short-term hospital stays require intensive health teaching by the nursing staff and
follow-up by home care or community health nurses.
Increased Use of Alternative Treatment Modalities

- There is a growing tendency to consult alternative forms of therapy, such as

acupuncture or therapeutic touch, in addition to, or instead of, traditional health care
providers. Nurses have an increasing obligation to be aware of complementary or
alternative therapies.
Increased Use of Technology

- The field of assisted reproduction (e.g., in vitro fertilization), seeking information on

the Internet, and monitoring fetal heart rates by Doppler ultra sonography are other
examples.
- In addition to learning these technologies, maternal and child health nurses must be
able to explain their use and their advantages to clients. Otherwise, clients may find
new technologies more frightening than helpful to them.

Technological Advances As the technology has revolutionized and increasingly

sophisticated computers in today’s world, it has become necessary for the nursing
personnel to have thorough knowledge of the new technology being used.

- Due to this advancement, ‘the hands on care’ of the client is reduced, so also is the,
quality nursing care.
- Today foetal monitoring has progressed from the use of fetoscope to electronic foetal
monitors. It can be used both, directly and indirectly.
 VITAL STATISTICS

The process of maintaining vital statistics is a purposeful mechanism of collecting, processing,

analyzing and transmitting the information required for organizing and operating health services
and also for research and training

Aims:

- Providing reliable, relevant, up to date, adequate, timely and reasonably complete

information to the health authority at all levels.
- Health care providers are able to intervene the health status of the population ,provided
availability of appropriate tools for measuring health, illness and the well being is there
- It is the transformation of information through integration and processing with perception
and experience based on social and political value

Definition:

- Vital statistics are conventionally numerical records of marriage, birth, sickness and
death by which the health and growth of community may be studied.
- It is a branch of biometry that deals with data and law of human mortality, morbidity and
demography.

Purpose:

- To describe the level of community health, diagnose community illness and solution of
health problems.
- To determine success or failure of specific health problems.
- To promote health legislation at local and national level.
- To develop policies and procedure at state and center level.

Importance of Vital Statistics:

- To evaluate impact of various national health programmes.

- To plan for better future measures of disease control.
- To explain hereditary nature of disease.
- To evaluate economic and social development.
- It is primary tool of research activity.

Uses of vital information:

- The vital information of a population are basis of planning, administration and effective
management health service and programs.
- Assessment of health service in terms of effectiveness and efficiency is done by
maintaining up to date record of all events.
- Assessment of attitude and degree of satisfaction of the beneficiaries from the health
policies can be done.
- Measurement of health services status of population.
Sources of vital information:

- Censes
- Epidemiological surveillance
- Registration of vital events
- Simple registration system
- Health service record
- Hospital records
- Notification of disease
- Population and health
- Disease register surveys
- Record linkage

VITAL STATISTICS /MATERNAL AND CHILD HEALTH INDICATORS

• Birth rate: The number of live births per 1,000 estimated mid- year, in a given year
populations.

No. of live Births during the year X 1000

Estimated mid-year population

• General fertility rate: The number of live births per 1,000 women in the reproductive age
group (15- 44 or 49) in a given year.

No. of live Births in an area during the year ___ X 1000

Mid-year female population age 15-44 or 49 in
the same given year
• Neonatal death rate: The number of deaths per 1,000 live births occurring at birth or in
the first 28 days of life.
No. of death of neonates less than 28 days during the year X 1000
No. of live births during the same year

• Infant Mortality Rate: The number of deaths per 1,000 live births occurring at birth or in
the first 12 months of life.
No. of Infant deaths during the year X 1000
No. of live births during the same year

• The Maternal mortality rate (MMR) is the annual number of female deaths per 100,000
live births from any cause related to or aggravated by pregnancy or its management
(excluding accidental or incidental causes).
No. of Maternal deaths during the year X 100,00
No. of live births during the year

• Perinatal mortality: The World Health Organization defines perinatal mortality as the
"number of stillbirths and deaths in the first week of life per 1,000 total births, the
perinatal period commences at 22 completed weeks (154 days) of gestation and ends
seven completed days after birth"
 Late fetal death (22wks gestation) + Early neonatal death (1st week) in a yr X 1000
live birth in the same year

UNIT-II

REPRODUCTIVE SYSTEM

Review of structure and function of female reproductive system: