2/10/2024

Midwifery Professional Ethics

Midwifery is a noble profession requiring informed mind and determined heart

Objectives
At the end of this session, students will be able

*Define midwifery
*Describe the international definition of
midwife
*Narrate the history of the midwifery
profession
*Discuss the scope of midwifery practice
*Differentiate profession and occupation
*Outline the four categories of essential
competency of midwifery practice
History of midwifery profession
 Midwife
Midwife: -The term is derived from English: midwife,
literally "with woman", i.e. (in middle and Old English,
mid = "with", wife = "woman").
The ICM developed a definition of a term 'midwife' in
1972
WHO adopted it in 1973

It was later amended & ratified by WHO in 1992

 International definition
A midwife is a person who has successfully completed
a midwifery education program that is duly recognized
in the country where it is located.
Who has acquired the requisite qualifications to be
registered and/or legally licensed to practice midwifery
and use the title 'midwife'.
Who demonstrates competency in the practice of
midwifery (ICM updated June 2017).

Cont..
'The greatest privilege of a human life is to become a
midwife to the awakening of the Soul in another
person. ' — Plato
'Speak tenderly; let there be kindness in your face, in
your eyes, in your smile, in the warmth of your
greeting. Always have a cheerful smile. Don't only give
your care, but give your heart as well. ' — Mother
Teresa
The profession that is concerned with assisting women
in pregnancy and childbirth.
It is a health care profession in which providers offer
care to childbearing women during pregnancy ,labor
and birth & the post partum period.
They also help care for the newborn & assist the mother
with breastfeeding.
 Purpose of
Midwives
Frontline workers that give care and support during
pregnancy, labor and post partum period
Benefit not only the client and her immediate family but
all members of the society and contributing to the
country's human and economic development
Provides care for the new born and the infant
Scope of practice
Can be defined as the extent or limits of intervention
that a midwife can perform
Outline the essential competencies that
midwifery practice that midwife is expected to
undertake. Currently there are four categories of
essential for midwifery practice as outlined by
(ICM,2018 updated)
 At the same time, the current Ethiopian BSc
curriculum outline 12 essential competencies that
midwifery graduate is expected undertake.
The four categories of entlalcompetencres
midwifery for practice are:
Competencies
Competencies Competencies >
specific to specific to the
specific to care ongoing care
prepregnancy thi
during labor Of women and
and antenatal
care
and birth newbom s
The cumulative effect of every course midwifery
students learn is to be able gain necessary knowledge
skill and attitudes that enable the to undertake essential
midwifery practice
• The core competencies of basic midwifery practice in
the current Ethiopian curriculum are organized in the
twelve domains as
I . social, epidemiological and cultural context of
midwifery practice
2. Family planning and pre-pregnancy care
3. Midwifery care during pregnancy
4. Midwifery care during labor and delivery/ birth
 5. Postpartum midwifery care
6. Midwifery care for newborns and under five
children
7. Midwifery care for gynecologic patients
8. Organizational management and
leadership 9. Research and evidence-
based midwifery practice
10. Interpersonal relationship and
communication
11 . Professional, ethical and legal midwifery
practice
12. Basic midwifery care
In general the scope of midwifery practice built up on
ICM which recognize them as
Responsible, accountable and autonomous professional
Works in partnership with women
 Provides support, care and advice during pregnancy, labor
and postpartum period prevention and detection of
complications

emergency care
Conducts births
Provides care for newborn and infant

Provides sexual and reproductive health

education/counseling
 Works in various practice settings
QA midwife also provides

Adolescent health care

U-5 health care(< 5yrs)

Family planning services identify

and treat Gynecologic problems

A midwife may practice in any setting including:

 home

'k community settlement

and refuge camp hospitals
health centers clinics or
health posts
The Midwife & the women

Women through out their age have depend up on a

skilled person, usually midwives to be with them
during pregnancy, child birth and post partum .
The skill of the midwife is based on a mixture of an
art and a science
Art - because the profession requires an ability of
understanding the woman's needs to encourage her
confidence, b/c it demands a high degree of
knowledge & decision making ability.

Science because the midwives exercise their

profession based on scientific grounds & all
activities are scientifically proved.

History of Midwifery
Historical back ground is as old as the history of human
species, archeological evidence of a woman squatting in
childbirth supported by another woman from behind
demonstrates the existence of midwifery in 1500 B.C.
Midwives are mentioned in the Old Testament, 'Genesis
35:IT and it come to pass when she was in hard labour that
the midwife said unto her, tear not Rachel, it is another
baby'.
In Exodus 1:5 it is recorded that the king of Egypt
commanded to sephora and phua, the two midwives
who helped Hebrew women when they gave birth, to
kill all male babies delivered to the Hebrew women
The midwives, however, "feared God" and
disobeyed pharaoh by allowing the male babies to
live.
When pharaoh asked the midwives why they had
disobeyed his orders, the midwives told him the
Hebrew women had easier labors than Egyptian
women and delivered their babies before the
midwife arrived and the people multiplied and grew
exceedingly strong.
These two midwives are the first midwives found in
the literature.
 Midwifery World wide
The name of midwife, we use it today popularly known during
the time of Hippocrates in the 4th century.
During this time the midwife was without training, knowledge
& in many cases unable to write.
From the 5th - 15thC, which was the period of decline of
Roman Empire, untrained midwives controlled the practice of
midwifery.

In the 16th century (1513), the 1st book was written in

Germany on midwifery
In the 17th century the physician was involved in obstetrics
and then the untrained midwife needs their help.
Training midwives start in France
The first midwifery hospital was opened in Ireland &
England in the 18th century and midwife become a
practitioner of midwifery.

Cont..
In 1862 a midwives training school in connection
with King's College Hospital were conducted.
Midwifery as a profession has its origin in the 17th C
when European countries such as Sweden, France,
Belgium & Netherlands began to acknowledge that
traditional attendants at birth required special
education, assistance in skills development and
appropriate supervision.
Other European countries such as the United
Kingdom, eventually followed suit later in the 19th
& early 20th Century, educational opportunities
opened for women.

Midwifery in Ethiopia
Historical background midwifery is not well documented
Historical documents show that professional midwifery
was established in Ethiopia in 1953
In 1954 Gonder Public Health College provided basic
midwifery training for few number of nurses with work
experience
In 1959 princess Tsehay Memorial Hospital started
midwifery nursing, and four midwives graduated in 1960.
The first graduated midwives completed midwifery
training from Asmara School of nursing after
completing nursing courses for one year midwifery
training.
The midwifery training was discontinued for about I
Oyrs and in 1985 post basic training of midwives
started again by the initiative of MOH in Ras Emiru
Campuss around "Chew berenda"
 In Gondar starting from 1986 EC three subsequent
post basic training were given. In 1989 EC two
years generic diploma training
> No future career for midwives
Leave their work in order to continue their
education in other fields of study.

cont..
 Gondar University is the first organized midwifery
school providing BSc in 2000 followed by AAU in
2006/7, Centralized School of Nursing & Midwifery
and Mekelle university in 2007/8.
Two years on (2008 G.C) University of Gondar
began offering master's degree in midwifery
Recently university of Gondar in 2018/19 started
PhD in midwifery
Jimma university started BSc degree in midwifery in
2003EC /2010/11 GC
In 2007, the Hamlin midwifery college, an
initiative of Hamlin fistula hospital, was opened as
a part of strategic to prevent obstetric fistula
It was opened Desta Mandar of Burayu and training
midwives still now
As years rolled on, more and more colleges and
universities began to give training midwifery in
diploma and degree level.
Additionally other midwifery training institutions were opened
like Hawassa, Haramaya and other universities.
Currently, there are about 60 midwifery training in Ethiopia.
31public university are providing BSc degree in midwifery, 6
of them providing MSc in midwifery

The number of midwifery professional in Ethiopia is

increasing from time to time.
There are only 294 midwives 1980, 1,275 midwives
in 2008 and 7200 in
The ratio of midwifery to population by 2014 is I
to I (),500 which more than half far away from
WHO recommendation
WHO recommends a ratio of I midwife for a
population of5,000
Rationale for expanding midwifery
program in Ethiopia
In effort to achieve MDG4(to reduce child mortality)
MDG5(to reduce maternal mortality) by 2015 and SDG3
by 2030, FMOH Ethiopia has given greater emphasis on
improving maternal and newborn health
The highest maternal and neonatal mortality occur during
labor, delivery and the first 24 hours after birth
But in 2006 world health report identified Ethiopia as one
of 57 countries having severe shortage midwives, medical
doctors and anesthesia
 Midwifery professional organizations
• Internationally: International confederation of
Midwives(lCM)
• Nationally: Ethiopian midwifery
association(EMA)
International confederation of
Midwives(lCM)
Over 1000 midwives internationally meet together
starting 1900s.
The name of ICM decided first time in 1954 in
Landon
 At the same time regular triennial congresses was
established and successfully continued
In 1999, ICM council decided to move the location of
headquarters from Landon to the Hague, in
Nertherlands and it has been there ever since.
Cont....
• Vision of ICM
ICM envisions a world where every childbearing woman has
access to a midwife's care for herself and her newborn
• Mission of LCM
To strengthen members of Midwives' Associations and to
advance the profession of midwifery globally by promoting
autonomous midwives as the most appropriate caregivers for
childbearing women and in keeping birth normal, in order to
enhance the reproductive health of women, their newborns
and their families
Ethiopian midwifery
association(EMA)
Ethiopian midwifery association(EMA) is national,
non profit, professional that represents and works to
strengthen Midwifery in Ethiopia
Formally EMwA was established in 1992 and
registered by Ethiopian ministry of justice in 1993
 and was subsequently registered under Ethiopian
civil society organization law
EMwA has been a member of ICM since 1993
Cont..
• Vision of EMwA
Envisions of midwifery to be valued and
autonomous profession where every families has
equitable and high quality midwifery services
Mission of EMwA
Professional association striving for autonomy and
excellent of midwifery care practice to provide high
quality care for women, newborn, children,
adolescent and youth through strengthening self
reliance and influencing for change
Occupation & profession
Occupation: An activity performed by a person
normally for monetary compensation.
is an activity undertaken by the person to earn his
livelihood. It can be business, profession or
employment that a person undertakes to make
money Eg: drivers, shopkeepers, government
servant, clerks, accountants, etc.
 Profession versus Occupation
Profession: refers to a specific career where work of an
intellectual nature is performed.
Professionalism: refers to the practitioner who practice
the profession and it implies she/he fulfills all the norms
and expectations.
• It is a calling that requires special knowledge and skilled
preparation.
Eg: Midwives, Doctors, Engineers, Lawyers, etc.
Cont..
Criteria of a profession

Is an activity that requires specialized training,

knowledge, qualification and skills
A profession is based up on theoretical knowledge.
The privilege to practice is granted only after the
individual was completed a standardized program of
highly specialized education and has demonstrated an
ability to meet the standards for practice

Cont..
 > The body of specialized knowledge is continually
developed and evaluated through research.

The members are self organized and collectively

assume the responsibility of establishing standards
for education and practice
A Profession is generally different from other kinds of
occupation

Professions vs. Occupations

Professions Occupations
College or University On the job training
Prolonged education Length varies
Mental creativity Largely manual work
Decisions based on science or Guided decision making
theoretical constructs
Values, beliefs & ethics integral Values, beliefs & ethics not part
part of preparation of preparation
Strong commitment Commitment may vary
Autonomous supervised
Unlikely to change professions Often change jobs
Commitment greater than $ Motivated by $ reward
reward
Individual accountability Employer is primarily
Eth
1M taccountable
 Terminologies
• Health: A state of complete physical, mental and
social well being and not merely the absence of
disease or infirmity (WHO, 1947) and the ability
to lead socially and economically productive life
 (WHO, 1978)

• Wellness: A freedom from sickness or illness,

freedom from disease state.
Terminologies.

• Disease: A change in the structure or function of

a person 's body or mind.

• Illness: Bad feeling in the body, mind which

 may have biological, physical, or
psychological roots.
The Dimensions of Health

• Physical Health: Ability to perform activities of daily living.

• Intellectual Health: Ability to think clearly,

reason objectively, & analyze critically.
• learning from successes and failures and making
sound responsible decisions.

Cont..
• Emotional Health: Ability to express emotions appropriately.
• Self esteem and self confidence, ability to trust, love, etc
• Environmental Health: Appreciation of external
environment & role of preserving, protecting, and improving
environment
• Spiritual Health: Belief in Supreme Being, feeling of oneness
with others and nature, guiding sense of meaning or value and
purpose in life

Key Midwifery Concepts

• These define the unique role of midwives in promoting
the health of women and childbearing families.
These includes;
• Partnership with women to promote self-care and the
health of mothers, infants, and families;
 • Respect for human dignity and for women as persons
with full human rights

Cont
Advocacy for women: so that their voices are heard and their
health care choices are respected
• Cultural sensitivity including working with women and
health care providers to overcome those cultural practices
that harm women and babies;
• Focus on health promotion and disease prevention that
views pregnancy as a normal life event; and
• Advocacy for normal physiologic labor and birth to
enhance best outcomes for mothers and infants.
 Role of Midwives in Hospital

• Providing antenatal care

• Monitor the progress of labor

• Conduct delivery
• Give newborn care

• Provide postpartum care for women and newborn

• Provide family planning
Provide safe abortion care.
 Role of midwives in community & home
Providing antenatal care
Conduct delivery Give newborn care postnatal
visit

Health education/advice/counseling on maternal

health services and others.
Role of midwives in settlement area & refugee camps

Provide family planning,

 Provide antenatal care and birth care
Giving health education/advice/counseling on
maternal, child and reproductive health services
What do Midwives do?

Teach, educate and empower women to take control of

their own health care.

They provide prenatal care and then assist the mother to

give birth.
They manage the birth, and guard the woman and her
newborn in the postpartum period.
Encourage and monitor women throughout their labor
Cont...
Reassurance, positive imaging and suggestions to
change positions and walk helps labor progress.
Provide family planning services and routine
women's health examinations such as pap smears and
physical examinations.
 They teach women about sexually transmitted
infections, and focus on prevention of the spread of
infections.

Functions of Midwifery
Midwifery has three functions
1. Dependent function/dependability:- Some activities are based on other
professionals
Eg. Midwives can't perform laboratory tests

2. Interdependent /co-operative/eollaborative function:- Collaboration

Of midwives with Other medical staffs
Eg. Physicians
3. Independent function:- Activities entirely performed by midwives
Eg: conducting second stage of labor

Three functions of midwife

 Duties and Responsibilities of a Midwife
a. Care provider: - caring /comforting involve knowledge and
sensitivity to what matter and what is important to the client.

b. Communicator/helper: - Effective communication is an essential

element of all helping profession. It helps the client to explain the
internal feeling.

c. Teacher/educator: - teacher refers to activities by which the

teacher helps the student to learn. The client also need education
based on the case.
d. Counselor: - counseling is processes of helping a client to
recognized and cope with stressful psychological or social
problem, to develop improved interpersonal relationships
and promote personal growth
e. Client advocate: - An advocate pleads the cause of others
or argues or pleads for a cause or proposal
f. Change agent: - a change agent is a person or group who
initiates changes or who assists others in making
modification in themselves or in the system.
 Cont...
g. Leader: - leader ship is defined as mutual process of inter
personal influence through which the professionals helps a
client make decision in establishing and achieving goals to
improve the client well being.

h. Manager: - management defines manager as who plans, gives

direction, developing staff, monitoring operations, giving
rewards fairly and representing both staff member and
administration as needed.
i. Researcher: - majority of researchers in midwifery
are prepared at doctoral and post doctoral level.

Though an increasing number of clinician midwives

with masters degree are beginning to practice it.

Midwifery Care Process

This care process is dynamic, continuous, and circular
when needed, following an orderly succession of steps
 and requiring critical thinking and various types and
levels of decision-making throughout.
At times data collected or decisions made or
unanticipated outcomes will require re-visiting an
earlier step and re-planning with the woman.
There are 5 steps
I. Assessment
Includes: - History and current needs expressed by woman,
physical examination, laboratory findings.
Sources of data: Woman, family, available records, observation.
Criteria for success: Systematic and accurate data collection done
in culturally appropriate, respectful manner.
2. Decision-making data collected to
clarify actual or potential midwifery diagnoses based on woman's
needs/problems and determining if emergency action required.

Sources of data: See Step 1.

Criteria for success: Correct interpretation of data that results
inaccurate midwifery diagnoses.

3. Planning
Includes:- Prioritizing need for action in partnership with the
woman, determining which needs/problems will be resolved by
midwifery actions; need for consultation or referral.
Sources of data: Steps I and 2.
Criteria for success: Comprehensive plan with input from
woman/family, including alternates when available based on
evidence/sound rationale.

4. Implementation
 Includes: Timely, appropriate, safe midwifery care provided with
compassion and cultural sensitivity, promoting self-care when
possible.

Sources of data: Steps 1, 2, and 3.

Criteria for success: Timely intervention with safe,
evidencebased, emcient, ethical, compassionate care-giving along
with appropriate recording of data and plan of care,
69
5. Evaluation
Includes: Feedback from woman/family on needs met,
satisfaction; midwife self assessment and reflection on outcomes
and whether new approach needed; confirmation/validation from
colleagues, teachers.
Sources of data: Self, woman, family, peers, supervisors.
Criteria for success: Extent to which care given met needs of
woman and midwifery goals. Outcomes of midwifery care
include improved health/well-being of women and newborns.
 I am a Midwife (By Dorothy Lazaro)
I stand on my feet for 8 hours in a day
I am on call 24 hours a day
I still keep the smile on my face
Because I am a midwife
The first cry Of the baby is music to my ears
The first cry Of the baby is melody to me
The first cry Of the baby is my satisfaction
The first cry of the baby energizes me
Because I am a midwife
The joy of the mother is my joy
 The smile of the mother is my satisfaction
The pain of the mother is my pain
The cry of the mother is my cry
Because I am a midwife
I am very comfortable in the labour ward
I am very comfortable in antenatal clinics
I am comfortable in family planning clinics
I am comfortable with Women seeking different reproductive health
services
Because I am a proud midwife
2/10/2024
Midwifery Professional Ethics

Midwifery is a noble profession requiring informed mind and determined heart

Objectives
At the end of this session, students will be able

*Define midwifery
*Describe the international definition of
midwife
*Narrate the history of the midwifery
profession
*Discuss the scope of midwifery practice
*Differentiate profession and occupation
*Outline the four categories of essential
competency of midwifery practice
History of midwifery profession
 Midwife
Midwife: -The term is derived from English: midwife,
literally "with woman", i.e. (in middle and Old English,
mid = "with", wife = "woman").
The ICM developed a definition of a term 'midwife' in
1972
WHO adopted it in 1973

It was later amended & ratified by WHO in 1992

International definition
A midwife is a person who has successfully completed
a midwifery education program that is duly recognized
in the country where it is located.
Who has acquired the requisite qualifications to be
registered and/or legally licensed to practice midwifery
and use the title 'midwife'.
Who demonstrates competency in the practice of
midwifery (ICM updated June 2017).

Cont..
'The greatest privilege of a human life is to become a
midwife to the awakening of the Soul in another
person. ' — Plato
'Speak tenderly; let there be kindness in your face, in
your eyes, in your smile, in the warmth of your
greeting. Always have a cheerful smile. Don't only give
your care, but give your heart as well. ' — Mother
Teresa
 The profession that is concerned with assisting women
in pregnancy and childbirth.
It is a health care profession in which providers offer
care to childbearing women during pregnancy ,labor
and birth & the post partum period.
They also help care for the newborn & assist the mother
with breastfeeding.

Purpose of
Midwives
Frontline workers that give care and support during
pregnancy, labor and post partum period
Benefit not only the client and her immediate family but
all members of the society and contributing to the
country's human and economic development
Provides care for the new born and the infant

Scope of practice
Can be defined as the extent or limits of intervention
that a midwife can perform.
Outline the essential competencies that
midwifery practice that midwife is expected to
undertake. Currently there are four categories of
essential for midwifery practice as outlined by
(ICM,2018 updated)
 At the same time, the current Ethiopian BSc
curriculum outline 12 essential competencies that
midwifery graduate is expected undertake.
The four categories of
midwifery essentlalcompetencres for
Competencies Competencies
Competencies
specific to specific to the
specific to care ongoing care
prepregnancy
during labor Of women and
and antenatal and birth
care newbom

practice are:
> The cumulative effect of every course midwifery
students learn is to be able gain necessary
knowledge skill and attitudes that enable the tothi
undertake essential midwifery practice s
• The core competencies of basic midwifery practice in
the current Ethiopian curriculum are organized in the
twelve domains as
I . social, epidemiological and cultural context of
midwifery practice
9. Family planning and pre-pregnancy care
10. Midwifery care during pregnancy
 11. Midwifery care during labor and delivery/ birth
12. Postpartum midwifery care
13. Midwifery care for newborns and under five
children
14. Midwifery care for gynecologic patients
15. Organizational management and
leadership 9. Research and evidence-
based midwifery practice
10. Interpersonal relationship and
communication
11 . Professional, ethical and legal midwifery
practice
12. Basic midwifery care
In general the scope of midwifery practice built up on
ICM which recognize them as
Responsible, accountable and autonomous professional
Works in partnership with women
 Provides support, care and advice during pregnancy, labor
and postpartum period prevention and detection of
complications

emergency care
Conducts births
Provides care for newborn and infant

Provides sexual and reproductive health

education/counseling
 Works in various practice settings
QA midwife also provides

Adolescent health care

U-5 health care(< 5yrs)

Family planning services identify

and treat Gynecologic problems

A midwife may practice in any setting including:

 home

'k community settlement

and refuge camp hospitals
health centers clinics or
health posts
The Midwife & the women

Women through out their age have depend up on a

skilled person, usually midwives to be with them
during pregnancy, child birth and post partum .
The skill of the midwife is based on a mixture of an
art and a science
Art - because the profession requires an ability of
understanding the woman's needs to encourage her
confidence, b/c it demands a high degree of
knowledge & decision making ability.

Science because the midwives exercise their

profession based on scientific grounds & all
activities are scientifically proved.

History of Midwifery
Historical back ground is as old as the history of human
species, archeological evidence of a woman squatting in
childbirth supported by another woman from behind
demonstrates the existence of midwifery in 1500 B.C.
Midwives are mentioned in the Old Testament, 'Genesis
35:IT and it come to pass when she was in hard labour that
the midwife said unto her, tear not Rachel, it is another
baby'.
In Exodus 1:5 it is recorded that the king of Egypt
commanded to sephora and phua, the two midwives
who helped Hebrew women when they gave birth, to
kill all male babies delivered to the Hebrew women
The midwives, however, "feared God" and
disobeyed pharaoh by allowing the male babies to
live.
When pharaoh asked the midwives why they had
disobeyed his orders, the midwives told him the
Hebrew women had easier labors than Egyptian
women and delivered their babies before the
midwife arrived and the people multiplied and grew
exceedingly strong.
These two midwives are the first midwives found in
the literature.
 Midwifery World wide
The name of midwife, we use it today popularly known during
the time of Hippocrates in the 4th century.
During this time the midwife was without training, knowledge
& in many cases unable to write.
From the 5th - 15thC, which was the period of decline of
Roman Empire, untrained midwives controlled the practice of
midwifery.

In the 16th century (1513), the 1st book was written in

Germany on midwifery
In the 17th century the physician was involved in obstetrics
and then the untrained midwife needs their help.
Training midwives start in France
The first midwifery hospital was opened in Ireland &
England in the 18th century and midwife become a
practitioner of midwifery.

Cont..
In 1862 a midwives training school in connection
with King's College Hospital were conducted.
Midwifery as a profession has its origin in the 17th C
when European countries such as Sweden, France,
Belgium & Netherlands began to acknowledge that
traditional attendants at birth required special
education, assistance in skills development and
appropriate supervision.
Other European countries such as the United
Kingdom, eventually followed suit later in the 19th
& early 20th Century, educational opportunities
opened for women.

Midwifery in Ethiopia
Historical background midwifery is not well documented
Historical documents show that professional midwifery
was established in Ethiopia in 1953
In 1954 Gonder Public Health College provided basic
midwifery training for few number of nurses with work
experience
In 1959 princess Tsehay Memorial Hospital started
midwifery nursing, and four midwives graduated in 1960.
The first graduated midwives completed midwifery
training from Asmara School of nursing after
completing nursing courses for one year midwifery
training.
The midwifery training was discontinued for about I
Oyrs and in 1985 post basic training of midwives
started again by the initiative of MOH in Ras Emiru
Campuss around "Chew berenda"
 In Gondar starting from 1986 EC three subsequent
post basic training were given. In 1989 EC two
years generic diploma training
> No future career for midwives
Leave their work in order to continue their
education in other fields of study.

cont..
 Gondar University is the first organized midwifery
school providing BSc in 2000 followed by AAU in
2006/7, Centralized School of Nursing & Midwifery
and Mekelle university in 2007/8.
Two years on (2008 G.C) University of Gondar
began offering master's degree in midwifery
Recently university of Gondar in 2018/19 started
PhD in midwifery
Jimma university started BSc degree in midwifery in
2003EC /2010/11 GC
In 2007, the Hamlin midwifery college, an
initiative of Hamlin fistula hospital, was opened as
a part of strategic to prevent obstetric fistula
It was opened Desta Mandar of Burayu and training
midwives still now
As years rolled on, more and more colleges and
universities began to give training midwifery in
diploma and degree level.
Additionally other midwifery training institutions were opened
like Hawassa, Haramaya and other universities.
Currently, there are about 60 midwifery training in Ethiopia.
31public university are providing BSc degree in midwifery, 6
of them providing MSc in midwifery

The number of midwifery professional in Ethiopia is

increasing from time to time.
There are only 294 midwives 1980, 1,275 midwives
in 2008 and 7200 in
The ratio of midwifery to population by 2014 is I
to I (),500 which more than half far away from
WHO recommendation
WHO recommends a ratio of I midwife for a
population of5,000
Rationale for expanding midwifery
program in Ethiopia
In effort to achieve MDG4(to reduce child mortality)
MDG5(to reduce maternal mortality) by 2015 and SDG3
by 2030, FMOH Ethiopia has given greater emphasis on
improving maternal and newborn health
The highest maternal and neonatal mortality occur during
labor, delivery and the first 24 hours after birth
But in 2006 world health report identified Ethiopia as one
of 57 countries having severe shortage midwives, medical
doctors and anesthesia
 Midwifery professional organizations
• Internationally: International confederation of
Midwives(lCM)
• Nationally: Ethiopian midwifery
association(EMA)
International confederation of
Midwives(lCM)
Over 1000 midwives internationally meet together
starting 1900s.
The name of ICM decided first time in 1954 in
Landon
 At the same time regular triennial congresses was
established and successfully continued
In 1999, ICM council decided to move the location of
headquarters from Landon to the Hague, in
Nertherlands and it has been there ever since.
Cont....
• Vision of ICM
ICM envisions a world where every childbearing woman has
access to a midwife's care for herself and her newborn
• Mission of LCM
To strengthen members of Midwives' Associations and to
advance the profession of midwifery globally by promoting
autonomous midwives as the most appropriate caregivers for
childbearing women and in keeping birth normal, in order to
enhance the reproductive health of women, their newborns
and their families
Ethiopian midwifery
association(EMA)
Ethiopian midwifery association(EMA) is national,
non profit, professional that represents and works to
strengthen Midwifery in Ethiopia
Formally EMwA was established in 1992 and
registered by Ethiopian ministry of justice in 1993
 and was subsequently registered under Ethiopian
civil society organization law
EMwA has been a member of ICM since 1993
Cont..
• Vision of EMwA
Envisions of midwifery to be valued and
autonomous profession where every families has
equitable and high quality midwifery services
Mission of EMwA
Professional association striving for autonomy and
excellent of midwifery care practice to provide high
quality care for women, newborn, children,
adolescent and youth through strengthening self
reliance and influencing for change
Occupation & profession
Occupation: An activity performed by a person
normally for monetary compensation.
is an activity undertaken by the person to earn his
livelihood. It can be business, profession or
employment that a person undertakes to make
money Eg: drivers, shopkeepers, government
servant, clerks, accountants, etc.
 Profession versus Occupation
Profession: refers to a specific career where work of an
intellectual nature is performed.
Professionalism: refers to the practitioner who practice
the profession and it implies she/he fulfills all the norms
and expectations.
• It is a calling that requires special knowledge and skilled
preparation.
Eg: Midwives, Doctors, Engineers, Lawyers, etc.
Cont..
Criteria of a profession

Is an activity that requires specialized training,

knowledge, qualification and skills
A profession is based up on theoretical knowledge.
The privilege to practice is granted only after the
individual was completed a standardized program of
highly specialized education and has demonstrated an
ability to meet the standards for practice

Cont..
 > The body of specialized knowledge is continually
developed and evaluated through research.

The members are self organized and collectively

assume the responsibility of establishing standards
for education and practice
A Profession is generally different from other kinds of
occupation

Professions vs. Occupations

Professions Occupations
College or University On the job training
Prolonged education Length varies
Mental creativity Largely manual work
Decisions based on science or Guided decision making
theoretical constructs
Values, beliefs & ethics integral Values, beliefs & ethics not part
part of preparation of preparation
Strong commitment Commitment may vary
Autonomous supervised
Unlikely to change professions Often change jobs
Commitment greater than $ Motivated by $ reward
reward
Individual accountability Employer is primarily
Eth
1M taccountable
 Terminologies
• Health: A state of complete physical, mental and
social well being and not merely the absence of
disease or infirmity (WHO, 1947) and the ability
to lead socially and economically productive life
 (WHO, 1978)

• Wellness: A freedom from sickness or illness,

freedom from disease state.
Terminologies.

• Disease: A change in the structure or function of

a person 's body or mind.

• Illness: Bad feeling in the body, mind which

 may have biological, physical, or
psychological roots.
The Dimensions of Health

• Physical Health: Ability to perform activities of daily living.

• Intellectual Health: Ability to think clearly,

reason objectively, & analyze critically.
• learning from successes and failures and making
sound responsible decisions.

Cont..
• Emotional Health: Ability to express emotions appropriately.
• Self esteem and self confidence, ability to trust, love, etc
• Environmental Health: Appreciation of external
environment & role of preserving, protecting, and improving
environment
• Spiritual Health: Belief in Supreme Being, feeling of oneness
with others and nature, guiding sense of meaning or value and
purpose in life

Key Midwifery Concepts

• These define the unique role of midwives in promoting
the health of women and childbearing families.
These includes;
• Partnership with women to promote self-care and the
health of mothers, infants, and families;
 • Respect for human dignity and for women as persons
with full human rights

Cont
Advocacy for women: so that their voices are heard and their
health care choices are respected
• Cultural sensitivity including working with women and
health care providers to overcome those cultural practices
that harm women and babies;
• Focus on health promotion and disease prevention that
views pregnancy as a normal life event; and
• Advocacy for normal physiologic labor and birth to
enhance best outcomes for mothers and infants.
 Role of Midwives in Hospital

• Providing antenatal care

• Monitor the progress of labor

• Conduct delivery
• Give newborn care

• Provide postpartum care for women and newborn

• Provide family planning
Provide safe abortion care.
 Role of midwives in community & home
Providing antenatal care
Conduct delivery Give newborn care postnatal
visit

Health education/advice/counseling on maternal

health services and others.
Role of midwives in settlement area & refugee camps

Provide family planning,

 Provide antenatal care and birth care
Giving health education/advice/counseling on
maternal, child and reproductive health services
What do Midwives do?

Teach, educate and empower women to take control of

their own health care.

They provide prenatal care and then assist the mother to

give birth.
They manage the birth, and guard the woman and her
newborn in the postpartum period.
Encourage and monitor women throughout their labor
Cont...
Reassurance, positive imaging and suggestions to
change positions and walk helps labor progress.
Provide family planning services and routine
women's health examinations such as pap smears and
physical examinations.
 They teach women about sexually transmitted
infections, and focus on prevention of the spread of
infections.

Functions of Midwifery
Midwifery has three functions
4. Dependent function/dependability:- Some activities are based on other
professionals
Eg. Midwives can't perform laboratory tests

5. Interdependent /co-operative/eollaborative function:- Collaboration

Of midwives with Other medical staffs
Eg. Physicians
6. Independent function:- Activities entirely performed by midwives
Eg: conducting second stage of labor

Three functions of midwife

 Duties and Responsibilities of a Midwife
j. Care provider: - caring /comforting involve knowledge and
sensitivity to what matter and what is important to the client.

k. Communicator/helper: - Effective communication is an essential

element of all helping profession. It helps the client to explain the
internal feeling.

l. Teacher/educator: - teacher refers to activities by which the

teacher helps the student to learn. The client also need education
based on the case.
m. Counselor: - counseling is processes of helping a client
to recognized and cope with stressful psychological or
social problem, to develop improved interpersonal
relationships and promote personal growth
n. Client advocate: - An advocate pleads the cause of others
or argues or pleads for a cause or proposal
o. Change agent: - a change agent is a person or group who
initiates changes or who assists others in making
modification in themselves or in the system.
 Cont...
p. Leader: - leader ship is defined as mutual process of inter
personal influence through which the professionals helps a
client make decision in establishing and achieving goals to
improve the client well being.

q. Manager: - management defines manager as who plans, gives

direction, developing staff, monitoring operations, giving
rewards fairly and representing both staff member and
administration as needed.
r. Researcher: - majority of researchers in midwifery
are prepared at doctoral and post doctoral level.

Though an increasing number of clinician midwives

with masters degree are beginning to practice it.

Midwifery Care Process

This care process is dynamic, continuous, and circular
when needed, following an orderly succession of steps
 and requiring critical thinking and various types and
levels of decision-making throughout.
At times data collected or decisions made or
unanticipated outcomes will require re-visiting an
earlier step and re-planning with the woman.
There are 5 steps
I. Assessment
Includes: - History and current needs expressed by woman,
physical examination, laboratory findings.
Sources of data: Woman, family, available records, observation.
Criteria for success: Systematic and accurate data collection done
in culturally appropriate, respectful manner.
6. Decision-making data collected to
clarify actual or potential midwifery diagnoses based on woman's
needs/problems and determining if emergency action required.

Sources of data: See Step 1.

Criteria for success: Correct interpretation of data that results
inaccurate midwifery diagnoses.

7. Planning
Includes:- Prioritizing need for action in partnership with the
woman, determining which needs/problems will be resolved by
midwifery actions; need for consultation or referral.
Sources of data: Steps I and 2.
Criteria for success: Comprehensive plan with input from
woman/family, including alternates when available based on
evidence/sound rationale.

8. Implementation
 Includes: Timely, appropriate, safe midwifery care provided with
compassion and cultural sensitivity, promoting self-care when
possible.

Sources of data: Steps 1, 2, and 3.

Criteria for success: Timely intervention with safe,
evidencebased, emcient, ethical, compassionate care-giving along
with appropriate recording of data and plan of care,
69
9. Evaluation
Includes: Feedback from woman/family on needs met,
satisfaction; midwife self assessment and reflection on outcomes
and whether new approach needed; confirmation/validation from
colleagues, teachers.
Sources of data: Self, woman, family, peers, supervisors.
Criteria for success: Extent to which care given met needs of
woman and midwifery goals. Outcomes of midwifery care
include improved health/well-being of women and newborns.
 I am a Midwife (By Dorothy Lazaro)
I stand on my feet for 8 hours in a day
I am on call 24 hours a day
I still keep the smile on my face
Because I am a midwife
The first cry Of the baby is music to my ears
The first cry Of the baby is melody to me
The first cry Of the baby is my satisfaction
The first cry of the baby energizes me
Because I am a midwife
The joy of the mother is my joy
 The smile of the mother is my satisfaction
The pain of the mother is my pain
The cry of the mother is my cry
Because I am a midwife
I am very comfortable in the labour ward
I am very comfortable in antenatal clinics
I am comfortable in family planning clinics
I am comfortable with Women seeking different reproductive health
services
Because I am a proud midwife