TIME SPECIFIC CONTENT AVAIDS STUDENT EVALUATION
OBJECTIVES TEACHER
ACTIVITY
NURSE MIDWIFE PRACTITIONER
INTRODUCTION
Nurse midwife practitionery is a health care profession in which providers offer care to
childbearing women during pregnancy, labour and birth, and during the postpartum
period. They also help care for the newborn and assist the mother with breastfeeding. A
practitioner of midwifery is known as a midwife, a term used in reference to both women
and men, although the majority of midwives are female. In addition to providing care to
women during pregnancy and birth, many midwives also provide primary care to
women, well-woman care related to reproductive health, annual gynecological exams,
family planning, and menopausal care.
DEFINITION
According to the International Confederation of Midwives (a definition that has also
been adopted by the World Health Organization and the International Federation of
Gynecology and Obstetrics):
A nurse midwife is a person who, having been regularly admitted to a midwifery
educational program that is 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 qualifications to be registered and/or legally licensed to practice midwifery.
The nurse midwife practitioners are nurses educated at the master’s or doctoral level
to add to the need of advanced technology, research and having indepth knowledge to
play a pivotal role in today’s health care system.This course is designed to prepare nurse
practitioners with the highest level of practice expertise integrated with the ability to
translate scientific knowledge into complex clinical interventions as well as to create
leaders for organization and system management, quality improvement, health policy
development and interdisciplinary collaboration.
MIDWIFERY AND PROFESSIONALISM
The newer idea of professionalism is that it involves constant competition between
different expertise over the same space.
Why Hasn't Midwifery Become a Profession?
There are several reasons why midwifery has not gone through the process of becoming
a profession. The premises on which midwifery is based actually, in many ways, stand in
complete opposition to the methodology that guides professional establishment and
maintenance.
Complementary Practices
Midwifery is largely based on incorporation and shared learning. In other words,
midwives do not compete for authority in the same way that medical professionals do.
They most readily incorporate new medical knowledge and integrate their own
experiences with those of other women, both birth attendants and those giving birth.
While the medical community would be careful about taking on any practices of
midwives, often for fear of losing any professional authority or "turf," the midwife does
not operate with such an exclusionary methodology.
Sharing, Not Distancing
While medical professionals often employ special language to create a separation
between themselves and those they treating, midwives strive for exactly the opposite.
They want the woman they attend to be an active and authoritative participant in the
pregnancy and birth. While the doctor works "on" the woman, the midwife works "with"
the woman.
Experience, Not Theory
The knowledge that midwives employ is gained largely through experience, rather than a
uniform body of objective information. To the extent that there is a type of "theory," it
concerns a conscious emphasis on the woman's birthing experience and does not serve
the purpose of distancing the midwife from the woman she is attending.
COURSE DETAILS
This is a two-year program leading to the Master of Science degree, with certificates in
nurse-midwifery and as a women's health nurse practitioner. The core curriculum
includes courses in:
advanced health assessment
nurse-midwifery management of the antepartum, intrapartum, and
postpartum woman
well woman health care and the newborn
nurse-midwifery management of complications
health promotion and disease prevention
assessment and management of common primary care signs and symptoms
clinical pharmacology
assessment and management of psychiatric symptoms
issues in nurse-midwifery professional practice, and
cultural and linguistic competency
ROLE OF NURSE MIDWIFE PRACTITIONERS
Besides clinical care, the nurse midwife practitioners focus on.
Provide quality care to mother and neonate
Manage & supervise care of mother and neonate at all the three levels
of care
Teach nurses, allied health professionals, patients and communities in areas
related to mother and neonate care
health promotion
disease prevention
health education and counselling
helping patients make wise health and lifestyle choices
family planning and birth control
counselling
normal gynecological services such as physical and breast exams, pap
smears, and preventive health screening.
Conduct research in areas of mother and neonate care
Prescribe medications.
DECISION MAKING SKILLS
There are various decisions to be taken by a nurse midwife practitioner in effect of the
principles related to care of mother and child.They include:
1) Consider the family as a whole as well as its individual members.
2) Assess families for strengths as well as for specific needs or challenges.
3) Respect diversity in families as a unique quality of that family.
4) Share or initiate information on health planning with family members so that care
is family oriented.
5) Encourage family bonding through roomig-in in both matenal and child health
hospital settings.
6) Encourage families to give care to a newborn of ill child.
7) Encourage family and sibling visits in the hospital to promote family contacts.
8) Participate in early hospital discharge programs to reunite families as soon as
possible.
9) Include developmental stimulation in nursing care.
10) Encourage family members to reach out of their community so that family
members are not isolated from their community or from each other.
NURSE MIDWIFE PRACTITIONERS PROGRAM AND PRACTICE -ABROAD
-The Nurse-Midwifery Practitioners Program is one of the largest U.S. programs offered
in a university setting, where students have the benefits of a rigorous education and
varied clinical experiences, while having a high level of faculty support and
involvement. It is fully accredited by the Accreditation Commission for Midwifery
Education .
-Nurse-midwives provide primary care to childbearing women in a variety of inpatient
and outpatient settings including hospitals, homes, and birth centers. They provide that
care from a core belief that birth is not a medical event, but a very normal physiologic
process.
-San Francisco General Hospital Nurse-Midwifery Service provide a site for the
education of Nurse-Midwives and Women's Health Nurse Practitioners (WHNP) and
demonstrates that nurse-midwifery practice is a safe alternative to traditional obstetrical
care in the hospital environment.
-Since its inception, the program has graduated hundreds of nurse-midwives while the
midwifery faculty practice has attended births for more than 15,000 women. The
program is dedicated to increasing service to vulnerable and underserved women and
families and adheres to the philosophy of the American College of Nurse-Midwives
(ACNM).
LEGAL ISSUES
1) The care is given to an unseen client-the fetus-or to clients who are not of legal age
for giving consent for medical procedures.
2) Labour and birth of a neonate are considered normal events,so the risk of a lawsuit
are greater when problems arise.
3) Nurses are legally responsible for protecting the rights of their clients,including
confidentiality,and are accountable for the quality of their individual nursing care
and that of other health care team members.
4) New regulations on patient on patient confidentiality guarantee that patients can see
their medical record but health information must be kept confidential.
5) Documentation is essential for protecting a nurse and justifying his or her
actions,This concern is long lasting because children who feel they wronged by
health care personnel can bring a lawsuit at the time when they reach their legal age.
6) Nurses must be conscientious about obtaining informed consent for invasive
procedures and determining that pregnant women are aware of any risk to the fetus
associated with a procedure or test.
7) Personal liability insurance is strongly recomended for all nurses so that they do not
incur great financial loses during a malpractice or professional negligence suit.
8) Midwives who are performing their practice illegally face a number of possible
charges, such as practicing medicine without a license and child endangerment.
Found guilty of these crimes, midwives can be admonished by state medical boards,
fined and even serve jail time. According to the midwifery website Natural
Attachment, in Pennsylvania the charge of midwifery without a license is a felony
punishable by a two-year sentence. Midwives can also be sued in civil court.
9) Midwives and Physicians-Although midwives may be licensed, the professional
medical establishment does always recognize them as being legitimate sources of
information. Midwives and physicians have been known to clash over the care of
patients. Dr. Thomas Purdon, a former president of the American College of
Obstetricians and Gynecologists, told CBS News that unlicensed midwives are
"unethical" and "immoral." By contrast, Dr. Mardsen Wagner, a neonatologist who
worked for the World Health Organization, said midwifery provided "an important
counterbalance to the obstetrical profession" by preventing unnecessary medical
interventions.
10) Standards of Care-Certified nurse-midwives practice according to Standards for the
Practice of Midwifery defined by the American College of Nurse-Midwives.
However, according to the National Center for Health Statistics, certified nurse-
midwives attend fewer than one-tenth of U.S. home births. Midwives who supervise
home births may stick to the College's standards, or they may choose to develop their
own standards of care, which may be of varying quality.
11) Payment-Another issue confronting midwives is the payment for their services.
While some health insurance plans will offer payment for midwives, others will not.
According to the book, "Professional Issues in Midwifery," by Lynette A. Ament, 38
states require that private insurance plans reimburse midwives for their services.
However, midwives must first become credentiated with insurance companies by
submitting an application outlining their qualifications and
experience.
REFERENCE
Book
1) Pillitteri A.Maternal and child health nursing,care of the child bearing and
child rearing family.6th ed.2010.Lippincott Williams and Wilkins
publishers:Philadelphia;pg no.5-25
