Roles of a midwife

Miss Edu-Mensah
 Definition of Nursing

• Nursing encompasses autonomous and collaborative care of individuals of

all ages, families, groups and communities, sick or well and in all settings.
Nursing includes the promotion of health, prevention of illness, and the
care of ill, disabled and dying people. Advocacy, promotion of a safe
environment, research, participation in shaping health policy and in
patient and health systems management, and education are also key
nursing roles. (ICN, 2002)
 Definition of Nursing
Cont’d
• “the unique function of the nurse is to assist the individual, sick or well, in
the performance of those activities contributing to health or its recovery
(or to peaceful death) that he would perform unaided if he had the
necessary strength, will or knowledge. And to do this in such a way as to
help him gain independence as rapidly as possible.” (Virginia Henderson,
1897-)
 Definition of a midwife
• “A midwife is a person who has successfully completed a midwifery
education programme that is based on the ICM Essential Competencies
for Midwifery Practice and the framework of the ICM Global Standards
for Midwifery Education and is 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’;
and who demonstrates competency in the practice of midwifery.” (ICM,
2017)
 Scope of Midwifery practice
• Responsible and accountable professional
• Partners with women to provide the necessary support, care and advice
during pregnancy, labour and the postpartum period
• Ensures preventative measures, promotes of normal birth, timely detects
complications in mother and child.
• May practise in any setting including the home, community, hospitals,
clinics or health centres (ICM, 2017).
 Scope of Midwifery practice (Cont’d)
• Recognises the full human rights of women and respects their dignity
• Advocacy for women for their voices are to be heard and their choices respected
• Cultural sensitivity, including working with women and health care providers to
overcome harmful cultural practices
• Views pregnancy as a normal life event and promotes normal physiologic child birth.
• Acts consistently in accordance with professional ethics and standards of practice
• Maintains the confidentiality
•
 Roles of a Midwife (Routine ANC)
• (ANC): infection prevention, counselling about gender based violence, treatment
of sexually transmitted infections/reproductive tract infections, health education,
nutrition counselling, malaria in pregnancy, immunizations, and growth
promotion.
• Routine Postpartum Care: promotion of breastfeeding and postpartum family
planning
• Routine Reproductive Healthcare: health education and provision of family
planning products and services, including treatment of STIs and other infections
• Routine Infant Care: newborn care, immunizations, and growth promotion
 Roles of a Midwife (Routine ANC)
• Accurate and detailed history taking
• Physical examination and explains findings
• Assess vital signs
• Assess maternal nutrition and provide the necessary dietary advice
• Evaluate foetal growth, placental location, and amniotic fluid volume
using ultrasound visualisation and measurement
 Routine ANC (Cont’d)
• Abdominal Assessment
• Assess foetal growth and listen to FHR
• Perform pelvic examination
• Calculate EDD
• Provide health education on relevant topics
• Demonstrate measures to decrease common discomforts of pregnancy
 Routine ANC (Cont’d)
• Provide guidance and basic preparation for labour, birth and parenting
• Identify variations from normal during act promptly
• Prescribe, dispense, furnish or administer selected life-saving drugs
 Roles of a Midwife (Labour and Birth)
• Take detailed history, monitor maternal vital signs and perform a focused
physical examination
• Monitor progress of labour using the partograph, promptly identify
abnormal labour patterns and intervene promptly
• Provide physical and psychological support for woman and family and
promote family involvement
• Provide adequate hydration, nutrition and non-pharmacological comfort
measures
 Labour and Birth (Cont’d)
• Provide for bladder care
• Deliver baby safely and where necessary, provide assisted vaginal birth
• Provide Active Management of Third Stage of Labour (AMSTL)
• Encourage bonding
• Inspect the birth passage and where necessary, repair any injury
• Estimate blood loss
• In case of any third stage emergency, Intervene accordingly
 Roles of a Midwife (PNC)
• Take a selective history, including details of pregnancy, labour and birth
• Perform a focused physical examination of both mother and baby
• Provide information and support for women and their families
• Provide bereavement care where necessary
• Initiate and support early breastfeeding
 PNC (Cont’d)
• Teach mothers how to express breast milk, and how to handle and store
expressed breast milk
• Provide health education on relevant topics
• Provide appropriate and timely first-line treatment for any complications
detected during the postpartum examination
 Roles of a Midwife (Care of the
newborn)
• Provide immediate care, including drying, warming, ensuring that
breathing is established, cord clamping and cutting
• Score APGAR
• Promote and maintain normal newborn body temperature
• Begin emergency measures for respiratory distress
• Perform head to toe physical examination
 Care of the newborn (Cont’d)
• Provide routine care of the newborn, in accord with local guidelines and
protocols (e.g., identification, eye care, screening tests, administration of
Vitamin K, birth registration)
• Encourage early initiation of breastfeeding
• Educate parents about danger signs and normal growth and development
 Qualities of a Midwife
• Class discussion
 Further Reading
• Roles of the midwife in pre-pregnancy and family planning
• Roles of the midwife in abortion-related care
• The basic skills set required for a midwives to perform all their respective
roles
• The International Code of Ethics for Midwives
 Resources
• https://www.safeabortionwomensright.org/wp-content/uploads/2016/05/IC
M-Essential-Competencies-for-Basic-Midwifery-Practice-2010-revised-2
013.pd

• https://www.internationalmidwives.org/assets/files/general-files/2019/10/e
ng-international-code-of-ethics-for-midwives.pdf

• https://www.safeabortionwomensright.org/wp-content/uploads/2016/05/IC
M-Essential-Competencies-for-Basic-Midwifery-Practice-2010-revised-2
013.pdf
 Midwifery scope of practice
• ‘A profession’s scope of practice incorporates the full spectrum of roles,
functions, responsibilities, activities and decision making capacity that
individuals within that profession are educated, competent and authorised
to perform’
• This can be redefined on an individual basis depending on several factors
such as their underpinning education, knowledge, skill, competence and
contract details.
 Framework for decision making in
midwifery
Points to consider when making a decision (Australian NMF)
• Is the activity within the individual’s scope of practice?
• Has the patient/consumer/client received a comprehensive health assessment from
the responsible registered nurse or midwife prior to the decision being made?
• Accountability remains with the registered nurse delegator for any activity
delegated to the enrolled nurse.
• Enrolled nurses are accountable for making decisions about their own scope of
practice before accepting a delegation.
 Framework (Cont’d)
• Does the organisation support the practice?
• Have the quality and risk management framework been considered?
• Are their sufficient staff and/or access to other relevant staff to support the
contemplated practice?
• Must the activity only be performed by a registered nurse or midwife?
• Is there any specific jurisdictional legislation that needs to be considered?
• What is the patient’s health status and what are the benefits of the practice for
them?
 Framework (Cont’d)
• Does the activity meet the professional practice standard or evidence?
• What is the model of care?
• What educational preparation has been undertaken to support the activity?
• Who is the most appropriate person to undertake the activity?
• Is there professional consensus for the delegation to someone else?