3. 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 3
4. Brainstorming
4
What is the difference b/n
midwifery, midwife and
midwives?
Is midwifery new
profession?
What is midwifery?
Is midwifery important
profession?
6. 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
6
7. 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).
7
8. 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
8
9. Midwifery
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.
9
10. Purpose of Midwife
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
10
11. Scope of midwifery 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)
11
12. Cont.…
At the same time, the current Ethiopian BSc
curriculum outline 12 essential competencies that
midwifery graduate is expected undertake.
12
13. Cont.…
The four categories of essential competencies for
midwifery practice are:
The cumulative effect of every course midwifery
students learn is to be able gain necessary knowledge
skill and attitudes that enable the to undertake this
essential midwifery practice
13
General
competencies
Competencies
specific to pre-
pregnancy and
antenatal care
Competencies
specific to care
during labor
and birth
Competencies
specific to the
ongoing care
of women and
newborn
14. Cont.…
• The core competencies of basic midwifery practice in
the current Ethiopian curriculum are organized in the
twelve domains as
1. 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
14
15. Cont.…
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
15
16. Cont..
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
16
17. Cont..
emergency care
Conducts births
Provides care for newborn and infant
Provides sexual and reproductive health
education/counseling
Works in various practice settings
17
18. Cont..
A midwife also provides
Adolescent health care
U-5 health care(< 5yrs)
Family planning services
identify and treat Gynecologic problems
18
19. Cont..
A midwife may practice in any setting including:
home
community
settlement and refuge camp
hospitals
health centers
clinics or health posts
19
20. 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
20
21. cont...
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.
21
22. 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
35:17’ and it come to pass when she was in hard labour
that the midwife said unto her, tear not Rachel, it is
another baby’.
22
23. Cont..
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.
23
24. Cont..
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.
24
25. 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.
25
26. Cont...
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.
26
27. 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.
27
28. Cont..
Other European countries such as the United
Kingdom, eventually followed suit later in the 19th &
early 20th Century, educational opportunities opened
for women.
28
29. 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.
29
30. Cont..
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
10yrs and in 1985 post basic training of midwives
started again by the initiative of MOH in Ras Emiru
Campuss around ″Chew berenda″
30
31. Cont..
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.
31
32. 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
32
33. Cont.…
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.
33
34. Cont.….
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
34
35. Cont…
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 2014(UNFPA,2014).
The ratio of midwifery to population by 2014 is 1 to
10,500 which more than half far away from WHO
recommendation
WHO recommends a ratio of 1midwife for a
population of 5,000
35
36. 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
38. International confederation of
Midwives(ICM)
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.
39. 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 ICM
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
40. 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
41. 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
42. 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.
42
Occupation & profession
43. 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.
43
Profession versus Occupation
44. 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
44
Cont..
45. 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
45
Cont..
46. Professions vs. Occupations
46
Professions Occupations
College or University On the job training
Prolonged education Length varies
Mental creativity Largely manual work
Decisions based on science or
theoretical constructs
Guided decision making
Values, beliefs & ethics integral
part of preparation
Values, beliefs & ethics not part
of preparation
Strong commitment Commitment may vary
Autonomous Supervised
Unlikely to change professions Often change jobs
Commitment greater than $
reward
Motivated by $ reward
Individual accountability Employer is primarily
accountable
Professional Ethics for Midwives
48. 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.
48
49. 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.
49
50. 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.
50
51. 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
51
52. 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
52
53. 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.
53
54. 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.
54
55. 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.
55
56. 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
56
57. 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
57
58. 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.
58
59. 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/collaborative function:- Collaboration
of midwives with other medical staffs
Eg. Physicians
3. Independent function:- Activities entirely performed by midwives
Eg: conducting second stage of labor
59
60. Three functions of midwife
Interdependent
Function
Independent
function
Dependent
function
60
61. 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.
61
62. Cont..
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.
62
63. 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.
63
64. Cont…
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.
64
65. 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
65
66. Cont..
1. 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.
66
67. Cont…
2. Decision-making
Includes:-Organizing 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.
67
68. Cont…
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 1 and 2.
Criteria for success: Comprehensive plan with input from
woman/family, including alternates when available based on
evidence/sound rationale.
68
69. Cont…
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, evidence-
based, efficient, ethical, compassionate care-giving along with
appropriate recording of data and plan of care.
69
70. Cont…
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.
70
71. 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
71
