Implementing Professional Midwife-Led Maternity Care in India for Healthy Pregnant Women: A Community Case Study

Abstract

More women and neonates die each year in India than in almost every other country of the world. Since 1947, India has in principle provided free medical maternal health care to all pregnant and childbearing women. Although rates of maternal and neonatal deaths have fallen since the 1990s, major inequalities remain. Some Indian States have very high rates of interventions, (e.g., cesarean section), while others have intervention and care rates that are too low. Disrespectful treatment of women in labor and lack of evidence-based practice have also been reported. The World Health Organization and others have strongly recommended that professional midwives (trained in a woman-centered philosophy and to international standards) have a key role for reducing mortality and morbidity, minimizing unnecessary interventions in pregnancy and labor, and improving maternal care quality in low- and medium-income countries. This paper provides a community case-report of the first professional midwifery programme in India designed to international standards, implemented in 2011 in Hyderabad. We describe the design and implementation in the programme's first eleven years, as a basis for further scale-up and testing in India, and in other low- or medium-income countries. The ultimate aim is to improve maternal care quality, choice and outcomes in India and in similar socio-economic and cultural settings.

Strengthening midwifery in the South-East Asian region: A scoping review of midwifery-related research

“…included evaluation of midwife-led services or introduction of midwives to maternity services [24][25][26][27][28][29][30][31][32], service delivery in hard to reach or remote settings [23,[33][34][35][36][37][38] and the integration of mHealth (i.e. digital health applications) to optimise service delivery [16,[39][40][41][42][43][44][45][46][47][48].…”

“…Nine sources specifically evaluated the introduction of midwives to maternity services or midwifery-led models of care in Bangladesh [25,[27][28][29], Indonesia [30,31], India [32] and Thailand [24]. In response to the introduction of midwives, increases were reported in WHOrecommended birth practices [25], overall service capacity [27,29], maternal and neonatal health outcomes [30,32] and women's satisfaction [32]. Two sources pre-emptively explored factors influencing the introduction of nurse-practitioners in midwifery [49] or independent nurse-midwifery practitioners [50] in India.…”

Perceived Gaps in Academic Training and Expectations From Refresher Training in Primary Care Nurses at an Urban Metropolis in Northern India: A Qualitative Study

“…However, these interventions are frequently ineffectual in resourcelimited settings of LMICs wherein primary care workers often work unsupervised in remote areas with high patient loads that overwhelm public health systems [1]. Furthermore, in India, there is a serious deficit of nurses and midwives compared to international standards [13] at 0.5 per 1000 population which is quite low compared to high-income countries (7.1 per 1000 population) and other Southeast Asian region countries (1.5 per 1000 population) [3,14]. There is pronounced regional variation in the availability of ANMs ranging from 0.7 in Bihar and Telangana to 26.6 in Andhra Pradesh suggestive of a correlation with the health system performance [15,16].…”