History Of Midwifery

History of Midwifery

• Midwifery involves caring for women during pregnancy, childbirth (parturition), and the postpartum period, including newborn care
• Midwifery is a health science and profession covering pregnancy, childbirth, postpartum, and women's sexual and reproductive health
• In many countries, it's a specialized medical profession with independent education
• A professional in midwifery is called a midwife
• Evidence suggests that midwifery has been practiced since biblical times
• Shiphrah and Puah were recorded as midwives in Genesis and assisted women during childbirth
• Before the historic period, female relatives and the husband helped during labour. Unrelated young women called midwives were hired and paid for assistance.
• Midwifery is the first holistic profession in the world with a woman-centered approach to care and has undergone social transitions.
• Macro socio-cultural factors, like social organization's power and consistent civilizations, have changed individualized concern to a holistic approach in midwifery
• Micro factors include gender identity, social class, authority, and education access, these shifted midwifery from an unstandardized practice to a professional one

Midwifery before the 20th Century

• Midwives were traditionally mothers who assisted in births within their communities
• Lacking formal training, some possessed significant herbal medicine knowledge and offered services beyond childbirth
• Midwifery provided income or social status for married, older, or widowed women
• Childbirth's universality makes midwifery a cultural touchstone, evident in historical texts and images
• A midwife's social standing varied from respected to marginalized, offering elevated status where highly regarded
• Midwives with specialized knowledge who touched visceral fluids were relegated to the lowest castes and were believed to be vulnerable to persecution as witches
• France introduced the earliest midwifery laws in the 15th century partly to curb perceived witchcraft
• Later laws were focused solely on midwifery
• 17th-century London had midwives licensed by the Church of England
• Britain imposed stricter licensing via the 1902 Midwife Act
• Austria, Norway, and Sweden established midwife licensing laws in the 19th century
• Prior to the 20th century, bearing children was a common qualification for midwives
• Midwives may undergo apprenticeship or be recruited by family to assist during labor
• The Netherlands established the earliest formal midwifery training in the 17th century
• Amsterdam was the primary location
• Sweden, France, and Scotland soon followed suit
• These programs coincided with maternity hospitals' rise in Europe
• Formal 19th-century training programs were established in Chile and Argentina
• Midwives became policymakers in Chile’s health ministry in the 20th century
• Midwifery practice was monitored irregularly by local religious or governmental institutions despite licensing in some countries
• Midwives often engaged privately with families without regulation
• Trained, regulated midwifery correlated with lower maternal mortality, compared to areas relying on untrained helpers or solo deliveries
• Male physicians collaborated and competed with midwives from the 18th century
• Men were generally perceived offensive in the birthing room
• Physicians provided pain relief during labour
• Physicians' ability to use forceps, and claims of better qualifications for complicated deliveries, led middle-class women to favor them over midwives
• Some countries prohibited women from using obstetrical tools
• The acceptance of antisepsis and enhanced obstetric techniques in the 20th century encouraged women of all classes to opt for hospital births

Developments in the 20th Century

• 20th-century professionalization of midwifery, nursing, and medicine led to varied outcomes globally
• Britain: midwifery coexisted with nursing and medicine as an independent profession
• Australia: midwifery became part of nursing
• United States: midwifery nearly disappeared
• Continued midwifery sparked public debate, centering on the midwife's role in healthcare
• The British Midwife Act of 1902 mandated training for midwives
• The Act restricted midwife's roles to normal births
• Midwives were required to transfer complicated cases to doctors and were banned from using forceps
• This helped integrate midwifery into British healthcare
• Sweden also trained midwives to use forceps when a doctor was unavailable
• Integrating midwifery among healthcare providers allowed it to survive competition from doctors and nurses
• Midwifery training was culturally specific
• Colonial professional standards reflected the colonizing country's approach
• Former British colonies in Africa and the Caribbean adopted a British postgraduate model, while former French territories used direct-entry training and licensure
• Many postcolonial countries maintain midwifery education and licensure within their healthcare systems
• Midwives were displaced in the US and Canada due to collaboration between medicine, nursing, and immigration
• In early 20th-century America, midwifery was linked to lower classes, immigrants, African Americans, and Native Americans and deemed unhygienic
• U.S. medical community viewed midwifery as superstitious, ignoring good birth outcomes
• Midwife-attended births were blamed for high infant and maternal mortality rates
• Midwives played an important role in assisting immigrant women and families in adapting to their new country
• As populations assimilated to American culture, many stopped using midwives
• Trained nursing further encroached on midwifery
• Public health nurses supervised untrained midwives
• Offered mothers infant care instructions
• Scientific medicine promised safe, hemorrhage-, infection-, and death-free deliveries, ending most North American midwifery practices
• Physicians delivered 88% of US births in hospitals by the 1950s
• Canadian provincial governments supported midwifery in remote northern and coastal areas
• The Frontier Graduate School of Nursing in Kentucky and the Catholic Maternity Institute in New Mexico contributed to nurturing midwifery practice
• These were modeled after British midwifery education with an emphasis on normal births
• Patients requiring complicated care were transfered to doctors
• These programs primarily served impoverished urban and rural communities and helped to sustain the existence of midwifery in North America during the mid-20th century

The History of Midwifery in Nigeria

• Nigerians used religious beliefs and superstitions to care for pregnant women
• People used charms to conduct delivery
• Nigerians were later trained in Britain to adopt modern methods of midwifery

Early Missionaries

• Early missionaries began practicing midwifery in Nigeria
• The practice led to establishing various training centers, including Mary Assumpta Hospital, Ado Ekiti; St. Louis Catholic Hospital, Owo; Wesley Guild Hospital, Ilesha; and Oluyoro Catholic Hospital, Ibadan
• Nigeria's midwifery training started in Ijebu Ode General Hospital, where ROSELINE DUROJAYE, the first Nigerian midwife, graduated in 1927
• Traditional birth attendants also began practicing midwifery, but the WHO intervened, requiring short training and issuing licenses with midwifery kits in 1977
• Only two classes of midwives were available between 1927 and 1967: grade 2 and grade 1
• Grade 1 midwives were recognized in 1968
• They underwent 18 months of retraining, with training focused on normal labour, pregnancy, and puerperium
• From 1946 to 1956, a ten-year plan focused on maternal and child health, leading to the establishment of maternity and general hospitals

Midwifery in the Modern Era

• Midwifery is culturally entrenched worldwide; midwifery standards and training differ by country
• The International Confederation of Midwives (ICM) sets midwife education and practice standards; lay midwives are excluded
• Early 21st-century midwifery includes women's childbearing and gynecological care throughout their lives
• Worldwide, there are two primary ways to become a licensed midwife: through nursing or direct entry
• Direct-entry midwives receive specialized training and enter midwifery without other healthcare experience (most common globally)
• Nurse-midwifery entails post-nursing training
• Canada, Ghana, Kenya, the UK, and the US provide both midwife types
• Countries such as Cameroon, Uzbekistan, and Sierra Leone only license nurse-midwives
• Côte d’Ivoire, Vietnam, and Ethiopia only support direct-entry midwifery
• US direct-entry midwives get Certified Midwife (CM) or Certified Professional Midwife (CPM) titles
• Certification is granted by the American Midwifery Certification Board or the North American Registry of Midwives
• Nurse-midwives first become nurses, then pursue midwifery graduate studies, getting certificates or master's degrees
• Midwives of all types assist births in homes, birth centers, and hospitals
• Lay midwives are trained informally by apprenticeship without formal licensing, delivering babies outside of hospitals
• The World Health Organization (WHO) deems lay midwives unskilled birth attendants due to lacking formal emergency training, associated with rising maternal and infant mortality
• The WHO estimates 62% of childbirths in developing countries employ skilled birth attendants (accredited midwife, physician, or nurse)
• The WHO stresses training all midwife types to meet Millennium Development Goals for improved maternal health and reduced infant mortality
• The ICM mandates three years of postsecondary education for trained midwives in its 2010 Global Standards for Midwifery Education
• Referred to as Basic Midwifery in Nigeria at the Former School of Midwifery, Akure, Ondo State
• Mid-20th century Western-country women pushed midwifery back from obscurity by seeking unmedicated, out-of-hospital births and more control
• Midwifery resurgence varied with:
  • Canadian nurse-midwives and direct-entry midwives collaborating
  • Britain saw a rise in direct-entry applicants
  • Australia introduced direct-entry training
• Various forms of midwifery are available again in Western countries, including hospitals, birth centers, and homes

Rules and Regulations Governing Midwifery Practice/Norms and Standards for the Practice of Midwifery. International Code of Ethics for Midwives

• The International Confederation of Midwives (ICM) intends to raise care standards for women, babies, and families via promoting professional midwife development, education, and use
• The ICM’s code acknowledges women’s human rights, promotes justice and equal healthcare access with respect, trust
• The code addresses ethical mandates to promote health and wellbeing for women and newborns, spanning from pre-pregnancy to after the end of life
• Including how midwives relate to others, uphold responsibilities, and ensure professional integrity

Midwifery Relationships

• Midwives team with women, sharing material for informed decisions and responsibility for choices
• Midwives advocate women and families' right to have a say in their care
• Midwives empower women and families to voice health issues within their cultures and societies
• Midwives collaborate and work with policy and funding groups to define health needs to ensure that resources are shared fairly
• Midwives support each other actively and nurture worth
• Midwives respectfully consult and refer to other experts for patient needs beyond their competence
• Midwives recognize interdependence and mend conflicts
• Midwives have duties to be persons of moral worth with self-respect

Practice of Midwifery

• Midwives culturally respect childbearing families, while stopping harmful practices
• Midwives encourage no harm during conception or birth
• Midwives use updated knowledge to maintain competence and safe practices
• Midwives address women’s mental, physical, emotional, and spiritual needs with no discrimination
• Midwives act as role models to promote health through life
• Midwives cultivate growth in their midwifery careers to integrate growth into practice

The Professional Responsibilities of Midwives

• Midwives keep client details private, with judgment on sharing, except if required by law
• Midwives are accountable for women's care outcomes
• Midwives may decline deep moral opposition, but never deprive essential services
• Midwives will refer service requests if conscientiously objected to
• Midwives know human rights violations impact women and infants and try to stop them
• Midwives affect health policies that promote women and childbearing families

Advancement of Midwifery Knowledge and Practice

• Midwives advance knowledge that protects women’s rights
• Midwives develop and share knowledge via reviews and research
• Midwives aid student education and midwife training
• Midwifery by a certified nurse-midwife (CNM) and certified midwife (CM) independently handles women's health particularly in pregnancy, childbirth, postpartum, newborn care, family planning and gynecologic concerns
• The CNM/CM operates inside a system that allows for advice, collaborative management, or referrals based on a client's health
• CNMs and CMs follow Standards for Midwifery Practice, per the American College of Nurse-Midwives (ACNM)

Standard I

• Midwifery care should be given by qualified practitioners who:
  • Is certified by the ACNM certifying body
  • Evidence continuing competency
  • Comply with legal jurisdiction requirements where the practice occurs

Standard II

• Midwifery care must happen in a safe place in the context of family, community, and healthcare system. The midwife must:
  • Know and use federal and state regulations for practice and infection control
  • Demonstrate how to give medical advice, collaboration, and referral
  • Use Community Services as needed
  • Know medical, psychosocial, economic, cultural and family factors affecting care
  • Show how to respond to emergencies, including medical transportation
  • Promote the support people

Standard III

• Midwifery care supports individual rights and self-determination within safe boundaries, requiring midwives to:
  • Follow the ethics and the Philosophy of the American College of Nurse-Midwives
  • Describe midwifery and the information about the client's rights and responsibilities
  • Provide clients with information, referral, or other service providers when asked or when care falls outside of their scope
  • Give data on health decisions and science facts

Standard IV

• Midwifery care is comprised of knowledge, skills, and judgment while providing culturally competent, safe, and satisfying care. The midwife must:
  • Gather info, evaluate care data, carry out and implement individualized plans and management, and assesment
  • Demonstrate the skills and judgments in the ACNM Core Competencies for Basic Midwifery Practice
  • Follow the guidelines for the Practice of Midwifery
  • Abide by practices, service pratices, and guidelines that fit the rules and settings applicable

Standard V

• Midwifery depends on knowledge, skills, and judgments reflected in written practice that guide the scope of midwifery and deliverable services. The midwife:
  • Keeps written service parameters for independent and collaborative midwifery and care management, and transfers care as needed
  • Has resources to bring clinical practice of evidence that can apply the each specialty, like women's medical care, families in the process, and newborn care

Standard VI

• Midwifery care is accessible, complete, and documented, so midwives:
  • Use accessible records that communicate with patients, consultants and facilities
  • Provide immediate, full documentation that include evaluation results, course of treatments, and their outcomes
  • Create a documentation system that secure confidential information on transmissibility for health records
  • Maintain confidential verbal and written communications

Standard VII

• Midwifery must be evaluated pursuant to a well-established program for managing quality, for problem-solving, identifying. The midwife:
  • Help quality management systems in the evaluation of the practice with the context
  • Plans for systematic tracking of the practice to be incorporated into managing the quality
  • Can consult to review problems, including reviewing other care to support its own
  • Respond and fix problems that are pointed out

Standard VIII

• Midwifery practice may be expanded in order to incorporate NEW procedures that aim to improve health for both women and their families. The midwife:
  • Has to pinpoint the NEW procedures that must be implemented that takes both consumer and the availibitly of safe practices from qualified help
  • Confirms that neither state, institutional, governmental or federal statures regulate or limit its use
  • Can successfully demonstrate knowledgable insight to demonstrate:
  • Know the risk, and benefit
  • Can collect the needed skills and have process
  • Will know and be able to identify and manage the problems, or any difficulties and know its process
  • And evaluate competence throughout various outcomes, maintaining the necessary comperency
  • Set a system that allows a medic to collaborate during referral-needed
  • Document the processes needed to have to achieve the necessary skills
  • And be competent to expand or create new the current practice

NURSING AND MIDWIFERY of Nigeria Act and Decree: The Nursing and Midwifery Council The Nursing And Midwifery of Nigeria in this council is created via:

• That the council can sue with its own name
• The council serves to also achieve these dutires
• What qualifies the profession to be known and also skillfull for member of the profession
• Creates register per Act in order to make a list of the persons who can practice
• Regulate within ramifications, maintain in an act that has discipline
• And can carry of duties under the act

Membership involves:

• A Minister-appointed chairman
• Head of the Nurse Services in Federal Ministry of Health
• 8, nurse, directors for the Health and 2 University nursing facilities from four zones
• 4 nursing tutors via Health Zone of Nigeria
• At least 2 person for the association
• Person with advise of 1 secondary educator
• person of public
• Nurses of University offering of rotated basis of three years in a tri rotation
• Medical practitioner, who is also GYN and Obstetrics person, that stands for 36 months
• All jobs done can be reapportioned-chairman- if his results are great
• The minister has to make paragraph for the tasks and the extra help and for proceeding for the council Registration via:
• Council can refuse you via this act, but you must be of good character, and if the certificates is of part 8.
• Unless exempted, the council still may required you to prove practical experience after the qualification is made
• Any person with issues in this section, can go to the high court where is most accessible to them. This also must stand after month upon giving word Special midwives made outside the territory:
• The council holds rights to request person to either be in institution, to create a scheme 6 during the act, you must provide prescribed details

Council's duties:

• As a registered professional, can perform any nursing or midwife duty
• If you have worked for 5 years and follow the state policies, you can practice and conduct services while having an official Obstetric GYN physician for emergencies