BACHELOR OF SCIENCE IN MID-WIFERY (BSMW)
HEALTH SERVICES ACADEMY
GOVERNMENT OF PAKISTAN
Ministry of National Health Services, Regulation & Coordination
Midwifery is a distinct profession than nursing in its own rights i.e., definition of title, scope of practice, philosophy, code of ethics, education, competencies, and services. Competent and qualified midwives contribute a pivotal role in improving maternal, neonatal, and child health. This document proposes an undergraduate four-year degree program to prepare midwives who will be qualified and licensed to provide quality care specifically to pregnant women and new born. The goal of the degree program is to establish midwifery education based on national and international best practices and on ICM (International Confederation of Midwives) standards that lead to excellence in evidence-based midwifery practice, teaching, and leadership. The higher education programs in midwifery will serve as exemplar for Pakistan and region.
At present, in Pakistan, there are several midwifery cadres, with different formal education levels, who provide maternal and newborn/ child health services; however, until recently, there was no opportunity to obtain higher education in midwifery in the country. As a result, midwives were not adequately prepared or permitted to provide full scope of care to women. From UNFPA funding, in 2014, a two-year degree program a.k.a Post RM program was initiated in two schools of nursing in Pakistan (both is Karachi). These two schools have produced handful of midwifery graduates who are currently deployed at various places including schools of nursing & midwifery, hospitals, MCH centers and reproductive health projects. Moving on as a next step, UNFPA along with Health Services Academy (HSA) is planning to offer undergraduate four-year degree program to prepare midwives who will be qualified and licensed to provide quality care specifically to pregnant women and new born.
Evidence shows that midwives prepared at international standards enhance normality throughout the birth cycle and reduce the rates of morbidity and mortality and promote health of mothers and newborns/ infants. Making higher education available based on the International Confederation of Midwives’ Global Standards for Midwifery Education and its Essential Competencies for Midwifery Practice in Pakistan will enable midwives to alter the high mortality and morbidity among women and children. Moreover, qualified midwives will provide improved health care services, quality of practice and teaching, further the development of midwifery as a profession as well as expand career opportunities for women in Pakistan.
Definition of Midwife and Midwifery:
Midwifery is the profession of midwives and has a unique body of knowledge, skills and professional attitudes drawn from disciplines shared by other health professions such as science and sociology, but practiced by midwives within a professional framework of autonomy, partnership, ethics and accountability. Midwifery care is provided by an autonomous midwife. Midwifery competencies (knowledge, skills and attitudes) are held and practiced by midwives, educated through a pre-service/preregistration. Midwifery is an approach to care of women and their newborn infants whereby midwives:
=> Optimize the normal biological, psychological, social and cultural processes of childbirth and early life of the newborn.
=> Work in partnership with women, respecting the individual circumstances and views of each woman;
=> Promote women’s personal capabilities to care for themselves and their families;
=> Collaborate with midwives and other health professionals as necessary to provide holistic care that meets each woman’s individual needs
In Pakistan, all the graduates will be titled as ‘MIDWIFE’ after successful completion of the undergraduate midwifery degree program. This program and title both are approved by Pakistan Nursing Council.
Scope of Practice:
The midwife is recognized as a responsible and accountable professional who works in partnership with women to give the necessary support, care, and advice during pregnancy, labor and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant. This care includes preventative measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency measures.The midwife has an important task in health counseling and education, not only for the woman, but also within the family and the community. This work should involve antenatal education and preparation for parenthood and may extend to women’s health, sexual or reproductive health and childcare. A midwife may practice in any setting including the home, community-based health units/ clinics, hospitals, or basic health units BHUs/ Rural Health Centers/ Taluqa and/or District hospitals.”
 Copied from Pakistan Nursing Council Curriculum for BSM – unpublished document – Adapted from ICM 2017
List of Competencies ( Adapted from ICM’s Essential Core Competencies, 2019)
Assume responsibility for own decisions and actions as an autonomous practitioner
Assume responsibility for self-care and self-development as a midwife
Appropriately delegate aspects of care and provide supervision
Use research to inform practice
Uphold fundamental human rights of individuals when providing midwifery care
Adhere to jurisdictional laws, regulatory requirements, and codes of conduct for midwifery practice
Facilitate women to make individual choices about care
Demonstrate effective interpersonal communication with women and families, health care teams, and community groups
Facilitate normal birth processes in institutional and community settings, including women’s homes
Assess the health status, screen for health risks, and promote general health and well-being of women and infants
Prevent and treat common health problems related to reproduction and early life
Recognize conditions outside midwifery scope of practice and refer appropriately
Care for women who experience physical and sexual violence and abuse
· Provide pre-pregnancy care
· Determine health status of woman
· Assess fetal well-being
· Monitor the progression of pregnancy
· Promote and support health behaviors that improve well being
· Provide anticipatory guidance related to pregnancy, birth, breastfeeding, parenthood, and change in the family
· Detect, stabilize, manage, and refer women with complicated pregnancies
· Assist the woman and her family to plan for an appropriate place of birth.
3. CARE DURING LABOUR AND BIRTH
labour and birth
· Manage a safe spontaneous vaginal birth; prevent, detect and stabilize complication
Provide care of the
newborn immediately after birth.
4. ONGOING CARE OF WOMEN AND NEWBORNS
· Provide pre-pregnancy care
· Determine health status of woman
Assess fetal well-being
Monitor the progression of pregnancy