Introduction
After the Reformation in the 16th century, the Church of England took over the task of approving licences for midwives to practise. At that time, only midwives, who were untrained in anatomy and obstetrics, practised midwifery. The same condition prevailed in India, where traditional “dais” practised midwifery. In Edinburgh, a chair of midwifery was established in 1726 to provide guidance to midwives. In several locations all around Britain in the 18th century, midwives received training, and a few hospitals awarded credentials.
John Douglas suggested in 1756 that midwives get appropriate training and that a test be conducted prior to granting a certificate of practise. At this time, midwifery practise improved. Daughters of professionals attended lectures at the Ladies’ Obstetrical College, London, which was established in 1864, and later graduated as midwives. The first English Midwives Act was passed in 1902, making state registration of midwives legally required.
The 1700s and 1800s were a period of rapid advancement in obstetric practice-related medical and nursing research, discoveries, and education. These advancements include the development of obstetrical forceps and their improvement, technical developments that reduced the risks associated with caesarean sections, ground-breaking work in obstetric anaesthesia, the eradication of puerperal fever, the rise of contemporary nursing, and the inclusion of obstetrics in medical practise.
William Smellie (1697–1763) dispelled the myths and misconceptions with his observations and teachings, which led to the development of teaching manikins and the identification of the mechanics of labour. The first obstetrics instructor, William Shippen, Junior (1736–1808), and the author of the first American obstetrics textbook, Samuel Bard (1742–1821), are credited with advancing obstetrical education in the United States (US).
However, these advancements, new information, and lessons remained inaccessible to midwives due to a dearth of educational programmes for them. The United States’ insufficient maternity care was recognized throughout the first two decades of the 20th century, and improvements were made as a result. The establishment of the Children’s Bureau in Washington, DC, and the Maternity Centre Association in New York City had a significant impact on the growth of midwifery and maternal-infant healthcare.
According to a 1906 survey on mother and newborn mortality in New York City, more than 40% of deliveries were attended by almost 3,000 inexperienced and untrained midwives. While not exclusively to blame for the high rates of mother and infant mortality at the time, these midwives bore the brunt of criticism.
The condition was gradually getting better, although slowly. The requirement that all states require birth registration dates back to 1935. The New York City Commissioner conducted yet another investigation into mother and newborn mortality in 1915. The results of this study showed a link between death and inadequate prenatal care. New York City saw the establishment of a number of maternity hospitals, and other states soon followed.
By 1930, legislation were passed to control the practise of the native midwives as obstetric care started to move from the home into the hospital. The legislation governing midwifery practise led to the establishment of several schools. The Bellevue School of Midwifery in New York City and the Preston Retreat Hospital in Philadelphia were two such schools that taught the native midwives how to meet the requirements for practise. These initiatives enhanced midwifery practise and enhanced obstetric care for moms and newborns.
Nurse-midwives in European nations had established their efficacy during this time, and they were now a part of the healthcare system. As part of her goal to offer healthcare for the isolated rural people in the Kentucky Mountains, Mary Breckinridge brought British-trained nurse-midwives to the country in 1925. They were the first nurse-midwives to practise there. Breckinridge’s professional background as a trained midwife in England and a registered nurse (RN) in the US was appropriate for the role she did. Up until 1939, when few schools were created in the US, Great Britain served as the primary provider of midwifery education for licenced nurses in the country.
The majority of births—roughly 70% at the time—were occurring in hospitals, therefore nurse-midwives relocated there in the late 1950s and early 1960s. The introduction of nurse-midwives into hospitals gave childbearing women who gave birth there access to family-centered maternity care and a consumer advocate. Several nurse-midwifery programmes were created between 1969 and 1979. Beginning operations in all conceivable practise settings, including clinics, hospitals, and nationally supported programmes. There are now higher degree programmes as well as certificate programmes.
Without any formal training, traditional “dais” in India provided midwifery services. Early in the 20th century, the practise started to change. In India at the time, there were two primary branches of the health organisation: one was responsible for managing medical aid and maintaining related institutions, and the other was in charge of creating preventative health services. The former was supervised by the Surgeon General of Civil Hospitals in the States and the Director General of the Indian Medical Services at the centre. The Public Health Commissioner at the federal level and the Sanitation Commissioner in the States oversaw preventive health services.
In 1921, the British Parliament shifted many administrative responsibilities, including those related to health, education, and the development of natural resources, from the Central Government to the Provincial Governments. The Rockefeller Foundation helped to found the All India Institute of Hygiene and Public Health in 1930. The institution offered courses in maternal and paediatric health. In all regions of the country, the number of maternal and newborn deaths was high. The Bhore Committee was established in 1943 by the government to examine the state of the health system and develop a thorough strategy for its management.
It offered both a short-term and long-term strategy. The creation of primary health centres to service a population of around 40,000 people was recommended by the short-term plan. Each unit had a staff of four midwives, four trained doulas, one institutional nurse, and additional personnel. Based on this report, training programmes for dais and auxiliary nurse midwives (ANMs) were launched.
Nurse education programmes were mostly found at mission hospitals. The Christian Medical College Hospital in Vellore, Tamil Nadu, was one of the first organisations to offer nurse training programmes. By 1911, nursing directors at Mission Hospitals began to feel the necessity for their own group. The Nurses Auxiliary of the Christian Medical Association of India (CMAI), a formal organisation of nurses, was established in 1931. The Nurses’ Auxiliary was renamed the Nurses League by the CMAI, which had two Boards of Nursing Education: the Mid India Board of Nursing Education and the Board of Nursing Education, South India Branch, in 1964. The CMAI had been registered as a non-profit charitable organisation in 1926.
The Boards regulated nursing education, held examinations, and granted diplomas and certificates to graduates of the general nursing and midwifery (GNM) and auxiliary nurse midwife (ANM) programmes through their affiliation with the nursing schools connected to Mission Hospitals.
The Indian Nursing Council was established in 1949 at the initiative of Nursing Administration of Mission Hospitals. Standards for nursing education in the nation were created by the Indian Nursing Council. The previous fifty years have seen a growth and advancement in nursing education. The three-year basic general nursing programme that leads to a diploma in nursing and midwifery includes training in midwifery. Different states provide auxiliary nurse-midwives programmes lasting two years that result in ANM certificates as well as multifunctional health workers (MHWs) programmes lasting one year that include midwifery training. Several nursing colleges offer graduate programmes and postgraduate specialisations in maternity nursing.
It is a requirement for practising nursing and midwifery to complete education, practise and registration with organisations recognised by the State Nursing Council and the Indian Nursing Council.
Current Trends
There have been significant developments in nursing care for the mother and the newborn from the time of our moms and grandparents. In those days, most births took place at home, either by an inexperienced lady, a neighbour, a family member, or a friend, or, in the case of a lucky few, by a doctor or certified midwife. The new mother received the attention and support of her family while being surrounded by loved ones and having her infant brought right away to her bed.
When parturition moved into the hospital setting in the second half of the 20th century, everything started to change. Priority was frequently given within the’maternity ward’ to the institutional protocols and practises, pushing the needs of the mother and her unborn child to the back of the queue. At that moment, having children stopped being a family matter. The family was only allowed to visit the mother and newborn for a week to ten days while they were kept apart. The child who had been taken away from its mother was put in a newborn nursery and only visited her at predetermined intervals.
Three subspecialties of nursing were established, with one nurse taking care of the mother during labour and delivery, another taking care of new moms, and a third taking care of the infant in the nursery. The idea of ‘rooming in’ was developed during the 1940s. Full-term babies were put in a cot next to their mothers’ beds, where the mothers took care of them. The nursing staff continued to be dispersed, with the nursery nurse caring for the baby and the postpartum nurse caring for the mother. The system’s benefits included a decrease in neonatal infections caused by cross-contamination, more mother confidence and independence, and increased nursing success. The baby gained weight more quickly and cried less. The new mother’s struggles with taking full responsibility for the baby’s care were a drawback, though.
New mothers are known to go through three psychological phases, including taking-in, taking-hold, and letting-go. New moms are passive and dependent during taking-in, necessitating rest and nurturing nursing care to encourage bonding and attachment. The mother lacked such caring support because she was rooming in. It had been thrust upon her too early in the taking-hold period, when the mother is prepared to learn how to be a mother. Additionally, the phase of letting go, during which she develops maternal role patterns and incorporates those changes into her personal and family life, was largely disregarded.
The 1960s saw a shift in emphasis from the carer to the individual receiving care. Terminology changed as a result, and maternity care replaced obstetric care. The expanded scope improves the health and wellbeing of the mother, the newborn, and the entire family and covers both prenatal and postnatal care.
The goal of maternity care, according to the World Health Organisation (WHO), is to guarantee that every expectant and nursing mother maintains excellent health, learns the skills of childrearing, experiences a normal delivery, and gives birth to healthy children. In a more restricted sense, maternity care refers to the treatment of the expectant mother, her safe delivery, her postpartum checkup, the care of her newborn, and the support of lactation. In a broader sense, it starts much earlier with initiatives to improve the health and wellbeing of young people who are considering becoming parents and to support them in forming the proper attitudes about family life and the role of the family in society. Additionally, it must to include advice on parenting and issues relating to infertility and family planning.
Trends changing patterns of childbirth and their effects on maternal and infant Mortality
A growing proportion of working women put off having children until their 30s. Teenage pregnancies continue to happen as early marriage customs persist. The risks of difficulties during pregnancy, such as preterm delivery, low birth weight babies, maternal, foetal neonatal, and postnatal mortality, increase for both older and younger mothers at both ends of the range. Additionally, as more women work outside the home during pregnancy and soon after delivery, the hazards associated with exposure to hazardous chemicals, loud noises, and other occupational stressors are increased for both the mother and the unborn child.
1. Antenatal Risk Factors :- Risks to today’s neonates are a reflection of societal issues (Styles, 1990). Among these are birth abnormalities brought on by sexually transmitted infections (STDs) and acquired immunodeficiency syndrome (AIDS) in pregnant women and neonates. In poor nations, 30–40% of live births are low-birth-weight infants. Two-thirds of low-birth-weight babies are preterm infants. The mother’s medical history during previous pregnancies, socioeconomic situation, education level, and the presence or lack of prenatal treatment are risk factors for low-birth-weight infants in addition to maternal age. A baby born with cerebral palsy, epilepsy, deafness, blindness, or mental retardation might be the outcome of an STD, as can infant death.
2. Technological Advances :- The diagnosis and management of many medical diseases have been transformed by technological advancements. Faster diagnosis and ongoing monitoring are now possible because to increasingly advanced computers (McKenzie and Vestal, 1983). The tools available for foetal monitoring and care provided by highly specialised personnel in the neonatal intensive care unit (NICU) are among those with the biggest impact on maternal and newborn nursing.
Due to these advancements, nursing staff had to become thoroughly familiar with the standards and procedures created for the use of this cutting-edge technology and treatment. The nursing process must continue to be the cornerstone of high-quality nursing care, despite worries that technology advancements inhibit “hands-on care” of the client (May and Mahlmeister, 1994).
Electronic foetal monitors (EFM), which allow for viewing of the baby’s heartbeat during pregnancy and labour, including during contractions, have replaced the fetoscope as the primary method of foetal monitoring. Ultrasound, phonocardiography, and abdominal foetal electrocardiography are examples of “indirect” EFM techniques. In order to perform “direct” (internal) foetal monitoring during labour and delivery, a spiral electrode is fastened to the infant’s scalp. An internal catheter connected to a monitor can now be used to measure the intensity of labour contractions.
Now, even when the mother is not in the same room as the monitor, telemetry via radio transmission makes it possible to monitor contractions and the foetal heartbeat. With this recent breakthrough, labouring women can move more comfortably. According to experts, ‘hi-tech’ advancements will be used in births that are even more normal in the years to come, reducing perinatal death and morbidity. Risk analysis and genetic counselling may start long before conception.
For more proactive obstetric care, risk scenarios may be monitored around-the-clock (McKenzie and Vestal, 1983). More advanced foetal assessment tools will be made available, as will new remedial methods such in utero surgery correction, medical treatment of anomalies, direct foetal blood transfusion, drug injection, and genetic diagnosis. The difficulties for nurses in providing humanistic, family-centered care in a technologically advanced environment will be immense.