Midwifery - Aastrika

What We Do > Midwifery

India faces a dual maternal health challenge. Medical treatment during childbirth is either ‘too much, too soon’ or ‘too little, too late’. In the first case, there is medical over-intervention such as when the privileged in private hospitals are pushed into induced labour and caesareans. In the second case, the less fortunate receive little intervention even when such interventions are critically needed. These extremes neglect the interests of mother and child.

Aastrika’s vision is that every woman receives the right treatment at the right time — high quality, respectful maternity care which is neither ‘too much, too soon’ nor ‘too little, too late’.

At Aastrika Foundation, we believe that midwifery is key to resolving this dual challenge. Our efforts and resources are channelled towards establishing midwifery as an essential component of maternal care.

We have adopted a collaborative, multipronged approach to ensure education about, advocacy for, and implementation of midwifery in the health system. In addition to Aastrika Sphere and our sister concern Aastrika Midwifery Centre, Aastrika Foundation has also extended our support to initiatives and organisations in this space.

Midwives are skilled healthcare professionals who provide prenatal, intrapartum, and post-natal care to childbearing women and their infants. When midwives are trained and regulated as per international standards, they can provide 87% of essential care for mothers and infants (UNFPA, WHO, and ICM 2014UNFPA, WHO, and ICM. 2014. The State of the World’s Midwifery 2014: A Universal Pathway. A Women’s Right to Health. New York: United Nations Population Fund.).

Midwives can address India’s ‘too little, too late’ problem, which is largely due to insufficient well-trained healthcare providers. For instance, in rural community health centres, only 34% of obstetrician posts were filled in 2016 (MoHFW 2018MoHFW, Ministry of Health and Family Welfare in Government of India. 2018. Guidelines on Midwifery Services in India 2018. https://nhm.gov.in/New_Updates_2018/NHM_Components/RMNCHA/MH/Guidelines/Guidelines_on_Midwifery_Services_in_India.pdf.). Training midwives at scale so that every woman has access to skilled care can reduce neonatal and maternal mortality.

Midwives can also address India’s ‘too much, too soon’ problem of needless clinical interventions and over-medicalisation of pregnancy and childbirth. Midwives are specialists in normal labour and are well equipped to provide time, attention, and care through the delivery.

Strong evidence from a Cochrane Review indicates that women reap several benefits from the ‘midwife-led continuity model’ of care. In this model, unlike in models led by obstetricians or where care is shared between obstetricians and midwives, the same midwife or midwife-team provides care throughout pregnancy, childbirth, and the postpartum period. With the midwife-led continuity model of care, women were less likely to experience preterm birth, lose their babies, have an epidural, have an episiotomy, or have an instrumental delivery (Sandall et al. 2016Sandall, Jane, Hora Soltani, Simon Gates, Andrew Shennan, and Declan Devane. 2016. “Midwife-Led Continuity Models versus Other Models of Care for Childbearing Women.” Cochrane Database of Systematic Reviews, April. https://doi.org/10.1002/14651858.CD004667.pub5.).

Recognising the crucial role of midwives, the Government of India has introduced a plan for a cadre of professional midwives called ‘Nurse Practitioners in Midwifery’ (NPMs).

These professionals will be skilled to international standards, will provide compassionate, woman-centered care, and will help achieve the Sustainable Development Goals for maternal and newborn health (MoHFW 2018MoHFW, Ministry of Health and Family Welfare in Government of India. 2018. Guidelines on Midwifery Services in India 2018. https://nhm.gov.in/New_Updates_2018/NHM_Components/RMNCHA/MH/Guidelines/Guidelines_on_Midwifery_Services_in_India.pdf.). Registered nurse-midwives who receive an additional 18 months of post-graduate training in midwifery can get an NPM degree. The Government of India also envisions ‘Midwifery-led Care Units’ in key public health facilities.

WE ARE CURRENTLY SUPPORTING THE ESTABLISHMENT OF MIDWIFERY IN A NUMBER OF WAYS

India needs to educate midwives at scale if they are to impact maternal and neonatal mortality rates. Aastrika Sphere provides tools for online learning and blended learning to help scale up the education of midwives.

We are investing in, curating, and developing high quality midwifery-specific learning resources on Aastrika Sphere. These will be freely available to nurses and midwives anywhere in the world. In time, the platform can help pre-service midwifery students learn essential skills and can also help in-service midwives to upskill and improve their competencies. We hope to build a comprehensive library by curating existing resources and developing new ones to fill specific gaps.

Aastrika Midwifery Centre at Vasavi Hospital, our sister concern, promotes the midwifery-led model of care. An interdisciplinary team of midwives, doctors, and nurses provides high quality, mother-centric, respectful maternity care to Bangalore mothers.

We are actively advocating for the development of the new cadre of Nurse Practitioners in Midwifery through networks and partnerships.

Through our advocacy, we also hope to improve awareness and acceptance of midwives among women in India.

We have established fellowships and scholarships for midwifery students.

Partnerships with government or private nursing colleges are also being explored to educate Nurse Practitioners in Midwifery.

Promoting & Supporting Midwifery

WE ARE CURRENTLY SUPPORTING THE ESTABLISHMENT OF MIDWIFERY IN A NUMBER OF WAYS