Full Text
EXTRAORDINARY
PART III—Section 4
PUBLISHED BY AUTHORITY
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XLVIII
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XLVIII
No. 147] NEW DELHI, WEDNES DAY , MARCH 6, 2024 /PHALGUNA 16, 1945
CG-DL-E-14032024-252941
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2https://www.internationalmidwives.org/assets/files/definitions -files/2018/06/eng -philosophy -and-model -of-midwifery -care.pdf
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bdkbZ le; ¼?kaVs½ vè;;u ds urhts fo"k; 'kSf{kd vè;;u
xfrfofèk;ka fufgr dk;Z vkadyu fofèk
I Vh&2 Lo;a ds Kku vkèkkj
vkSj fodkl {ks=ksa dk
vkadyu
vkbZlh,e n{krkvksa
dh le> çnÆ'kr
djuk vkSj buds
fo#) vkadyu djuk
Çpru'khy vH;kl dh
O;k[;k djuk vkSj
bldk mi;ksx
vè;;u vkSj Kku dks
fodflr djus ds
fy, dSls fd;k tk
ldrk gS vH;kl ds fy, Kku fodflr
djuk vkSj Kku dks vH;kl esa
ykuk
• f'k{kk vkSj vH;kl dh rkdr
• n{krk,a D;k gSa] vkSj vè;;u]
f'k{k.k dh fofHkUu fofèk;ka
D;k gSa\
• bUgsa fodflr djus ds fy,
vuqHko rS;kj djuk
• feMokbQjh Kku] Çpru'khy
vH;kl vkSj fofHkUu n`f"Vdks.k
ds ckjs esa D;k vuks[kk gS \ • O;k[;ku] VîwVksfj;y]
Nk= dh vxqokbZ
okyh lsfeukj
• Lo&funsZf'kr vè;;u
• vkbZlh,e n{krkvksa
dk mi;ksx djrs gq,
ifjn`'; fodkl • vH;kl esa Kku
ds vuqç;ksx
ij fufgr dk;Z
rS;kj djuk]
tSls]
varxZHkkZ'k;h
ns[kHkky esa
vkj,elh • O;fDrxr
vè;;u
;kstuk ds
lkFk
iksVZQksfy;ks
vkSj
ykWx&cqd dk
fodkl
bdkbZ le; ¼?kaVs½ vè;;u ds urhts fo"k; 'kSf{kd vè;;u
xfrfofèk;ka fufgr dk;Z vkadyu fofèk
II Vh&2 'kS{kf.kd fl)karksa dh
le> çnÆ'kr djuk]
ftlesa vuqHkok Red
çKrk] dkS'ky
vè;;u]
ifjn`';&vkèkkfjr
vè;;u]
vH;kl&vkèkkfjr
vè;;u 'kkfey gSa]
ysfdu bUgÈ rd
lhfer ugÈ gSa feMokbQjh f'k{k.k ij ykxw gksus
okys 'kSf{kd fl)kar
• vuqHkokRed çKrk]
ifjn`';&vkèkkfjr vè;;u]
vè;;u dkS'ky] vH;kl esa
f'k{k.k vkSj vkadyu] oSpkfjd
vè;;u • dqN vkbZlh,e
n{krkvksa vkSj
MCY;w,pvks
feMokbQjh ,MwdsVj
daihVsalh Mksesal ds
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fMtkbu] f'k{k.k
n`f"Vdks.k vkSj ikB
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djuk • fdlh Hkh {ks=
esa vkbZlh,e
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djuk • iksVZQksfy;ks
dk fodkl
• ikB ;kstuk
dk vkadyu
III Vh&2 vkbZlh,e n{krkvksa
vkSj MCY;w,pvks
çf'k{kd n{krkvksa dks
lh[kus ds fy, vkèkkj
ds :i esa vH;kl ls
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djuk feMokbQjh vH;kl ds fy,
vuqHkokRed vkSj
ifjn`';&vkèkkfjr vè;;u
• ifjn`';&vkèkkfjr vè;;u]
vH;kl] i<+us ;k vkWuykbu
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• vH;kl vkèkkfjr f'k{kk ftlesa
uSnkfud fu.kZ; ysuk] O;ogkj
esa lk{; dk mi;ksx djuk
'kkfey gS
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• fleqys'ku dk mi;ksx djuk • vkbZlh,e n{krkvksa
ds vkèkkj ij fofHkUu
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ds fy, ml
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mi;ksx djuk
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n{krkvksa ds
vkèkkj ij
ifjn`'; dk
vkadyu
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lacaèkijd çlkfodh;
ns[kHkky ds fy,
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• lacaèkijd f'k{kk & lacaèkijd
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çlkfodkvksa dks rS;kj djuk
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ns[kHkky ds fy, çlkfodkvksa
dks rS;kj djuk
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lacaèk cukuk
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nkSjs vkSj çfrosnu] csMlkbM • ifjppkZ vkSj
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çn'kZu
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tkap lwph]
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djuk]
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ifjn`';
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mÙkj vkSj
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• vH;kl
f'k{k.k
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xfrfofèk;ka fufgr dk;Z vkadyu fofèk
lQy çlkfodk&
efgyk lk>snkjh
LFkkfir djus ds fy,
vko';d lapkj
dkS'ky dh igpku
djuk
fofoèk lkaLÑfrd
leqnk;ksa ds chp
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igpkuuk fDyfud] lEesyu
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vkSj jksy ekWMÇyx
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o lapkj
o nyh; lapkj
o Vdjko çcaèku
• çlkfodk vkSj efgyk ds chp
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VI Vh&3
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o ,elhD;w
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o i;Zos{k.k tkaplwph
o vks,llhbZ@vks,lihbZ
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fleqys'ku {ks=ksa
dh LFkkiuk
• vkadyu ds
fy, psdfyLV
rS;kj djuk • fucaèk]
laf{kIr mÙkj
vkSj
,elhD;w
• vks,llhbZ
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IV:
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I:
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IV:
III
MgSO 4
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• https://www.who.int/maternal_child_adolescent/topics/quality -of-care/midwifery/strengthening -
midwifery -education/en/
• https://www.who.int/hrh/nursing _midwifery/educator_competencies/en/
• https://www.internationalmidwives.org/our -work/policy -and-practice/essential -competen cies-for-
midwifery -practice.html
• https://www.cochrane.org/CD004667/PREG_midwife -led-continuity -model s-care-compared -other -
models -care-women -during -pregnancy -birth -and-early
• https://www.whiteribbonalliance.org/wp -content/uploads/2017/11/Final_RMC_Charter.p df
• https://transform.childbirthconnection.org/reports/physiology/
• https://www.whiteribbonalliance.org/whatwome nwant/
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http://www.open.ac.uk/opencetl/files/opencetl/file/ecms/web -
content/Finlay -(2008) -Reflecting -on-reflective -practice -PBPL -paper -52.pdf
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https://www.internationalmidwives.org/our -work/policy -and-practice/essential -competencies -for-
midwifery -practice.ht ml
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CD004667. DOI: 10.1002/14651858.CD004667.pub5
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E
VIII
INDIAN NURSING COUNCIL
NOTIFICATION
New Delhi, the 16 th February, 2024
Indian Nursing Council {Nurse Practitioner in Midwifery (NPM) Educator Program}, Regulations, 2023
F.No. 11-1/2022 -INC(i) .—In exercise of the powers conferred by sub -section (1) of Sect ion 16 of Indian
Nursing Council Act, 1947 (XLVIII of 1947), as amended from time to time, the Indian Nursing Council hereby
makes the following regulations, namely: —
1. SHORT TITLE AND COMMENCEMENT
i. These Regulations may be called the Indian Nursing Council { Nurse Practitioner in Midwifery (NPM)
Educator Program}, Regulations, 2023.
ii. These shall come into force on the date of notification of the same in the Official Gazette of India.
2. DEFINITIONS
In these Regulations, unless the context otherwise requires
i. ‘the A ct’ means the Indian Nursing Council Act, 1947 (XLVIII of 1947) as amended from time to time;
ii. ‘the Council’ means the Indian Nursing Council constituted under the Act;
iii. ‘BEmONC’ means Basic Emergency Obstetric and Newborn Care;
iv. ‘DOP ’ means Directly Observed Practical;
v. ‘GoI’ means Government of India;
vi. ‘HDU’ means High Dependency Unit;
vii. ‘ICM’ means International Confederation of Midwives;
viii. ‘ICU’ means Intensive Care Unit;
ix. ‘IMNCI’ means Integrated Management of Neonatal Childhood Illnesses;
x. ‘LaQshya’ means Labor Room and Maternity Operation Theatre Quality Improvement Initiative ;
xi. ‘MCQ’ means Multiple Choice Questions;
xii. ‘MLCC’ means Midwife -led Continuity of Care;
xiii. ‘MLCUs’ means Midwife -led Care Units;
xiv. ‘MMR’ means Maternal Mortality Rate;
xv. ‘MoHFW’ means the Ministry o f Health & Family Welfare, Government of India;
xvi. ‘NMTI’ means National Midwifery Training Institute;
xvii. ‘NPM’ means Nurse Practitioner in Midwifery;
xviii. ‘OBG’ means Obstetrics and Gynecology;
xix. ‘OPD’ means Out Patient Department;
xx. ‘OT’ means Operation Theatre;
xxi. ‘QMNC’ means Quality Maternal and Newborn Care;
xxii. ‘RMNCH ’ means Reproductive, Maternal and Newborn Child Health;
xxiii. ‘RN&RM’ means a Registered Nurse and Registered Midwife (RN&RM) and denotes a nurse who has
completed successfully, recognised Bachelor of Nursing (B. Sc. Nursing) or Diploma in General Nursing
and Midwifery (GNM) course, as prescribed by the Council and is registered in a SNRC as Registered
Nurse and Registered Midwife;
xxiv. ‘SBL’ means Scenario -based Learning;
xxv. ‘SDA’ means Safe Delivery App;
xxvi. ‘SDGs’ means Sus tainable Development Goals;
xxvii. ‘SMTI’ means State Midwifery Training Institute;
xxviii. ‘SNRC’ means the State Nurse and Midwives Registration Council, by whichever name constituted, by the
respective State Governments;
xxix. ‘UHC’ means Universal Health Coverage;
xxx. ‘UNFPA’ means United Nations Population Fund ;
xxxi. ‘WHO’ means World Health Organisation.
NURSE PRACTITIONER IN MIDWIFERY (NPM) EDUCATOR PROGRAM1
1. INTRODUCTION AND BACKGROUND
1.1 Introduction
In 2015, India became one of the 193 countries to commit to the Sustainable Development Goals (SDGs), which
aim to transform the world by 2030 to a more prosperous, more equal, and more secure planet for all. Needless to say,
India’s responsibility is immense as these ambitious goa ls cannot be achieved without accelerating progress in one -
sixth of the world that resides in our country.
Health is central to commitments made by the Government of India. For us to be able to ensure healthy lives and
promote wellbeing for all at all ages , it is critical to focus on improving our core health indicators, which include
maternal and infant mortality.
When a pregnant woman enters the health system, she puts her faith in the system to receive high quality services
for herself and her newborn. R esponding to this faith India has strengthened maternal and child health services in our
country under the National Health Mission. India has made tremendous progress over the last few decades in
increasing institutional deliveries through the National Hea lth Mission and schemes like the Janani Suraksha Yojana
and Janani Shishu Suraksha Karyakram, and this has greatly reduced the maternal and infant mortality. India’s
maternal mortality ratio has declined from 254 per lakh live births in 2004 -06 to 130 per lakh live births in 2014 -16
(Sample Registration System). India has shown impressive gains in reduction of maternal mortality evident from the
fact that the compound annual rate of decline of MMR has increased significantly from 5.8% during (2007 -09 to
2011-13) to 8.01% (2011 -13 to 2014 -16). Similar achievements are also visible in reduction of under -five and infant
mortality rates.
Investments on maternal and child health remain a key focus area under the National Health Mission.
Operationalizing First Ref erral Units, new Maternal and Child Health Wings, Obstetric High Dependency Units and
Intensive Care Units; capacity building initiatives such as Dakshata trainings; quality antenatal care strengthening
programs such as the Pradhan Mantri Surakshit Matritv a Abhiyan etc. continue to be a key priority.
In addition to above, the Government of India has recently launched the LaQshya - Labor Room and Maternity
Operation Theatre Quality Improvement Initiative. Substantial global evidence exists that addressing th e time around
and immediately after childbirth is critical for saving the lives of mothers and newborns. Studies conducted by White
Ribbon Alliance have also highlighted the need to focus on respectful maternity care. The LaQshya program has thus
been laun ched to provide quality intrapartum and immediate postpartum care and promote respectful maternity care.
Despite the tremendous progress, nearly 32,000 pregnant women each year still lose their lives during pregnancy,
childbirth and the postnatal period. I n addition, 5,90,000 newborns die every year in the first month of life. Additional
efforts are needed in India to increase Universal Health Coverage (UHC) and to achieve Sustainable Development
Goals (SDGs) for maternal and newborn and child health. The N ational Health Policy 2017 aims at the reduction of
maternal mortality ratio to 100 per lakh live births by 2020.
The survival of women and newborns is closely correlated with the care and attention received during pregnancy
and, most importantly, at the t ime of delivery. Delayed management of cases, due to lack of access to skilled care, is
one of the major reasons for the deaths, particularly in the rural areas. Skilled and respectful care during childbirth is
important because millions of women and newbo rns develop serious and hard to predict complications before, during
or immediately after delivery.
Evidence shows that quality midwifery care, provided by midwives educated to international standards, reduces
maternal and newborn mortality and stillbirth rates by 83%. And with 56 improved maternal and newborn health
outcomes, it is also evident that 87% services can be delivered by midwives educated to international standards. There
also has been an increasing body of evidence globally that Midwife -led Car e Units (MLCUs) can address maternal
and neonatal mortality and morbidity by promoting quality and continuity of care through provision of women -centric
care and promoting natural births. Where a model of Midwife -led Continuity of Care (MLCC) is introduced , this
reduces preterm birth by 24%. Beyond survival, quality midwifery care improves breastfeeding rates and psychosocial
1This document has been developed by Ministry of Health & Family Welfare, Government of India and the Indian Nursing Council in
collaboration with the International Confederation of Midwives and based on inputs from the curriculum sub -committee of the National
Midwifery Task Force.
outcomes, and reduces the use of unnecessary interventions, in particular caesarean sections and increases access to
family planning (Lancet Series, 2014; UNFPA, 2014 & WHO, 2017).
The International Confederation of Midwives outline the midwifery philosophy and model of care2. Midwifery
has a unique body of knowledge, skills and professional attitudes drawn from disciplines shared by ot her health
professions such as science and sociology, but practised by midwives within a professional framework of autonomy,
partnership, ethics and accountability. Midwifery is an approach to care of women and their newborn infants whereby
midwives optimi se 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 ca re for themselves and their families; and collaborate with midwives and
other health professionals as necessary to provide holistic care that meets each woman’s individual needs. Midwifery
care is provided by an autonomous midwife.
1.2 The ‘Midwifery Servi ces Initiative’ of India
Considering the need for trained human resources to provide quality care to 30 million pregnancies every year in
India and at the same time recognizing the challenges earlier, Government of India has proposed an alternative model
of service provision for strengthening reproductive, maternal and neonatal health services by nurse practitioners in
midwifery through MLCUs. Quality maternity care provided by midwives through the MLCUs is vital to this
transformation. The recognition that quality of care will not only save lives but will also provide a positive experience
of childbirth means that the change required must be transformative. This will require making fundamental change to
the way services are delivered, and the culture of car e provided to women. The ‘Guidelines on Midwifery Services
in India’ set transformative change must be at the heart of midwifery education.
The ‘midwifery services initiative’ aims to create a new cadre of midwives titled “Nurse Practitioners in
Midwifery” (NPM) who are skilled in accordance with ICM competencies, knowledgeable and capable of providing
compassionate women centered, reproductive, maternal and newborn child health services (RMNCH) and to develop
an enabling environment for integration of this cadre into the public health system in order to achieve the SDGs for
maternal and newborn health (MoHFW, 2018).
1.3 Preparing Nurse Practitioners in Midwifery (NPM) and NPM Educators for the future of India
Quality education is essential to prepare intern ational -standard midwives with ICM competencies with the
knowledge and skills to provide the full scope of care that women and newborns need. Evidence indicates that the
optimum duration of training required to acquire needed midwifery skills and competenc ies is 18 months. The existing
one-year Nurse Practitioner in Midwifery Post Basic Diploma Program of the Council is re -designed and upgraded to
an 18 -month intensive residency program to develop more NPMs for providing respectful, highest standards of qua lity
and evidence -based care at the institutional and community levels with specific emphasis on providing safe and
competent midwifery care. The essential components for quality midwifery based on the Quality Maternal and
Newborn Care (QMNC) framework is also integrated in the curriculum.
The Nurse Practitioner in Midwifery (NPM) will be responsible for promotion of health of women throughout
their life cycle, with special focus on women during their childbearing years and their newborns. He/She will be
responsible for care during preconception, pregnancy, childbirth, and post -natal period and care of newborn. He/She
will be responsible and accountable for her practice. The NPM will practice independently and collaboratively with
the doctors in the hospital and within the existing peripheral health system consisting of skilled birth attendants,
auxiliary nurse midwives, nurses, doctors and specialists. Midwife -led Care Units would be established at high case
load facilities. Midwives posted in these MLCUs wo uld be expected to handle the low risk and normal births and will
also be expected to ensure initial management and stabilization of women with complications before safely referring
them to doctors for further collaborative management.
The aspirations and plans for the quality of India’s midwives and their contribution to the transformation of
RMNCH services in India, call for a midwifery education program that will combine the ability to practice
autonomously to meet the emotional, social, geographical, ph ysical, medical and personal needs of childbearing
women, their newborns and families, while shifting the culture of care, learning continuously and working within a
novel organization of midwife led care. Such education can only be provided by midwifery e ducators who have
engaged in a curriculum based on international standards and that supports relationship building, critical thinking,
reflection, creativity and a good understanding of theory from midwifery and health sciences and apply to judgment,
probl em solving, diagnostic, communication and clinical skills that are basic to midwifery.
Therefore, it is necessary to train a pool of nurse practitioner in midwifery (NPM) educators with the ability to
train nurse practitioners in midwifery as per the WHO/I CM competencies and regulations of the Council. It is
essential that midwifery educators are well versed with these competencies before they take their role as educators in
2https://www.internationalmidwives.org/assets/files/definitions -files/2018/06/eng -philosophy -and-model -of-midwifery -care.pdf
order to bring about transformation in the midwifery services provided by the NPMs. The need for this transformative
change and the paradigm shift of maternity care must be at the heart of education for midwife educators who will be
leaders in the change and ensure the sustainability of education into practice.
Responding to this urgent need, the NPM educator curriculum is designed in line with WHO midwifery educator
core competencies alongside ICM competencies, that emphasize humanizing transformation and autonomous role of
midwives. The curriculum is developed in four course modules, MO DULE I: Preparing midwives for relationship
based and transformative midwifery care, MODULE II: Preparing midwives for care during pregnancy, birth and
puerperium, MODULE III: Preparing midwives to lead, manage and supervise quality midwifery care, MODULE IV:
Preparing midwives for evidence -based midwifery practices. It aims to strengthen the technical knowledge, clinical
skills and facilitation skills of the midwifery educators alongside role modeling the core values underpinning the
midwifery practice. Th e midwifery educator program prepares competent NPM educators, who can effectively
educate and train NPMs to provide quality, compassionate, women -centered, respectful care to woman, neonate and
family. The program will also equip the NPM educators in lead ership, supervision and management skills and enable
them to understand and utilize the research end evidence relevant to midwifery practice.
2. PHILOSOPHY AND VISION
2.1 Philosophy
The Council believes that registered nurses need to be given additional ed ucation and training to work as nurse
practitioners in midwifery (NPMs) in clinical and community settings in the present context of emerging expanded
and specialist roles of nurses and advances in technology. S trengthening midwifery education is fundament al to
quality midwifery and that the NPM educators need to be trained to international standards before they take their role
as educators in order to bring about transformation in terms of humanization and autonomous role in the midwifery
services provided by the NPMs.
The Council believes that competency -based training would enable the nurse practitioner in midwifery (NPM)
educators to demonstrate knowledge, skills and behaviors based on sound evidence -based knowledge, focusing on the
concept of ‘women -centered and respectful care’ that is central to midwifery practice. To achieve a respectful
environment and to develop students’ knowledge and practice of the relationship -based care that is central to
midwifery practice, there is also an emphasis on the stu dent-teacher relationship, communication and attention to
power relationships (Cranton, 2009) and emphasis on the role and responsibility of the educator to shape educational
experiences for developing the next generation of practitioners (Biesta, 2015). T he trained educators will be able to
combine their knowledge, attitude and skills with interpersonal and cultural competencies to work independently as
well as collaboratively with the inter -professional team.
The curriculum for NPM educators, who will pla y a critical part in developing midwifery into the future and
provide ongoing leadership, will therefore need to develop the ability to be responsive to this much -needed radical and
complex transformative change, in educating and making fit for practice th is new cadre of educated, skilled and
compassionate midwives who are prepared for autonomous role in providing midwifery led care for the future of
India.
Therefore, the NPM educator curriculum philosophy is based on the idea of transformative learning cen tred on
critical reflection, problem -posing and dialogue, as well as attention to praxis (reflection/action/dialectic). The
teaching learning approaches will integrate adult learning principles, competency -based education, collaborative
learning, experient ial learning, mastery learning and self -directed learning. Teaching and learning will be led by
midwifery educators supported by medical faculty from Obstetrics and Gynecology, Pediatrics and Public Health for
collaborative and interdisciplinary learning a s required.
The Council believes that the NPM educators involved in training the nurse practitioners in midwifery should be
competent in all midwifery skills (knowledge, attitude and practice), well qualified to lead by example in the clinical
field and su pport the management and implementation of the NPM training across the country.
The Council also believes that a variety of innovative educational strategies can be used in the clinical settings to
provide best clinical learning experiences. It is hoped to facilitate developing policies towards creation of cadre
positions for appropriate placement of these NPMs to function in midwifery lead care units.
2.2 Vision
The program aims to prepare midwifery educators who are able to engage students in transformati ve education,
with a vision for midwifery and midwifery education for India, who meet the WHO competencies for midwifery
educators, and lead development of the midwifery practice and scholarship, through education and research.
3. AIM & OBJECTIVES
3.1 Aim
The aim of this educational program is to prepare competent NPM educators to function in the capacity of
educators and trainers for nurse practitioners in midwifery, to provide quality and compassionate care to woman,
newborn, and family, manage and superv ise care of woman and newborn at all the three levels of care, teach NPMs in
areas related to woman and newborn care using latest educational technology and prepare them to conduct or
participate in research areas of woman and newborn care.
3.2 Objectives
The program prepares NPM educators to -
1. Develop and provide transformational education and leadership.
2. Demonstrate achievement of the WHO Midwifery Educator Competencies (2013a).
3. Demonstrate achievement of the ICM Essential Competencies for Midwifery Pract ice and practice midwifery as
per the Council regulations and MoHFW guidelines.
4. Role model skilled, woman -centered, compassionate, respectful midwifery care that meets the needs of women,
their newborns and families, and the communities they live in.
5. Demon strate the ability to use experiential learning methodologies to teach NPMs that prepare NPMs who will
practice autonomously within the scope of practice in designated midwife -led services in India.
6. Show a commitment to humanization, professional developme nt, lifelong learning, and leadership in the practice
of midwifery.
4. CURRICULUM CONCEPTUAL MODEL
The conceptual model places relationships (woman/newborn, educator/student) at the heart of the midwifery
educator curriculum as the program seeks to equip e ducators who will drive the aspirations for a positive childbirth
experience in India. The curriculum will reinforce or model woman -centered care by also placing the student at the
center of learning. A transformative, competency -based experiential learnin g approach will equip midwives to become
educators who will promote quality midwifery care to address the needs of women in India. Quality midwifery care
and transformative midwifery education are underpinned by ICM essential midwifery competencies (ICM, 2 019) and
WHO Midwifery educator competencies (WHO, 2013).
The content, values and philosophy that form this program are informed by current pedagogical best practice.
Advancements in learning and teaching show that student learning is enhanced when student s are immersed in an
intensive experience based on experiential/theoretical learning, with support for professional and personal self -
reflection. It is essential that NPM educator receive and provide respectful education, including role modeling
respectful behavior while educating and communicating with students in both classroom and clinical practice
settings, in order to teach respectful maternity care attitudes. The model is illustrated in Figure 1 below:
Figure 1. Curriculum Conceptual Model
The curri culum focuses on preparing Midwifery Educators attuned to the core values, integrated concepts
and maternity care priorities weaved into the curriculum for Nurse Practitioners in Midwifery so that the
educators are empowered and capable of providing the tr ansformational education to the upcoming Midwives.
The core values, integrated concepts and maternity care priorities weaved into the NPM Educator and NPM
curriculums are outlined below:
4.1 Core Values
The core values provide a foundation to develop midwi ves who are committed to promoting a positive childbirth
experience for all women and were derived from core government, WHO and ICM documents. These values include:
(i) compassion, (ii) respect, (iii) woman, baby and family -centredness, (iv) equity and ri ghts, (v) collaboration
and teamwork, (vi) ethical practice, (vii) moral courage.
4.2 Integrated Concepts
Within the curriculum there are seven concepts which represent key approaches that inform contemporary
midwifery practice. These concepts include: ( i) social inequities and midwives as primary health practitioners, (ii)
evidence -based midwifery practice, (iii) cultural competence, (iv) quality maternity and newborn care, (v)
continuity of midwifery care, (vi) midwifery as a relationship between a woman, baby, family and a midwife,
(vii) optimizing physiological birth, (viii) community knowledge.
4.3 Maternity Care Priorities
The program provides a strong focus on identified maternity care needs and priorities which are addressed across
the curriculum, e. g., (i) improving maternity and newborn care for vulnerable and hard to reach women, (ii)
reducing maternal and newborn mortality and morbidity, (iii) effective management of emergency care, (iv)
Human rights and gender -based violence, (v) strengthening mi dwifery -led care, (vi) humanising and de -
medicalising birth.
5. QUALITIES OF NPM EDUCATOR
The NPM Educator graduating from this program will be an educator, leader and practitioner of midwifery, with
an in-depth understanding of midwifery, its role in prim ary health care, how midwifery could/should evolve in India,
the impact on midwifery on women and their families, and how education will enable this . The values of woman -
centered care, student -centered teaching, equity and justice, human and reproductive r ights, and compassion
for others, will be foundational for practice. Midwife educators for the future of India will have vision, leadership
qualities, the courage to question, and the ability to form collaborative working relationships to achieve change
particularly in changing the existing paradigm of physician led midwifery care to a new paradigm of midwife led care.
6. SCOPE OF PRACTICE
On completion of the educational program, the NPM educator will be certified by the Examination Boards
approved by the Council and get registered as additional qualification at the SNRC. The NPM educators will ensure
the implementation of Nurse Practitioner in Midwifery (NPM) program and provide education and training to those
who enroll for the course at the State Midwife ry Training Institutes. The NPM educator will also practice midwifery
in all settings including hospitals and health centers particularly in midwife led care units (MLCUs), utilizing the
knowledge and clinical competencies acquired during the training, alo ngside mentorship support in strengthening the
clinical midwifery competencies. The NPM educator will be able to perform full scope of practice as per education
and training and the Council regulations and MoHFW guidelines (Annexure -VIII).
The specific rol es of the NPM educator and midwifery practitioner are listed in the Annexure -I.
7. COMPETENCIES
The Council adapts WHO Core Competencies for Midwifery Educators (WHO, 2013) in educating and training
midwifery educators for India with minor modifications in the competencies relevant to NPM program and the
framework is given below: It also adapts ICM Essential competencies for midwifery practice (2019) found in
Annexure -II.
Figure 2. NPM Educator Competencies
The competencies are organized under 8 competenc y domains with a total of 28 competencies for all the domains.
Competency Domain 1: Ethical and legal principles of midwifery
Midwifery educators incorporate and promote ethical and legal aspects of midwifery care in teaching/ learning
activities and by co nsistent role modelling.
Competencies:
1.1 Demonstrate professional accountability for the delivery of midwifery care as per the Council standards that are
consistent with moral, altruistic and humanistic principles in midwifery practice.
1.2 Demonstrate understan ding of the legal and regulatory principles in midwifery practice within the legal
framework of India.
1.3 Demonstrate understanding of midwifery philosophy of care focused on respectful maternity care placing the
woman’s sexual and reproductive health rights at the center of the care process.
Competency Domain 2: Midwifery practice
Midwifery educators maintain current knowledge and skills in midwifery theory and practice based on the best
evidence available.
Competencies:
2.1 Demonstrate knowledge, attitude and sk ills as per the ICM competencies adopted by the Council to practice
midwifery.
2.2 Provide care for normal birth and pregnancy.
2.3 Demonstrate skills in providing safe, competent and effective midwifery care to women and their neonates.
2.4 Practice midwifery that re flects evidence based and up -to-date knowledge.
2.5 Demonstrate respect and empathy towards mother, family and society at all levels of care.
Competency Domain 3: Theoretical learning
Midwifery educators create an environment that facilitates learning.
Compete ncies:
3.1 Incorporate educational strategies to enhance active learning to develop students’ critical thinking, critical
reasoning skills and innovative thinking.
3.2 Select and use effective and appropriate teaching and learning resources.
3.3 Demonstrat e skill in providing competency -based skill training using simulation for the students of the NPM
course.
3.4 Recognize and support the learning styles and unique learning needs of NPM students.
Competency Domain 4: Learning in clinical area
Midwifery educ ators maintain an environment for effective clinical teaching of midwifery care.
Competencies:
4.1 Facilitate a safe and effective clinical learning environment.
4.2 Promote individualized experiential learning.
4.3 Demonstrate skills in clinical education and trainin g.
Competency Domain 5: Assessment and evaluation of students and program
Midwifery educators conduct regular monitoring and evaluation of students and programs.
Competencies:
5.1 Assess student competency using various assessment strategies, tools and mai ntain accurate records.
5.2 Monitor, assess and evaluate the effectiveness of the NPM program.
Competency Domain 6: Organization, management and supervision
Midwifery educators organize and implement the NPM curriculum effectively.
Competencies:
6.1 Participate actively in planning and organizing the NPM curriculum.
6.2 Implement the NPM curriculum effectively and provide feedback for quality improvement.
6.3 Provide facility -based mentoring for the NPM’s after placement.
Competency Domain 7: Communication, leadership and advocacy
Midwifery educators communicate effectively and function as advocates, change agents and leaders.
Competencies:
7.1 Demonstrate effective communication using variety of methods in diverse care delivery settings.
7.2 Demonstrate cul tural competence in course design and development and teaching and midwifery practice.
7.3 Function as leaders and change agents to improve midwifery education and practice.
7.4 Use a variety of advocacy strategies to promote midwifery education and practi ce.
7.5 Participate in professional development activities relevant to midwifery education .
Competency Domain 8: Research
Midwifery educators promote the use of research and use it to inform midwifery education and practice.
Competencies:
8.1 Use research and inform teaching and practice.
8.2 Cultivate a culture supporting critical inquiry and evidence -based practice.
8.3 Train NPM’s to develop skills to conduct, communicate and utilize research.
8. PROGRAM DETAILS
8.1 Program Description
The NPM educator t raining is a six month’s residency program with a main focus on competency -based
training facilitated by mastery and experiential learning centered around transformational and relationship -based
teaching and learning. The curriculum comprises of four cours e modules, MODULE 1: Preparing midwives for
relationship based and transformative midwifery care, MODULE II: Preparing midwives for care during pregnancy,
birth and puerperium, MODULE III: Preparing midwives to lead, manage and supervise quality midwifery care,
MODULE IV: Preparing midwives for evidence -based midwifery practices. The curriculum encompasses hands on
skill training and orientation to the treatment protocols and drugs permitted for use by NPMs trained to function in
various health care setting s.
This will be followed by a 12 -month structured mentorship program where the NPM educators would teach the
NPM students as well as practice midwifery simultaneously. The NPM educators maintain the logbooks, keep their
portfolio and reflect on experience during the interaction with the mentor individually or in groups, face to face or
online. Peer support alongside mentor support is essential component of the mentorship program. A balance of clinical
and classroom teaching using a variety of teaching metho ds will be maintained.
As the program sets the standard of midwifery education in India, it is important that these students engage with a
program that models contemporary experiential learning. As such the curriculum will be taught incorporating
experient ial and scenario -based learning approaches (Chorazy M. and Klinedinst K. 2019; Smith et al. 2018; Kolb
1984; Dewey 1938). The curriculum will also utilize a competency -based approach drawing on the eight competency
domains from the WHO Midwifery Educator C ore Competencies (2013a) and 28 competency statements formulated
under these domains. It is expected that, upon completion of the course the midwifery educators of this program will
incorporate the same approaches when they begin teaching the new generatio n of midwives through the 18 -month
NPM training.
8.2 Program Structure
Course Modules Theory
(Hours) Practicum (Hours)
Skills Lab
(Hours) Clinical
(Hours)
MODULE I: Preparing midwives for relationship based and transformative midwifery
care 30 5 10
MODULE II: Preparing midwives for care during pregnancy, birth & puerperium 80 35 790
MODULE III: Preparing midwives to lead, manage and supervise quality midwifery
care 15 20
MODULE IV: Preparing midwives for evidence -based midwifery practices 15 20
Total Hours 140 hours 40 hours 840 hours
8.3 Guidelines for Starting the Nurse Practitioner in Midwifery Educator Program
8.3.1 Staffing
1. Faculty Trainer (Teacher): M.Sc. OBG/Pediatrics/Community Health Nursing with minimum 2 years of
clinical maternity expe rience and 5 years of teaching experience. (International Midwifery Educators would be
engaged along with Indian midwifery faculty trainers for training initial batches).
2. Medical Preceptors: Medical faculty from Obstetrics and Gynecology, Pediatrics and Pu blic Health with 3 years
post PG experience/as a consultant.
3. Guest Faculty: NHM/MoHFW officials/Experts from other fields.
Faculty student ratio: 1:5
Preceptor student ratio: 1:5
No. of seats: Maximum 30 per batch
8.3.2 Physical Facilities
1. Classroom - 1
2. Skills/simulation lab - 1 with necessary equipment and supplies (Annexure -III)
3. Library - Current nursing textbooks including midwifery, maternal, neonatal & journal (National and
International publications), relevant GoI guidelines/modules
4. Teaching Aids
• LCD projector
• Screen for projection
• Computer
• Laptop
• Tablet for IT applications (For ex. Safe Delivery App, e -Partograph and other apps)
• Connectors to project tab screens to external screen
• 4 Mbps internet leased line
• Midwifery related equipment such as Gym bal ls, Floor mats, Rebose cloth etc.
5. Office facilities for educators
8.3.3 Clinical Facilities
Minimum Bed strength and other Clinical Facilities:
• 100-200 bedded Parent Hospital having minimum 50 maternity beds or 50 bedded maternity hospital with an
establis hed MLCU
• Labour room as per the LaQshya guidelines of Government of India
• Minimum 6 labour rooms/spaces
• Maternal and neonatal units
• Case load of minimum 6000 deliveries per year
• Maternity OT and Obstetric HDU/ICU
• Separate Kangaroo Mother Care Unit
• 8-10 lev el II neonatal beds
• Affiliated Heath Sub -Centre, Community Health Centre and Primary Health Centre
• Referral links to tertiary care hospital
• Affiliation to Tertiary Hospital - Medical College Hospital
• Affiliation with level III neonatal beds
8.4 Admission Requirements
8.4.1 Eligibility for Admission
The candidate seeking admission to this program should have the following qualifications:
• Be a registered nurse and registered midwife (RN&RM).
• M.Sc. Nursing with specialty in Obstetrics and Gynaecology, Pediatrics or community health with minimum 2
years of clinical maternity working experience.
• B.Sc. Nursing with Nurse Practitioner in Midwifery with 2 years of clinical experience.
• Inservice candidates are also eligible for admission and will be receiving their regula r salary. Being a residency
program, the other students undergoing the program will be given salary/stipend equivalent to their counterparts
in the respective organization.
Note:
• In the initial batches, any M.Sc./B.Sc. Nursing candidate with a minimum of 5 years of clinical maternity working
experience, with passion towards midwifery, clinical/hands on experience of conducting deliveries and
willingness to continue clinical practice and conduct deliveries. Candidates with teaching experience in OBG
nursing will be given preference. Research experience is an added advantage.
• The candidate in order to be trained and practicing in midwifery has to obtain registration to practice (RN&RM)
in the State where enrolled in the NPM educator program.
8.4.2 Selection Process
Selection Criteria and Process Overview for Recruitment of Midwifery Educators is outlined below:
• The entrance will be conducted in two parts with certain percentage weightage for each component. The overall
score for entrance examination is 100 marks (60 for written test & OSCE and 40 for interview).
• Part 1 : Written Test and OSCE
- Written Test (40%) : Multiple Choice Questions and two short essays (2 hours duration) covering the areas
of antenatal, intrapartum, postnatal, complication management and neonatal care. Short essays will be
screened for technical proficiency as well as fluency in written English. Some weightage should be given for
proficiency in written English.
- OSCE - Objectively Structured Clinical Examination (20%): An OSCE bank based on current protocols
under LaQshya is annexed for reference.
• Part 2: Interview (40%)
Successful candidates who clear the written test and OSCE will be screened for the following at the interview:
1) Motivational Screening (20%)
Based on the information provided in the personal statement of the candidate:
a) Passion for woman’s health - to provide respectful care for a positive birthing experience.
b) Willingness to undergo the 6 -month residential course at the designated NMTI in a different State and 12
months mentorship at t heir home State in the designated training centre.
c) Willingness to serve as individual practitioners of midwifery care - low-risk pregnancies and normal
births as posted after the training.
d) Willingness to continue with her clinical practice throughout her c areer, though the distribution between
teaching and clinical practice may vary depending on the stage of her career.
e) Commitment to program goals and GoI’s vision of providing quality of care around the time of birth.
Candidates should have clear understand ing of the 18 -month training and midwifery -led-model of care.
2) Aptitude Assessment (20%) will be a part of interview process to ascertain spoken English language
proficiency and communication, technical knowledge, leadership and advocacy for client’s rights , and team
spirit.
8.5 Organization of the Program
8.5.1 Distribution of the program in weeks (26 weeks):
1. Teaching: Theory & Clinical Residency 23 weeks
2. Examination (including preparation) 1 weeks
3. AL + CL + Public holidays 2 weeks
26 weeks
8.5.2 Distribut ion of the courses for teaching: 23 weeks = 1020 hours
Block Classes (Theory & Skill Lab): 3 weeks = 3 × 40 = 120 hours
Clinical Residency (Clinical Practice, Theory & Skill Lab): 20 weeks = 20 × 45 = 900 hours
Details
Full Theory Block Classes: 3 weeks × 40 hours per week = 120 hours (Theory 100 hours + Skill Lab 20 hours)
Clinical Residency (20 weeks): 20 weeks × 45 hours per week = 900 hours (Theory 40 hours + Skills Lab 20 hours + Clinical
840 hours)
• 40 hours of theory and 20 hours of skills lab to be integrated during clinical experience. They can be covered in the form of skill
lab learning, faculty lecture, clinical rounds, clinical presentations, drug presentations etc. ( 3-4 hours per week for 18 weeks :
First 10 weeks - 2 hours per week × 10 week s = 20 hours for skill lab and 2 hours per week × 10 weeks = 20 hours of theory and
Next 8 weeks - 3 hours per week × 8 weeks = 24 hours of theory).
• The NPM educators would be posted in different shifts as per the duty roster of the clinical facility in ma ternity service areas
only (ANC clinic, Triage, Labour room, Antenatal/postnatal ward, SNCU etc.).
• Minimum 45 hours per week and on call duties every fortnight should be given.
Total = 140 hours (theory) + 40 hours (skills lab) + 840 hours (clinical pract ice) = 1020 hours
8.6 Course of Instruction
S.No. Courses Theory Practicum
(Skills Lab +
Clinical) Areas of Clinical Postings
I MODULE I: Preparing midwives for relationship -based
and transformative midwifery care 30 SL-5
CL-10
Section 1: Relational e ducation: preparing midwives for
relationship -based midwifery care 15 SL-2
CL-5 Integrated clinical practices
Unit1: Introduction 1
Unit 2: Introduction to Midwifery and what women want 4
Unit 3: Universal rights of childbearing women 1
Unit 4: Respectful relationship -based care 5 SL-1
Unit 5: Maternal and newborn health scenarios 2 SL-1
Unit 6: Chain of Referral system 2 CL-5
Section 2: Transformative education: preparing
midwives for transformative midwifery care (Teaching
and Learn ing Approaches) 15 SL-3
CL-5 Integrated clinical
practices
Unit 1: Developing knowledge for practice and putting
knowledge into practice 2
Unit 2: How we learn to be competent - knowledge, skills
and behaviour for practice 2
Unit 3: Experiential and scenario -based learning for
practice 2
Unit 4: Develop educational approaches based on principles
of adult learning 3
Unit 5: Teaching and clinical training skills 3 CL-3
SL-3
Unit 6: Assessment/Evaluation Methods 3 CL-2
II.
MODULE II: Pr eparing midwives for care during
Pregnancy, Birth & Puerperium 80 SL-35
CL-790
A.1.1.1 Section 1: Maternal, Fetal and Newborn Physiology 6 SL-3
Unit 1: Review of anatomy and physiology 2 SL-2
Unit 2: Embryology and Fetal growth and development 2 SL-1
Unit 3: Physiological changes in pregnancy 2 Antenatal OPD/ward
Section 2: Normal Pregnancy, Birth and Puerperium 22 SL-12
CL-450
S.No. Courses Theory Practicum
(Skills Lab +
Clinical) Areas of Clinical Postings
Unit 1: Beginning the pregnancy journey 2
Unit 2: Pregnancy assessment and midwifery care during 1st
Trimester 3 SL-1
CL-40 Antenatal OPD/ward
Unit 3: Midwifery care during 2nd trimester of pregnancy 1 SL-1
CL-40 Antenatal OPD/ward
Unit 4: Midwifery care during 3rd trimester of pregnancy 1 SL-1
CL-40 Antenatal OPD/ward
Unit 5: Midwifery care during 1st stage of lab our 4 SL-3
CL-70 Labour room/casualty
Unit 6: Midwifery care during 2nd stage of labour 2 SL-3
CL-40 Labour room
Unit 7: Midwifery care during 3rd stage of labour 2 SL-2
CL-70 Labour room
Unit 8: Midwifery care during 4th stage of labour 2 SL-1
CL-70 Labour room
Unit 9: Postnatal midwifery care 5 CL-80 Postnatal ward/OPD
A.1.1.2 Section 3: Care of the Newborn 6 SL-2
CL-40
Unit 1: Family centered care 1 Postnatal ward
Unit 2: Ongoing care of newborn 1 CL-10 Postnatal ward/OPD
Unit 3: Risk identifi cation and referral of newborn 2 CL-15 SNCU/NICU/Postnatal
ward/OPD
Unit 4: Nutritional needs of the newborn and establishing
breastfeeding 1 SL-2
CL-10 Postnatal ward/OPD
Unit 5: Disease prevention and immunization
1 CL-5 Postnatal OPD/Family
Plannin g ward/
Immunization OPD
B SECTION 4: COMPLEX CARE OF THE WOMEN
AND NEWBORN, HEALTHY FAMILIES AND
COMMUNITIES 22 SL-16
CL-300
Unit 1: Recognition and management of problems during
pregnancy 6 SL-2
CL-70 ANC OPD/ ANC Ward/
Obstetric HDU
Unit 2: Recognit ion of deviations from the normal and
management during labour 6 SL-4
CL-70 Labour ward/Obstetric
HDU/Maternity OT
Unit 3: Recognition and Management of postnatal problems 4 SL-4
CL-70 Postnatal Ward/ Obstetric
HDU
Unit 4: Recognition and Management of neonatal problems 4 SL-3
CL-50 SNCU/NICU
Unit 5: Healthy families and communities 2 SL-3
CL-40 Postnatal ward/
Family Planning ward
C SECTION 5: PHARMACOLOGY, INFECTION
CONTROL & LEGAL AND ETHICAL ISSUES 24 SL-2
Unit 1: Applied pharmacology and fund amentals of
prescribing 20
Unit 2: Infection Control 2 SL-2 Integrated clinical practice
S.No. Courses Theory Practicum
(Skills Lab +
Clinical) Areas of Clinical Postings
Unit 3: Legal and ethical issue 2
III. MODULE III: Preparing midwives to lead, manage and
supervise quality midwifery care 15 CL-20
Unit 1: Midwifery leade rship 4 CL-5 All maternity areas/
MH/DH/CHC
Unit 2: Change theories and transformative practice 4 CL-5
Unit 3: Management of MLCU’s 4 CL-5
Unit 4: Records and reports 3 CL-5
IV. MODULE IV: Preparing midwives for evidence -based
midwifery practices 15 CL-20
Unit 1: Knowledge and utilization - research and evidence 15 CL-20
Total = 1020 hours 140 hours 40+840 hours
9. TEACHING AND LEARNING
Teaching learning within the NPM Educator curriculum draws on Experiential Learning theories. Experienti al
learning recognizes that learning is an active process that occurs as students interact with authentic activities,
experiences and social encounters. The educational process is underpinned by respect, with educators modelling the
respectful care and com munication that these graduates will engage in with women. The student is intentionally
situated at the center of learning and becomes directly involved in the process of constructing knowledge. As such,
experiential learning relies on experience, as the s ource material and thoughtful reflection to facilitate learning.
Providing ‘real world’ context to activities and experiences aligns students learning to the types of practice and
complexities they might encounter as midwifery graduates. Motivation and eng agement increase as students work
with real -life situations that require decision -making that reflect the nature of maternity care environments and
promote autonomous roles that need to be assumed upon completion of the program and called to lead midwifery care
in MLCUs.
Experiential learning is also committed to minimizing the theory -practice gap that has been recognized as a
challenge in contemporary tertiary health care education. Experiential learning integrates practice with theory,
avoiding teaching a nd learning which occurs in silos. As part of the experiential learning pedagogy students will
engage in significant practice experience through midwifery practicums. Practicums will be organized to reflect a
diversity of clinical settings across the conti nuum of childbirth, pre -conception to postpartum and will include hospital
and community settings. Students will also be required to engage in defined continuity of care experiences where they
follow women through their pregnancy, labour, birth and puerper ium.
Complementing experiential learning in this program is scenario -based learning (SBL) and reflective practice.
SBL uses scenarios which reflect realistic situations, for example they may be based on case studies, critical incidents
or narratives, which provide contextual material and/or learning triggers and provide an ideal environment for
exploring practice, complexities and encourage critical thinking, problem solving and decision -making skills. The
learning processes in SBL moves through phases that requires students to engage in the scenario, analyze the situation,
identify learning needs, construct knowledge, reflect and apply learning. Scenario based learning is best provided
through tutorials and flipped classroom, where students can access pre -tutorial readings and recorded lectures to
support the interactive nature of the learning.
A dedicated simulated environment will be developed to provide a safe learning environment where students will
have the opportunity through simulation workshops to d evelop midwifery skills, work in teams, explore scenarios and
problems, and practice clinical decision -making. Carefully designed simulation activities will also provide the
opportunity to develop communication skills relevant to the women’s needs and heal th problems, including interacting
with scenarios representing families from different demographic and cultural backgrounds, which is vital considering
India’s cultural and demographic diversity. Interprofessional learning may also be fostered through impl ementing
team simulation scenarios.
Reflective practice assists students to learn from experience, both positive and negative and to gain new insights
about themselves and practice. Gibbs cyclic model provides a six -stage approach to systematically reflect on an
experience or activity; including description, feelings, evaluation, analysis, conclusion and an action plan.
Experiential learning supported by scenario based learning and reflective practice will be integrated
throughout the curriculum in bot h theoretical and practice components. Teaching and learning arrangements will be
organized to encourage collaboration and interaction, examples of teaching modes include tutorials and group work,
online resources and lectures, smart classrooms, personal r esearch and reflection, experiential workshops, journal
club, post clinical reviews.
9.1 Teaching and Learning Methods
Classroom Skills Lab Clinical
• Tutorials and workshops
• Lecture cum Discussion
• Experiential learning
• Self-directed learning (Learning
resources - Annexure -IV)
• Problem based learning
• Practice teaching
• Micro teaching
• Audio -video assisted teaching
• Virtual learning - virtual
classroom
• *Safe Delivery App /any other
apps as self -directed learning • Skill demonstration
• Simulation
• Scenario -based
reflec tive learning
• OSCE (plan and
conduction)
• Role play
• Drills
• Microteaching - skill
demonstrations
• Videos • Clinical practice under supervision
• Independent clinical practice
• Bed side clinics
• Reflective learning
• Experiential learning
• Case presentation
• Case studie s/discussions
• Health talk
• Clinical rounds/conference
• Drug discussion and presentation
• Microteaching - theory/skill demonstrations
• Field visit/report
• Logbook (Annexure -III)
Example: * ETech based learning may be incorporated throughout the curriculum by int egration of Safe Delivery App
into the various teaching methodologies. The Safe Delivery App is a smartphone application that provides direct and
instant access to evidence -based and up -to-date clinical guidelines on BEmONC. The SDA can be used as a teachi ng
and learning tool that covers 11 modules: Infection Prevention, Post Abortion Care, Hypertension, Active
Management of Third Stage Labour, Prolonged Labour, Post Partum Haemorrhage, Manual Removal of Placenta,
Maternal Sepsis, Neonatal Resuscitation, Ne wborn Management, Low Birth Weight.
GIBBS CYCLE
9.2 Assessment Methods
Continuous formative assessments
• Self-assessment through reflective learning, as well as peer review
• Group work
• Objective Structured Clinical Examinations (OSCEs)
• Essays, case discussions, literat ure review , written assignments
• Written examinations
• Practical assessments - teaching activities, simulation
• Teaching observation assessment - direct observation of teaching practice (practice teaching)
• Competency assessment
• Clinical practice evaluation
10. EXAMINATION REGULATIONS
EXAMINING AUTHORITY: Examination boards approved by the Council.
The candidates are expected to undergo six months intensive residential training at the National Midwifery
Training Institute. During the training, i.e., at the end of three months of training, the educators would be expected to
undergo a competency -based examination. However, if the educator does not clear the examination , he/she would be
given one chance to reappear for the examination failed either in theory or pra ctical only within 2 -4 weeks and if
failed again and found unsuitable would be discontinued from the program. The educators who clear the examination
at the end of three months would be re -assessed at the end of six months of training followed by final ass essment at
the end of 18 months. The examination pattern for the 3 -month exam would be similar to the examination pattern for
the final examination at the end of 18 months. (The examination guidelines are detailed and given separately in
Annexure -VII.)
10.1 Eligibility for Admission to Examination
• Percentage of attendance in theory and practical before appearing for final examination should be 90%.
• Candidate who successfully completes all the requirements such as logbook and clinical requirements is eligibl e
and can appear for the final exam.
• Completion of 12 -month mentorship experience is mandatory requirement for admission to final examination.
• The details of eligibility to appear for first assessment after 3 months and second assessment after 6 months are
outlined in the exam guidelines.
10.2 Supplementary Examination
• Failed candidates can appear for the supplementary examination after 6 weeks in the final exam failed either
theory or practical only.
• Number of attempts - 3
10.3 Examination Pattern (One the ory paper and one practical examination)
Internal (formative assessment) External (summative assessment)
Theory 25 marks (tests, assignments, presentations) 75 marks (10 marks - MCQ, 30 marks - short
answers, 35 marks - essay/scenario)
Practical 50 mar ks (10 for clinical performance + 10 for clinical
assignments + 10 for OSCE + 20 for DOP) 50 marks (20 in OCSE + 30 in DOP
10.4 Practical Examination
• A panel of three examiners - Faculty trainer - 2 (one internal and one external) and medical preceptor – 1 (the
examiners as well as the medical preceptor who are involved in teaching the program and are familiar with the
curriculum)
10.5 Qualification of Examiner
• M.Sc. Nursing, OBG specialty with 5 years of teaching or clinical experience after PG with a dua l role/M.Sc.
OBG nursing with 5 years of experience as faculty with a minimum of 2 years midwifery clinical working
experience.
• Medical faculty from Obstetrics and Gynecology, Pediatrics and Public Health with 3 years post PG
experience/consultant.
11. CER TIFICATION
A. Title - Nurse Practitioner in Midwifery (NPM) Educator
B. The title is awarded upon successful completion of the prescribed study program, which will state that the
candidate
i. Has completed the prescribed course of Nurse Practitioner in Midwifery (N PM) Educator.
ii. Has attended 90% of the theoretical and 100% of the practical instruction hours before awarding the
certificate.
iii. Has passed (70% marks both internal and external together) in the prescribed theory and practical
examination.
C. Certification will be done by the Examination Boards approved by the Council. The SNRC will be registering
NPM Educator as an additional qualification.
Midwifery Educators, who clear the examinations at the end of six months, should be posted at State Midwifery
Training Ins titutes for training of Nurse Practitioners in Midwifery (NPMs). Six Month training of Midwifery
Educators would be followed by one year of onsite mentorship to ensure proficiency of Midwifery Educators. The
Examination Boards approved by the Council would provide a provisional certificate to the candidates who have
successfully completed six months of training and would further provide a final certification after they have completed
the 12 months of mentorship.
12. COURSE MODULES
COURSE MODULE I
PREPARING MIDWIVES FOR RELATIONSHIP BASED AND
TRANSFORMATIVE MIDWIFERY CARE
Theory (T): 30 hours
Practicum: Skills Lab (SL): 5 hours, Clinical (CL): 10 hours
Course Aim
This course prepares the students to understand their role as an educator by building on their u nderstanding of
midwifery in Indian and global context, thus prepares future NPMs for relationship -based and transformative
midwifery care. It aims to prepare educators who have imbibed the principles of midwifery philosophy and practice
and are competent and skilled in the art of transformative teaching and learning practices.
Course Description
Central to this course are the dual concepts of woman -centered care and student -centered learning. The
philosophy of midwifery practice based on the scope of pract ice, code of ethics, and essential competencies by the
Council/ICM for the midwife will be explored. This will also enable the NPM educator to gain knowledge on adult
learning principles and to develop the skills and attitude in effectively teaching and tr aining nurse practitioners in
midwifery.
Course Objectives
1. Explore the midwifery educator’s competencies in tangent with the ICM midwives’ competencies in Indian
context.
2. Demonstrate an understanding of the midwifery curriculum and key national & internati onal documents and
guidelines for midwifery and midwifery education.
3. Demonstrate skills in effective communication and providing respectful maternity and newborn care.
4. Describe current educational theories including experiential and scenario -based learning principles to create an
environment to facilitate learning.
5. Identify own learning needs and apply student -directed study goals.
6. Describe group dynamics and the importance of peer review and self -reflection.
7. Develop effective learning, teaching practices a nd resources based on evidence.
8. Apply competency -based education in the context of midwifery practice across the continuum and the ICM
essential competencies.
9. Demonstrate current midwifery knowledge and skills and recognize the role of continuing professio nal
development.
Competencies (WHO educator competencies)
1. Demonstrate professional accountability for the delivery of midwifery care as per the Council standards that are
consistent with moral, altruistic and humanistic principles in midwifery practice. (1 .1)
2. Demonstrate understanding of midwifery philosophy of care focused on respectful maternity care placing the
woman’s sexual and reproductive health rights at the center of the care process. (1.3)
3. Incorporate educational strategies to enhance active learn ing to develop students’ critical thinking, critical
reasoning skills and innovative thinking. (3.1)
4. Select and use effective and appropriate teaching and learning resources. (3.2)
5. Demonstrate skill in providing competency -based skill training using simula tion for the students of the NPM
course. (3.3)
6. Recognize and support the learning styles and unique learning needs of NPM students. (3.4)
7. Facilitate a safe and effective clinical learning environment. (4.1)
8. Promote individualized experiential learning. (4. 2)
9. Demonstrate skills in clinical evaluation and training. (4.3)
10. Assess student competency using various assessment strategies, tools and maintain accurate records. (5.1)
11. Monitor, assess and evaluate the effectiveness of the NPM program. (5.2)
12. Participate actively in planning and organizing the NPM curriculum. (6.1)
13. Implement the NPM curriculum effectively and provide feedback for quality improvement. (6.2)
14. Demonstrate effective communication using variety of methods in diverse care delivery settings. (7.1)
The Course Module I is sub -divided into two Sections:
Section 1 – Theory (T): 15 hours, Skill Lab (SL): 1 hour and Clinical (CL): 5 hours
Section 2 – Theory (T): 15 hours , Skill Lab (SL): 4 hours and Clinical (CL): 5 hours
Section 1: Relational education : preparing midwives for relationship -based midwifery care
Drawing on the WHO educator competencies and ICM midwifery philosophy and core documents, this this
section will introduce students to their role as an educator by building on their understanding of midwifery in a global
context and situating it within the new midwifery initiative for India. Central to this are the dual concepts of woman -
centred care and student -centred learning.
Philosophy of midwifery practice based on the ICM definition of a midwi fe, scope of practice, code of ethics, and
essential competencies for the midwife; LaQshya guidelines; WHO guidelines and recommendations on antenatal,
intrapartum and postnatal care; mother, baby and family attachment and psychology; literature, framework s and
guidelines around humanizing birth, cultural competence, respectful care, sexual health and reproductive rights,
gender -based violence and the ethical and legal aspects of the Council will be explored and applied to teaching and
clinical practice. Th is section will introduce the WHO Midwifery educator core competencies in conjunction with the
new guidelines for midwifery -led care and the curriculum for the NPM in India; introduction to learning and teaching
pedagogy. There will be a specific focus on the role of the educator, positive human relationships, respectful
compassionate communication, development of confident active listening and communication skills. Students will
start to use group work, peer support and reflective practice and to incorpora te these into their teaching practice;
development of lifelong learning skills, including critical thinking skills, reflective practice and evidence -based policy
and practice.
SECTION 1: CONTENT OUTLINE
Theory (T): 15 hours , Skill Lab (SL): 1 hour and Clinical (CL): 5 hours
Unit Hours Learning
Outcomes Content Teaching Learning
Activities Assignments Methods of
Assessment
I T-1 Build rapport
with other
students and
educator
Identify previous
experience of
student peers Introduction
• Vision of the midwifery
educators training program
• Overview of courses and
expectations
• Studying for success • Icebreakers and
‘getting to know you’
activitie s • Development of
self-portfolio • Assessment of
portfolio
Unit Hours Learning
Outcomes Content Teaching Learning
Activities Assignments Methods of
Assessment
working in
groups
Confidently
begin journey as
midwife
educator student
Articulate
understanding of
becoming a
midwifery
educator • Accessing resources
(online)
• Seminar a nd tutorial
expectations and working in
groups
• Role of self -directed
learning
• Overview of course
assessments, academic
policies and procedures,
group norms
• WHO educator
competencies
• Developing your portfolio
II T-4 Describe current
scenario and
status of
midwifery in
India and its
future
Describe the
philosophy of
midwifery
practice and
ethics
Apply the
midwifery model
of care in clinical
practice
Discuss
autonomy and
accountability
within the
context of
midwife led care
and continuity of
care
Contextualize
ICM midwifery
practice
standards
Describe the
concept of
woman, newborn
and family
centred care
Describe
relational
education and
relationship -
based midwifery Current scenario and status
of midwifery in India and its
future
• Current scenario and status
of midwifery in India and
its future
• History of midwifery
• Current scenario:
Midwifery in India
• Introduction to
philosophy of midwifery
practice
• The Council/ICM code
of ethics
• Models of midwifery
care - including distinction
between midwives and
other providers with
midwifery skills
• Midwife led care and
continuity of care (MLCC)
• Autonomy and
accountability within the
context of midwife led ca re
and continuity of care
• Essential competencies
for basic midwifery practice
(ICM)
• The Council practice
standards
• ICM global standards
for midwifery practice
• Trends in midwifery
• Midwifery associations
and its role
• Philosophy and practice of
woman, newborn and
family centred care for
India
• ‘What women want’ -
the expectations and
experience of care
• Building positive
relationships
• Key challenges in
midwifery practice in India
and influence of midwifery
education for
transformation
• Roles and scope of NPMs
in India • Seminars (student
led)
• Self-directed learning
• Talking with a
pregnant woman/new
mother about her
experience • Journal
reference and
presentation
• MCQ
• Long Essays
Unit Hours Learning
Outcomes Content Teaching Learning
Activities Assignments Methods of
Assessment
• Relational education and
relationship -based
midwifery
III T-1 Describe
universal rights
of childbearing
women and how
they might be
applied in India?
Explain how
these might be
applied in
practice Universal rights of
childbearing women
• Universal rights of
childbearing women and
how they can be applied in
India?
• International studies of
huma n rights violations and
their effects • Lectures, tutorials
and seminars
• Observation in
practice • Develop a
scenario to
illuminate
universal rights
in practice • Assignment on
scenario
IV T-5
Describe the
importance of
RMNC
Link the practice
of women
centered care to
the provision of
respectful
maternity care
Develop
strategies to
promote
respectful and
compassionate Respectful relationship -based
care: Respectful maternity
and newborn care (RMNC)
• What is RMNC?
• The natu re of respectful
care
• Type of care expected from
women and family
• Importance of RMNC in
improving quality of care
• Clients’ rights for health
care and examples of social
accountability practices
• Behavior change strategy
for RMC services
• Creating Social and
Cultural Barrier Free
Environment
• RMC for women in
MLCU’s
• RMC at all phases
o Preconception
o During ANC
o During labour
o During delivery
o During postpartum
period
• Newborn care integrated
into RMC
• Client privacy
• Respectful communication:
bereavement, maternal
death, newborn death, IUD,
still birth
• RMC in complication
• RMC during psychological
morbidity of women
postpartum
• RMC for differently - abled
woman
• Effect of non -respectful
care
• Role of NPM in assuring
RMNC in MNH service
• Model respectful
relationships in pract ice and
in education • Discussion and
experiential learning
• Video - RMNC
• Integrated clinical
practice in maternity
ward
• Clinical scenarios
and role plays - e.g.,
domestic/ sexual
abuse - students
respond and bring in
the evidence
• Encourage respectful
educato r/ student
relationship
• Exercise: Build
positive relationships
within the clinical
environment and
sensitize everyone to
the new role of the
midwife practitioner
• Explore studies of
relationship -based
continuity of care • Writing role
play script
• Explore key
challenges in
midwifery
practice in
implementing
RMNC during
antenatal care,
intra-natal care
and postnatal
care
• Prepare a role
play • Essay, short
answers and
MCQ
• Assessment of
clinical
performance
with rating scale
• Feedback form
from mothers
(Particularly
designed for
assessing
delivery of
respectful care)
• Assessment of
the scenario on
implementing
RMNC during
antenatal care,
intra-natal care
and postnatal
care
Unit Hours Learning
Outcomes Content Teaching Learning
Activities Assignments Methods of
Assessment
care
V T-2
SL-1
Describe the
epidemiology of
maternal and
neonatal health
in India
Discu ss various
national
RMNCH
programs
including new
midwifery
service
initiatives Maternal and newborn
health scenario in India
• Public health for midwives
(Self Learning)
• Epidemiological aspects
and magnitude of maternal
and neonatal health in India
(Self Le arning)
• Issues of maternal and
neonatal health: age,
gender, sexuality, psycho
socio -cultural factors,
gender disparities and
women empowerment
• Health care delivery
system: National, State,
District, and Village level
with reference to MCH
• National health programs
related to RMNCH
• Quality of care in MNH • Discussion and
experiential learning
scenarios
• Self-directed learning
• Supervised practice
in HSC, PHC, CHC • Preparation &
presentation of
vital statistics
records/Fact
sheet
• Literature search
on MNH care • Essay, short
answers and
MCQ
• Assessment of
visit report
VI T-2
CL-5 Identify and
implement the
chain of referral
system
Identify and
apply policies
and protocols
required to
stabilize women
for referral Chain of Referral system
• Limitations and possibilities
of other health care
providers
• Policy and protocols for
referral; range of strategies
(Conditions requiring
referral, when, where and
how to refer for what
condition)
• Transport arrangements:
community resources,
advice to families and
referral note
• Follow up: feedback on
cases referred
• Records and reports on
referrals • Discussion and
experiential learning
• Supervised clinical
practice • Writing referral
slip/ note
• Safe Delivery
App (SDA) • Essay, short
answers and
MCQ
Section 2: Transformative education: prepa ring midwives for transformative midwifery care (Teaching and
Learning Approaches)
Section 2 will introduce educational theories such as experiential and scenario -based learning and competency -
based education in the context of midwifery practice across the continuum and in primary health care settings.
Students will be taught the skills to create an environment that facilitates learning in both theoretic and clinical
environments. It will also draw on the student’s midwifery knowledge and clinical experienc e across the continuum of
pregnancy, birth and postpartum care of women and newborns. Use of evidence in facilitating informed decision -
making, risk management/wellbeing support, working in community and primary health settings, midwifery education
for wom en and role in public health. Highlight the need for continuing professional competence; the role of clinical
supervision; provide opportunity to develop teaching materials and resources; introduce experiential and scenario -
based learning, simulation techn ologies, consolidate learning and teaching approaches.
SECTION 2: CONTENT OUTLINE
Theory (T): 15 hours , Skill Lab (SL): 4 hours and Clinical (CL): 5 hours
Unit Hours Learning
Outcomes Content Teaching Learning
Activities Assignments Methods of
Assessment
I T-2 Assessment of own
knowledge base
and areas for Developing knowledge
for pr actice and putting
knowledge into practice • Lecture, tutorial,
student led seminar
• Self-directed study • Prepare
assignment on
application of • Development
of portfolio and
log-book with
Unit Hours Learning
Outcomes Content Teaching Learning
Activities Assignments Methods of
Assessment
development
Demonstrate
understanding of
ICM competencies
and assess against
these
Describe reflective
practice and how
this might be used
to develop learning
and knowledge • Power in education
and in practice
• What are
competencies, and
different methods of
learning, teaching?
• Creating experience
for developing these
• What is unique about
midwifery knowledge,
reflective practice and
different approaches? • Development of a
scenario using ICM
competencies knowledge into
practice, e.g.,
RMC in intra -
natal care plan for
individual
learning
II T-2 Demonstrate
understanding of
educational
theories including
but not limited to
experiential
learning, skill
learning, scenario -
based learning,
practice -based
education Educational theories
applicable to midwifery
education
• Experiential learning,
scenario - based
learning, learning
skills, teaching and
assessment in practice,
conceptual learning • Develop educational
design, teaching
approaches and
lesson plans based on
some of the ICM
competencies and
WHO midwifery
educator competency
domains • Prepare Lesson
Plan based on
ICM
competencies in
any area • Development
of portfolio
• Assessment of
the Lesson Plan
III T-2 Develop a scenario
from practice as a
basis for learning
ICM competencies
and WHO
educators’
competencies Experiential and
scenario -based learning
for midwifery practice
• Scenario -based
learning, how to
develop a scenario
from practice, reading
or online resources
• Practice based
education including
clinical decision
making, using
evidence in practice
• Shaping ed ucation for
practice in the clinical
area
• Using simulation • Intensive workshops
developing different
scenarios, based on
ICM competencies
and integrating part
of the range of WHO
educator
competencies
• The class will cover
the whole range of
WHO competencie s • Written scenario
and using that
scenario for
teaching in the
class
• Development of
portfolio • Assessment of
the scenario
based on ICM
competencies
IV T-3 Demonstrate
understanding and
application of the
educational
approaches for
transformational
and rela tionship -
based midwifery
care Educational approaches
• Relational
education - Preparing
midwives for
relationship -based
midwifery care
(student/teacher/
women/families)
• Transformative
education - Preparing
midwives for
transformative
midwifery care
• Student centered
learning
• Competency
based
education/training • Exercise: Build
positive relationship
between the student
and teacher
• Role play: Scenario
based learning
• Written script for
role play
V T-3
SL-2
CL-5
Describe principles
of teaching and
clinic al training and
strategies/ skills Teaching and clinical
training skills
• Teaching -learning • Discussion and
experiential learning
• Practice teaching:
theory and skill • Practice
teaching: theory
and skill
demonstration • Essay, short
answers and
MCQ
• Practice
Unit Hours Learning
Outcomes Content Teaching Learning
Activities Assignments Methods of
Assessment
Utilize different
teaching
methodologies
focusing on student
centered and
relationship - based
learning
Participate in peer
review and self -
reflection activities
Promote
interpersonal
communication
Identify
communication
skills required to
establish successful
midwife -woman
partnership
Recognize
challenges to
effective
communication
within diverse
cultural
communities process
• Adult learning
princi ples
• Methods of
teaching - simulation,
projects, problem -
based learning, drills
• Reflective
learning
• Microteaching
• Preparation of
lesson plans and skill
checklist
• Preparation of AV
aids
• Preparation of
case studies,
case/simulation
scenarios
• Preparation of m aster
and clinical rotation
plan
• Clinical teaching
methods - rounds and
reports, bedside clinic,
conferences
• Clinical
preceptorship,
mentoring and role
modeling
• Peer-review, self -
reflection
• Interpersonal
communication
o Communication
o Team
communication
o Confl ict
management
• Effective and
respectful
communication
between midwife and
woman
• Communication within
diverse cultural
communities
• Guidance and
counseling demonstration
• Practice reflec tive
learning
• Role play using various
teaching
methodologies
• Preparation of
lesson plan,
checklists, AV
aids
• Preparation
of case studies,
case/ simulation
scenarios
• Microteaching teaching
sessions/
micro -teaching
VI T-3
SL-2
Explain various
methods of
knowledge and
skills assessment
Develop
assessment tools
Participate in self -Assessment/ Evaluation
Methods
• Assessment of
knowledge :
Prepa ration of
o Essay
o Short answers
o MCQs
• Assessment of
skills
o Assignments
o Observation
checklist
o OSCE/OSPE
o Practical
examination • Discussion and
experiential learning
• Self-directed learning
• Simulation • Preparation of
knowledge
assessment test
• Setting up of
OSCE stations
and simulation
areas
• Prepare
checklists for
evaluation • Essay, short
answers and
MCQ
• OSCE
Unit Hours Learning
Outcomes Content Teaching Learning
Activities Assignments Methods of
Assessment
assessment/
appraisal o Viva voce
• Assessment of
attitude: Attitude
scales
COURSE MODULE II
PREPARING MIDWIVES FOR CARE DURING PREGNANCY, BIRTH AND PUERPERIUM
Theory (T): 80 hours
Practicum: Skills Lab (SL): 35 hours , Clinical (CL): 790 hours
The Course Module II is sub -divided into five Sections:
Section 1 – Theory (T): 6 hours and Skill Lab (SL) : 3 hours
Section 2 - Theory (T): 22 hours, Skill Lab (SL) : 12 hours and Clinical (CL) : 450 hours
Section 3 - Theory (T): 6 hours, Skill Lab (SL) : 2 hours and Clinical (CL) : 40 hours
Section 4 - Theory (T): 22 hours, Skill Lab (SL) : 16 hours and Clinical (CL) : 300 hours
Section 5 - Theory (T): 24 hours and Skill Lab (SL) : 2 hours
Course Aim
This course will equip the NPM educators to upscale their knowledge, clinical skill and competencies and lead by
example to prepare competent NPMs to deliver skilled, knowledgeable, compassionate and respectful midwifery care
across the continuum of childbir th.
Course Description
This module is designed to enable the NPM educators to review the principles of related biological and behavioral
sciences and midwifery to promote physiological birth and provide respectful quality care. The course comprises of
review of anatomy and physiology, pre pregnancy care, antenatal care, intrapartum care, postpartum care and care of
newborn and applied pharmacology including fundamentals of prescribing, legal & ethical issues, and infection
control. It also includes recognit ion and management of problems/complications during pregnancy, labour, and
postnatal period, and neonatal problems.
Course Objectives
1. Discuss the anatomy and physiology of the female reproductive system and conception.
2. Assess and provide pre pregnancy care including counseling.
3. Assess and provide care for women in the antenatal, intra -natal and postnatal period including conduction of
normal deliveries.
4. Assess and provide care for neonates.
5. Identify deviations from normalcy, stabilize and transport women an d neonates to the higher health centers .
6. Demonstrate sound knowledge of applied pharmacology and principles of prescribing.
7. Identify and use medicines appropriately in midwifery, obstetric emergencies and complex situations as per GoI
guidelines.
8. Demonstra te professional accountability for the delivery of midwifery care as per the Council standards that are
consistent with moral, altruistic, legal and ethical and regulatory and humanistic principles in midwifery practice.
9. Implement infection control practic es in maternal and newborn care facilities.
10. Collaborate with the health care team in providing midwifery care to women and their neonates.
11. Promote health of families and communities and provide family welfare services.
Competencies (ICM)
1. Adhere to jurisdic tional laws, regulatory requirements, code of conduct for midwifery practice. (1f)
2. Provide pre -pregnancy and antenatal care. (2a)
3. Determine health status of women. (2b)
4. Assess the fetal wellbeing. (2c)
5. Monitor the progression of pregnancy. (2d)
6. Promote and support health behaviors that improve their wellbeing. (2e)
7. Provide anticipatory guidance related to pregnancy, birth, breastfeeding, parenthood, and change in the family.
(2f)
8. Detect, manage, and refer women with complicated pregnancies. (2g)
9. Assist the woman and her family to plan for an appropriate place of birth. (2h)
10. Provide care to women with unintended or mistimed pregnancy. (2i)
11. Promote physiologic labour and birth. (3a)
12. Manage a safe spontaneous vaginal birth and prevent complications. (3b)
13. Provid e care of the newborn immediately after birth. (3c)
14. Provide postnatal care for the healthy woman. (4a)
15. Provide care to healthy newborn infant. (4b)
16. Promote and support breast feeding. (4c)
17. Detect and treat or refer postnatal complications in woman. (4d)
18. Detect and manage health problems in newborn infant. (4e)
19. Provide family planning services. (4f)
Section 1: Maternal, Fetal and Newborn Physiology
This section will review the students’ knowledge of anatomy and physiology of reproduction and fetal
developmen t in order to support the facilitation of normal physiological birth.
This section will include but not be limited to anatomy and physiology of reproductive system, conception,
menstruation and ovulatory cycle; anatomy of maternal pelvis and fetal skull. I t will provide an in -depth study of the
normal physiological changes that occur in pregnancy. It will review placental physiology and fetal growth and
development, fetal circulation. Content will be sequentially aligned with the normal pregnancy, providing the bio -
science to support midwifery knowledge and application of practice skills.
SECTION 1: CONTENT OUTLINE
Theory (T) : 6 hours and Skills Lab (SL) : 3 hours
Unit Hours Learning
Outcomes Content Teaching Learning
Activities Assignments Methods of
Assessm ent
I T-2
SL-2
Review the
reproductive
system
Understand the
female hormonal
cycle (ovarian and
uterine) Review of a natomy
and physiology of
human reproductive
system
• Female pelvis and
Fetal skull (with
feto-pelvic
relationships)
• Hormonal cycles • Self-directing
learning
• Discussion and
experiential learning
• Presentations/
seminars
• Demonstration -
female pelvis and
fetal skull
• Essay, short
answers and
MCQ
II T-2
SL-1 Understand the
process of
fertilization and
conception
Understand
placental
development and
function
Demonstrate
knowledge of fetal
growth & Embryology and fetal
growth and
development
• Fertilization and
conception
• Implantation
• Embryological
development
• Placental • Tutorial
• Group work
• Online lecture
• Self-directed
learning • Foetal circulation
- schematic
representation • Evaluation of
the assignment
Section 2 : Normal Pregnancy, Birth and Puerperium
This section will prepare the student to provide skilled, knowledgeable, compassionate and respectful midwifery
care across the continuum of childbirth in both community and institution.
It will include knowledge an d skills to promote physiological birth and provide respectful quality maternal and
newborn care. This will include but not limited to Antenatal care: assessment of pregnancy, comprehensive health
history, physical assessment, screening, managing existing disease/pathology, support for pregnancy discomforts,
assessment of fetal growth and wellbeing, health information and informed consent, antenatal education;
Intrapartum care: 1st, 2nd, 3rd and 4th stage of labour, which includes the assessment of progress of labour,
partograph, vaginal examination, observations and documentation, supporting women in labour and birth, promotion
of physiological birth, non -pharmacological and pharmacological pain relief, assessment of perineal trauma, perineal
suturing, obse rvation and bleeding assessment, timely referral; Postnatal care: maternal care, transition to parenthood
- mother, father and family, promoting attachment, skin -to-skin contact, establishing breastfeeding, managing
breastfeeding challenges, documentation, reporting etc. Compassionate, woman centred midwifery care during normal
pregnancy, labour, birth and postnatal period alongside evidence -based quality, holistic and continuity of midwifery
care utilizing cultural competence and sensitivity are highly emp hasized throughout.
SECTION 2: CONTENT OUTLINE
Theory (T) : 22 hours, Skills Lab (SL) : 12 hours and Clinical (CL) : 450 hours
Unit Hours Learning Outcomes Content Teaching Learning
Activities Assignments Methods of
Assessment
I T-2
Facilitate a
partnership3 with
women through
continuity of care Beginning the pregnancy
journey
Pre-pregnancy Care • Discussion and
experiential learning
• Demonstration • Pre- conception
counseling
• History taking
and assessment • Evaluation of
skills using
checklist
• Assessment of
3Note that in a partnership relationshi p between a midwife and a woman, both make equally essential (but different) contributions. The
woman defines who her family are and how they will be involved. Information is shared, decisions are negotiated, and the woma n makes
decisions that are right fo r her. The midwife upholds the woman’s decisions. See chapter on partnership in practice in Pairman et al
textbook. development in
early pregnancy
Understand the
role of the
placenta in fetal
wellbeing and
nutrition development
• Placental function;
blood brain barrier
• Fetal growth and
development
• Fetal circulation
• Fetal nutrition
III T-2 Recognize
physiological
changes in early
pregnancy across
the body systems
Understand the
interaction of
pregnancy
hormones Physiological changes
in early pregnancy
• Cardiovascular,
hematological,
endocrine, digestive,
respiratory, ute rine,
renal, immune
system
musculoskeletal,
integumentary
changes
• Hormones of
pregnancy
• Ongoing signs of
pregnancy • Tutorial
• Group work
• Online lecture
• Self-directed
learning • Formative quiz
(final course
exam)
• Educational
resource
development
Unit Hours Learning Outcomes Content Teaching Learning
Activities Assignments Methods of
Assessment
Explain the
significance of pre
pregnancy care
Recognize birth as a
normal life event for
women and their
families
Provide
preconception care
for eligible couples
Provide information
and develop skills to
enable shared
decision making in
midwifery practice
Understand and
advocate for planned
parenthood • Review of sexual
development (Self
Learning)
• Socio -cultural aspects of
human sexuality (Self
Learning)
• Evidence based screening
for health problems such
as diabetes, hypertension,
thyroid conditions, and
chronic infections that
impact pregnancy
• Pre-conception
counseling (including
awareness regarding
normal births)
• Genetic counseling (Self
Learning)
• Assess and confi rm
pregnancy
• Shared decision making
in midwifery practice
• Planned parenthood • Role play -
counselling
• Tutorial, group work
• Case study of health statu s
of women
• Assessment of
nutritional status
and screening of
women clinical
performance
with using
checklist
• Evidence based
essay
II T-3
SL-1
CL-40 Respond effectively
to women’s
individuality, and
lack of knowledge
about their social and
cultural contexts
Explain the
significance of
antenatal care for the
women and family
Demonstrate skills in
providing antenatal
care, health
education for
pregnant women and
continuity of care
• Promote equity
and access to care
during pregnancy
• Recognize birth as
a normal life event
for women and
their families
• Describe the need
for documentation
and record keeping
Pregnancy assessment and
midwifery care during 1st
trimester
Review of
• Normal pregnancy
• Maternal nutrition and
malnutrition
• Diagnosis of pregnancy -
signs and symptoms,
differential diagnosis,
confirmatory tests
• Definition, nature,
objectives and
importance of antenatal
care
o Building partnership
with women following
RMC protocol
• Antenatal assessment:
History t aking, physical
examination, breast
examination, obstetrical
and pelvic examination
(Leopold’s maneuvers),
laboratory investigation
• Identification and
management of minor
discomforts of pregnancy
• Antenatal care and
counseling (lifestyles in
pregnancy, nutr ition, • Discussion and
experiential learning
• Demonstrations
• Bed side clinics
• Case discussions
• Seminar
• Nursing rounds
• Supervised clinical
practice in antenatal
OPD and ward
• Self-directed learning
• Skilled Birth
Attendant module
• Online lecture
• Scenario -based
learning
• Health education
• Case
presentation
• Bed side clinic
• Clinical
Conference
• Antenatal history
taking and
assessment
• Draw a micro -
birth plan
• Laboratory
investigations:
perform and
interpret - UPT,
Hb estimation,
HIV/Syphilis
testing; urine
analysis for
albumin and
sugar
• Assessment of
fetal well -being
• Antenatal
counselling
• Essay, short
answers and
MCQ
• Assess clinical
skills using
procedure
checklists
• Assess clinical
performance
using rating
scale
• OSCE/ OSPE
Unit Hours Learning Outcomes Content Teaching Learning
Activities Assignments Methods of
Assessment
shared decision making,
risky behavior in
pregnancy, counseling
regarding sexual life
during pregnancy etc.)
• Screening for antenatal
anxiety
• Screening for family
violence
o Point of Care and One
Stop Service during
ANC
• Danger signs during
pregnancy
• Birth preparedness and
complication readiness
(including promoting
“Normalcy during
pregnancy”)
• Childbirth preparation
• Respectful care and
compassionate
communication
• Recording and reporting
o Clinical procedures as
per the GoI guidelines
• Various models of ANC
and their evolution
• GoI current model of
ANC provision
• Role of Doula/
ASHA’s
III T-1
SL-1
CL-40 Demonstrate
knowledge of
midwifery practice
throughout the 2nd
trimester
Maintain woman
centered
relationship -based
care
Assess fetal growth
and development
Discuss management
for existing disease
or patholog y
Facilitate ethical
midwifery practice
promoting maternal Midwifery care during 2nd
trimester of pregnancy
• Education and
management of
physiological changes
and discomforts of 2nd
trimester
• Rh negative and
prophylactic anti D
• Second trimester tests
and health education
o Interpreting screening
results
o Health education on
IFA, calcium and
vitamin D
supplementation,
glucose tolerance test,
immunization etc.
• Informed decision
making • Tutorial
• Group work
• Online lecture
• Scenario based
learning
• Case study
• Simulation workshop • Quiz, (end of
course exam)
• Competency
based
assessment
• OSCE
Unit Hours Learning Outcomes Content Teaching Learning
Activities Assignments Methods of
Assessment
autonomy and choice • Antenatal assessment:
abdominal palpation, fetal
assessme nt, auscultate
fetal heart rate - Doppler
and Pinnards
• Assessment of fetal well -
being: fetal pattern,
DFMC, biophysical
profile, non -stress test,
cardiotocography, USG,
vibro -acoustic stimulation
• 2nd trimester antenatal
care
o Women centered care
o Respectful care and
compassionate
communication
o Referral and
collaboration,
empowerment
o Ongoing risk
assessment
o Maternal Mental
Health
o Role of Doula/
ASHA’s
IV T-1
SL-1
CL-40 Demonstrate
knowledge of
midwifery practice
throughout the 3rd
trimester
Maintain woman
centered
relationship -based
care to develop birth
plan
Provide antenatal
care related to
preparation for birth
and breastfeeding
education to build
each woman’s
confidence
Midwifery care during 3rd
trimester of pregnancy
• Physiological
discomforts during 3rd
trimester
• Third trimester tests and
screening
• Fetal engagement in late
pregnancy
• 3rd trimester antenat al
education classes
• Birth preparedness and
complication readiness
• Health education on
exclusive breastfeeding
• Danger signs of
pregnancy - recognition
of ruptured membranes
• Ongoing risk assessment
• Cultural needs
• Women centered care
• Respectful and
compassio nate
communication
• Alternative birthing • Tutorial
• Group work
• Online lecture
• Scenario based
learning
• Case study
• Simulation workshop
• Demonstration of
birthing position • Quiz, (end of
course exam)
• Com petency
based
assessment
Unit Hours Learning Outcomes Content Teaching Learning
Activities Assignments Methods of
Assessment
positions - women’s
preferred choices
• Role of Doula/ ASHA’s
V T-4
SL-3
CL-70 Apply the physiology
of labour
Describe how a
midwife builds a
woman’s confidence
and provides
respectful care for
the women during
labour
Encourage the role of
birth companion
during labour
Discuss the effect of
the midwife’s (and
other team members)
language on the
woman’s emotional
well-being
Discuss how to
maintain an
environment for
labour in which the
woman feels safe
Work effectively
with pain during
labour Midwifery care during 1st
stage of labour
Revi ew of
• Normal labour and birth
• Onset of birth/labour
• Per vaginal examination
(if necessary)
• Stages of labour
• Organization of labor
room - Triage,
preparation for birth
• Positive birth
environment
• Respectful care and
communication
1st Stage
• Physiology of norm al
labour
• Monitoring progress of
labour
• Using Partograph
• Pain relief in labour
(non-pharmacological
and pharmacological)
• Assessing and
monitoring fetal well
being
• Psychological support -
managing fear
• Activity and positioning
for labour
• Nutrition during la bour
• Care during 1st stage of
normal labour
o Positive childbirth
experience for women
o Birth companion for
labour
o Safe environment
for mother and
newborn to promote
bonding
o Role of Doula/
ASHA’s
o Evidence based
theories (e.g.,
becoming a mother) • Discussion and
experiential learning
• Bed side clinics
• Case discussions
• Seminar
• Simulation
• Video
• Demonstrations
• Supervised clinical
practice in labour
ward
• SBA, IMNCI,
NSSK modules
• LaQshya
guidelines • Bed side clinic
• Healt h education
• Case
presentation
• Clinical
Conference
• Case study
• Plotting and
interpretation of
partograph
• Supervised
clinical practice • Essay, short
answers and
MCQ
• OSCE/ OSPE
• Assessment of
skills using
procedure
checklist
• Assess clinical
performance
with rati ng
scale
Unit Hours Learning Outcomes Content Teaching Learning
Activities Assignments Methods of
Assessment
and practice in relation
to labour interventions
VI T-2
SL-3
CL-40 Apply knowledge of
the physiology of
birth to midwifery
care
Discuss how the
midwife provides
care and support for
the women during
birth to enhance
physiology and
promote normal birth
Midwifery care during 2nd
stage of labour
Self-directed learning
• Physiology (mechanism
of labour)
• Signs of imminent labour
• Intrapartum monitoring
• Birth position of choice
• Warm compresses
• Vaginal examination (if
necessary)
• Management -
preparation and
supporting birth
• Psychological support
• Non-directive coaching
• Role of Doula/ ASHA’s
VII T-2
SL-2
CL-70 Assessment and care
of the newborn
immediately
following birth Care during 3rd stage of
labour
• Physiology - placental
separation and expulsion,
homeostasis
• Physiological
management of third
stage of labour
• Active management of
third stage of labour
• Examination of placenta,
membranes and vessels
• Assess perineal, vaginal
tear/injuries and suture if
required
• Immediate perineal care
• Assessment and care of
the newborn immediately
following birth
• Essent ial newborn care
(ENBC)
• Initiation of breast
feeding
• Skin to skin contact
• Vitamin K prophylaxis
• Newborn resuscitation • Tutorial
• Group work
• Online lecture
• Scenario based
learning • Case study
• Simulation • Quiz (end of
course exam)
VIII T-2
SL-1 Discuss the impact of
labour and birth as a
transitional event in Care during 4th stage of
labour
Observation, Critical • Tutorial
• Group work • Quiz (end of
course exam)
• Competency
Unit Hours Learning Outcomes Content Teaching Learning
Activities Assignments Methods of
Assessment
CL-70 the woman’s life
Ensure initiation of
breast feeding and
adequate latching
Analysis and Management
of mother and newborn
• Maternal assessment,
observation of fundal
height, urine output,
blood loss
• Documentation and
Record of birth
• Breastfeeding and
latching
• Managing uterine cramp
• Alternative/
complementary therapies
• Role of Doula/ ASHA’s
• Various childbirth
practices
• Safe environment for
mother and newborn to
promote bonding • Online lecture
• Scenario based
learning
• Case study
• Simulation
Workshop based
assessment
IX T-5
CL-80 Demonstrate
integration of the
role of midwife in
the care of woma n
Explore the maternal
physiological
changes following
birth
Understand the
physiology of
lactation and
composition of breast
milk
Demonstrate skill in
caring for postnatal
women
Understand
homeostasis and
nutritional
requirements of the
newborn Postpa rtum care/ Ongoing
care of women
Review of
• Normal postpartum
period
• Physiology of
puerperium
• Post-natal assessment
and care - facility and
home -based care
• Perineal hygiene and care
• Bladder and bowel
function
• Minor disorders of
puerperium and its
management
• Physiology of lactation
and lactation
management
• Postnatal counseling and
psychological support
• Normal postnatal baby
blues and recognition of
postnatal depression
• Transition to parenthood
• Care for the mother from
72 hours to 6 weeks after
the delivery
o Cultural competence
(Taboos related to
postnatal diet and • Discussion and
experiential learning
• Demonstration
• Simulations
• Bedside rounds/
clinics
• Case discussion
• Role play
• Safe Delivery App
video on feeding • Seminar
• Case studies
• Clinical
presentation
• Counseling
mothers for
breast feeding -
techniques and
position
• Health talk
• Postnatal
assessment
• Supervised
clinical practice
in postnatal ward
and OPD • Essay, short
answers and
MCQ
• Assessment
of skills with
procedure
check list
• OSCE/ OSPE
Unit Hours Learning Outcomes Content Teaching Learning
Activities Assignments Methods of
Assessment
practices)
o Evidence based
practice in relation to
postnatal and newborn
care
• Knowledge on
postpartum family
planning methods
• Follow -up
Section 3: Care of the Newborn
This section will prepare the student to provide skilled, knowledgeable, respectful and compassionate midwifery
care to the newborn in both community and institution.
It will address the knowledge and skills required to provide quality care for the newborn and promote a healthy
transition to life. This will include but not limited to: supporting the transition to extra uterine life; immediate care of
the newborn, Apgar score, newborn assessment, essential newborn care; complete physical examination; newborn
health needs; nutritional needs of the newborn, skin to skin contact; breastfeeding; maternal newborn bonding; gro wth
and development of the infant; prophylactic measures; involve partner/support person; screening and immunization;
provide evidence based information to parents; consideration of cultural norms; respectful care. It further equips the
students to disting uish variations in normal development of the newborn and refer to the inter professional team.
SECTION 3: CONTENT OUTLINE
Theory (T): 6 hours, Skills Lab (SL) : 2 hours and Clinical (CL) : 40 hours
Unit Hours Learning Outcomes Content Teaching Learning
Activities Assignments Methods of
Assessment
I T-1
Discuss the need for
compassionate, family
centered midwifery care
of the newborn and how
this is provided
Discuss how the woman
and family’s views and
beliefs are respected
Understand that actions
and inter ventions carried
out on baby need to be
fully explained and
informed consent
obtained Family centered care
• Concept of family
centered care
• Partnership and cultural
competency
• Respectful care and
communication
• Informed consent and
shared decision making • Tutorials and group
work
• Scenarios • Formative
assessment,
competency
based
II T-1
CL-10 Discuss preparation for
newborn at birth
Explain the midwife’s
role in observing and
assessing the newborn
immediately after birth
Explore the
physiological adaptions
that the newborn
undergoes following
birth
Assessment and ongoing
care of normal neonates
Review of
• Normal neonate -
physiological adaptation
• Newborn assessment
and care
• Screening for congenital
anomalies
• Care of newborn from
72 hours to 6 weeks
after the delivery
(routine care of
newborn) • Discussion and
experiential learning
• Demonstrations
• Self-directed learning
• Seminar
• Case discussion
• Safe Delivery App
module on newborn
management and risk
management
• Supervised clinical
practice in postnatal
ward/NICU/ Nursery • Case
presentation/
Case discussion
• Health talk
• Newborn
assessment • Essay, short
answers a nd
MCQ
• OSCE/OSPE
Unit Hours Learning Outcomes Content Teaching Learning
Activities Assignments Methods of
Assessment
Demonstrate skills in
caring for normal
newborns in the
presence of mother • Skin to skin contact
• Thermoregulation
• Infection prevention
(asepsis and hand
washing)
III T-2
CL-15 Identify the newborn at
risk and give relevant
immediate care
Understand the process
to refer unwell
newborns
Educate the mother and
family on prevention,
recognition, and
management of common
newborn problems Risk identific ation and
referral
• Risk Identification and
referrals
• Minor disorders of
newborn and their
management
• Newborn screening
• Signs of distress and
risk assessment
• Identification of
complications,
management and
referral as per IMNCI
protocol
• Documentation and
record
• Health education to the
mother and family
about the management
of common newborn
problems • Tutorials and group
work
• Scenarios
• Simulation
• Workshops
• Online lecture
• Case study
IV T-1
SL-2
CL-10 Discuss the benefits of
breastfeeding for the
baby and mo ther
Understand the
composition of breast
milk
Discuss the
recommendation of
exclusive breastfeeding
for six months
Explain how to help a
mother succeed with the
first breastfeeding and
recognize if the baby is
breastfeeding well
Explain and demonstrat e
how to express breast
milk and storage
Understand the BFHI Nutritional needs of the
newborn and establishing
breastfeeding
• Breastfeeding
• Breast milk
composition
• Benefits of
breastfeeding for the
newborn and mother
• Lactation management:
Breast feeding
techniques and
positions, rest and
nutrition for mother
during breastfeeding
• Exclusive breastfeeding
• Expression and storage
of breast milk
• Signs of hunger
• Supportive environment
for breastfeeding
• Baby Friendly Hospital
Initiative (BFHI)
guidelines
• Health edu cation to • Tutorials and group
work
• Scenarios
• Simulation
• Workshops
• Online lecture
• Formative
quiz
• Competency
based OSCE
• Summative
exam
Unit Hours Learning Outcomes Content Teaching Learning
Activities Assignments Methods of
Assessment
mother and family on
breastfeeding
V T-1
CL-5 Understand the
midwife’s role in
immunization
Demonstrate skill in
immuni zation of the
newborn
Disease prevention and
immunization
• Immunization
• Importance of
immunization
• Health education to
family on current
immunization schedule • Tutorials and group
work
• Scenarios
• Simulation
• Workshops
• Online lecture
• Self-directed
learning • Formative
quiz
• Summative
exam
SECTION 4: COMPLEX CARE OF THE WOMEN AND NEWBORN, HEALTHY FAMILIES AND
COMMUNITIES
This section will develop students’ knowledge and skills in providing woman and family -centred, evidence -based
midwifery care for women with co mplex needs across pregnancy, labour and birth and the puerperium, management
of the compromised newborn. It further will provide student with a sound understanding of the midwifery role in
primary health and optimising positive outcomes for the woman and her family .
This will include but not limited to: assessment of risk; triaging, midwifery management and care of medical and
obstetric complications and emergencies, provision of midwifery care in the event of poor maternal and/or neonatal
outcomes or demi se; law and ethics in relation to complex care; effective communication, collaboration, team work
and referral; application and use of technology during complications of pregnancy, childbirth and the postpartum
period, m alpositions and abnormal presentatio ns, cephalo -pelvic disproportion (CPD), preterm labour, disorders of
uterine action; complications of third stage: obstetric emergencies, obstetric procedures induction of labour, basic
life-saving skills - adult CPR; r ecognition and management of postnata l problems; identification of deviation from
normal, puerperal pyrexia, puerperal sepsis, urinary complications, secondary postpartum haemorrhage, vulval
haematoma, breast engorgement including mastitis/breast abscess, thrombophlebitis, DVT, uterine subinv olution,
Vesico Vaginal Fistula (VVF), recto vaginal fistula (RVF), decision making about management and referral.
Content on complex care of newborn will include but not limited to: Newborn mortality and major causes in
India, care planning and midwifery management of the neonate with complex needs, use of technology; incorporation
of family -focused care in the management of the compromised neonate; care in stillbirth and neonatal death, Models
of newborn care in India - NBCC, SNCUs, NICU. Management of co nditions include: p rematurity, birth asphyxia,
newborn sepsis, hypothermia, respiratory distress, hypoxia and asphyxia, jaundice, neonatal infections, high fever,
convulsion neonatorum tetanus, low birth weight, congenital anomalies, haemorrahagic diseases , birth injuries, home
based newborn care program - community facility integration in newborn care, calculation of fluid requirements,
EBM/formula feeds/tube feeding, care of bereaved families, shared decision making about management and referral,
Integrat ed Management of Neonatal Childhood Illnesses (IMNCI).
This section will also include: health promotion; disease prevention; family planning and family planning
counselling using Balanced Counselling Strategy (BCS), cultural norms and cultural competence; community
knowledge and understanding; men’s engagement in maternity care; reproductive health and rights; adolescent
pregnancy; unintended pregnancy; post -abortion care; ICM Bill of rights for women and midwives. Care includes:
impact of early/frequent ch ildbearing, MTP Act, methods of MTP, post abortion family planning methods,
collaboration with other health workers, social welfare schemes of GoI .
SECTION 4: CONTENT OUTLINE
Theory (T): 22 hours, Skills Lab (SL): 16 hours and Clinical (CL): 300 hours
Unit Hours Learning
Outcomes Content Teaching Learning
Activities Assignments Methods of
Assessment
I T-6
SL-2
CL-70 Identify, provide
initial
management and
refer women with
problems during
pregnancy within Recognition and Management
of problems during Pregnancy
Review of
• High -risk pregnancy • Discussion and
experiential learning
• Bedside clinics
• Demonstration • Write on health
assessment,
screening and
management of
high-risk • Essay, short
answers and
MCQ
• OSCE
• Evaluation of
Unit Hours Learning
Outcomes Content Teaching Learning
Activities Assignments Methods of
Assessment
the scope of
midwifery
practice
Support women
with complicated
pregnancy and
facilitate safe and
positive birthing
outcome
• Triaging and risk stratification
• Performing and interpreting
fetal surveillance (CTG/NST)
• Review of complications
during pregnancy (definition,
causes, signs and symptoms,
diagnosis, management and
complications)
o Bleeding in early
pregnancy:
✓ Abortion
✓ Ectopic pregnancy
✓ Hydatidiform mole
o Bleeding in late pregnancy:
✓ Antepartum haemorrhage
- placenta previa,
abruption placenta
o Hyperemesis gravidarum
o Pregnancy induced
hypertension
✓ Pre-eclampsia
✓ Eclam psia
o Multiple pregnancy
o Oligohydramnios
o Polyhydramnios
o Medical conditions in
pregnancy
✓ Anemia in pregnancy
✓ Gestational diabetes
mellitus
✓ Cardiac disease
✓ Pulmonary disease
✓ Thyrotoxicosis
✓ Sexually transmitted
diseases
✓ HIV/AIDS
✓ Rh incompatibility
o Infections in pregnancy -
urinary tract infection,
bacterial, viral, protozoal,
fungal
o Intrauterine growth
restriction
o Intrauterine fetal death
o Gynecological disorders
complicating pregnancy
o Adolescent pregnancy • Case presentation
and discussion
• Simulation
• Safe Delivery App
modules on post
abortion care and
hypertension
• Supervised clinical
practice in antenatal
ward/ OPD/ Obstetric
IUC mothers
• Health education
plan
• Case study plan
and report case
study/case
presentation
Unit Hours Learning
Outcomes Content Teaching Learning
Activities Assignments Methods of
Assessment
o Elderly primi gravida and
grand multipara
• Management of conditions as
per the protocol
• Decision making for
management and referral
• Policy for the referral services
• Role of NPM in management
of the problems durin g
pregnancy
II T-6
SL-4
CL-70 Identify, provide
initial
management an d
refer women with
problems during
labour within the
scope of
midwifery
practice
Facilitate
communication
link between the
midwife, women
and families
Collaborate with
the obstetricians
in the
management of
obstetric
emergencies and
complications
Recog nition of deviations from
the normal and management
during labour
Review of
• Preterm labour: Prevention
and management of preterm
labour ( use of antenatal
corticosteroids in preterm
labour)
• Premature rupture of
membranes
• Malposition’s and abnormal
presentat ions (breech, brow,
face)
• Cephalo Pelvic Disproportion
(CPD)
• Disorders of uterine action
o Prolonged labour
o Precipitate labour
o Dysfunctional labour
• Complications of 3rd stage:
o Retained placenta
o Injuries to birth canal
o Postpartum hemorrhage
(bimanual compress ion of
the uterus, aortic
compression, uterine
balloon tamponade)
• Obstetric emergencies
o Ruptured uterus
o Obstetrical shock
o Amniotic fluid embolism
o Foetal distress
o Cord prolapses
o Shoulder dystocia
o Uterine inversion
o Vasa previa
• Episiotomy and suturing with
informed consent (types, • Discussion and
experiential learning
• Bed side clinics
• Demonstratio n
• Self-directed learning
• Seminar
• Case discussion • Case
Presentation plan
and report
• Simulations
• Safe Delivery
App modules on
PPH, Manual
removal of
Placenta and
prolonged labour
• Supervised
clinical practice
in labour room/
obstetric
casualty/
Obstetric IUC,
operation theatre
• Scenario based
learning • Essay, short
answers and
MCQ
• Assessment of
skills using
procedure
check list
• OSCE/ OSPE
• Assessment of
case study
Unit Hours Learning
Outcomes Content Teaching Learning
Activities Assignments Methods of
Assessment
indication etc.)
• Obstetric procedures
o Forceps delivery
o Vacuum delivery
• Manual removal of the
placenta
• Induction of labour
• Caesarean section: indications
& preparation
III T-4
SL-4
CL-70 Identify, provide
initial
management and
refer women with
postnatal
problems wi thin
the scope of
midwifery
practice.
Develop rapport
with the women
and families for
continuity of care
Recognition and Management
of postnatal problems
Review of
• Physical examination,
identification of deviation
from normal
• Review of puerperal
compl ications and its
management
o Puerperal pyrexia
o Puerperal sepsis
o Urinary complications
o Secondary Postpartum
hemorrhage
o Vulval hematoma
o Breast engorgement
including mastitis/ breast
abscess, feeding problem
o Thrombophlebitis
o DVT
o Uterine subinvolution
o Vesico va ginal fistula
(VVF)
o Recto vaginal fistula (RVF)
o Postpartum blues/ psychosis
• Decision making about
management and referral
• Clinical procedures as per the
guidelines
• Discussion and
experiential learning
• Bedside clinics • Preparation of
health talk
• Clinical
presentation -
plan & report
• Self-directed
learning
• Seminar
• Case discussion
• Supervised
clinical practice
in postnatal
ward/ postnatal
OPD/ obstetric
casualty/
operation theatre
• Safe Delivery
App module on
Sepsis
• Discussion on
variety of case
studies/
simulat ion
scenarios to
practice decision
making • Essay, short
answers and
MCQ
• Assessment of
skills with
procedure
check list
IV T-4
SL-3
CL-50
Identify, manage
and refer high -
risk newborn
Recognition and Management
of neonatal problems
• Newborn mortality and major
causes in India
• Models of newborn care in
India - NBCC; SNCUs
• Screening of high -risk
newborn • Discussion and
experiential learning
• Demonstration
• Self-directed learning
• Seminar
▪ Case discussion
▪ Safe Delivery App
video on newborn • Newborn
assessment
report • Essay, short
answers and
MCQ
• Assessment of
skills with
procedure
check list
• Asse ssment of
clinical
Unit Hours Learning
Outcomes Content Teaching Learning
Activities Assignments Methods of
Assessment
Encourage
mother -infant
bonding
Counse l women
and families with
situations
requiring grief
counseling
• Review of conditions a ffecting
newborns and their
consequences
• Prematurity
• Low birth weight
o Kangaroo Mother Care
• Birth asphyxia/Hypoxic
encephalopathy
• Newborn sepsis
• Hypothermia
• Respiratory distress
• Jaundice
• Neonatal infections
• High fever
• Convulsions
• Neonatorum tetanus
• Congenit al anomalies
• Hemorrhagic diseases
• Birth injuries
• SIDS (sudden infant death
syndrome) prevention,
Compassionate care
• Calculation of fluid
requirements, EBM/ formula
feeds/tube feeding
• Home based newborn care
program - community facility
integration in newbo rn care
• Decision making about
management and referral
• Integrated Management of
Neonatal Childhood Illnesses
(IMNCI)
• Bereavement counseling resuscitation,
newborn
management and low
birth weight module
▪ Supervised clinical
practice in NICU/PN
ward/well baby clinic
▪ Role play performance
with rating
scale
▪ OSCE/ OSPE
V T-2
SL-3
CL-40
Explain various
family welfare
services available Healthy families and
communities
• Health promotion & disease
prevention
• Social and cultural norms and • Discussion and
experiential learning
• Demonstration
• Role plays • FP counseling
report
preparation
• Demonstration • Essay, short
answers and
MCQ
• OSCE
Unit Hours Learning
Outcomes Content Teaching Learning
Activities Assignments Methods of
Assessment
to couples and
families
Counsel couples
and provide
family welfare
services
Support the
women with
abortion and
provide post
abortion care competence
• Father’s engagement in
maternity care
• Family Welfare Services
o Planned Parenthood
o Impact of early/ frequent
childbearing
o Comprehensive range of
family planning methods
✓ Action, effectiveness,
advantages,
disadvantages, myths,
misconception and
medical eligibility criteria
(MEC) for use of various
family planning methods
o Emergency contraceptives
o Family planning co unseling
using Balanced Counseling
Strategy (BCS)
o Importance of follow up
and recommended timing
o Unintended or mistimed
pregnancy
o Post abortion counseling
o Collaboration with other
health workers (especially
ASHAs and ANMs)
o Role of NPM in family
planning pr ogram/ family
welfare services • Self-directed learning
• Seminar
• Supervised clinical
practice in PN
ward/PN OPD/FP
ward/
PHC/CHC/HSC • Role plays
• Self-directed
learning
• Seminar
• Supervised
clinical practice
in PN ward/PN
OPD/FP ward/
PHC/CHC/ HSC
• Counselling on
Family planning
management to
the couple
SECTION 5: PHARMACOLOGY, INFECTION CONTROL & LEGAL AND ETHICAL ISSUES
This section will deepen students’ knowledge and understanding of pharmacology to ensure safe practice for the
woman, fetus and newborn.
The content will include but not be limited to: pharmacokinetics; pharmacodynamics; quality use of medicines,
medication therapy in emergency and complex care; drug classification and legislation as well as environmental
hazards and teratogens. Complementary therapies and supplementation. The legal, regulatory and ethical frameworks
and requirements of midwifery practice, i ncluding code of ethic and professional conduct, jurisdictional laws (incl.
legislation regarding abortion), local policy and guidelines, respectful behaviour, human rights, humanizing birth,
autonomy and shared decision making, confidentiality and privacy . It will also support students to develop skills on
infection prevention and control measures in maternal and newborn care facilities.
SECTION 5: CONTENT OUTLINE
Theory (T): 24 hours and Skills Lab (SL): 2 hours
Unit Hours Learning
Outcomes Content Teachi ng Learning
Activities Assignments Methods of
Assessment
I T-20
Describe the
pharmacology
of drugs to be
used in
obstetrics for
mothers and
neonates
Identify
challenges and
promote
collaboration
Identify
teratogenicity
and its
prevention
Prescribe
permitted
drugs for
women as per
the protocols
Applied pharmacology and
fundamentals of prescribing
• Drugs used in obstetrics for
mothers and neonates
• Classification
• Mechanism of action
• Dosage
• Uses
• Side effects
• Role of NPMs - Advice to
women and family (including
special precautions while
taking medicines)
• Teratogenic effect of drugs
• Classification of drugs as
pregnancy risk category
• Documentation: accurate and
complete records
• Fundamentals of prescribing
o Principles of prescribing
and factors influencing it
o Process and steps of
prescribing
o Prescribing competencies
• Prescriptive role of Nurse
Practitioners (National &
International)
• Professional, legal and ethical
issues relevant to prescribing
practice
• Implications of wrong
practices related to prescribing
(using case studies)
• Prescription of medicines as
per protocols (national
guidelines & regulations - the
Council/MoHFW)
• List of drugs that can be
administered by nurse
practitioner as approved by
GoI ▪ Lecture
• Discussion and
experiential
learning
• Self-directed
learning
• Review of
literature - laws
and regulations,
trends of nurse
prescribing
practice
• Integrated Clinical
practice in
maternal -neonatal
areas
• Writing
prescription • Drug dosage
calculation
• Drug study/
presentation
• Writing
prescription
• Case study
analysis and
discussion • MCQs
• Short
answers and
essay
• Case study
analysis
• Drug
presentation
& Case
reports
Unit Hours Learning
Outcomes Content Teachi ng Learning
Activities Assignments Methods of
Assessment
II
T-2
SL-2
Explain the
infection
control policies
Demonstrate
skills in
infection
control
practices
Explore and
reflect on the
role o f NPM
and health
team in
infection
prevention Infection Control
• National guidelines and
institutional policy
• Principles of prevention of
infection
• Standard precautions for
prevention of infections
o Hand washing
o Use of protective attire
o Processing of used
items/equipment
o Proper handling and
disposal of sharps
o Maintaining a clean
environment
o Biomedical waste disposal
• National infection control
guidelines
• Role of NPM and health team
in infection prevention/
control • Discussion and
experiential
learning
• Games
• Dem onstration
using IP materials
• Skill
demonstrations -
infection practices
to reach expert
level in IP
• Videos
• Clinical practice
• Self-directed
learning
• Safe Delivery App
module on IP • Review notes
on national
guidelines
• Draw from
clinical
experience
and write
infection
control
related
practice
standards • OSCE/
OSPE
III T-2 Explain the
code of ethics
and legal
implications of
various aspects
of midwifery
practice
Identify key
legislation
governing the
practice of
midwives
Reflect on the
nature of ethics
and diverse
moral and
ethical
outlooks of
people Legal and ethical issues
• National legal framework for
Medical Practice including
National Health Policy 2017
• IMNC Act
• The Council/ICM Code of
ethics and its implications
• Practice standards for
midwifery and its rationale
o Policies and procedures
o Establishing standing orders
and protocols
o Informed consent
• Legal framework for
midwifery practice and its
implications
• Ethical issues in maternal and
neonatal care
• Adoption laws, MTP Act, Pre -
Natal Diagnostic Test (PNDT)
Act, Surrogate mothers
• Scope and specifics of
national MNH Guidelines of
the MoHFW • Discussion and
experiential
learning
• Scenarios • Presentation
- ethical and
legal issues
in midwifery • Essay, short
answers and
MCQ
Unit Hours Learning
Outcomes Content Teachi ng Learning
Activities Assignments Methods of
Assessment
COURSE MODULE III
PREPARING MIDWIVES TO L EAD, MANAGE AND SUPERVISE QUALITY MIDWIFERY CARE
Theory (T): 15 hours; Clinical (CL) : 20 hours
Course Aim
The NPM educator will demonstrate skills of leadership, supervision and management for provision of quality
midwifery education and practice.
Course D escription
This module is designed to enable the NPM educators to develop an understanding of the principles of leadership,
supervision and management. It also focuses on management of MLCUs, quality assurance of MNH services and
continued professional dev elopment.
Course Objectives
1. Describe the importance of leadership, supervision, management and advocacy for midwifery.
2. Demonstrate current midwifery knowledge and skills and recognize the role of continuing professional
development.
Competencies (WHO educa tor competencies)
1. Provide facility -based mentoring for the NPM’s after placement. (6.3)
2. Demonstrate effective communication using variety of methods in diverse care delivery settings. (7.1)
3. Demonstrate cultural competence in course design and development a nd teaching and midwifery practice. (7.2)
4. Function as leaders and change agents to improve midwifery education and practice. (7.3)
5. Use a variety of advocacy strategies to promote midwifery education and practice. (7.4)
6. Participate in professional developme nt activities relevant to midwifery education. (7.5)
CONTENT OUTLINE
Theory (T): 15 hours and Clinical (CL): 20 hours
Unit Hours Learning
Outcomes Content Teaching Learning
Activities Assignments Methods of
Assessment
I T-4
CL-5 Demonstrate an
understandi ng of
contemporary
leadership
Identify elements
underpinning
effective team
building and
negotiation skills
Identify strategies to
respond to
community needs Midwifery leadership
• Leadership and styles
(transformational leadership)
• Personality styles
• Myer B riggs personality style
• Team building, Negotiation
• Conflict resolution
• Respectful communication
• Emergency response,
community development • Tutorial, group work
• Scenario -based
learning
• Online resources
• Personality quiz • Summative
continuous
assessment -
comm unity
development
plan
II T-4
CL-5 Identify key theories
of change
Describe
transformative
midwifery practice Change theories and
transformative practice
• Change theories
• Agents of change
• Transformative care
• Innovation • Tutorial, group work
• Scenario -based
learning
• Online resources • Summative
report on
leadership styles
Unit Hours Learning
Outcomes Content Teaching Learning
Activities Assignments Methods of
Assessment
III T-4
CL-5 Describe role of
NPM in
management and
supervision of
maternal and
neonatal care in
various health care
settings including
MLCUs
Utilize advocacy
skills and cultural
competence for
promoting
midwifery education
and MLCC Management including
management of MLCU’s
• Management
o Definition, principles and
elements
o Management of (time,
material and personnel)
MLCU
o Team management
o Material management -
equip ment and supplies
• Supervision
o Definition, objectives and
types of supervision
o Mentoring - facility based
mentoring for NPMs
• Quality Assurance
o Nursing and midwifery
audit
o Quality assurance of MNH
services
• Quality assurance of
midwifery training
• Advocacy
o Definition, principles,
type/level of advocacy,
advocacy skills for
midwives • Discussion and
experiential learning
• Scenarios
• Case studies
• Role play
• Observation
• Exercises/
case studies
• Essay, short
answers and
MCQ
IV T-3
CL-5 Describe and utilize
the diff erent types
of records and
reports in midwifery
care and their
importance
Perform clinical
audits based on the
role of nurse
midwives
Records and Reports
• Importance of records
keeping
• Various records and reporting
formats to be maintained in
MLCU
• Record storage systems
• Retrieval of records
• E-records
• Role of nurse midwives in
clinical audits - MPDSR;
Newborn death audit;
Caesarean audits; maternal
and newborn service audits
• Practical utility of regular
records and reporting
• MoHFW Clinical Case
Sheets for M NH including
safe childbirth checklist
• Role of NPM in reviewing
and reporting the data in
terms of indicators and • Discussion and
experiential learning
• Seminar
• Orientation on
various records and
reporting form ats in
MNH area
• Supervised clinical
practice in
PHC/CHC/
HSC/DH/ MCH • List of
records and
reports in
MLCU • Essay, short
answers and
MCQ
Unit Hours Learning
Outcomes Content Teaching Learning
Activities Assignments Methods of
Assessment
discussion how that impacts
care being provided
COURSE MODULE IV
PREPARING MIDWIVES FOR EVIDENCE -BASED MIDWIFERY PRACTICES
Theory (T): 15 hours, Clinical (CL) : 20 hours
Course Aim
The NPM educator will identify and utilize evidence in the practice of midwifery.
Course Description
This module is designed to enable the NPM educators to develop an understanding of research process and
utilization of evidence in daily midwif ery practice.
Course Objectives
1. Develop effective learning and teaching practice and resources based on evidence.
2. Utilize the assessment and evaluation data to critically analyze and enhance midwifery practice.
3. Demonstrate an understanding of quality indic ators in education and as they relate to midwifery practice.
Competencies (WHO educator competencies )
1. Use research and inform teaching and practice (8.1)
2. Cultivate a culture supporting critical inquiry and evidence -based practice. (8.2)
3. Train NPM’s to deve lop skills to conduct, communicate and utilize research. (8.3)
CONTENT OUTLINE
Theory (T): 15 hours and Clinical (CL): 20 hours
Unit Hours Learning
Outcomes Content Teaching Learning
Activities Assignments Methods of
Assessment
I T-15
CL-20
Describe t he
research process,
quantitative and
qualitative methods
Discuss the value of
evidence in the
context of best
practices in
maternity care
Demonstrate
application of
academic integrity
principles and
correct use of Knowledge and utilization of
research and evidence
Qualitative & Quantitative
Research
• Overview of qualitative and
quantitative research paradigms
• Research questions in
quantitative and qualitative
research
• Research approaches and design s
• Methodology
o Sampling
o Data collection - tools and
techniques
• Analysis and interpretation of
data
• Communication, dissemination
and utilization of research -
academic integrity, correct
referencing
• Research critique • Discussion and
experiential
learning
• Portfolio, reflection
activities and
planned modules
• A research study
based on area of
work (e.g., WHO
Intrapartum
recommendations
or LAQSHYA
indicators)
• EBMP - Journal
club (discussion of
evidence on
midwifery
practices)
• Literature
search on
MNH care
• Research
report • Essay/short
answers and
MCQ
• Assessment
of
assignments
• Assessment
of completed
research
study -
presentation
and report
Unit Hours Learning
Outcomes Content Teaching Learning
Activities Assignments Methods of
Assessment
referencing
Identify and utilize
evidence through
review of literature
and valid
recommendations
for midwifery
practice
Identify and select
relevant literature
Analyze and
synthesise research
literature
Demonstrate
understanding of
different levels of
evidence
Describe the use of
evidence in practice • Literature search strategies -
selection of relevant literature
• Critical appraisal, analysis and
synthesis
• Writing literature review
• Statistics
• Sources and presentation of data
• Statistical packages and its
application
• Preparing research proposal
Evidence based midwifery
practice (EBMP)
• Recommende d sources of
data/evidence -
Facility/District/State - available
registers, HMIS, DLHS, Indian -
NFHS, RHS, SRS, HMIS,
DLHS, AHS, Census, MoHFW
GoI guidelines
• Global standards – WHO
recommendations; ICM
recommendations;
CONCHRANE; State of Worlds
Midwifery
• Research priorities in midwifery
• Utilization of facility data for
improvement in health services;
health outcomes
13. STRUCTURED MENTORSHIP
The clinical residency program is of 6 months duration to develop educational abilities as well as to ensure
clinical skills are up to date. This can be made more effective by integrating the 12 -month mentorship and a portfolio
approach, which is seen as an extension of the residency program.
A portfolio is a collection of experiences and reflections which the student gathers across the mentorship period
and includes continuity of care experiences and p rovides a competency -based approach to learning and assessment.
The portfolio provides evidence of learning and competence, contextualizing the learning and linking it with theory
and practice. Students are required to develop their learning plan having id entified learning needs and objectives for
their clinical practice experience. The portfolio helps the student develop self -directed learning and critical reflection.
It provides personal and professional evidence of the student’s learning and is used as a means to promote interactions
between students and preceptors, mentors and/or teachers. Students receive feedback based on competencies achieved
and documented reflective practice. The portfolio will be paper based initially but with the development of an
e-portfolio anticipated. The structure may include a title page (giving student’s name, year of training and name of the
mentor), contents page, a list of learning objectives, clinical experience records and a short reflection on each
experience. A compe tency assessment will be collected during clinical placements and specific skills will be assessed
for competency according to the ICM essential competencies. A final reflective overview will summarize the learning
that has taken place since the last portf olio review.
Preceptorship and mentoring are crucial for competency -based learning and assessment, as it enhances the
feedback process and stimulates students’ reflections in relation to the ICM competencies. Students will have
individual mentors allocated for their mentorship experience. The aims of mentoring are to: provide feedback;
stimulate reflection; support students in compiling the portfolio; monitor students’ competency development; support
students in developing a better awareness and understandi ng of their strengths and weaknesses; support students in
creating a learning plan for the placement; and motivate/inspire students. The mentors will be required to complete a
competency assessment of general and specific practice skills.
If the organisati on and logistics permit students should be brought together for at least 1, 2 or 3 workshop
intensives in which they share experience, what went well, what was difficult, with tutor support. The students will
bring with them teaching material they have pre pared. They will use their log books, keep their portfolio, and reflect
on experience.
During this period students should be encouraged to have peer support of each other.
Mentorship Plan
Month - 1
Objective: Onsite orientation of local stakeholders, gap analysis and support for initiating midwifery service
• Baseline assessment - Training infrastructure, clinical practice site and midwifery services.
• Unlearning of practices and encompassing the normal physiological aspects of births.
• Clinical mentoring - Focus on organizing ANC clinic, triaging area, childbirth education area, labor room.
• Clinical mentoring - Support in running antenatal clinic, triaging area and childbirth education area.
• Handholding support for antepartum and intrapartum care.
• Clinical m entoring - Support in running antenatal clinic, triaging area and childbirth education area.
• Handholding support for antepartum and intrapartum care.
• Reflections with educators.
Month - 2
Objective: Clinical handholding, competency assessment and trainin g on PPH
• Reflections with educators, NPM trainees and obstetric champions to identify challenges.
• Clinical mentoring - Support in running antenatal clinic, triaging area and childbirth education area.
• Handholding support for antepartum and intrapartum car e.
• Competency assessment for antenatal health education, abdominal examination, vaginal examination.
• Obstetric emergency drill - PPH.
• Clinical Mentoring - Support in running antenatal clinic, triaging area and childbirth education area.
Month - 3
Object ive: Clinical handholding, clinical training on CTG, Pre -eclampsia and eclampsia identification and
management, competency assessments
• Clinical teaching on CTG monitoring and interpretation.
• Obstetric emergency drill - Pre-Eclampsia/Eclampsia.
• Competency assessment - Management of first stage of labor, care of 2nd Stage, physiological third stage of labour
and AMTSL.
• Clinical Mentoring - Support in running antenatal clinic, triaging area and childbirth education area.
Month - 4
Objective: Clinical han dholding, clinical training on induction of labor, NBR and competency assessments
• Clinical teaching on induction of labor.
• Obstetric emergency drill – NBR.
• Competency assessment of clinical skills - CTG monitoring, new born care and assessment, post -natal care.
• Clinical Mentoring - Support in running antenatal clinic, triaging area and childbirth education area.
Month - 5
Objective: Clinical handholding, clinical training, family planning and competency assessments
• Reflections with educators, NPM traine es and obstetric champions to identify challenges.
• Clinical teaching - Family planning counselling and IUCD insertion (Interval and PPIUCD).
• Competency assessment of clinical skills - Episiotomy, perineal assessment and suturing.
• Clinical Mentoring - Suppo rt in running antenatal clinic, triaging area and childbirth education area.
• Handholding support for antepartum and intrapartum care.
Month - 6
Objective: Clinical handholding and clinical teaching on Midwifery care - abortion related services
• Competenc y assessment - consolidating skills.
• Clinical teaching - Midwifery care - abortion related services (Bereavement counselling, advice in terms of safe
abortion).
• Clinical Mentoring - Support in organizing competency assessments for NPM trainees.
Month - 7
Objective: Clinical handholding, competency assessments and support for preparation of research protocol
• Competency assessment - Consolidating skills.
• Teaching - Research proposal development.
Month - 8
Objective: Clinical handholding, competency asses sments and review on IMNCI protocols
• Competency assessment - consolidating skills.
• Teaching - IMNCI protocols.
Month - 9
Objective: Clinical handholding, competency assessments and review on Facility Based New -born Care protocols
• Competency assessmen t - consolidating skills.
• Teaching - Facility Based New -born Care protocols.
Month - 10
Objective: Clinical handholding, competency assessments
Month - 11
Objective: Clinical handholding, competency assessments
Month - 12
Objective: Competency based assessments of midwifery educators and appraisal of research study
Dr. T. DILEEP KUMAR, President
[ADVT. -III/4/Exty./ 796/2023 -24]
14. ANNEXURES
ANNEXURE -I
ROLES AND RESPONSIBILITIES OF THE NPM EDUCATOR
The NPM Educator will ensure the implementation of Nurse Practitioner in Midwifery (NPM) program and train
those who enroll for the course at the State Midwifery Training Institutes.
• The NPM Educator will ensure that trainee NPM’s who enroll for NPM course are adequately exposed to theory
and practice duri ng the entire program.
• The NPM Educator will follow the curriculum prescribed by the Council to provide details of content in theory,
practice, and internship along with lesson plans for standardized training.
• The NPM Educator will also be in charge of kee ping a record for every NPM student (logbook). A copy of the
same will remain with the NPM student as well. This will be managed as a joint responsibility to ensure
participatory learning.
• The NPM Educator would be required to continuously update their kno wledge and participate in professional
development activities relevant to midwifery education.
• To maintain competency, the NPM Educator will also practice in the clinical facility of the training institute and
provide comprehensive midwifery care to the wo men under her care. He/She would focus on the care of women
with low -risk pregnancies for whom he/she provides antenatal care and offers support to women during labour
and childbirth. After birth he/she focuses on ensuring that the mother and baby are well , develops close bonding
and makes sure that the baby has the best start in life. He/She also utilizes her knowledge and competencies to
identify deviations from normal pregnancy, labour and postpartum care, provide initial management and obtain
appropriat e medical help as indicated.
ANNEXURE -II
ICM ESSENTIAL COMPETENCIES FOR MIDWIFERY PRACTICE (2019)
COMPETENCY CATEGORY I: GENERAL COMPETENCIES
NPMs demonstrate professional accountability as an autonomous practitioner in the delivery of midwifery care as
per ICM standards adopted by the Council that are consistent with moral, altruistic and humanistic principles in
midwifery practice.
Competencies
1a. Assume responsibility for own decisions and actions as an autonomous practitioner .
1b. Assume responsibility for self -care including personal safety and self -development as a midwife .
1c. Appropriately delegate aspects of care and provide supervision .
1d. Utilize research to informed practice .
1e. Uphold the fundamental human rights of individuals when providing midwifery care .
1f. Adhere to jurisdictional laws, ethical, regulatory requirements, codes of conduct for midwifery practice .
1g. Facilitate women to make individual choices about care .
1h. Demonstrate effective interpersonal communication with women and families, health care teams, and community
groups .
1i. Facilitate normal birth processes in institutional and community settings, including women’s homes .
1j. Assess the health status, screen for health risks, and promote general health and well -being of w omen and infants .
1k. Prevent and treat common health problems related to reproduction and early life .
1l. Recognize conditions outside midwifery scope of practice and refer appropriately .
1m. Care for women who experience physical and sexual violence and abuse .
COMPETENCY CATEGORY II: PRE -PREGNANCY AND ANTENATAL
NPMs perform health assessment of woman and fetus, promote their health and well -being, detect complications
during pregnancy, and provide care to women with unexpected pregnancy .
Competencies
2a. Provide pre -pregnancy and antenatal care .
2b. Determine health status of women .
2c. Assess the fetal wellbeing .
2d. Monitor the progression of pregnancy .
2e. Promote and support health behaviors that improve their wellbeing .
2f. Provide anticipatory guidan ce related to pregnancy, birth, breastfeeding, parenthood, and change in the family .
2g. Detect, manage, and refer women with complicated pregnancies .
2h. Assist the woman and her family to plan for an appropriate place of birth .
2i. Provide care to women with unintended or mistimed pregnancy .
COMPETENCY CATEGORY III: CARE DURING LABOUR AND CHILDBIRTH
The NPMs continue to monitor and provide care to woman during labour that facilitates physiological processes
and a safe birth, immediate care to newborn infa nt and detect complications in mother and infant.
Competencies
3a. Promote physiologic labour and birth .
3b. Manage a safe spontaneous vaginal birth and prevent complications .
3c. Provide care of the newborn immediately after birth .
COMPETENCY CATEGORY IV: ONGOING CARE OF WOMEN AND NEWBORNS
The NPMs continue to perform health assessment of mother and infant, provide health education and support for
breast feeding, detect complications, and initiate family planning services.
Competencies
4a. Provide postnata l care for the healthy woman .
4b. Provide care to healthy newborn infant .
4c. Promote and support breast feeding .
4d. Detect and treat or refer postnatal complications in woman .
4e. Detect and manage health problems in newborn infant .
4f. Provide family pl anning services .
ANNEXURE -III
CLINICAL LOGBOOK FOR NPM EDUCATORS (PROCEDURAL COMPETENCIES/SKILLS)
S.No. Specific Procedural Competencies/Skills Performs independently/
Performs collaboratively
with doctor/Assists in
procedures (P/PC/A) * Date &
Signature o f
the Faculty
1 ANTENATAL CARE
1.1 Health assessment of antenatal woman: History taking,
physical examination and obstetrical examination P
1.2 Urine pregnancy test P
S.No. Specific Procedural Competencies/Skills Performs independently/
Performs collaboratively
with doctor/Assists in
procedures (P/PC/A) * Date &
Signature o f
the Faculty
1.3 Estimation of hemoglobin using Sahli’s hemoglobinometer/ true
Hb-P P
1.4 Preparation of peripheral smear for malaria P
1.5 Urine testing for albumin and sugar P
1.6 Point of care HIV test P
1.7 Point of care syphilis test P
1.8 Preparation of mother for USG P
1.9 Perform USG PC
1.10 Fetal patterns/Kick chart/DFMC (Dai ly Fetal Movement Count) P
1.11 Preparation and recording of Cardiotocography (CTG)/
Non-Stress Test (NST)/Contraction Stress Test (CST) P
1.12 Preparation/assisting woman for antenatal investigations -
amniocentesis, cordocentesis, chorionic villus sa mpling A
1.13 Antenatal counseling - diet & exercise P
1.14 Administration of TT/Td -P P
1.15 Prescription of iron and folic acid tablets
1.16 Prenatal counseling and care of general and vulnerable groups
such as adolescent pregnant mothers P
2 INTRANATAL CARE
2.1 Identification, assessment and admission of woman in labour P
2.2 Perform CTG PC
2.3 Vaginal examination during labour including clinical pelvimetry P
2.4 Plotting and interpretation of partograph P
2.5 Preparation for birthing - physical and psychological P
2.6 Setting up of the birthing room/unit P
2.7 Pain management during labour - non-pharmacological P
2.8 Supporting normal births P
2.9 Episiotomy only if required and repair P
2.10 Essential newborn care P
2.11 Active management of third stage of labour P
2.12 Examination of placenta P
2.13 Care during fourth stage of labour P
2.14 Initiation of breast feeding and lactation management P
S.No. Specific Procedural Competencies/Skills Performs independently/
Performs collaboratively
with doctor/Assists in
procedures (P/PC/A) * Date &
Signature o f
the Faculty
2.15 Assessment and weighing of newborn P
2.16 Administration of Vi tamin K P
3 POSTNATAL CARE
3.1 Postnatal assessment and care P
3.2 Perineal/episiotomy care P
3.3 Breast care P
3.4 Postnatal counseling - diet, exercise & breast feeding P
3.5 Postpartum family planning P
4 NEWBORN CARE
4.1 Assessment of ne wborn including gestational age P
4.2 Baby bath P
4.3 Kangaroo Mother Care P
4.4 Identification of minor disorders of newborn and their
management P
4.5 Neonatal immunization - Administration of BCG, Hepatitis B
vaccine P
5 CARE OF WOMAN WITH COM PLICATIONS/HIGH RISK MOTHER
5.1 Identification of antenatal complications - pre-eclampsia, anemia,
antepartum hemorrhage P
5.2 Glucose challenge test/ Glucose Tolerance test P
5.3 Administration of MgSO 4 P
5.4 Identification of fetal distress and its management P
5.5 Preparation of woman for emergency/elective caesarean section
and assisting in caesarean A
5.6 Prepare the mother and perform vacuum delivery when
favourable P&PC
5.7 Diagnosis of malpresentations and malpositions P
5.8 Diagnos is and management of cord presentation/cord prolapse P & PC
5.9 Early diagnosis of preterm labor P
5.10 Prepare, assess suitability and support the mother during breech
delivery when favorable P
5.11 Conduct Breech delivery PC
5.12 Infection preven tion during labor and newborn care P
5.13 Diagnosis and management of prolonged labour P
S.No. Specific Procedural Competencies/Skills Performs independently/
Performs collaboratively
with doctor/Assists in
procedures (P/PC/A) * Date &
Signature o f
the Faculty
5.14 Prepare and perform low forceps operation A
5.15 Manual removal of the placenta PC
5.16 Diagnosis and initial management of PPH
• Bimanual compression of ut erus
• Balloon tamponade for atonic uterus
• Aortic compression for PPH
• Prescription and administration of fluids and electrolytes
through intravenous P & PC
5.17 Repair of perineal and vaginal tears (upto II degree) P
5.18 Repair of perineal and vaginal t ears (above II degree) PC
5.19 Identification and first aid management of obstetric shock P
5.20 Manage obstetric shock PC
5.21 Diagnosis and management of puerperal sepsis P & PC
5.22 Management of breast engorgement P
5.23 Management of thrombo phlebitis P & PC
6 HIGH RISK NEWBORN
6.1 Identification of high -risk newborn P
6.2 Neonatal resuscitation P
6.3 Assisting in neonatal diagnostic procedures A
6.4 Feeding of high -risk newborn - EBM (spoon/paladai) P
6.5 Insertion/removal/feedi ng - Naso/orogastric tube P
6.6 Administration of medication - oral/parenteral PC
6.7 Neonatal drug calculation P
6.8 Oxygen administration P
6.9 Care of neonate in incubator/warmer/ventilator P
6.10 Neonatal intubation/ventilator PC
6.11 Care of neonate on phototherapy P
6.12 Assist in exchange transfusion A
6.13 Organizes different levels of neonatal care P
6.14 Transportation of high -risk newborn P
7 FAMILY WELFARE
7.1 Family planning counseling P
S.No. Specific Procedural Competencies/Skills Performs independently/
Performs collaboratively
with doctor/Assists in
procedures (P/PC/A) * Date &
Signature o f
the Faculty
7.2 Distribution of temporary cont raceptives - condoms, OCP’s,
emergency contraception P
7.3 Insertion and removal of Interval IUCD P
7.4 Insertion and removal of PPIUCD/PAIUCD P
7.5 Counselling of the woman for Postpartum sterilization P
7.6 Prepare and assist in tubectomy A
8 OTHER PROCEDURES
8.1 Prepare and assist for D&C/D&E operations A
8.2 Perform Manual Vacuum Aspiration P & PC
8.3 Post abortion care P
8.4 Post abortion family planning services P
8.5 Post abortion counseling P
8.6 Pre-conception nutritional a ssessment, screening HIV, Cervical
cancer P
8.7 Preconception counseling and care P
8.8 Pap smear P
8.9 Visual inspection with acetic acid/iodine P
8.10 Counseling on breast self -examination P
8.11 Conduction of maternal and perinatal death audit PC
8.12 Maintenance of registers P
8.13 Maintenance of records P
* When the learner is found competent to perform the skill, the faculty/trainer will sign it.
Learners: are expected to perform the listed skills/competencies many times until they rea ch level 3 competency,
after which the faculty signs against each competency.
Faculty/Trainers: Must ensure that the signature is given for each competency only after they reach level 3.
• Level 3: competency denotes that the leaner is able to perform that c ompetency without supervision
• Level 2: Competency denotes that the learner is able to perform each competency with supervision
• Level 1: competency denotes that the learner is not able to perform that competency/skill even with supervision
PORTFOLIO
The ski lls that require collaborative performance and that are only assisted can be followed up even during
mentorship and maintained through portfolio. However, the skills that need to be performed independently and the
learners are able to reach level 3 perform ance have to be completed before appearing for the final examination at the
end of 6 months.
ANNEXURE -IV
NPM EDUCATOR TRAINING PROGRAM: CLINICAL REQUIREMENTS
S.No. Clinical Requirement Date Signature of the
Faculty/Preceptor
1 Antenatal assessment and ca re - 40
2 Postnatal assessment and care - 40
3 Assessment of labour using partograph - 40
4 Per vaginal examination - 20
5 Observing normal births - 5
Facilitating normal births from 1st stage (independent) - 40
6 Assisting instrumental birt hs - 10
7 Placental examination - 10
8 Episiotomy and suturing only if indicated - 10
9 Insertion of Interval IUCD - 5
10 Insertion of PPIUCD/PPIUCD - 5
11 Newborn assessment - 40
12 ENBC - 40
13 Newborn Resuscitation - 20
14 Kangar oo Mother care - 5
15 Antenatal care study - 2 (normal - 1, high risk - 1)
Diagnosis:
Intrapartum care study - 2 (normal - 1, high risk - 1)
16 Postnatal care study - 2 (normal - 1, high risk - 1)
Diagnosis:
17 Newborn care study - 1
Diagnosis:
18 Clinical presentation - 4
• Antenatal:
• Intra natal:
• Postnatal:
• Newborn:
Health talk
• Antenatal - Topic:
• Postnatal - Topic
• Newborn - Topic:
• Family Welfare - Topic:
20 Counseling mothers & family members
1.
S.No. Clinical Requirement Date Signature of the
Faculty/Preceptor
2.
21 Antenata l in-patient reviews - 2
1.
2.
22 Clinical Seminar/Clinical Conference
Topic:
23 Drug study, presentation and report - 1
Drug:
24 Visits - report
• Peripheral health facility
25 Project: Evidence based midwifery practice (Individual/Group) -
Topic:
26 Microteaching sessions - Theory - 4
1.
2.
3.
4.
Microteaching - Skill demonstration - 4
1.
2.
3.
4.
Signature of the Program Coordinator
ANNEXURE -V
NPM EDUCATOR TRAINING PROGRAM: CLINICAL EXPERIENCE DETAILS
Area of Posting Clinical Condition Number of days
care given Signature of
Faculty/Preceptor
Signature of the Program Coordinator
ANNEXURE -VI
LEARNING RESOURCES
List of GoI Guidelines (RMNCH)
• Guideline on Midwifery Services in India (2018)
• LaQshya: Labour Room Quality Improvement Initiative Guideline
• Guidelines for Standardization of Labour Rooms at Delivery Point
• Dakshata: Empowering Providers for Improved MNH Care during Institutional Deliveries
• SBA: Gui delines for Antenatal Care and Skilled Attendance at Birth by ANMs/LHVs/SNs, Handbook and
Trainers Guide
• IMNCI Training Modules, Photo and Chart Booklets
• Navjat Shishu Suraksha Karyakram Guidelines
• Routine Immunization Handbook for Health Workers
• Postpartu m Family Planning Handbook for Service Providers
• IUCD Reference Manual for Medical Officers and Nursing Personnel
• PPIUCD Reference Manual
• Operational Guidelines: Introduction of Haemophilus influenza b (Hib) as Pentavalent Vaccine in Universal
Immunization Program of India
• Use of Antenatal Corticosteroids in preterm Labour
• Facility based IMNCI (F -IMNCI) (Participants Manual and Chart Booklet)
• Guidance Note on use of Uterotonics during labour
• Vitamin K Prophylaxis at Birth (in facilities)
• National Guideline for Calcium Supplementation during Pregnancy
• National Guideline on Management of Hypothyroidism during Pregnancy
• National Guidelines for Diagnosis & Management of Gestational Diabetes Mellitus
• Screening for Syphilis during Pregnancy
• National Guidelines Res pectful Newborn Care - Child Health Division, MoHFW
• Guidance for Mentoring and Support Visit - DAKSHATA
• Assessment Guidelines for Selection of NPM Educators - MoHFW Guidelines
Other Resources
• WHO Report on Strengthening Quality Midwifery Care and Midwifery Education
• The Lancet Series 2014, 2018 - Midwifery Quality Maternal and Newborn Care (QMNC) Framework
• ICM Essential Competencies for Midwifery Practice (2018 update) Framework Structure
• WHO Midwifery Educator Competencies
• Safe Delivery App
• Pairman et al, Midwifery Preparation for Practice (2019)
• Downe and Byrom, Squaring the Circle (2019)
• Downe and Byrom, ROAR Compassionate Care
• Midwifery Continuity of Care, 2nd Edition
• Caroline Homer, Pat Brodie, Jane Sandall and Nicky Leap
• Empowering Decision -making in M idwifery: A Global Perspective, 1st Edition by Elaine Jefford (Editor), Julie
Jomeen (Editor)
• Dahlen H., Schmied V., Hazard B., Birthing Outside the System: The Canary in the Coalmine (2019)
• Visaria L., Midwifery and Maternal Health in India (2010)
• WHO, Midwives Voices, Midwives Realities (2016)
• UNFPA. State of World’s Midwifery (2014)
E- Resources
• https://www.who.int/maternal_child_adolescent/topics/quality -of-care/midwifery/strengthening -midwifery -
education/en/
• https://www.who.int/hrh/nurs ing_midwifery/educator_competencies/en/
• https://www.internationalmidwives.org/our -work/policy -and-practice/essential -compe tencies -for-midwifery -
practice.html
• https://www.cochrane.org/CD004667/PREG_midwife -led-continuity -models-care-compared -other -models -care-
women -during -pregnancy -birth -and-early
• https://www.whiteribbonalliance.org/wp -content/uploads/2017/11/Final_RMC_Charte r.pdf
• https://transform.childbirthconnection.org/reports/physiology/
• https://www.whiteribbonalliance.org/whatw omenwant/
References
• Biesta G. (2015) What is education for? On Good Education, Teacher Judgement and Educational
Professionalism, European Journal of Education , 50(1), 75 -87
• Cranton P. (2009) Understanding and Promoting Transformative Education: A Guide for Educators of Adults,
Canadian Journal of University Continuing Education, 35(1)
• Chorazy M. and Klinedinst K. (2019) Learning by doing: A model for incorporating high -impact experiential
learning into an undergraduate public health curriculum . Frontiers in Public Health Journal, 7(31), 1 -6
• Dewey J. (1938) Experience and Education . New York, NY: Collier Books
• Finlay L. (2008) Reflecting on 'Reflective Practice'. 1st ed. [ebook] The Open University, Accessed on 12th July
2019 at http://www.open.ac.uk/opencetl/files/opencetl/file/ecms/web -content/Finlay -(2008) -Reflecting -
on-reflective -practice -PBPL -paper -52.pdf
• Friere P. (1972) Pedagogy of the Oppressed , Penguin Books, Hammondsworth, UK
• Gibbs G. (1988) Learning by Doing: A guide to teaching and learning methods, Further Education Unit, Oxford
Polytechnic: Oxford
• Homer C.S.E., Friberg I.K., Dias M.A.B., ten Hoope -Bender P., Sandall J., Speciale A.M. & Bartlett L.A. (2014)
The projected effect of scaling up midwifery. The Lancet, 384 (9948), 1146 -1157
• Kolb D.A. (1984) Experiential Learning: Experience as the Source of Learning and Development, Englewood
Cliffs, NJ: Prentice -Hall
• Mezirow J. (1991) Transformative dimensions of adult learning , Jossey -Bass, San Francisco
• Renfrew M.J., Mcfadden A., Bastos M.H., Campbell J., Channon A.A., Cheung N.F., Silva D.R.A.D., Downe S.,
Kennedy H.P., Malata A., Mccormick F., Wick L . & Declercq E. (2014) Midwifery and quality care: findings
from a new evidence -informed framework for maternal and newborn care, The Lancet, 384, 1129 -1145
• Miller S., Abalos E., Chamillard M., Ciapponi A., Colaci D., Comandé D., Diaz V., Geller S., Hanson C., Langer
A., Manuelli V., Millar K., Morhason -Bello I., Castro C.P., Pileggi, V.N., Robinson N., Skaer M., Souza J.P.,
Vogel J.P. & Althabe F. (2016) ‘Beyond too little, too late and too much, too soon: a pathway towards evidence -
based, respectful mater nity care worldwide’, The Lancet, 388 (10056), 2176 -2192.
• ICM Essential Competency Standards for the Midwife (ICM 2018) accessed on July 12th July 2019 at
https://www.internationalmidwives.org/our -work/policy -and-practice/essential -competencies -for-
midwifery -practice.html
• Sandall J., Soltani H., Gates S., Shennan A., Devane D. (2016) Midwife -led continuity models versus other
models of care for childbearing women, Cochrane Database of Systematic Reviews, Issue 4. Art. No.: CD004667.
DOI: 10.1002/14651858.CD004667.pub5
• Smith M., Warnes S. & Vanhoestenberghe A (2018) Scenario -based learning in Teaching and Learning in Higher
Education: Perspectives from UCL, Ch. 10 Ed Davies J and Pachler N., UCL Institute of Education Press,
University College, London
• Tracy S K., Welsh A., Hall B., Hartz D., Lainchbury A., Bisits A., White J. & Tracy M.B. (2014) Caseload
midwifery compared to st andard or private obstetric care for first time mothers in a public teaching hospital in
Australia: a cross sectional study of cost and birth outcomes. BMC Pregnancy and Childbirth, 14, 46
• United Nations Population Fund (UNFPA) 2014. The State of the World ’s Midwifery, A Universal Pathway. A
Woman’s Right to Health
• World Health Organization (WHO) 2013a. Midwifery educator core competencies, Geneva.
• World Health Organization (WHO) 2013b. WHO recommendations on postnatal care of the mother and newborn ,
Geneva
• World Health Organization (WHO) 2014a. Midwifery educator core competencies adaptation tool, Geneva
• World Health Organization (WHO) 2014b . WHO midwifery educator core competencies: building capacities of
midwifery educators, Geneva
• World Health Organizati on (WHO) 2016. WHO recommendations on antenatal care for a positive pregnancy
experience , Geneva
• World Health Organization (WHO) 2018. WHO recommendation: intrapartum care for a positive childbirth
experience , Geneva
• World Health Organization (WHO) 2019. Strengthening quality midwifery education for Universal Health
Coverage 2030: Framework for action , Geneva
ANNEXURE -VII
EXAMINATION GUIDELINES FOR
NURSE PRACTITIONER MIDWIFERY EDUCATOR PROGRAM
Indian Nursing Council
INTRODUCTION
The Government of India (Go I) is implementing the ‘Midwifery initiative’ in India to bring about a
transformation in the quality of care given to women and their families during pregnancy, labour, childbirth and
postpartum period. This initiative has brought about the setting up of a new cadre of Nurse Practitioners in Midwifery
(NPM) who would be functioning under the title ‘Nurse Practitioner Midwife’ providing compassionate, respectful,
competent and women centered midwifery care.
These NPMs are trained by the NPM educators at the State Midwifery Training Institutes (SMTI). The knowledge
and skills of the NPM educators are standardized through a specialized NPM educator program which includes 6
months of intensive residential training in the national midwifery training institute (N MTI) followed by onsite
mentoring for 12 months. The NPM educators would receive their certification at the end of 18 months on successful
completion of the program. This training program is conducted by a group of 6 international trainers and 6 national
trainers who are the faculty trainers for this program.
During their training program, the NPM educators undergo 3 assessments/examinations:
(i) First assessment after 3 months of training
(ii) Second assessment after 6 months of residential training for provisional certification
(iii) Final assessment/examination for certification at the end of 18 months, that is after 12 months of onsite
training with mentorship.
This document gives a complete description of the preparation and process of conduction of examination and
certification.
EXAMINING AUTHORITY
The examining authority for the NPM educator program will be the state examination boards approved by the
Council. The examination as per the Council curriculum guidelines, will be designed, conducted and evaluated by the
board and certificates would be issued by the same authority. Three examinations/assessments will be conducted at
specified intervals for final certification. Registration numbers are allotted to the candidates at the time of admission.
TYPE OF EXAMINATIONS
Considering the transformative nature of the NPM program, the NPM educators should be highly efficient,
competent and motivated to teach and train NPMs to bring about change in the delivery of compassionate and
respectful midwifery care. The process of ev aluation and certification is made robust to meet this demand.
(i) First assessment
At the end of 3 months, the NPM educators will undergo examination in one theory paper and one practical
examination to assess the suitability to continue the course. However, if the NPM educator does not clear the
examination, she may be given one more chance and if still does not clear, she would be discontinued from the
program. (Module 1 and Module 2: Section 1-3 would be covered in this examination.
(ii) Second assessment
At the end of 6 months, the candidates would undergo Second assessment in theory and practical examination. On
passing the examination, a provisional certificate of partial completion of the program would be issued. All modules
are included for the examination.
(iii) Final assessment
After completion of 12 months onsite mentorship experience, the NPM educators would appear for their final
examination in theory and practical conducted at the respective NMTI. All modules are included for the examination.
On successful co mpletion, the candidates would be certified as NPM educators.
Note: For all the three examinations, the same pattern of exam ination will be followed.
ELIGIBILITY FOR ADMISSION TO EXAMINATION
The candidates who fulfill the following criteria only would be e ligible to appear for the examinations.
(i) First assessment
• Completion of at least 90% of prescribed attendance (3 months) for both theory and clinical practice.
• Completion of 40% of logbook and clinical requirements.
• Certificate of completion of attendance a nd requirements by the Principal of College of Nursing/Program
coordinator (faculty trainer).
(ii) Second assessment
• Completion of at least 90% of prescribed attendance (6 months) for both theory and clinical practice.
• Completion of 80% of logbook and clinical requirements.
• Certificate of completion of attendance and requirements by the Principal of College of Nursing/Program
coordinator (faculty trainer).
(iii) Final examination
• Completion of at least 90% of prescribed attendance (6 months) for both theory and clinic al practice.
• Completion of 12 months of mentorship experience in the SMTI according to the plan.
• Completion of 100% of logbook and clinical requirements.
• Certification of completion of logbook and clinical requirements by the principal college of Nursing/P rogram
coordinator (Faculty trainer) based on the records maintained by the respective faculty trainer who mentored
the NPM educator during the 12 months of onsite training.
• Successful conduction of trainings for the NPMs in the SMTI.
PASS: 70% both intern al and external together in prescribed theory and practical examination
SUPPLEMENTARY EXAMINATION
Candidates who fail in the first assessment would be given one more chance to appear for the examination within
2-4 weeks in the examination failed, either in theory or practical only and if they fail again and are not found suitable,
would be discontinued from the program. Candidates who fail in the Second assessment at the end of 6 months, can
appear for the examination after 6 weeks in the examination failed , either in theory or practical only. The provisional
certificate of partial completion of the program would be given only after passing the Second assessment. However,
the candidates can proceed for onsite training under mentorship.
EXAMINATION PATTERN
The pattern of examination is the same for all three assessments/examinations. There will be one theory paper and
one practical examination
Theory
Internal assessment External examination
Theory
Internal (25 marks) +
External (75 marks)
= 100 marks Total = 25 marks
• *Tests: 3 tests × 5 marks = 15 marks
• *Assignments/presentations:
5 × 2 marks = 10 marks Total = 75 marks; Duration = 3 hours
• Multiple choice questions:
10 × 1 = 10 marks
• Short answers: 5 × 2 = 10 marks
Short notes: 5 × 5 = 25 marks
• Essay/Scena rio: 30 marks
2 × 15 = 30 marks
Practical
Internal (50 marks) +
External (50 marks)
= 100 marks Total = 50 marks
• Clinical performance = 10 marks
• Clinical assignments/presentations = 10
marks
• OSCE = 10 marks
• Direct observed practical = 20 marks Total = 5 0 marks
• OSCE (5 stations) = 20 marks
• Direct observed practical =30 marks
*Tests should be conducted for 25 marks (MCQ - 3 marks, Short answers - 1 × 2 = 2 marks, Short answers 2 × 5 = 10
marks and essay/scenario type - 10 marks) and converted to 5 marks for consolidation. Assignments/ presentations can
be scored for 10 marks and converted to 2 marks for consolidation.
EXAMINERS
Theory
• Question paper setting - The board assigns a panel of 2 examiners to set 2 sets of question papers each examiner
as per th e blue -print (Annexure -A). Question papers should be set by the faculty trainers of the NPM educators.
Questions from these 4 question papers as per the blue -print and question paper pattern are selected and the final
question paper is prepared by the exam ination board. Confidentiality should be maintained and each faculty who
is setting the question paper should sign an undertaking of confidentiality.
• Invigilation - The invigilation of the examination should be done by an external faculty appointed by the board.
The Principal of the nursing college/Program coordinator (faculty trainer) in which the NMTI is located will be
the chief superintendent of the examination.
• Evaluation - The theory papers should be evaluated at the examination board or the center al lotted by the
examination board by the faculty trainers under the supervision of the secretary/chairperson of the examination
board.
• Mark sheet – The sample of the mark sheet is enclosed in Annexure -B.
Practical Examination
• Practical examination should be conducted for 2 to 3 days – on day one OSCE is conducted followed by directly
observed practical on the subsequent days.
• OSCE – For the conduction of OSCE, a team of 5 evaluators for 5 stations should be appointed by the board from
the NMTI along with the Principal of the college of nursing/Program coordinator (Faculty trainer) who will be the
chief superintendent for the examination. An external examiner (faculty trainer) is appointed by the board to
observe and moderate the conduction of the OSCE sessions . List of the OSCE stations for examination is selected
by the board and sent to the examination center in a sealed cover – 3 basic skills and 2 advanced skills (List
enclosed in Annexure -D).
• Directly Observed Practical – This is conducted by a team of 3 e xaminers. 2 faculty trainers - one internal and
one external and 1 medical preceptor who were involved in the teaching program of the NPM educators.
• Qualification of Examiners : M.Sc. nursing, OBG specialty with 5 years of teaching or clinical experience af ter
PG with a dual role/M .Sc. OBG nursing with 5 years of experience as faculty with a minimum of 2 years
midwifery clinical working experience. Medical preceptor should be medical faculty from Obstetrics and
Gynecology, Pediatrics and Public Health with 3 years post PG experience/consultant.
CONDUCTION OF EXAMINATION
• The examination schedule for both theory and practical examination is given at least 2 weeks prior to the
examination by the board.
• Hall tickets are sent from the examination board to the exam ination center.
• The center for examination is allotted by the examination board.
• The invigilators and practical examiners are appointed by the examination board.
• Question papers are sealed and sent to the examination center or may be done online. The chief superintendent
who is either the principal/program coordinator (faculty trainer) is responsible for the security of the papers.
• The candidates should use only their registration numbers. Names should not be written anywhere in the answer
scripts.
Theory
• The examination hall is arranged with adequate lighting and ventilation. Seating is arranged as per the registration
number.
• Candidates can be permitted into the hall 15 minutes before commencement of the examination on producing the
hall ticket.
• Duration o f examination is 3 hours.
• No candidates should enter the examination hall after the expiry of thirty minutes from the commencement of
examination and leave the examination hall before the expiry of sixty minutes from the commencement of the
examination.
• No electronic devices should be permitted in the examination hall.
• The answer scripts should be signed by the invigilator before commencement of the examination.
• The question paper pack should be opened by the chief superintendent and the invigilators in the presence of the
candidates 15 minutes prior to commencement. (If online, downloaded in the same manner)
• A bell should be given every half an hour of the examination to alert the candidates.
• On completion of the examination, the answer scripts are collecte d in order, packed, sealed, signed by the chief
superintendent and sent to the examination board on the day of examination by registered post or speed post.
Practical Examination
(i) Objective Structured Clinical Examination (OSCE)
• OSCE is done on day 1 of th e examination.
• The OSCE station list is given by the examination board which can be opened 60 minutes prior to the
commencement of the examination. 5 stations are selected - 3 basic skills and 2 advanced skills (list of skills
- Annexure -D).
• Each station s hould be set up with the necessary articles and checklist.
• Each candidate can be allowed 10 minutes for each station.
• The time allotted for 1 OSCE session is 50 minutes. There can be a maximum of 6 rounds of OSCE in a day.
30 candidates can be assessed on the same day. The candidates who complete the OSCE should not be
allowed to meet the other candidates waiting for the examination. If the number of candidates is more, the
examination can be done on the next day with a different set of skill stations.
• The scores for the OSCE are done for each station by the individual evaluators and the final scoring sheet is
compiled and consolidated jointly by the external evaluator and chief superintendent. OSCE Score sheet is
enclosed in Annexure -E.
(ii) Directly Observed Pr actical (DOP)
• DOP is done on day 2 of the examination.
• Each candidate is allotted a mother for examination - antenatal, intranatal or postnatal by lottery method.
They would be given 3 -4 hours for assessment and care of the mothers and newborn (if postnata l).
• The care given is evaluated by the internal examiner, external examiner and medical preceptor individually
and their scores are combined for the final score. Viva voce is conducted in the bedside/ conference room in
the clinical area. The DOP assessmen t form is enclosed in Annexure -F.
• A maximum of 15 -20 students can be examined on the same day.
• The score is compiled with the OSCE scores and signed by the examiners and the chief superintendent. The
score sheet is sent to the examination board on the day of examination by registered post or speed post.
RESULTS
The results of the examination are declared by the examination board within a period of 15 days up to one month
from the conduction of the examinations. The paper evaluation center can be decided by the board. A candidate
successfully clears the examination if she has scored at least 70% of marks in both theory and practical papers
together which is Pass. Format of mark sheet and certificate (provisional & Final) is enclosed in Annexure -B & C.
CERTIFI CATION
A. Title - Nurse Practitioner Midwifery Educator (NPM Educator)
B. The title is awarded upon successful completion of the prescribed study program, which will state that the
candidate
i. Has completed the prescribed course of nurse practitioner midwifery edu cator
ii. Has attended 90% of the theoretical and 100% of the practical instruction hours before awarding the
certificate.
iii. Has passed (70% marks both internal and external together) in the prescribed theory and practical
examination.
C. SNRC will register NPM edu cator as additional qualification.
On passing the second examination at the end of 6 months, a provisional certificate of partial completion of the
program would be issued. On successful completion of the final examination, the candidates would be awarded the
certificate of NPM educator. Model of the certificates are enclosed in Annexure -C.
SUB -ANNEXURES IN ANNEXURE -VII
ANNEXURE -A: Blueprint of Question Paper
Exam : Preliminary/interim/final examination Marks : 75
Date : Time : 3 hours
S.No. Type of questi ons MCQ
1 mark Short
answers
2 marks Short
notes
5 marks Essay/ Situation
15 marks Marks Percentage
1 Remembering (knowledge
based simple recall
questions, facts, terms,
concepts, principles,
theories, identify, define
information) 2 1 1 - 9 12%
2 Unde rstanding
(comprehension, understand
conceptually, interpret,
compare, contrast, explain,
paraphrase, interpret
information) 3 1 1 1(10) 20 26%
3 Application (use abstract
information in concrete
situation, apply knowledge
to new situation, solve
problems ) 2 1 1 1(10) 19 25%
4 Analysis and synthesis
(classify, compare, contrast,
differentiate, organize and
integrate new pieces of
information) 1 1 1(15) 18 24%
5 Evaluation (appraise, judge,
justify the value or worth of
a decision or outcome,
predict out comes based on
values) 2 1 1 - 9 12%
TOTAL 10×1=10 5×2=10 4×5=20 2×10+1×15=35 100 100
*Question Paper Pattern
Name of the Examination Board: ________________________
State: ________________________________
Name of the Theory Examination - First/Secon d/Final Examination
Date : Maximum marks : 75 marks
Duration : 3 hours
Answer all the questions in the answer booklet given
I. Multiple choice question: choose the best answer 10 × 1 = 10 marks
(A question stem with 4 options)
II. Short answers: answer in one or two sentences 5 × 2 = 10 marks
(definitions, meanings, application, differences, list etc.)
III. Short notes: 4 × 5 = 20 marks
(analyze, interpret, comprehend, brief, explain)
IV. Essay/situation: (2 × 10) + (1 × 15) = 35 marks
(Discuss, apply, narrat e, evaluate, compare and contrast)
ANNEXURE -B: Sample Mark Statement
NAME OF EXAMINATION BOARD
STATE
STATEMENT OF MARKS – NPM EDUCATOR PROGRAM
Course NPM Educator Registration Number
ANNXURE -C: Sample Certificates (Provisional & Final)
NAME OF EXAMINATION BOARD
STATE
PROVISIONAL CERTIFICATE OF PARTIAL COMPLETION
The _________________________________________________________ Examination Board hereby
makes known that _____________________________________________________________, born on Phot o of
candidate
(to be
attested)
EMBLEM
Sample of Certificate - Final Certificate
NAME OF EXAMINATION BOARD
STATE
AWARD OF DIPLOMA
Nurse Practitioner Midwifery Educator
The _________________________________________________________ Examination Board hereby
makes known that ______________________ _______________________________________, born on Photo of
candidate
(To be
attested)
EMBLEM
ANNEXURE -D: List of Skills for OSCE
Basic Skills Advanced Skills
1. Antenatal assessment: calculation of EDD
2. Antenatal assessment: detecting pregnancy using
pregnancy testing kit
3. Antenatal examinatio n: measuring blood pressure
4. Antenatal examination: measuring pulse 1. Management of antenatal complications: pre -
eclampsia and eclampsia
2. Adm inistration of Inj. MgSO 4
3. Identification and management of hemorrhage in
pregnancy
4. Preparation and recording of Cardiotocography Seal of the Board
5. Abdominal examination during pregnancy
6. Laboratory investigation: Testing blood - hemoglobin
7. Laboratory investigation: Testing urine for sugar
8. Laboratory investigation: Testing urine for pro tein
9. Laboratory investigation: RDT for malaria
10. Glucose challenge test/Glucose Tolerance test
11. Antenatal general examination
12. Administration of Inj. TT
13. Counseling of antenatal woman
14. Setting up of the birthing room/unit
15. Assessment during first stage of labor: PV
examination including clinical pelvimetry
16. Pain management during labour - non-
pharmacological
17. Assessment and care during second stage of labor:
conducting normal delivery
18. Assessment and care during third stage of labor:
active management
19. Essential new born care
20. Examination of placenta
21. Assessment and weighing of newborn
22. Neonatal immunization - Administration of BCG,
Hepatitis B vaccine
23. Care during fourth stage of labour
24. Baby bath
25. Perineal/episiotomy care
26. Breast care
27. Counseling postnatal woman
28. Distributio n of oral contraceptive pills
29. Counseling on postpartum family planning
30. Counseling on family planning - method specific
31. Post abortion counseling
32. Counseling on breast self -examination (CTG)/Non -Stress Test (NST)/Contraction Stress
Test (CST)
5. Assessment during first stage of labor: plotting of
partograph
6. Intrap artum complications: Identify and manage
7. Newborn resuscitation
8. Kangaroo mother care
9. Prepare and perform low forceps operation
10. Conduct Breech delivery
11. Initial management of PPH: preparation and
administration of oxytocin drip
12. Initial Management of PPH: Bima nual compression
of uterus
13. Balloon tamponade for atonic uterus
14. Aortic compression for PPH
15. Prescription and administration of fluids and
electrolytes through intravenous
16. Manual removal of the placenta
17. Catheterization - Plain catheter
18. Catheterization - Indwe lling catheter
19. Starting up of IV line
20. Repair of perineal and vaginal tears (upto II degree)
21. Identification and first aid management of obstetric
shock
22. Management of postnatal complications
23. Oxygen administration
24. Care of neonate on phototherapy and ventilat or
25. Insertion and removal of PPIUCD/PAIUCD
26. Perform Manual Vacuum Aspiration
27. Post abortion care
28. IUCD insertion - Interval
29. Pap smear
30. Visual inspection with acetic acid/iodine
*A total of 5 skills – 3 basic and 2 advanced skills are selected for each OSCE session.
ANNEXURE -E: OSCE SCORE SHEET
Plan for OSCE Examination and Compilation Sheet
(External Examination)
Name of the Examination Centre :
Name of the Examination : First/Second/Final Examination
Date :
Total Number of Students : 30
Time per Station : 10 minutes
Total duration : 6 hours (4 hours morning, 2 hours evening)
Evaluators : 1.
2.
3.
4.
5.
Moderator :
Chief Superintendent :
S.No. Station Category Skill Assessed Marks
1 I Basic 20
2 II Advanced 20
3 III Basic 20
4 IV Advanced 20
5 V Basic 20
Total marks 100/5 = 20 marks
OSCE Compilation sheet
Name of the Examination Center :
Name of the Examination : First/Second/Final Examination
Date :
Roll Number of Students allotted : From ____________ to _____________
Total Number of Students : Allotted: Attended:
Total Number of OSCE Station : Basic Skills - 03 Advanced Skills - 02
OSCE Score Summary Sheet :
Name of OSCE Station Stations Total Marks
(out of 100) Total Marks
(out of 20) Registration Number 1 2 3 4 5
Signature of Moderator Signature of Chief Superintendent
ANNEXURE -F: Assessment Form for Directly Observed Practical
NAME OF THE EXAMINATION CENTER
NPM Educator Program
Evaluation form for Practical Examination - First/Second/Final Examination
(Same but separate forms for internal examiner, external examiner and medical preceptor)
Examiner: Internal/External/Medical Preceptor S.No
Registration
Number
History collection
General physical
examination Specific/Focused
assessment
Plan of care
Goal/objective
Midwifery care
provided
Application of
scientific principles
Evaluation of care
Communication
Education &
Counseling
Mothers feedback
Viva
Total
Max marks 2 2 4 2 2 6 2 2 2 2 2 2 30
Signature of the Examiner
External Practical Examination Consolidation Sheet
Name of the Examination Center :
Name of the Examination : First/Second/Final Examination
Dates of the Examination : OSCE - DOP -
Roll Nu mber of Students allotted : From to
Total Number of Students : Allotted: Attended:
S.No Registration
Number Internal
Examiner External
Examiner Medical
Preceptor Total DOP Total
OSCE Grand
total
Maximum Marks 30 30 30 90/3=30 20 50
Internal Examiner External Examiner Medical Preceptor
Place:
Date:
Seal:
Signature of Chief Superintendent
(Principa l/Program Coordinator /Faculty Trainer)
ANNEXURE -VIII
SCOPE OF PRACTICE
For
Nurse Practitioner in Midwifery (NPM) Educator
&
Nurse Practitioner Midwife
Document Prepared by MoHFW and Indian Nursing Council (June 2021)
Reference: Available at MoHFW and INC websites
Uploaded by Dte. of Printing at Government of India Press, Ring Road, Mayapuri, New Delhi -110064
and Published by the Controller of Publications, Delhi -110054.
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