1.

INDEPENDENT NURSE MIDWIFERY PRACTITIONER

2.  INTRODUCTION :  Activities of health care providers who are experts in the women
health care including prenatal care to expectant mothers, attending at birth and providing
post partum care to mother and infant.  Practitioners of midwifery are known as
midwives.
3.  Independent midwifery practice enables registered nurse midwives to utilize their
knowledge skills, judgment and authority in the provision of midwifery practice package
and primary women’s health services while maintaining accountability for the
management of patient care in accordance with midwifery standards laid down by the
midwifery or nursing council of their country.
4.   Independent should not interpreted to mean alone, as there are clinical situations when
any prudent practitioner would seek the assistance of other qualified.

5. . MIDWIFERY PRACTICE PACKAGE FOR INDEPENDENT PRACTICE : 1. Access to a

midwife 24 hours a day, 7 days a week. 2. Two midwives available alternatively and
provide women centered antenatal, intrapartum and postnatal midwifery care. 3.
Antenatal care in privacy. 4. Continuity of care throughout labour. 5. Postnatal care up to
6 weeks. 6. Knowledgeable breast feeding support.

6. . STANDARDS REQUIRED FOR THE PRACTICE OF MIDWIFERY :  Midwifery practice

as conducted by midwife is the independent management of women’s health care,
focusing particularly on pregnancy, child birth the postpartum period care of newborn,
family planning and gynecological needs of women.  Midwives provide consultation,
management, collaborative management or referral as indicated according to standards
of midwifery practice.
7.   In India as such standards of midwifery practice act are not developed to do
independent midwifery practices which are one of the essential requirements. American
college of nursing midwives has defined eight standards of practice.

8.  STANDARD- I :  Midwifery care is provided by qualified practitioners.  Midwifery should

be registered.  Shows evidence of continuing competency as required by certification
agency by council.  It is in compliance with the legal requirements of the jurisdiction
where the midwifery practice occurs.
9. . STANDARD- II :  Midwifery care occurs in a safe environment within the context of the
family, community and a system of health care.  Demonstrate a safe mechanism for
obtaining medical consultation, collaboration and referral.  Uses community services as
needed.

10.  •Demonstrates knowledge of the medical, psychological, economical, cultural and family
factors that affect care. •Demonstrates appropriate techniques for emergency
management including arrangements for emergency transportation. •Promotes
involvement of support persons in the practice settings.

11. . STANDARD- III :  The midwives practices in accordance with the philosophy and the
code of ethics of the professional body provides clients with a description of the scope of
midwifery services and information regarding the client’s rights and responsibilities.
12. . Provides clients with information regarding services when requested or when care
required is not within the midwife’s scope of practice. Provides client with information
regarding health care decisions and the state of science regarding these choices to allow
for informed decision making.
13. . STANDARD- IV :  Midwifery care is comprised of knowledge, skills and judgment that
foster the delivery of safe satisfying and culturally competent care.  The midwife collects
and assesses client care data, develops and implement individualized plan of
management and evaluates outcome of care.
14.  Demonstrates the clinical skills and judgments described in the basic midwifery practice.
Practices in accordance with standards. Practices in accordance with service or practice
guidelines that meet the requirements of the particular institution or practice settings.

15. STANDARD- V :  Midwifery care is based upon knowledge, skills and judgment which
are reflected in written practice guidelines.  Midwife describes the parameters of services
for independent and collaborative midwifery management and transfer of care when
needed.  Establish practice guidelines for each specialty area which may include, but is
not care of the child bearing family and newborn care.
16.   Includes the following information in each specialty area :  Client selection criteria. 
Parameters and methods for assessing health status.  Parameters for risk assessment. 
Parameters for consultation, collaboration and referral.  Appropriate interventions
including treatment, medications and or devices.

17. STANDARD- VI :  Midwifery care is documented in a format that is accessible and

competent.  The midwife uses records that facilitate communications and institutions. 
Provides prompt and complete documentation of evaluation, course of management and
outcome of care.  Promotes documentation system that provides for confidentiality and
transmissibility of health records.  Maintain confidentiality in verbal and written
communications.

18. . STANDARD- VII :  Midwifery care is evaluated according to an established programme

for quality management that includes a plan to identify and resolve problems.  The
midwife participates in programme of quality management for the evaluation of practice
within the setting in which it occurs.  Provides for a systemic collection of practice data
as a part of a programme of quality, management.  Seeks consultation to review
problems, including peer review of care.  Acts to resolve problems identified.

19. . STANDARD- VIII :  Midwifery practice may be extended beyond the set competencies
to incorporate new procedure that improve care for women and their fames.  The
midwife identifies the need for new procedure taking into consideration consumer
demand, standards for safe practice and availability of other qualified personnel.
20.   Ensures that there are no institutional state or council statures, regulations or laws that
would constrain the midwife from incorporation of the procedure into practice.  Reports
the incorporation of this procedure to the authority. In respect to provide standardized
practice independently, the nurse midwife has to meet required education, experience,
advanced skills and competency.