Do the pre-service education programmes for midwives in India prepare confident ‘registered midwives’? A survey from India

Bharati Sharma,Ingegerd Hildingsson,Eva Johansson,Malvarappu Prakasamma,K.V Ramani,Kyllike Christensson

doi:10.3402/gha.v8.29553

Abstract

ObjectiveThe graduates of the diploma and degree programmes of nursing and midwifery in India are considered skilled birth attendants (SBAs). This paper aimed to assess the confidence of final-year students from pre-service education programmes (diploma and bachelor's) in selected midwifery skills from the list of midwifery competencies of the International Confederation of Midwives (ICM).DesignA cross-sectional survey was conducted in Gujarat, India, involving 633 final-year students from 25 educational institutions (private or government), randomly selected, stratified by the type of programme (diploma and bachelor's). Students assessed their confidence on a four-point scale, in four midwifery competency domains – antepartum, intrapartum, postpartum, and newborn care. Explorative factor analysis was used to reduce skill statements into separate subscales for each domain.ResultsOverall, 25–40% of students scored above the 75th percentile and 38–50% below the 50th percentile of confidence in all subscales for antepartum, intrapartum, postpartum, and newborn care. The majority had not attended the required number of births prescribed by the Indian Nursing Council.ConclusionsThe pre-service education offered in the diploma and bachelor's programmes in Gujarat does not prepare confident SBAs, as measured on selected midwifery competencies of the ICM. One of the underlying reasons was less clinical experience during their education. The duration, content, and pedagogy of midwifery education within the integrated programmes need to be reviewed.

Highlights

This study aimed to assess the confidence of final-year students from the diploma and bachelor’s programmes, in their skills in antepartum, intrapartum, postpartum, and newborn care from the list of midwifery competencies of the International Confederation of Midwives (ICM)
From the 19 skills statements under the antepartum domain, more than 20% of the students expressed low confidence in: assessing foetal growth through abdominal palpation (23%), interpreting foetal heart rate assessment (20%), initiating first-line management of high-risk factors based on national guidelines, and administering prescribed life-saving drugs (38%)
Students expressed low confidence in providing essential newborn care according to national guidelines (16%), in managing newborn complications such as hypothermia and respiratory distress and managing referral for such babies (29Á40%), and in screening for congenital anomalies and supporting parents with babies who were HIV positive (15Á20%)

Summary

Introduction

In 2 to 3 weeks’ time, the skilled birth attendant (SBA) training is meant to develop competence of staff nurses in first-level care for obstetric and newborn complications [13]. Given the facts that midwifery is part of nursing in India with much less duration than what is internationally recommended, we assumed that measuring confidence would partly reflect the quality of the teachingÁlearning experience the midwifery educational institutions are able to provide to their students and could partially help to assess their fitness to practice as confident and competent midwives, post-registration.

Results

Conclusion