National Standards for Midwives

(Core Competencies and Education)

2015

Ministry of Health and SportsDepartment of Health Professional

Resource Development and Management

2015

National Standards for Midwives

(Core Competencies and Education)

I

FOREWORD

The WHO first report of the independent Expert Review Group (iERG) on Information and Ac-countability for Women’s and Children’s Health declared that there has been considerable progress in addressing maternal and child mortality, but MDGs 4 and 5 will not be met in most developing countries by 2015 where women and infants continue to die from preventable causes.

In order to improve maternal health, it has been recognized that the cornerstone of good quality mater-nal health care is a person with adequate knowledge and skills in midwifery. In Myanmar, basic health staff including midwives are responsible for providing health services to approximately 70% of the pop-ulation, largely in rural areas. Additionally, nurses and midwives are the largest number among health personnel, and midwives play a pivotal role in providing care to reduce maternal & child deaths. In light of this, and in response to the needs expressed by the public, the Ministry of Health has undertaken a number of initiatives to strengthen midwifery education and practice in collaboration with partners and stakeholders. Moreover, the current National Health Plan (2011-2016) highlights the importance of developing a comprehensive National Strategic Plan for Health Human Resource to strengthen health system through effective health human resource planning, development and management. The Minis-try of Health is also making major investments in strengthening the capacity of universities and other training institutions for health professionals to provide quality education. (Health Workforce Strategic Plan 2012-2017).

The new midwifery curriculum which was upgraded from one and a half year certificate course to a two year diploma course was approved by the University Senate in February 2012 and it has been in use since November 2012. With UNFPA support, the Department of Health Professional Resource Develop-ment and Management (DHPRDM) has been conducting Training of Trainers and hands-on trainings on Basic Emergency Obstetric Care & Emergency Newborn Care for faculty members of nursing and mid-wifery schools across the country since 2012 to equip them with updated knowledge and skills.

Led by the Ministry of Health and supported by UNFPA, the ASEAN Task Force on Maternal and Child Health organized a workshop in October 2013 to develop the ASEAN Regional Guideline for Minimum Requirements for Training and Accreditation of Skilled Birth Attendants. The Guideline was launched in December 2014 and in the following consultation for midwifery standards, stakeholders discussed in detail, earlier recommendations made at the launch of the State of the World Midwifery Report 2014 and the Stakeholder Meeting for Midwifery in Myanmar which was organized by the Ministry of Health, UNFPA and Jhpiego. These recommendations included strengthening midwifery education, developing a definitive career path for midwives and enhancing midwifery accreditation/licensing. Higher authorities’ commitment was taken for these recommendations at the Executive Committee Meeting 4/ 2015 of the Ministry of Health in February 2015.

As one of the outcomes of these developments, a stakeholder meeting on the development of national midwifery standards and strengthening midwifery education was conducted in June 2015, culminating in the publication of the National Standards for Midwives (Core Competencies and Education) which provides critical information on the required core competencies of midwives in Myanmar, the standards for the training programmes, as well as relevant requirements for training institutions.

The Ministry of Health would like to take this opportunity to thank UNFPA for its partnership and con-tributions towards advancement of midwifery in Myanmar. I am confident that this National Standards for Midwives (Core Competencies and Education) will be followed by midwives and faculty members of nursing and midwifery institutions in providing maternal and newborn care in their respective commu-nities, contributing to better health outcomes for mothers and their newborns.

H.E Dr. Thein Thein HtayDeputy Minister for Health, Myanmar

II

ACKNOWLEDGEMENT

In Myanmar, where 70% of the population live in rural areas, midwives play an important role in provid-ing vital support to a woman who is pregnant or giving birth. Midwives can make a difference between life and death of mothers and newborns when they provide basic emergency obstetric care. According to WHO standards, 23 health workers (doctors, nurses and midwives) per 10,000 population are need-ed for delivering quality maternal and newborn health services. Myanmar is yet to reach this minimal standard. And, in a country that has approximately 21,435 midwives and 66,000 villages, where the Government is ambitiously aiming to have “one midwife for every village”, there is considerable way yet to go in order to fill the need for more midwives.

Myanmar’s first report on midwifery was launched in October 2014, having for the second time also participated in the State of the World’s Midwifery (SoWMy) 2014 global survey. The findings of this study and the consultations that ensued outlined how midwifery in Myanmar needed to be strengthened as well as promoted. Midwifery education and its professionalization especially were cited as two key areas that needed to be addressed in order to ensure consistent, competent and safe clinical practice.

“The National Standards for Midwives (Core Competencies and Education)” are the culmination of a joint effort that began in June 2015, between UNFPA Myanmar and the Department of Health Profes-sional Resource Development and Management (DHPRDM), Department of Public Health (DPH) and the Myanmar Nurse and Midwife Council (MNMC). Technical and financial support was provided to develop the national midwifery standards in line with ASEAN Regional Guidelines.

UNFPA congratulates the Ministry of Health and Sports for this accomplishment. These National Stan-dards for Midwives will provide critical information on the required competencies for midwives in Myan-mar. They set out the standards for training programmes and the requirements for training institutions. They are fundamental to larger efforts in the skilling and professionalizing of midwives.

Our grateful thanks, therefore, go to the concerned departments under the Ministry of Health and Sports, including the Department of Health Professional Resource Development and Management, the Department of Public Health and the Department of Medical Services, the professors and heads of nursing universities, the principals and trainers of midwifery schools from across the country, the assis-tant directors of nursing from states and regions, as well as WHO, UNICEF, Jhpiego and members of the Myanmar Nurse and Midwife Association and the Myanmar Nurse and Midwife Council. Special thanks also go to the steering and working committees, facilitators and participants of the workshop who con-tributed to the development of these standards.

UNFPA continues to be committed to promoting and supporting the role of skilled birth attendants and midwives and recognizes the important contribution they make to reducing maternal and neonatal mortality. The production of the National Standards is a clear step towards midwifery being recognized as a profession in its own right in Myanmar. This will make for a stronger and more confident health workforce and in delivering a world where every pregnancy is wanted, every childbirth is safe and every young person’s potential is fulfilled.

Janet E. JacksonUNFPA Representative for Myanmar

III

CONTENTS

Requirements for core competencies of midwives in Myanmar 1

Knowledge, skills and attitude for each competency of midwives 8

Standards for midwifery training programmes 17

Requirements for training institutions 18

Annex 1: Minimum number of cases during the training 19

Annex 2: Standard Classroom and Skills Lab Room 20

1National Standards for Midwives 2015

REQUIREMENTS FOR CORE COMPETENCIES OF MIDWIVES IN MYANMAR

All midwives at all levels of the health system must have skills and abilities to perform all of the core functions below:

Competency 1:Competencies Core functions Skill and/or ability to do as minimum the following:

Competency 1:

To be able to use all forms of communication effectively and to apply the underlying knowledge to be able to provide quality, culturally relevant care.

1. Communicate effectively cross-culturally in order to be able to provide holistic “women-centred” care.

2. Communicate effectively with clients regardless of educational and economic status, religious and ethnic background.

3. Cultivate effective communication with colleagues and other members of the health care team.

4. Promote a rights-based approach to health that encourages women to participate in decision making.

• Engage in health education discussions with and for women and their families.

• Use appropriate communication and listening skills across all domains of competency.

• Use simple language to convey messages that are easy-to-understand.

• Record and interpret relevant findings for services provided across all domains of competency, including what was done and what needs follow-up.

• Take account of the local circumstances such as geographical diversity, culture, beliefs, customs, etc. when providing services and communicating.

• Respect and encourage traditional practices which are beneficial and not harmful and discourage practices which are known to be harmful.

• Take a leadership role in the practice arena based on professional beliefs and values, practice effective interpersonal communication skills and emphasize respectful mother care.

2 National Standards for Midwives 2015

Competency 2:Competencies Core functions Skill and/or ability to do as minimum the following:

Competency 2:

Provide high quality antenatal care to maximize health during pregnancy that includes early detection and treatment and where needed referral of selected complications.

1. Take a detailed history by asking relevant questions.

2. Assess individual needs and give appropriate advice and guidance.

3. Perform a physical examination to assess health status and progress of pregnancy and identify problems and give appropriate treatment and/or refer.

4. Perform appropriate screening tests as required.

5. Assist pregnant women to make and update birth plans.

6. Educate women (and their families and others supporting pregnant women) in self-care, good nutrition and danger signs during pregnancy, childbirth and the postnatal period.

7. Identify obstetric and medical conditions detrimental to the health of the mother and foetus especially pre-eclampsia, perform first-line management (including performance of life-saving procedures when needed) and make arrangements for effective referral.

8. Administer medications.

• Take an initial and ongoing history at each antenatal visit.

• Perform a physical examination and explain findings to the woman and her family.

• Take and assess maternal vital signs including temperature, blood pressure and pulse.

• Assess maternal nutrition and its relationship to foetal growth; give appropriate advice on nutritional requirements of pregnancy and how to achieve them.

• Perform a complete abdominal assessment including assessment of fundal height using manual measurements, lie, position, and presentation.

• Listen to the foetal heart rate and determine foetal well-being and interpret findings and take appropriate action.

• Evaluate foetal growth, placental location and amniotic fluid volume, using ultrasound visualization and measurement (if equipment is available for use and within scope of practice).

• Perform a pelvic examination, including sizing the uterus, and determining the adequacy of the birth canal.

• Perform screening tests for anaemia, HIV, syphilis, proteinuria or any other tests according to national protocol.

• Take blood to determine blood grouping, and other haematological investigations as may be required.

• Administer tetanus immunization according to national protocols.

• Record and report all findings at each antenatal visit.• Make decisions based on clinical findings and take

appropriate action including giving feedback to the woman and family and referral to higher level health facilities.

• Assist pregnant women and their families in making and updating a plan for birth.

• Make arrangements for timely effective referral• Discourage harmful customs and practices• Identify signs and symptoms of obstetric and

medical conditions detrimental to the health of the woman and foetus and make clinical decisions based on findings and take appropriate action including giving first line management and making effective referral.

• Provide full counseling to the woman to accept treatment and/or referral check-up, monitoring.

• Educate women (and their families and others supporting pregnant women and newborn) on: the importance of regular check-up Self and family care the need for creating a safe and healthy environment

• Counseling on the benefits of early and exclusive breastfeeding. sexual practice during pregnancy and after childbirth

voluntary family planning and birth spacing following childbirth

• Psychological support for mother: normal psychological changes in pregnancy, information about relief of common discomforts, techniques for increasing relaxation and pain relief measures available for labour.

3National Standards for Midwives 2015

• Explain to the woman on how to identify the onset of labour and need for going to health facility early to allow for good monitoring and care during labour.

• Emergency preparedness and preparing for possible community-based referral: who to contact, what support, etc.

• Perform first-line management (including performance of life-saving procedures when needed).

• Administer tetanus toxoid, immunization, supply of folic acid, FeSo4, Vit B1, deworming, health education on medications during pregnancy.

Competency 3:Competencies Core functions Skill and/or ability to do as minimum the following:

Competency 3:

Provide high quality, culturally sensitive care during labour, conduct a clean and safe birth and handle selected emergency situations to maximize the health of women and their newborns.

1. Identify the onset of labour

2. Perform vaginal examination, ensuring the woman’s privacy and safety, and proper conduct by SBA.

3. Monitor maternal and foetal well-being during labour.

4. Provide supportive care.

5. Record maternal and foetal well-being on a partograph.

6. Identify delayed progress in labour and take appropriate action, including referral.

7. Manage a normal vaginal delivery.

8. Effectively manage the third stage of labour, including application of AMTSL where appropriate and initiate early breastfeeding, including skin-to-skin contact.

• Provide culturally sensitive care throughout the full process of labour and birth.

• Assess and record the woman’s general status and condition: vital signs, physical conditions, etc.

• Explain to pregnant women the stages of labour, the reasons for and procedures for vaginal examination during labour.

• Prepare sterilized equipment for vaginal examination.• Perform limited and timely vaginal examinations, to

reduce infection and record findings on partograph or similar record.

• Perform a complete and accurate pelvic examination vaginally with privacy and respect, to assess for dilatation, effacement, descent, presenting part, position, status of membranes, and adequacy of pelvis for birth of baby and record all finding on partograph or similar record.

• Regularly monitor progress of labour: dilatation, effacement, etc. and foetal heart rate and record all findings on partograph or similar record.

• Provide supportive care during labour: Instruction on how to move/lie, breath during labour and delivery, how to relieve pain, psychological support, etc.

• Provide adequate hydration, nutrition and non-pharmacological comfort measures during labour and birth.

• Provide pain relief during labour and birth (by using physical methods, e.g. warm bath and psychological support).

• Allow companion of choice during labour and birth.• Encourage position of choice during labour and birth.• Manage in accordance with national guidelines.• Identify delayed progress in labour, by using the

partograph and clinical signs.• Augment uterine contractility, using pharmacologic

agents (in appropriate birth settings), according to national guidelines.

• Early identification of maternal and foetal distress and take appropriate action, including referral where required.

• Keep the woman and her family/supporter regularly updated about the status of labour and planned management.

• Explain to families/their supporters and mobilize community - for timely referral.

• Assist normal delivery according to best practice.• Perform an episiotomy timely, if indicated.

4 National Standards for Midwives 2015

• Conduct active management of the 3rd stage of labour (AMTSL), including estimation and recording of maternal blood loss.

• Perform fundal massage to stimulate postpartum uterine contraction.

• Perform urine catheterization if indicated.• Make Rapid Assessment and institute management

of obstetrical and newborn emergencies according to national protocols, including: management of cord around the baby’s neck at birth, prolapsed cord and severe maternal and foetal distress, eclampsia, etc.

• Provide immediate essential care of the newborn at birth.

• Recognize signs of asphyxia at birth and take immediate action, including performing newborn resuscitation according to best practices.

• Initiate early breastfeeding including skin-to skin contact.

• Inspect the placenta and membranes for completeness.

• Inspect the vagina and cervix for lacerations and repair 1st and 2nd degree perineal or vaginal lacerations.

• Repair an episiotomy.• Educate women and families to detect early signs

of haemorrhage during the postpartum period and where to seek assistance.

• Perform first line management of postpartum bleeding and haemorrhage, including using uterotonic agents and fundal message.

• Recognize and respond to shock, including insertion of intravenous line, and drawing blood for laboratory tests.

• Perform cardio-pulmonary resuscitation.• Perform manual removal of placenta, in accordance

with national guidelines. (Allow in remote area)• Perform internal bimanual compression of the uterus

to control severe uterine bleeding and perform aortic compression if indicated.

• Arrange for and undertake timely referral and transfer of women with serious complications to a higher level health facility, taking appropriate drugs and equipment and accompanied by a health professional.

5National Standards for Midwives 2015

Competency 4: • Competency 4.1:

Competencies Core functions Skill and/or ability to do as minimum the following:

Competency 4.1:

Provide comprehensive, high quality, culturally sensitive care in postpartum period.

1. Identify haemorrhage and perform management during immediate postpartum period.

2. Provide postnatal care to women.

3. Identify illnesses and conditions detrimental to the health of women in the postnatal period.

4. Provide advice on postpartum family planning.

• Provide culturally sensitive care and support.• Monitor contraction of the uterus, pulse, blood

pressure to early detect haemorrhage during the pospartum period (at least once during the first 6 hours after delivery, first day after delivery, and following days as needed).

• Assess for uterine involution and healing of lacerations and/or repairs. Refer if necessary.

• Perform postnatal screening tests according to national policy.

• Educate woman how to massage the uterus to keep it well-contracted.

• Explain to woman and her family about life-threatening situations if they arise, and management procedures.

• Provide education on self-care, nutrition, personal hygiene, breastfeeding and sexual relations.

• Provide support for women and their families who are bereaved (stillbirth, pregnancy loss, neonatal death, congenital abnormalities).

• Detect and manage abnormal conditions in the postnatal period, including eclampsia, breast complications, sepsis, psychological disorder, urinary tract infections, etc.

• Teach women and families on early detection of abnormal signs in postnatal period: eclampsia, breast complications, sepsis, psychological disorder, urinary tract infections etc.

• Administer, life saving drugs according to national guidelines (e.g. antibiotics, anticonvulsants, anti -malarials, antihypertensive, anti-retroviral).

• Make arrangements for timely referral and apply management as per national protocols.

• Counsel couples on the importance of family planning/ birth spacing after delivery, as well as appropriate contraceptives that can be used during breast feeding period.

• Provide family planning services concurrently, as an integral component of postpartum care.

• Competency 4.2:Competencies Core functions Skill and/or ability to do as minimum the following:

Competency 4.2:

Provide high quality, culturally sensitive, post- abortion care.

1. Detect signs of miscarriage and provide emergency management.

2. Provide post abortion family planning counseling and services.

• Diagnose miscarriage.• Insert IV line. (in life-saving condition)• Accompany the patient to the health facility.• Perform evacuation of retained products of

conception according to national guidelines.• Provide psychological support.• Provide post- abortion family planning counseling

and service according to national guidelines.

6 National Standards for Midwives 2015

Competency 5:Competencies Core functions Skill and/or ability to do as minimum the following:

Competency 5:

Provide high-quality, comprehensive care for the healthy infant from birth to two months of age.

1. Assess the newborn at birth and give immediate care.

2. Identify any life threatening conditions in the newborn and give essential lifesaving measures, including, where necessary, active resuscitation as a component of the management of birth asphyxia, and referral where appropriate.

3. Assist women and their families in initiating, establishing and maintaining exclusive breastfeeding, including providing education on benefits of early exclusive breastfeeding and seeking assistance early for breast feeding difficulties.

4. Educate women and their families on benefits of early exclusive breastfeeding.

5. Provide monitoring and care for the infant in the first two months.

• Provide immediate care to the newborn, including: dry the new born; place in skin-to-skin contact on mother’s abdomen or chest and cover to keep baby warm; suctioning (if needed); cord clamping and cutting when pulsation ceases.

• Take steps to prevent infection.• Assess the immediate condition of the newborn

(e.g., APGAR scoring or rapid assessment method: breathing, colour of the skin and heart rate).

• Promote and maintain normal newborn body temperature through skin-to -skin contact (e.g., blanket, cap), and environmental control (e.g. warmer).

• Provide routine care of the newborn, in accordance with national guidelines and protocols (e.g., identification, eye care, screening tests, administration of Vitamin K, HBV, BCG and need for birth registration.

• Perform newborn screening.• Identify congenital abnormalities and initiate

appropriate and timely intervention.• Identify respiratory distress in the newborn by

rapid assessment by breathing, skin colour and heart rate, and perform in-line management.

• Perform emergency newborn resuscitation: Suction (in case of airway obstruction) Ventilation with bag and mask/tube and mask Chest compression. Make arrangements for timely and effective referral

• Explain to women and their families about the importance of breastfeeding.

• Initiate and support early breastfeeding (within the first hour).

• Teach mothers how to express breast milk, and how to handle and store expressed breast milk.

• Teach mothers how to breastfeed and maintain successful breastfeeding.

• Give appropriate care including, kangaroo mother care for the low birth weight baby, and arrange for referral if potentially serious complications arise, or if very low birth weight.

• Detect and teach mothers on early detection of abnormal signs of newborn in postnatal period: eyes, complexion, digestion, umbilical cord, etc.

• Recognize complications in the infant, stabilize and transfer high-risk infant to emergency care facility accompanied by health professional and mother.

• Make arrangements for timely effective referral• Monitor the growth and development of the infant.• Perform immunization according to national

immunization schedule.• Provision of counseling and appropriate

intervention on transmitted infection for PMCT.

7National Standards for Midwives 2015

Competency 6:Competencies Core functions Skill and/or ability to do as minimum the following:

Competency 6

Provide high quality, culturally sensitive health education and services to all in the community, to promote healthy family life, planned pregnancies and positive parenting.

1. Educate women and their families on how to prevent sexually transmitted infections including HIV.

2. Supervise non-skilled attendants, including TBAs where they exist, in order to ensure that the care they provide during pregnancy, childbirth and early postpartum period is of sound quality.

3. Collect, analyze and report relevant data of women and their newborns.

4. Promote an ethos of shared responsibility and partnership with individual women, their family members and the community for the care of women and newborns throughout pregnancy, childbirth and the postnatal period.

• Educate and communicate with women and their families on the benefits of regular check- up/medical examination.

• Educate women and their families on risk factors of sexually transmitted infections and how to prevent sexually transmitted infections.

• Educate members of the community on how to recognize sexually transmitted infections/ reproductive tract infections and seek health care.

• Educate families and communities on dangers of early teenage pregnancies.

• Promote benefits of planned pregnancies.• Identify birth attendants who are not yet SBAs,

including TBAs where they exist (numbers, workplace).

• Work in partnership with non-skilled attendants to identify pregnant women and encourage them to seek antenatal care, safe delivery and postnatal care with skilled health professionals.

• Educate non-skilled attendants on practices to avoid during pregnancy, delivery and postnatal period.

• Collect, report data (for maternal, newborn and child only) on a monthly, quarterly and yearly basis, as the national reporting guidelines dictate.

• Analyse relevant data on women and their newborns and share findings with communities to promote good health care practice (evidence-based practices).

• Promote partnership with colleagues to provide high-quality Maternal and Newborn Health care in health facilities: manage and provide comprehensive health care, provide adequate information on maternal and newborn care.

• Promote partnership with the community to provide quality evidence-based home-based care for mothers and newborns.

• Make arrangements for referrals including for emergency care, etc.

• Health education and promotion to families and communities, including community leaders and influencers to promote good maternal and newborn health practices and services.

8 National Standards for Midwives 2015

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9National Standards for Midwives 2015

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ealth

dur

ing

preg

nanc

y th

at in

clud

es e

arly

det

ectio

n an

d tr

eatm

ent a

nd w

here

nee

ded

refe

rral

of s

elec

ted

com

-pl

icati

ons.

Core

func

tions

Attitu

de, s

kill

and/

or a

bilit

y to

per

form

to p

rofic

ienc

y th

e co

re fu

nctio

ns:

Know

ledg

e re

quire

men

t to

perf

orm

skill

s pro

fi-ci

ently

1. T

ake

a de

taile

d hi

stor

y by

ask

ing

rele

vant

qu

estio

ns.

2. A

sses

s in

divi

dual

ne

eds

and

give

ap

prop

riate

adv

ice

and

guid

ance

.

3. P

erfo

rm a

phy

sical

ex

amin

ation

to a

sses

s he

alth

stat

us a

nd

prog

ress

of p

regn

ancy

an

d id

entif

y pr

oble

ms

and

give

app

ropr

iate

tr

eatm

ent a

nd/o

r ref

er.

4. P

erfo

rm a

ppro

pria

te

scre

enin

g te

sts

as

requ

ired.

5. A

ssist

pre

gnan

t w

omen

to m

ake

and

upda

te b

irth

plan

s.

6. E

duca

te w

omen

(and

th

eir f

amili

es a

nd

othe

rs s

uppo

rting

pr

egna

nt w

omen

) in

sel

f-car

e, g

ood

nutr

ition

and

da

nger

sig

ns d

urin

g pr

egna

ncy,

child

birt

h an

d th

e po

stna

tal

perio

d.

• Ta

ke a

n in

itial

and

ong

oing

hist

ory

at e

ach

ante

nata

l visi

t.•

Perf

orm

a p

hysic

al e

xam

inati

on a

nd e

xpla

in fi

ndin

gs to

the

wom

an a

nd

her f

amily

.•

Take

and

ass

ess

mat

erna

l vita

l sig

ns in

clud

ing

tem

pera

ture

, blo

od

pres

sure

, pul

se.

• As

sess

mat

erna

l nut

rition

and

its

rela

tions

hip

to fo

etal

gro

wth

; giv

e ap

prop

riate

adv

ice

on n

utriti

onal

requ

irem

ents

of p

regn

ancy

and

how

to

achi

eve

them

.•

Perf

orm

a c

ompl

ete

abdo

min

al a

sses

smen

t inc

ludi

ng a

sses

smen

t of

fund

al h

eigh

t usin

g m

anua

l mea

sure

men

ts, l

ie, p

ositi

on, a

nd

pres

enta

tion.

• Li

sten

to th

e fo

etal

hea

rt ra

te a

nd d

eter

min

e fo

etal

wel

l-bei

ng a

nd

inte

rpre

t find

ings

and

take

app

ropr

iate

acti

on.

• Ev

alua

te fo

etal

gro

wth

, pla

cent

al lo

catio

n an

d am

nioti

c flu

id v

olum

e,

usin

g ul

tras

ound

visu

aliza

tion

and

mea

sure

men

t (if

equi

pmen

t is

avai

labl

e fo

r use

and

with

in s

cope

of p

racti

ce).

• Pe

rfor

m a

pel

vic

exam

inati

on, i

nclu

ding

siz

ing

the

uter

us, a

nd

dete

rmin

ing

the

adeq

uacy

of t

he b

irth

cana

l.•

Perf

orm

scr

eeni

ng te

sts

for a

naem

ia, H

IV, s

yphi

lis, p

rote

inur

ia o

r any

ot

her t

ests

acc

ordi

ng to

nati

onal

pro

toco

l.•

Take

blo

od to

det

erm

ine

bloo

d gr

oupi

ng, a

nd o

ther

hae

mat

olog

ical

in

vesti

gatio

ns a

s m

ay b

e re

quire

d.•

Adm

inist

er te

tanu

s im

mun

izatio

n ac

cord

ing

to n

ation

al p

roto

cols.

• Re

cord

and

repo

rt a

ll fin

ding

s at

eac

h an

tena

tal v

isit.

• M

ake

deci

sions

bas

ed o

n cl

inic

al fi

ndin

gs a

nd ta

ke a

ppro

pria

te a

ction

in

clud

ing

givi

ng fe

edba

ck to

the

wom

an a

nd fa

mily

and

refe

rral

to h

ighe

r le

vel h

ealth

faci

lities

.•

Assis

t pre

gnan

t wom

en a

nd th

eir f

amili

es in

mak

ing

and

upda

ting

a pl

an

for b

irth.

• M

ake

arra

ngem

ents

for ti

mel

y eff

ectiv

e re

ferr

al.

• Di

scou

rage

har

mfu

l cus

tom

s an

d pr

actic

es.

• Id

entif

y sig

ns a

nd sy

mpt

oms

of o

bste

tric

and

med

ical

con

ditio

ns

detr

imen

tal t

o th

e he

alth

of t

he w

oman

and

foet

us a

nd m

ake

clin

ical

de

cisio

ns b

ased

on

findi

ngs

and

take

app

ropr

iate

acti

on in

clud

ing

givi

ng

first

line

man

agem

ent a

nd m

akin

g eff

ectiv

e re

ferr

al.

• Pr

ovid

e fu

ll co

unse

ling

to th

e w

oman

to a

ccep

t tre

atm

ent a

nd/o

r ref

erra

l ch

eck-

up, m

onito

ring.

Aim

s an

d O

bjec

tives

of A

nten

atal

car

e. D

ecisi

on-m

akin

g sk

ills.

Saf

e M

othe

rhoo

d pr

ogra

mm

e (g

loba

l and

na

tiona

l): in

clud

ing

fact

ors

that

put

chi

ldbe

arin

g w

omen

at r

isk s

uch

as to

o-ea

rly, t

oo-fr

eque

nt

preg

nanc

ies

and

too

shor

t int

erva

ls be

twee

n pr

egna

ncie

s. P

hysio

logy

of m

enst

ruati

on, c

once

ption

and

foet

al

deve

lopm

ent.

Ana

tom

y of

pel

vis.

Nut

rition

al n

eeds

dur

ing

preg

nanc

y. P

hysio

logy

and

man

agem

ent o

f pre

gnan

cy,

incl

udin

g sig

ns a

nd sy

mpt

oms

of p

regn

ancy

an

d no

rmal

psy

chol

ogic

al c

hang

es th

roug

hout

pr

egna

ncy.

Rea

sons

for t

reat

men

ts, i

nclu

ding

sel

f-car

e fo

r m

inor

diso

rder

s of

pre

gnan

cy.

Cau

ses,

sig

ns sy

mpt

oms

and

man

agem

ent o

f bl

eedi

ng in

pre

gnan

cy (e

arly

and

late

). S

igns

, man

agem

ent a

nd p

oten

tial c

onse

quen

ces

of

pre-

ecla

mps

ia a

nd e

clam

psia

. P

hysio

logy

of f

orm

ation

of r

ed b

lood

cel

ls an

d ha

emog

lobi

n. B

lood

gro

upin

g, R

h fa

ctor

, phy

siolo

gica

l im

pact

of

preg

nanc

y on

car

diov

ascu

lar s

yste

m.

Blo

od g

roup

inco

mpa

tibili

ty.

Cau

ses,

sig

ns a

nd sy

mpt

oms,

con

sequ

ence

s an

d m

anag

emen

t of a

nem

ia in

pre

gnan

cy.

Cau

ses,

sig

ns, s

ympt

oms,

con

sequ

ence

s an

d m

anag

emen

t of u

rinar

y tr

act i

nfec

tion

in

preg

nanc

y. I

nfec

tion

prev

entio

n pr

otoc

ols.

Mec

hani

sm o

f acti

on o

f vac

cine

s an

d na

tiona

l im

mun

izatio

n pr

ogra

mm

e. S

igns

, sym

ptom

s an

d tr

eatm

ent f

or te

tanu

s. C

ause

, sig

ns a

nd sy

mpt

oms,

incl

udin

g ho

me-

base

d ca

re fo

r min

or d

isord

ers

of p

regn

ancy

.

10 National Standards for Midwives 2015

7. Id

entif

y ob

stet

ric a

nd

med

ical

con

ditio

ns

detr

imen

tal t

o th

e he

alth

of t

he m

othe

r an

d fe

tus

espe

cial

ly

pre-

ecla

mps

ia,

perf

orm

firs

t-lin

e m

anag

emen

t (in

clud

ing

perf

orm

ance

of l

ife-

savi

ng p

roce

dure

s w

hen

need

ed) a

nd

mak

e ar

rang

emen

ts

for e

ffecti

ve re

ferr

al.

8. A

dmin

ister

m

edic

ation

s

• Ed

ucat

e w

omen

(and

thei

r fam

ilies

and

oth

ers

supp

ortin

g pr

egna

nt

wom

en a

nd n

ewbo

rn) o

n: th

e im

port

ance

of r

egul

ar c

heck

-up

Sel

f and

fam

ily c

are

the

need

for c

reati

ng a

saf

e an

d he

alth

y en

viro

nmen

t•

Coun

selin

g on

the

bene

fits

of e

arly

and

exc

lusiv

e br

eastf

eedi

ng.

sex

ual p

racti

ce d

urin

g pr

egna

ncy

and

after

chi

ldbi

rth

vol

unta

ry fa

mily

pla

nnin

g an

d bi

rth

spac

ing

follo

win

g ch

ildbi

rth

• Ps

ycho

logi

cal s

uppo

rt fo

r mot

her:

norm

al p

sych

olog

ical

cha

nges

in

preg

nanc

y, in

form

ation

abo

ut re

lief o

f com

mon

disc

omfo

rts,

tech

niqu

es

for i

ncre

asin

g re

laxa

tion

and

pain

relie

f mea

sure

s av

aila

ble

for l

abou

r.•

Expl

ain

to th

e w

oman

on

how

to id

entif

y th

e on

set o

f lab

our a

nd n

eed

for

goin

g to

hea

lth fa

cilit

y ea

rly to

allo

w fo

r goo

d m

onito

ring

and

care

dur

ing

labo

ur.

• Em

erge

ncy

prep

ared

ness

and

pre

parin

g fo

r pos

sible

com

mun

ity-b

ased

re

ferr

al: w

ho to

con

tact

, wha

t sup

port

, etc

.•

Perf

orm

firs

t-lin

e m

anag

emen

t (in

clud

ing

perf

orm

ance

of l

ife-s

avin

g pr

oced

ures

whe

n ne

eded

).•

Adm

inist

er te

tanu

s to

xoid

, im

mun

izatio

n, s

uppl

y of

folic

aci

d, F

eSo4

, Vit

B1, d

ewor

min

g, h

ealth

edu

catio

n on

med

icati

ons

durin

g pr

egna

ncy.

Cau

ses,

sig

ns, s

ympt

oms,

con

sequ

ence

s an

d m

anag

emen

t of S

exua

lly T

rans

mitt

ed In

fecti

ons,

in

clud

ing

HIV

/AID

S. I

mpa

ct o

f pov

erty

and

poo

r nut

rition

on

preg

nanc

y an

d fo

etal

dev

elop

men

t. D

rugs

and

pre

gnan

cy, i

nclu

ding

dan

gers

of n

on-

pres

crib

ed a

nd tr

aditi

onal

dru

gs in

pre

gnan

cy.

App

lyin

g he

alth

edu

catio

n ap

proa

ches

in

preg

nanc

y, in

clud

ing

beha

vior

cha

nge

stra

tegi

es

and

impa

ct o

f tra

ditio

nal b

elie

fs o

n he

alth

of

mot

her a

nd c

hild

. P

hysio

logy

of l

acta

tion,

ben

efits

of e

arly

exc

lusiv

e br

eastf

eedi

ng a

nd p

repa

ring

wom

en to

bre

astfe

ed.

Sex

ualit

y an

d se

x in

pre

gnan

cy.

Sig

ns a

nd sy

mpt

oms

of o

nset

of l

abou

r. P

repa

ratio

n fo

r pre

gnan

cy.

Birt

h an

d em

erge

ncy

plan

ning

pro

cess

es.

11National Standards for Midwives 2015

Com

pete

ncy

3:Pr

ovid

e hi

gh q

ualit

y, cu

ltura

lly s

ensiti

ve c

are

durin

g la

bour

, con

duct

a c

lean

and

saf

e bi

rth

and

hand

le s

elec

ted

emer

genc

y sit

uatio

ns t

o m

axim

ize t

he h

ealth

of

wom

en a

nd th

eir n

ewbo

rns.

Core

func

tions

Attitu

de, s

kill

and/

or a

bilit

y to

per

form

to p

rofic

ienc

y th

e co

re fu

nctio

ns:

Know

ledg

e re

quire

men

t to

perf

orm

skill

s pro

fi-ci

ently

1. Id

entif

y th

e on

set o

f la

bour

2. P

erfo

rm v

agin

al

exam

inati

on, e

nsur

ing

the

wom

an’s

priv

acy

and

safe

ty, a

nd p

rope

r co

nduc

t by

SBA.

3. M

onito

r mat

erna

l an

d fo

etal

wel

l-bei

ng

durin

g la

bour

.

4. P

rovi

de s

uppo

rtive

ca

re.

5. R

ecor

d m

ater

nal a

nd

foet

al w

ell-b

eing

on

a pa

rtog

raph

.

6. Id

entif

y de

laye

d pr

ogre

ss in

labo

ur

and

take

app

ropr

iate

ac

tion,

incl

udin

g re

ferr

al.

• Pr

ovid

e cu

ltura

lly s

ensiti

ve c

are

thro

ugho

ut th

e fu

ll pr

oces

s of

labo

ur a

nd

birt

h.•

Asse

ss a

nd re

cord

the

wom

an’s

gene

ral s

tatu

s an

d co

nditi

on: v

ital s

igns

, ph

ysic

al c

ondi

tions

, etc

.•

Expl

ain

to p

regn

ant w

omen

the

stag

es o

f lab

our,

the

reas

ons

for a

nd

proc

edur

es fo

r vag

inal

exa

min

ation

dur

ing

labo

ur.

• Pr

epar

e st

erili

zed

equi

pmen

t for

vag

inal

exa

min

ation

.•

Perf

om li

mite

d an

d tim

ely

vagi

nal e

xam

inati

ons,

to re

duce

infe

ction

and

re

cord

find

ings

on

part

ogra

ph o

r sim

ilar r

ecor

d.•

Perf

orm

a c

ompl

ete

and

accu

rate

pel

vic

exam

inati

on v

agin

ally

with

priv

acy

and

resp

ect,

to a

sses

s fo

r dila

tatio

n, e

fface

men

t, de

scen

t, pr

esen

ting

part

, po

sition

, sta

tus

of m

embr

anes

, and

ade

quac

y of

pel

vis

for b

irth

of b

aby

and

reco

rd a

ll fin

ding

on

part

ogra

ph o

r sim

ilar r

ecor

d.•

Regu

larly

mon

itor p

rogr

ess

of la

bour

: dila

tatio

n, e

fface

men

t, et

c. a

nd fo

etal

he

art r

ate

and

reco

rd a

ll fin

ding

s on

par

togr

aph

or s

imila

r rec

ord.

• Pr

ovid

e su

ppor

tive

care

dur

ing

labo

ur: I

nstr

uctio

n on

how

to m

ove/

lie, b

reat

h du

ring

labo

ur a

nd d

eliv

ery,

how

to re

lieve

pai

n, p

sych

olog

ical

sup

port

, etc

.•

Prov

ide

adeq

uate

hyd

ratio

n, n

utriti

on a

nd n

on-p

harm

acol

ogic

al c

omfo

rt

mea

sure

s du

ring

labo

ur a

nd b

irth.

• Pr

ovid

e pa

in re

lief d

urin

g la

bour

and

birt

h. (b

y us

ing

phys

ical

met

hods

, e.g

. w

arm

bat

h an

d ps

ycho

logi

cal s

uppo

rt)

• Al

low

com

pani

on o

f cho

ice

durin

g la

bour

and

birt

h.•

Enco

urag

e po

sition

of c

hoic

e du

ring

labo

ur a

nd b

irth.

• M

anag

e in

acc

orda

nce

with

nati

onal

gui

delin

es.

• Id

entif

y de

laye

d pr

ogre

ss in

labo

ur, b

y us

ing

the

part

ogra

ph a

nd c

linic

al s

igns

.•

Augm

ent u

terin

e co

ntra

ctilit

y, us

ing

phar

mac

olog

ic a

gent

s (in

app

ropr

iate

bi

rth

setti

ngs)

, acc

ordi

ng to

nati

onal

gui

delin

es.

• Ea

rly id

entifi

catio

n of

mat

erna

l and

feta

l dist

ress

and

take

app

ropr

iate

acti

on,

incl

udin

g re

ferr

al w

here

requ

ired.

• Ke

ep th

e w

oman

and

her

fam

ily/s

uppo

rter

regu

larly

upd

ated

abo

ut th

e st

atus

of

labo

ur a

nd p

lann

ed m

anag

emen

t.•

Expl

ain

to fa

mili

es/t

heir

supp

orte

rs a

nd m

obili

ze c

omm

unity

- for

tim

ely

refe

rral

.•

Assis

t nor

mal

del

iver

y ac

cord

ing

to b

est p

racti

ce.

Aim

s an

d ob

jecti

ves

of c

are

durin

g la

bour

Ana

tom

y of

birt

h ca

nal,

incl

udin

g ce

rvix

, vag

ina

and

pelv

ic fl

oor.

The

pel

vis,

land

mar

ks n

oted

on

pelv

ic

exam

inati

on a

nd p

ossib

le c

onse

quen

ces

on

labo

ur o

utco

mes

for d

iffer

ent t

ypes

and

size

s of

pel

vis.

Phy

siolo

gy o

f lab

our (

all 3

stag

es).

Ide

ntific

ation

and

con

sequ

ence

s of

diff

eren

t fo

etal

pos

ition

s in

labo

ur.

Phy

siolo

gica

l and

psy

chol

ogic

al n

eeds

of t

he

wom

an d

urin

g la

bour

and

chi

ldbi

rth,

incl

udin

g nu

triti

onal

nee

ds a

nd n

eed

for g

ood

hydr

ation

. M

anag

emen

t of l

abou

r (4

stag

es).

Ben

efits

and

use

of p

arto

grap

h. P

ain

relie

f in

labo

ur.

Im

pact

on

mat

erna

l and

foet

al w

ellb

eing

and

bi

rthi

ng p

roce

ss o

f pos

ture

. C

ause

s, s

igns

, sym

ptom

s an

d m

anag

emen

t of

mat

erna

l dist

ress

in la

bour

. C

ause

s, s

igns

, sym

ptom

s an

d m

anag

emen

t of

foet

al d

istre

ss in

labo

ur.

Cau

ses,

sig

ns, s

ympt

oms

and

man

agem

ent o

f pr

olon

ged

labo

ur.

Nati

onal

pro

toco

ls, in

clud

ing

prot

ocol

s fo

r de

alin

g w

ith e

mer

genc

y sit

uatio

ns.

Ben

efits

of u

sing

AMTS

L. C

linic

al in

dica

tions

for u

se o

f epi

sioto

my.

Per

form

ing

an e

pisio

tom

y. T

echn

ique

s fo

r rep

airin

g pe

lvic

lace

ratio

ns a

nd

episi

otom

ies.

Cau

ses,

sig

ns, s

ympt

oms

and

man

agem

ent o

f im

med

iate

/prim

ary

post

-par

tum

hae

mor

rhag

e (P

PPH

).

12 National Standards for Midwives 2015

7. M

anag

e a

norm

al

vagi

nal d

eliv

ery.

8. E

ffecti

vely

man

age

the

third

stag

e of

la

bour

, inc

ludi

ng

appl

icati

on o

f AM

TSL

whe

re a

ppro

pria

te

and

initi

ate

early

br

eastf

eedi

ng,

incl

udin

g sk

in-t

o-sk

in

cont

act.

• Pe

rfor

m a

n ep

isiot

omy

timel

y, if

indi

cate

d.•

Cond

uct a

ctive

man

agem

ent o

f the

3rd

stag

e of

labo

ur (A

MTS

L), i

nclu

ding

es

timati

on a

nd re

cord

ing

of m

ater

nal b

lood

loss

.•

Perf

orm

fund

al m

assa

ge to

stim

ulat

e po

stpa

rtum

ute

rine

cont

racti

on.

• Pe

rfor

m u

rine

cath

eter

izatio

n if

indi

cate

d.•

Mak

e Ra

pid

Asse

ssm

ent a

nd in

stitu

te m

anag

emen

t of o

bste

tric

al

and

new

born

em

erge

ncie

s ac

cord

ing

to n

ation

al p

roto

cols,

incl

udin

g:

man

agem

ent o

f cor

d ar

ound

the

baby

’s ne

ck a

t birt

h, p

rola

psed

cor

d an

d se

vere

mat

erna

l and

foet

al d

istre

ss, e

clam

psia

, etc

.•

Prov

ide

imm

edia

te e

ssen

tial c

are

of th

e ne

wbo

rn a

t birt

h.•

Reco

gnize

sig

ns o

f asp

hyxi

a at

birt

h an

d ta

ke im

med

iate

acti

on, i

nclu

ding

pe

rfor

min

g ne

wbo

rn re

susc

itatio

n ac

cord

ing

to b

est p

racti

ces.

• In

itiat

e ea

rly b

reas

tfeed

ing

incl

udin

g sk

in-t

o sk

in c

onta

ct.

• In

spec

t the

pla

cent

a an

d m

embr

anes

for c

ompl

eten

ess.

• In

spec

t the

vag

ina

and

cerv

ix fo

r lac

erati

ons

and

repa

ir 1st

and

2nd

deg

ree

perin

eal o

r vag

inal

lace

ratio

ns.

• Re

pair

an e

pisio

tom

y.•

Educ

ate

wom

en a

nd fa

mili

es to

det

ect e

arly

sig

ns o

f hae

mor

rhag

e du

ring

the

post

part

um p

erio

d an

d w

here

to s

eek

assis

tanc

e.•

Perf

orm

firs

t lin

e m

anag

emen

t of p

ostp

artu

m b

leed

ing

and

haem

orrh

age,

in

clud

ing

usin

g ut

erot

onic

age

nts

and

fund

al m

essa

ge.

• Re

cogn

ize a

nd re

spon

d to

sho

ck, i

nclu

ding

inse

rtion

of i

ntra

veno

us li

ne, a

nd

draw

ing

bloo

d fo

r lab

orat

ory

test

s.•

Perf

orm

car

dio-

pulm

onar

y re

susc

itatio

n.•

Perf

orm

man

ual r

emov

al o

f pla

cent

a, in

acc

orda

nce

with

nati

onal

gui

delin

es.

(Allo

w in

rem

ote

area

s)•

Perf

orm

inte

rnal

bim

anua

l com

pres

sion

of th

e ut

erus

to c

ontr

ol s

ever

e ut

erin

e bl

eedi

ng a

nd p

erfo

rm a

ortic

com

pres

sion

if in

dica

ted.

• Ar

rang

e fo

r and

und

erta

ke ti

mel

y re

ferr

al a

nd tr

ansf

er o

f wom

en w

ith s

erio

us

com

plic

ation

s to

a h

ighe

r lev

el h

ealth

faci

lity,

taki

ng a

ppro

pria

te d

rugs

and

eq

uipm

ent a

nd a

ccom

pani

ed b

y a

heal

th p

rofe

ssio

nal.

Rec

ogni

tion

and

man

agem

ent o

f sho

ck,

parti

cula

rly fi

rst-l

ine

life

savi

ng m

easu

res.

Im

pact

of l

abou

r and

birt

h on

foet

us.

Ada

ptati

on o

f the

foet

us to

ext

ra-u

terin

e lif

e:

incl

udin

g ca

uses

and

sig

ns o

f birt

h as

phyx

ia

and

hypo

ther

mia

. M

anag

emen

t of e

mer

genc

y sit

uatio

ns in

the

new

born

at b

irth.

Exa

min

ation

of t

he p

lace

nta,

cor

d an

d m

embr

anes

. C

ause

s, s

igns

and

man

agem

ent o

f ret

aine

d pl

acen

ta a

nd/o

r mem

bran

es.

13National Standards for Midwives 2015

Com

pete

ncy

4:

Prov

ide

com

preh

ensiv

e, h

igh

qual

ity, c

ultu

rally

sen

sitive

car

e in

pos

tpar

tum

per

iod.

Pro

vide

hig

h qu

ality

, cul

tura

lly s

ensiti

ve, p

ost a

borti

on c

are.

• Co

mpe

tenc

y 4.

1:

Prov

ide

com

preh

ensiv

e, h

igh

qual

ity, c

ultu

rally

sen

sitive

car

e in

pos

tpar

tum

per

iod.

Core

func

tions

Attitu

de, s

kill

and/

or a

bilit

y to

per

form

to p

rofic

ienc

y th

e co

re fu

nctio

ns:

Know

ledg

e re

quire

men

t to

perf

orm

skill

s pro

ficie

ntly

1. Id

entif

y ha

emor

rhag

e an

d pe

rfor

m

man

agem

ent

durin

g im

med

iate

po

stpa

rtum

per

iod.

2. P

rovi

de p

ostn

atal

ca

re to

wom

en.

3. Id

entif

y ill

ness

es

and

cond

ition

s de

trim

enta

l to

the

heal

th o

f wom

en

in th

e po

stna

tal

perio

d.

4. P

rovi

de a

dvic

e on

po

stpa

rtum

fam

ily

plan

ning

.

• Pr

ovid

e cu

ltura

lly s

ensiti

ve c

are

and

supp

ort.

• M

onito

r con

trac

tion

of th

e ut

erus

, pul

se, b

lood

pre

ssur

e to

ear

ly d

etec

t ha

emor

rhag

e du

ring

the

posp

artu

m p

erio

d (a

t lea

st o

nce

durin

g th

e fir

st 6

ho

urs

after

del

iver

y, fir

st d

ay a

fter d

eliv

ery,

and

follo

win

g da

ys a

s ne

eded

).•

Asse

ss fo

r ute

rine

invo

lutio

n an

d he

alin

g of

lace

ratio

ns a

nd/o

r rep

airs

. •

Perf

orm

pos

tnat

al s

cree

ning

test

s ac

cord

ing

to n

ation

al p

olic

y.•

Educ

ate

wom

an o

n ho

w to

mas

sage

the

uter

us to

kee

p it

wel

l-con

trac

ted.

• Ex

plai

n to

wom

an a

nd h

er fa

mily

abo

ut li

fe-t

hrea

teni

ng s

ituati

ons

if th

ey

arise

, and

man

agem

ent p

roce

dure

s.•

Prov

ide

educ

ation

on

self-

care

, nut

rition

, per

sona

l hyg

iene

, bre

astfe

edin

g an

d se

xual

rela

tions

. •

Prov

ide

supp

ort f

or w

omen

and

thei

r fam

ilies

who

are

ber

eave

d (s

tillb

irth,

pr

egna

ncy

loss

, neo

nata

l dea

th, c

onge

nita

l abn

orm

aliti

es).

• De

tect

and

man

age

abno

rmal

con

ditio

ns in

the

post

nata

l per

iod,

incl

udin

g ec

lam

psia

, bre

ast c

ompl

icati

ons,

sep

sis, p

sych

olog

ical

diso

rder

, urin

ary

trac

t inf

ectio

ns, e

tc.

• Te

ach

wom

en a

nd fa

mili

es o

n ea

rly d

etec

tion

of a

bnor

mal

sig

ns in

po

stna

tal p

erio

d: e

clam

psia

, bre

ast c

ompl

icati

ons,

sep

sis, p

sych

olog

ical

di

sord

er, u

rinar

y tr

act i

nfec

tions

etc

.•

Adm

inist

er, l

ife-s

avin

g dr

ugs

acco

rdin

g to

nati

onal

gui

delin

es (e

.g.

antib

iotic

s, a

ntico

nvul

sant

s, a

nti -m

alar

ials,

anti

hype

rten

sive,

an

ti-re

trov

iral).

• M

ake

arra

ngem

ents

for ti

mel

y re

ferr

al a

nd a

pply

firs

t-lin

e m

anag

emen

t as

per n

ation

al p

roto

cols.

• Co

unse

l cou

ples

on

the

impo

rtan

ce o

f fam

ily p

lann

ing/

birt

h sp

acin

g aft

er

deliv

ery,

as w

ell a

s ap

prop

riate

con

trac

eptiv

es th

at c

an b

e us

ed d

urin

g br

east

feed

ing

perio

d.•

Prov

ide

fam

ily p

lann

ing

serv

ices

con

curr

ently

, as

an in

tegr

al c

ompo

nent

of

post

part

um c

are.

Aim

s an

d ob

jecti

ves

of p

ostn

atal

car

e. P

hysio

logi

cal c

hang

es in

the

body

imm

edia

tely

afte

r bi

rth.

Phy

siolo

gica

l cha

nges

in p

ostp

artu

m p

erio

d: in

clud

ing

proc

ess

of in

volu

tion

and

reco

mm

ence

men

t of

men

ses.

Man

agem

ent o

f pos

tpar

tum

per

iod,

incl

udin

g na

tiona

l pro

toco

ls fo

r pos

tnat

al c

are.

Risk

fact

ors

in p

ostp

artu

m p

erio

d. R

ecog

nitio

n an

d m

anag

emen

t of m

inor

diso

rder

s aft

er b

irth,

incl

udin

g br

east

eng

orge

men

t. R

ecog

nitio

n an

d m

anag

emen

t of m

ajor

com

plic

ation

s aft

er b

irth,

incl

udin

g ha

emor

rhag

e, s

epsis

, dee

p ve

in

thro

mbo

sis a

nd U

TI.

Use

of l

ife-s

avin

g m

edic

ines

in th

e po

stna

tal p

erio

d. S

igns

, sym

ptom

s an

d m

anag

emen

t of p

hysio

logi

cal

diso

rder

s aft

er b

irth,

incl

udin

g “b

aby-

blue

s”,

post

nata

l dep

ress

ion

and

post

nata

l psy

chos

is. E

stab

lishm

ent a

nd m

aint

enan

ce o

f lac

tatio

n. F

amily

Pla

nnin

g M

etho

ds a

nd s

ervi

ces,

incl

udin

g na

tura

l met

hods

, Lac

tatio

nal A

men

orrh

oea

Met

hod

(LAM

). H

ealth

edu

catio

n fo

r pos

tnat

al w

omen

.

14 National Standards for Midwives 2015

• Co

mpe

tenc

y 4.

2:

Prov

ide

high

qua

lity,

cultu

rally

sen

sitive

, pos

t- ab

ortio

n ca

re.

Core

func

tions

Attitu

de, s

kill

and/

or a

bilit

y to

per

form

to p

rofic

ienc

y th

e co

re fu

nctio

ns:

Know

ledg

e re

quire

men

t to

perf

orm

skill

s pro

ficie

ntly

1. D

etec

t sig

ns o

f m

iscar

riage

and

pr

ovid

e em

erge

ncy

man

agem

ent.

2. P

rovi

de p

ost

abor

tion

fam

ily

plan

ning

co

unse

ling

and

serv

ices

.

• Di

agno

se m

iscar

riage

.•

Inse

rt IV

line

. (in

life

-sav

ing

cond

ition

)•

Acco

mpa

ny th

e pa

tient

to th

e he

alth

faci

lity.

• Pe

rfor

m e

vacu

ation

of r

etai

ned

prod

ucts

of c

once

ption

acc

ordi

ng to

na

tiona

l gui

delin

es.

• Pr

ovid

e ps

ycho

logi

cal s

uppo

rt.

• Pr

ovid

e po

st- a

borti

on fa

mily

pla

nnin

g co

unse

ling

and

serv

ice

acco

rdin

g to

na

tiona

l gui

delin

es.

Aim

s an

d ob

jecti

ves

of p

ost-a

borti

on c

are.

Ble

edin

g in

ear

ly p

regn

ancy

, inc

ludi

ng m

olar

pr

egna

ncy.

Cau

ses

of e

arly

pre

gnan

cy lo

ss, i

nclu

ding

hab

itual

ab

ortio

n. R

ecog

nitio

n of

sig

ns o

f misc

arria

ge (c

ompl

ete

and

inco

mpl

ete)

and

imm

edia

te li

fe-s

avin

g m

easu

res.

Ect

opic

pre

gnan

cy, i

nclu

ding

reco

gniti

on a

nd

man

agem

ent.

Phy

sical

and

psy

chol

ogic

al im

pact

of e

arly

pre

gnan

cy

loss

. M

anag

emen

t pro

toco

ls fo

r pos

t-abo

rtion

car

e (P

AC).

Pos

t-abo

rtion

cou

nsel

ing.

Pos

t-abo

rtion

fam

ily p

lann

ing.

Pre

gnan

cy fo

llow

ing

misc

arria

ge/e

arly

pre

gnan

cy

loss

.

Com

pete

ncy

5:Pr

ovid

e hi

gh-q

ualit

y, co

mpr

ehen

sive

care

for t

he h

ealth

y in

fant

from

birt

h to

two

mon

ths

of a

ge.

Core

func

tions

Attitu

de, s

kill

and/

or a

bilit

y to

per

form

to p

rofic

ienc

y th

e co

re fu

nctio

ns:

Know

ledg

e re

quire

men

t to

perf

orm

skill

s pro

ficie

ntly

1. A

sses

s th

e ne

wbo

rn a

t bi

rth

and

give

im

med

iate

car

e.

• Pr

ovid

e im

med

iate

car

e to

the

new

born

, inc

ludi

ng: d

ry th

e ne

w b

orn;

pl

ace

in s

kin-

to-s

kin

cont

act o

n m

othe

r’s a

bdom

en o

r che

st a

nd c

over

to

keep

bab

y w

arm

; suc

tioni

ng (i

f nee

ded)

; cor

d cl

ampi

ng a

nd c

utting

whe

n pu

lsatio

n ce

ases

.•

Take

step

s to

pre

vent

infe

ction

.•

Asse

ss th

e im

med

iate

con

ditio

n of

the

new

born

(e.g

., AP

GAR

sco

ring

or

rapi

d as

sess

men

t met

hod:

bre

athi

ng, c

olou

r of t

he s

kin

and

hear

t rat

e).

• Pr

omot

e an

d m

aint

ain

norm

al n

ewbo

rn b

ody

tem

pera

ture

thro

ugh

skin

-to

-ski

n co

ntac

t (e.

g., b

lank

et, c

ap),

and

envi

ronm

enta

l con

trol

(e.g

. war

mer

).•

Prov

ide

routi

ne c

are

of th

e ne

wbo

rn, i

n ac

cord

ance

with

nati

onal

gu

idel

ines

and

pro

toco

ls (e

.g.,

iden

tifica

tion,

eye

car

e, s

cree

ning

test

s,

adm

inist

ratio

n of

Vita

min

K, H

BV, B

CG a

nd n

eed

for b

irth

regi

stra

tion.

Aim

s an

d ob

jecti

ves

of n

ewbo

rn c

are.

Phy

siolo

gica

l nee

ds o

f the

new

born

at b

irth.

Ben

efits

of s

kin-

to-s

kin

cont

act.

The

rmor

egul

ation

pro

cess

in n

ewbo

rn.

Exa

min

ation

of t

he n

ewbo

rn a

t birt

h, in

clud

ing

use

of

APG

AR o

r oth

er s

corin

g sy

stem

. C

ause

s, re

cogn

ition

and

man

agem

ent o

f asp

hyxi

a at

bi

rth.

New

born

resu

scita

tion

met

hods

. C

ause

s, re

cogn

ition

and

man

agem

ent a

nd p

reve

ntion

of

hyp

othe

rmia

, inc

ludi

ng d

iffer

ent t

echn

ique

s fo

r w

arm

ing

new

born

with

low

tem

pera

ture

.

15National Standards for Midwives 2015

2. Id

entif

y an

y lif

e th

reat

enin

g co

nditi

ons

in th

e ne

wbo

rn a

nd g

ive

esse

ntial

life

savi

ng

mea

sure

s,

incl

udin

g, w

here

ne

cess

ary,

activ

e re

susc

itatio

n as

a

com

pone

nt o

f th

e m

anag

emen

t of

birt

h as

phyx

ia,

and

refe

rral

whe

re

appr

opria

te.

3. A

ssist

wom

en

and

thei

r fam

ilies

in

initi

ating

, es

tabl

ishin

g an

d m

aint

aini

ng

excl

usiv

e br

eastf

eedi

ng,

incl

udin

g pr

ovid

ing

educ

ation

on

bene

fits

of

early

exc

lusiv

e br

eastf

eedi

ng a

nd

seek

ing

assis

tanc

e ea

rly fo

r bre

ast

feed

ing

diffi

culti

es.

4. E

duca

te w

omen

an

d th

eir f

amili

es

on b

enefi

ts o

f ea

rly e

xclu

sive

brea

stfee

ding

.

5. P

rovi

de m

onito

ring

and

care

for t

he

infa

nt in

the

first

tw

o m

onth

s.

• Pe

rfor

m n

ewbo

rn s

cree

ning

.•

Iden

tify

cong

enita

l abn

orm

aliti

es a

nd in

itiat

e ap

prop

riate

and

tim

ely

inte

rven

tion.

• Id

entif

y re

spira

tory

dist

ress

in th

e ne

wbo

rn b

y ra

pid

asse

ssm

ent b

y br

eath

ing,

ski

n co

lour

and

hea

rt ra

te, a

nd p

erfo

rm in

-line

man

agem

ent.

• Pe

rfor

m e

mer

genc

y ne

wbo

rn re

susc

itatio

n: S

uctio

n (in

cas

e of

airw

ay o

bstr

uctio

n) V

entil

ation

with

bag

and

mas

k/tu

be a

nd m

ask

Che

st c

ompr

essio

n. M

ake

arra

ngem

ents

for ti

mel

y an

d eff

ectiv

e re

ferr

al•

Expl

ain

to w

omen

and

thei

r fam

ilies

abo

ut th

e im

port

ance

of

brea

stfee

ding

.•

Initi

ate

and

supp

ort e

arly

bre

astfe

edin

g (w

ithin

the

first

hou

r).

• Te

ach

mot

hers

how

to e

xpre

ss b

reas

t milk

, and

how

to h

andl

e an

d st

ore

expr

esse

d br

east

milk

.•

Teac

h m

othe

rs h

ow to

bre

astfe

ed a

nd m

aint

ain

succ

essf

ul b

reas

tfeed

ing.

• G

ive

appr

opria

te c

are

incl

udin

g, k

anga

roo

mot

her c

are

for t

he lo

w b

irth

wei

ght b

aby,

and

arra

nge

for r

efer

ral i

f pot

entia

lly s

erio

us c

ompl

icati

ons

arise

, or i

f ver

y lo

w b

irth

wei

ght.

• De

tect

and

teac

h m

othe

rs o

n ea

rly d

etec

tion

of a

bnor

mal

sig

ns o

f new

born

in

pos

tnat

al p

erio

d: e

yes,

com

plex

ion,

dig

estio

n, u

mbi

lical

cor

d, e

tc.

• Re

cogn

ize c

ompl

icati

ons

in th

e in

fant

, sta

biliz

e an

d tr

ansf

er h

igh-

risk

infa

nt

to e

mer

genc

y ca

re fa

cilit

y ac

com

pani

ed b

y he

alth

pro

fess

iona

l and

mot

her.

• M

ake

arra

ngem

ents

for ti

mel

y eff

ectiv

e re

ferr

al•

Mon

itor t

he g

row

th a

nd d

evel

opm

ent o

f the

infa

nt.

• Pe

rfor

m im

mun

izatio

n ac

cord

ing

to n

ation

al im

mun

izatio

n sc

hedu

le.

• Pr

ovisi

on o

f cou

nsel

ing

and

appr

opria

te in

terv

entio

n on

tran

smitt

ed

infe

ction

for P

MCT

.

Kan

garo

o m

etho

d of

nur

sing

new

born

. R

ecog

nitio

n an

d im

med

iate

man

agem

ent o

f obv

ious

co

ngen

ital a

bnor

mal

ities

, inc

ludi

ng in

stitu

ting

lifes

avin

g m

easu

res.

Cau

ses,

reco

gniti

on a

nd m

anag

emen

t of l

ow b

irth

wei

ght a

nd p

rete

rm n

ewbo

rn.

Nati

onal

pol

icie

s an

d pr

otoc

ols

for n

ewbo

rn c

are,

in

clud

ing

natio

nal v

acci

natio

n pr

ogra

mm

e. S

cree

ning

test

s in

firs

t tw

o m

onth

s of

life

. N

orm

al d

evel

opm

ent i

n fir

st tw

o m

onth

s of

life

. C

ause

s, re

cogn

ition

and

man

agem

ent,

incl

udin

g sa

fe h

ome-

care

rem

edie

s w

here

pos

sible

, for

co

mpl

icati

ons

that

can

occ

ur in

firs

t tw

o m

onth

s of

lif

e. R

ecog

nitio

n of

hig

h ris

k ne

onat

e. P

roto

col f

or e

ffecti

ve re

ferr

al fr

om h

ome/

com

mun

ity

to fa

cilit

y an

d in

faci

lity

for h

ighe

r lev

el c

are.

Bar

riers

to s

ucce

ssfu

l bre

astfe

edin

g. F

eedi

ng c

ompl

icati

ons

and

how

to o

verc

ome

them

.

16 National Standards for Midwives 2015

Com

pete

ncy

6Pr

ovid

e hi

gh q

ualit

y, cu

ltura

lly s

ensiti

ve h

ealth

edu

catio

n an

d se

rvic

es t

o al

l in

the

com

mun

ity, t

o pr

omot

e he

alth

y fa

mily

life

, pla

nned

pre

gnan

cies

and

pos

itive

pa

renti

ng.

Core

func

tions

Attitu

de, s

kill

and/

or a

bilit

y to

per

form

to p

rofic

ienc

y th

e co

re fu

nctio

ns:

Know

ledg

e re

quire

men

t to

perf

orm

skill

s pro

ficie

ntly

1. E

duca

te w

omen

and

th

eir f

amili

es o

n ho

w

to p

reve

nt s

exua

lly

tran

smitt

ed in

fecti

ons

incl

udin

g H

IV.

2. S

uper

vise

non

-ski

lled

atten

dant

s, in

clud

ing

TBAs

whe

re th

ey

exist

, in

orde

r to

ensu

re th

at th

e ca

re

they

pro

vide

dur

ing

preg

nanc

y, ch

ildbi

rth

and

early

pos

tpar

tum

pe

riod

is of

sou

nd

qual

ity.

3. C

olle

ct, a

naly

ze a

nd

repo

rt re

leva

nt d

ata

of w

omen

and

thei

r ne

wbo

rns.

4. P

rom

ote

an e

thos

of

shar

ed re

spon

sibili

ty

and

part

ners

hip

with

indi

vidu

al

wom

en, t

heir

fam

ily

mem

bers

and

the

com

mun

ity fo

r the

ca

re o

f wom

en a

nd

new

born

s thr

ough

out

preg

nanc

y, ch

ildbi

rth

and

the

post

nata

l pe

riod.

• Ed

ucat

e an

d co

mm

unic

ate

with

wom

en a

nd th

eir f

amili

es o

n th

e be

nefit

s of

regu

lar c

heck

- up/

med

ical

exa

min

ation

.•

Educ

ate

wom

en a

nd th

eir f

amili

es o

n ris

k fa

ctor

s of

sex

ually

tran

smitt

ed

infe

ction

s an

d ho

w to

pre

vent

sex

ually

tran

smitt

ed in

fecti

ons.

• Ed

ucat

e m

embe

rs o

f the

com

mun

ity o

n ho

w to

reco

gnize

sex

ually

tr

ansm

itted

infe

ction

s/ re

prod

uctiv

e tr

act i

nfec

tions

and

see

k he

alth

ca

re.

• Ed

ucat

e fa

mili

es a

nd c

omm

uniti

es o

n da

nger

s of

ear

ly te

enag

e pr

egna

ncie

s.•

Prom

ote

bene

fits

of p

lann

ed p

regn

anci

es.

• Id

entif

y bi

rth

atten

dant

s w

ho a

re n

ot y

et S

BAs,

incl

udin

g TB

As w

here

th

ey e

xist

(num

bers

, wor

kpla

ce).

• W

ork

in p

artn

ersh

ip w

ith n

on-s

kille

d att

enda

nts

to id

entif

y pr

egna

nt

wom

en a

nd e

ncou

rage

them

to s

eek

ante

nata

l car

e, s

afe

deliv

ery

and

post

nata

l car

e w

ith s

kille

d he

alth

pro

fess

iona

ls.•

Educ

ate

non-

skill

ed a

tten

dant

s on

pra

ctice

s to

avo

id d

urin

g pr

egna

ncy,

deliv

ery

and

post

nata

l per

iod.

• Co

llect

, rep

ort d

ata

(for m

ater

nal,

new

born

and

chi

ld o

nly)

on

a m

onth

ly, q

uart

erly

and

yea

rly b

asis,

as

the

natio

nal r

epor

ting

guid

elin

es

dict

ate.

• An

alys

e re

leva

nt d

ata

on w

omen

and

thei

r new

born

s an

d sh

are

findi

ngs

with

com

mun

ities

to p

rom

ote

good

hea

lth c

are

prac

tice

(evi

denc

e-ba

sed

prac

tices

).•

Prom

ote

part

ners

hip

with

col

leag

ues

to p

rovi

de h

igh-

qual

ity m

ater

nal

and

new

born

hea

lth c

are

in h

ealth

faci

lities

: man

age

and

prov

ide

com

preh

ensiv

e he

alth

car

e, p

rovi

de a

dequ

ate

info

rmati

on o

n m

ater

nal

and

new

born

car

e.•

Prom

ote

part

ners

hip

with

the

com

mun

ity to

pro

vide

qua

lity

evid

ence

-ba

sed

hom

e-ba

sed

care

for m

othe

rs a

nd n

ewbo

rns.

• M

ake

arra

ngem

ents

for r

efer

rals

incl

udin

g fo

r em

erge

ncy

care

, etc

.•

Hea

lth e

duca

tion

and

prom

otion

to fa

mili

es a

nd c

omm

uniti

es, i

nclu

ding

co

mm

unity

lead

ers

and

influ

ence

rs to

pro

mot

e go

od m

ater

nal a

nd

new

born

hea

lth p

racti

ces

and

serv

ices

.

Hea

lth p

rom

otion

tech

niqu

es.

Dev

elop

ing

a co

mm

unity

pro

file,

incl

udin

g id

entifi

catio

n of

sou

rces

of i

nfor

mati

on a

nd s

uppo

rt

to w

omen

of r

epro

ducti

ve a

ge.

Mak

ing

com

mun

ity p

lans

for e

mer

genc

y ev

acua

tion

of w

omen

and

new

born

s to

Em

ON

C fa

cilit

y. V

ital s

tatis

tics.

Ben

efits

of b

irth

and

deat

h re

gist

ratio

n. P

roto

col f

or n

otific

ation

of m

ater

nal o

r neo

nata

l de

ath

or sti

llbirt

h. A

ffecti

ng c

hang

e. S

kills

trai

ning

met

hodo

logi

es.

Dev

elop

ing

trai

ning

pla

ns.

Wor

k pl

anni

ng.

Rec

ord

keep

ing.

Adv

ocac

y m

odel

s. T

eam

wor

k. C

reati

ng a

hea

lthy

wor

k en

viro

nmen

t, in

clud

ing

heal

th a

nd s

afet

y at

wor

k.

17National Standards for Midwives 2015

STANDARDS FOR MIDWIFERY TRAINING PROGRAMMES

1. Types of training

Two types of training are recognized as applicable in Myanmar:

1.1. Standards for midwives as part of an initial pre-service programme (e.g. for nursing or mid-wifery).1.2. Standards for midwives as integral to a recognized post-basic nursing programme to obtain an additional License/Certification/Registration (e.g.: as a midwife/nurse-midwife)

2. Admission requirements

Type 1 and 2: determined by national regulations depending on the type of programme.Regardless of type of training, on completion of any of above, the health providers must be able to demonstrate they have all the required competencies of Standards in Myanmar. As such they should be able to demonstrate they have:

-The requisite knowledge and skills to be able to perform all the core functions as defined in re-quirement for core competencies of midwives in Myanmar.-The required professional and ethical attitude to practice maternal and newborn care for safe motherhood while respecting human rights, dignity and the cultural values of the mother’s locality.

3. Standards for training programmes

3.1. All training programmes should be competency–based.3.2. All courses should provide minimum of 50% clinical practice for type 1 and type 2 should be a minimum of 70%. 3.3. For the minimum number of cases during the training, see Annex 1.

18 National Standards for Midwives 2015

REQUIREMENTS FOR TRAINING INSTITUTIONS

Based on global standards for initial education of professional nurses and midwives (for pre-service training), and standards of good practice for nursing and midwifery education, all training institutions wishing to prepare midwives/ nurse-midwives must meet minimum requirements as described below.

1. Teaching staff• Teaching staff/Trainee ratioFor classroom teaching, the minimum standard teacher to student ratio is 1:20.For skills laboratory, the minimum standard teacher to student ratio is 1:5 for simulation practices.For clinical practice, the minimum standard teacher/clinical preceptor or mentor to student ratio is 1:4.

• Qualifications of Teaching StaffMust hold a recognized professional qualification in the subject they are teaching.Must have undertaken a preparation for Training of Trainers (TOT).Must have undertaken recent (within the last 3-5 years) professional updating.

In addition to small group teaching and clinical training, teaching staff also have the responsibility of supervising, coaching and mentoring of trainees.

2. Training programme and materials2.1. The training institution must develop a specific training programme including curriculum and teaching and learning materials based on the minimum competencies and the standard for train-ing programme of this guideline.

2.2. All teaching and learning materials must be suitable for competency-based training – both theory and practicum. The materials need to be evidence-based with up-to-date information on health promotion, obstetrics and newborn care.

3. Required infrastructure and equipment3.1. Standards for Type 1 and Type 2 training will be defined according to national regulations.

A large classroom with at least 2M2/participant that is fully equipped with audiovisual equipment.At least one skills lab room equipped with models, teaching/learning aids, posters, etc for ensuring quality of training. The amount of equipment should be sufficient for each participant to be able to practice three times for each skill. (For detailed description of classroom and skills lab room requirements, see Annex 2).

4. Clinical practice siteAll training institutions must have or cooperate with at least one clinical practice site offering MCH ser-vices which meet the following minimum requirements:

4.1. Have the appropriate number of teaching staff, as described under teaching staff/trainee ratio.4.2. Normally have, as minimum, an average of 60 vaginal deliveries per month in the 6 months prior to student practice.4.3. Have written commitment to ensure each trainee will have the opportunity to implement the minimum number of cases in clinical practice as in Annex 1.4.4. All clinical sites must have regular periodic audits of clinical practice, to ensure they meet national guidelines/protocols.

A clinical practice site could be a provincial, district level health facility or district level health facility in combination with sub-district level health facilities.

19National Standards for Midwives 2015

ANNEX 1MINIMUM NUMBER OF CASES DURING THE TRAINING

Minimum number of casesType 1

Accreditation-part of initial pre-service

programme

Type 2Accreditation

Post-basic nursingprogramme

1. ANC 40 202. Complicated pregnancies 10 103. Normal vaginal deliveries 20 104. Abnormal /complicated

deliveries (breech/face ) 2 2

5. Essential care of newborn at birth

20 10

6. Postnatal care of mother and baby - first 24 hours

40 20

7. Postnatal care mother and baby after 24 hrs up to 6 weeks

40 20

8. Complications of postpartum period

10 10

9. Care of women following haemorrhage and/or sepsis in pregnancy

2 2

20 National Standards for Midwives 2015

ANNEX 2STANDARD CLASSROOM AND SKILLS LAB ROOM

I. Classroom (for 15 - 20 trainees)1. General requirement:

• Area at least 2M2/participant2. Tools and equipment:

Item Unit Quantity1 Table piece 252 Chair piece piece 303 Flipchart stand piece 24 Large white board piece 15 Television piece 16 VCD/DVD player piece 17 Multi-projector piece 18 Slide projector piece 19 Projector screen piece 2

10 Video tapes, CD-Roms, DVDs for skills demonstration piece 1011 Desktop computer with internet piece 212 Laptop computer piece 213 Photocopier piece 114 Flipchart size AO piece 5015 Board markers (3 colours of blue, red, black) piece 3016 Pens (various) piece 2017 Glass markers piece 1018 Whiteboard wiper piece 519 Transparencies box 220 Bookshelf/library piece 321 Standard guidelines on RH services22 Clinical practice guideline23 Poster, flipchart set 524 Skill checklist (size AO) piece 525 Reference books on RH26 Scientific journals, publications27 Air conditioner set 1

21National Standards for Midwives 2015

II. Skills Lab room (assuming 15-20 trainees)

1. General requirements:• Area at least 2.5M²/participant• Wall, floor, water supply, electricity and lighting installation, washing basins, firefighting equip-

ment, etc. should be rational, safe, clean and suitable for operation process.2. List of tools and equipment

Item Unit Quantity1 Patient bed, bedside shelf with mattress, bed sheets, blankets, pillows Set 12 Stainless steel 2-layer instrument cart piece 13 Newborn scale piece 14 Syringes 10ml and 5ml, 20 pieces each Set 15 Delivery table (with spotlight) Set 16 VCD/DVD player Set 107 Newborn model (doll) Set 108 Newborn care and resuscitation simulators Set 39 Female reproductive tract models Set 4

10 Obstetric simulators Set 311 Episiotomy-repair model Set 412 Placenta models Set 413 Pregnancy examination instruments Set 214 Delivery instruments Set 215 Newborn resuscitation instruments Set 116 Episiotomy/repair instruments Set 217 Newborn bathing, cord care consumables Set 218 Towel for drying and warming newborn piece 1019 Kangaroo aprons piece 1020 Infection prevention instruments/consumables piece 121 Female pelvic charts Set 222 Flipchart, leaflet about RH Set 1023 Skill checklist (size AO) Set 2024 Air conditioner Set 1

22 National Standards for Midwives 2015

References

• ASEAN Regional Guideline for Minimum Requirements for Training and Accreditation of Skilled Birth Attendants (SBA), 2014, UNFPA, www.asean.org.

• Recommendations of Stakeholder Meeting on Development of National Midwifery Stan-dards and Strengthening Midwifery Education, ၂၀၁၅ ခနစ ဩဂတလ၊ ၁၃ရက ရကစပါ စာအမတ၊ နဆရ/အေထေထ/အ-၂(၂၀၁၅)၊၁၄၄၅၃။

Stakeholder Meeting on the Development of National Midwifery Standards and Strengthening Midwifery Education

Steering Committee1. Prof. Dr. Nwe Nwe Oo, Director General, Department of Health Professional Resource Development

and Management2. Prof. Dr. Myint Han, Director General, Department of Medical Services3. Dr. Soe Lwin Nyein , Director General, Department of Public Health

Technical Contribution1. Prof. Dr. Win Win Mya, Professor Emeritus, University of Medicine (1), Yangon2. Prof. Dr. Yin Yin Zaw, Professor/Head (retired), Defense Services Medical Academy3. Ms. Janet E. Jackson, UNFPA Representative4. Prof. Dr. Katherine Ba Thike, Consultant, UNFPA5. Prof. Dr. Mya Thida, Professor/ Head, Department of Obstetrics & Gynecology, UM (1), Yangon.

Facilitators1. Dr. Tin Tin Lay, Deputy Director General, Department of Health Professional Resource Development

and Management2. Dr. Yin Thandar Lwin, Deputy Director General, Department of Public Health3. Prof. Dr. Myat Thandar, Rector, University of Nursing, Yangon4. Prof. Dr. Thida, Rector (Acting), University of Nursing , Mandalay5. Daw Phyu Phyu, President, Myanmar Nurse and Midwife Council6. Prof. Daw Yin Mya, President, Myanmar Nurse and Midwife Association7. Daw Nwe Nwe Khin, Director (Nursing), Department of Health Professional Resource Development

and Management8. Daw Khin Mar Kyi, Director (Nursing), Department of Medical Services9. Dr Hla Hla Aye, Assistant Representative, UNFPA

Working Committee1. Daw Htay Htay Hlaing, Deputy Director (Nursing), Department of Health Professional Resource

Development and Management2. Daw Mya Mya Nyo, Assistant Director (Nursing), Department of Health Professional Resource

Development and Management3. Daw Nant Kyu Kyu Khaing, Assistant Director (Nursing), Department of Health Professional Resource

Development and Management4. Daw Nwe Ni Sein Myint, Nursing Officer, Department of Health Professional Resource Development

and Management5. Daw Mya Thida Hlaing, Nursing Officer, Department of Health Professional Resource Development

and Management

23National Standards for Midwives 2015

Participants1. Dr. Tin Tun, Director, Department of Health Professional Resource Development and Management2. Dr. Kyaw Shwe, Director (Admin/ Budget), Department of Health Professional Resource Development

and Management3. Dr. Tin Tun Aung, Director, Department of Health Professional Resource Development and Management4. Dr. Theingi Myint, Director (Maternal and Reproductive Health), Department of Public Health 5. Dr. Myint Myint Than, Director (Child Health Development), Department of Public Health6. Dr. Thuzar Chit Tin, Director (Basic Health), Department of Public Health7. Dr. May Khin Than, Director (Nutrition), Department of Public Health8. Dr. Hla Mya Thwe Endra, Director (Health Education), Department of Public Health9. Daw Aye Nyunt, Delegate, Myanmar Nurse and Midwife Council10. Daw Naw Aye Shwe, Delegate, Myanmar Nurse and Midwife Council11. Daw Than Nyunt Oo, Delegate, Myanmar Nurse and Midwife Council12. Daw Khin Mar Shwe, Member, Myanmar Nurse and Midwife Association13. Dr. Win Aung, National Programme Officer, UNFPA14. Daw Yin Yin Swe, Programme Assistant, UNFPA15. Dr. Hnin Wai Hlaing, Deputy Country Director, Jhpeigo, an affiliate of Johns Hopkins University16. Dr. Thidar Moe, MNCH Technical Advisor, Jhpeigo an affiliate of Johns Hopkins University17. Delegate (2), WHO18. Delegate (2), UNICEF19. Daw Khin Thein, Associated Professor/ Head, Department of Maternal and Child Health Nursing,

University of Nursing, Yangon.20. Daw Hla Shwe, Associated Professor/ Head, Department of Maternal and Child Health Nursing,

University of Nursing, Mandalay21. Daw Amar Sein, Assistant Director(Nursing), Department of Medical Services, Ministry of Health22. Daw S Ban Taung, Assistant Director(Nursing), Department of Medical Services, Ministry of Health23. Daw Leoni, Assistant Director (Nursing), Department of Health, Myitkyina, Kachin State24. Daw Aye Aye San, Nursing Officer, Department of Health, Loikaw, Kayah State25. Daw Naw Eh Thwe, Assistant Director (Nursing), Department of Health, Hpa-An, Kayin State26. Daw Om Awi, Nursing Officer, Department of Health, Ha-kha, Chin State27. Daw Moe Cherry Aung, Nursing Officer, Department of Health, Mawlamyaing, Mon State28. Daw Oo Than Tin, Assistant Director (Nursing), Department of Health, Sittwe, Rakhine State29. Daw Khin Win Myaing, Assistant Director (Nursing), Department of Health, Taungyi, Shan State30. Daw Khin Thant Zin, Assistant Director (Nursing), Department of Health, Lashio, Shan State31. Daw Mar Mar Aye, Assistant Director (Nursing), Department of Health, Kyaingtong, Shan State32. Daw Mu Mu Win, Nursing Officer, Department of Health, Monywa, Sagaing Region33. Daw San Win, Assistant Director (Nursing), Department of Health, Dawei, Thinintharyi Region34. Daw Patricia Moses, Assistant Director (Nursing), Department of Health, Bago, Bago Region35. Daw Kyin Yee, Nursing Officer, Department of Health, Magway Magway Region36. Daw Myint Myint Mar, Nursing Officer, Department of Health, Mandalay, Mandalay Region37. Daw Win Win Myint, Assistant Director (Nursing), Department of Health, Yangon,Yangon Region38. Daw San San Tin, Assistant Director (Nursing), Department of Health, Pathein, Ayeyawady Region 39. Daw Win kyi, Assistant Director (Nursing), Department of Health, Nay Pyi Taw40. Daw Hnin Hnin Lwin , Principal, Midwifery Training School, Myitkyina, Kachin State41. Daw Naw Mi Mi Chun, Principal, Nursing & Midwifery Training School, Loikaw, Kayar State42. Daw Marlar Aung , Principal, Midwifery Training School, Hpa-an, Kayin State43. Daw Nant Si Si Ohn , Principal, Midwifery Training School, Mawlamyaing, Mon State44. Daw Nu Nu Zan, Principal, Nursing & Midwifery Training School, Sittwe, Rakhine State45. Daw Nyunt Nyunt Yee, Principal, Midwifery Training School, Taunggyi, Shan State46. Daw Nang Awn Kham, Principal, Nursing & Midwifery Training School, Lashio, Shan State47. Principal, Nursing and Midwifery Training School, Monywa, Sagaing Region48. Daw Naing Naing Aye, Principal, Midwifery Training School, Myeik, Thinintharyi Region49. Daw Mya Mya San, Principal, Midwifery Training School, Bago, Bago Region50. Daw Nang Mya Thandar, Principal, Midwifery Training School, Taungoo, Bago Region51. Daw Khin Moe Moe Oo, Principal, Nursing & Midwifery Training School, Pyay, Bago Region

24 National Standards for Midwives 2015

52. Daw Nwe Nwe Cho, Principal, Nursing & Midwifery Training School, Magway, Magway Region53. Daw Phyu Phyu Tun, Principal Nursing & Midwifery Training School, Pakokku, Magway Region54. Daw Molly, Principal, Midwifery Training School, Mandalay, Mandalay Region55. Daw Moe Thet Thet Mon, Principal, Midwifery Training School, Pyin Oo Lwin, Mandalay Region56. Daw Nyunt Nyunt Han, Principal, Central Midwifery Training School, Yangon, Yangon Region57. Daw Ni Ni Cho, Principal, Midwifery Training School, Thanlyin, Yangon Region58. Daw Naw Kapaw Shee, Principal, Nursing & Midwifery Training School, Pathein, Ayeyawady Region59. Daw Dashi Hkawn Nu, Principal, Central Domiciliary Midwifery Training School, Yangon, Yangon Region 60. Daw Wai Wai Lwin , Principal, Nursing and Midwifery Training School, Kalay, Sagaing Region61. Daw Aye Aye Khine, Principal, Midwifery Training School, Nay Pyi Taw