History and legal

aspects of
midwifery
By
James Mundia
 Expected outcomes

• By the end of the module the student

should be able to;
• Describe brief historical development of
midwifery and midwifery practice with
specific reference to Kenya
• Discuss the ethical legal aspects of midwifery

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 Content to be included

• History of the midwifery in the; ancient

period, Egyptian and biblical times,
renaissance period, history of midwifery
training in Kenya legislation and licence.

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 Introduction

• Who is a midwife?
• International definition
• A midwife is a person who, having been
regularly admitted to a midwifery educational
program that is duly recognized in the
country in which it is located, has
successfully completed the prescribed course
of studies in midwifery and has acquired the
requisite qualifications to be registered
and/or legally licensed to practice midwifery.
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Defn. of midwifery cont…
• Scope of practice
• A midwife is recognised as a responsible and
accountable professional who works in partnership
with women to give the necessary support, care and
advice during pregnancy, labour and the postpartum
period, to conduct births on the midwife’s own
responsibility and to provide care for the new-born and
the infant. This care includes preventive measures, the
promotion of normal birth, the detection of
complications in mother and child, the accessing of
medical care or other appropriate assistance and the
carrying out of the emergency measures.

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 The early tradition of midwifery:
issues of social class and gender

• In the early Christian and Jewish writings, midwives

were called wise women. The role of midwifes during
this time were central to the survival of the mother and
the child. The knowledge and skills of the midwives
were passed from one generation to the other through
apprenticeship.
• The Greeks and the romans were the first to apply
qualifications to midwifery practice, requiring that all
midwives have had a child of their own. The writings of
Hippocrates in the 5th century BC include a description
of normal birth. Hippocrates is thought to be the first
one to organize and formally educate midwives.
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 Cont…

• Historical literature on midwifery

suggests that midwives took care of
normal birth but in an emergency, a
male physician (or a priest) had to be
summoned.

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 Cont…
• However important the midwives were to the society,
they were not respected and the work was exclusively
done by the women, and rarely women of higher class
status in their society. This social stigma prevailed
well into the middle ages, with particular strong
endorsement by the church, which forbade males to
attend at births. Midwifery was seen as unclean
profession at best, and an unholy one-the practice of
witchcraft at worst. Female healers became the target
for with-hunting, a program of ruthless persecution
that was promoted by the church and supported by
both the clerical and secular authorities.
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 History of the midwifery in the
Egyptian and biblical times
• In the midst of harsh treatment, the Israelites
remained faithful to God’s command to be
fruitful and multiply (Gen. 1:28). That entailed
bearing children, which in turn depended on the
work of midwives. In addition to its presence in
the Bible, the work of midwifery is well-attested
in ancient Mesopotamia and Egypt. Midwives
assisted women in childbearing, cut the infant’s
umbilical cord, washed the baby, and presented
the child to the mother and father.

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 Cont…
• In ancient Egypt there were no known words for
midwife, obstetrician, or gynecologist midwives at
this time did not have formal training to learn their
trade. Instead they learned by apprenticeships
where the knowledge was passed down from
family member to family member or from friend to
friend. The work of the midwife included providing
emotional support, encouragement, medical care,
and religious help and protection to women during
their lives. The areas that midwives focused on
were pregnancy, labor, fertility, and contraception.
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 Cont…

• Most ancient Egyptian women labored and

delivered their babies on the �cool roof of
the house or in an arbor or confinement
pavilion, which was a structure of papyrus-
stalk columns decorated with vines
• he positions that these women took when
they delivered their babies were standing,
kneeling, squatting, or sitting on their heels
on birthing bricks, or sitting on a birthing
chair.
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 Cont…

• The midwife would then be positioned in

front of the mother to help the delivery and
catch the baby. Two other women or
midwives would be placed on either side of
the mother to hold her hands and arms
while she was pushing and to give
encouragement. Sometimes the midwife
would place a dish of hot water under the
birthing chair so that steam could help ease
delivery.
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 Cont…
• The birthing bricks that ancient Egyptian women used were
14 by 7 inches long and decorated with colorful painted
scenes and figures of the birth process. Birthing chairs were
made of brick and had a hole in the center. They were
decorated with hieroglyphic inscriptions of the owner and
painted scenes of the mother, baby, and goddesses.
• Since birth and delivery could be dangerous for both the
mother and child, ancient Egyptian midwives used many
goddesses and gods for help and protection.
• For more information, find at
https://www.midwiferysupplies.ca/blogs/ancient-midwifery-b
log/295322-ancient-egyptian-midwifery-and-childbirth

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 The middle tradition of
midwifery: Issue of
technological developments,
and the dominance of male
physicians in the practice of
•obstetrics (Renaissance
As late as 15 century,
th period).
only women birth attendants are
depicted in the paintings and the engravings. The man-
midwife appears around 17th century, at the time when
the male medical profession begins to control the
practice of healing arts.
• There were some exceptions, however. For example,
German midwifery has a strong tradition that has
developed since the 12th century. The first known
professional contract between a midwife and a municipal
authority dates to 138, when the city of Nurnberg
established a salary, accommodations, and tax benefits
for the midwives who agreed to serve the city’s poor.
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 Cont…

• Madam du coudray, who lived and

worked in the mid-1700s, travelled
throughout France, bringing education to
midwives on behalf of the king. She
wrote her own text and crafted a life size
obstetrical teaching mannequin. Madam
du Coudray taught over 10,000 students
over a 30 year period.

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 Cont...

• The development of the obstetric forceps, used only by

man-midwife obstetricians, had a further negative
influence on the status of midwifery.
• Developments of the 19th century included efforts in
obstetrics anaethesia (specifically the use of
chloroform), advances in the understanding of the
functions of the placenta, an importantly, the conquest
of childbed fever. Still without wide access to education,
the midwife was largely left without opportunity to
benefit from the new knowedge, creating an even wider
social and economic gap between male-physician
midwives and women practitioners of the midwifery art.
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 BACKGROUND OF
MIDWIFERY
• In 16th C midwifery was entirely practiced by women
with no training at all
• In 18th C, Dr. William Smiles did a study to investigate
the relationship between fetal skull and maternal
pelvis, and later a group of experts was charged with
the mandate to investigate the cause of high
maternal/infant mortality rates
• 1869 a recommendation was made to set up a board
to award training in midwifery
• 1872 Florence Nightingale organised training for
midwives in King’s college in the UK
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• 1902 the act to protect midwives in the UK was
passed and it authorised them to frame rules,
regulations, exams, issue certificates, maintain
records for their activities and those of clients
In Kenya,
• 1926 the colonial government found it necessary to
establish a maternity for the natives, before this
there was no training
• 1930 Dr. Brown started casualty training for
midwives in Kikuyu hospital and only married women
with children were allowed to train
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• These women were trained on how to
recognise the complications and refer
the mother to the nearest hospital

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• 1951, the act was recommended to read nurses
midwives council of Kenya and the pioneer
hospitals to train were Mombasa and Nairobi
(Pumwani) where they recruited class 3 and 4
leavers but later they only allowed those with class
7 or 8 education
• 1961 health visitors society was formed and
recruited young girls with form 2 educations but
the league of women contacted the nursing council
to incorporate the already trained nurse to educate
mothers regarding maternal and child health.
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1966 Kenya registered nurses training
programme was started in King George
hospital for government trained nurses
but not until the following year that it
was successful due to lack of nurse
educators

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• 1972 Mater hospital started training KRM
for private hospitals
• Between 1973/4 the two year
programme was modified to one year
programme for enrolled midwives
• Today, midwifery is a component on
KRCHN (Basic/BScN) training curriculum

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 ROLES AND DUTIES OF A
MIDWIFE
• Provide sound family planning and necessary
information and advice to clients.
• Offer pre-conception care to the aspiring
parents, availing all necessary information.
• Diagnose pregnancy and monitor its progress
closely by both physical and clinical
examinations.
• Advice and direct the woman to comprehensive
screening for pregnancy at risk.
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 Cont…

• Provide parental preparation courses and

promote family cohesion during
pregnancy.
• Provide information about hygiene,
nutrition, referral methods and health.
• Care for and assist the mother during
labour and actively monitor the condition
of the fetus in uterus during this process.
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 Cont…

• Conduct spontaneous delivery; normal and

uncomplicated, or assist in emergencies
• Recognise the warning signs of abnormality in
the mother and infant and refer them to the
doctor.
• Examination and care of the newborn and
resuscitation whenever necessary.
• Care and monitor the postnatal mother during
the puerperium and give health education on
continuum of care.
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 Cont…

• Administer all the prescribed drugs and

care to the woman and family.
• Maintain all the medical records in the
best available method.

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 QUALITIES OF A
PROFESSIONAL MIDWIFE
• As a professional, you are personally accountable
for actions and omissions in your practice and
must always be able to justify your decisions. You
must always act lawfully, whether those laws
relate to your professional practice or personal life.
• Make the care of people your first concern,
treating them as individuals and respecting their
dignity – You must treat people kindly and
considerately
• Provide a high standard of practice and care at all times

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 Cont…

• Obtain consent from the client, explain the

rationale of your nursing actions.
• Critical thinker, critical communicator and
critical decision maker.
• Responsibility taking and sharing – assign duties,
perform prescriptive roles.
• Competent practice – ability to perform the roles
and duties assigned to a professional or
practitioner to the most satisfactory manner, as
stipulated by the standard of practice
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 Cont...

• You must act as an advocate for those in

your care, helping them to access relevant
health and social care, information and
support. You must refuse any gifts, favours
or hospitality that might be interpreted as an
attempt to gain preferential treatment.
• You must establish and actively maintain
clear sexual boundaries at all times with
people in your care, their families and
carers.
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 Cont…

• Ability to function as a team leader,

team member and collaborator.
• Ethical and prudent (fore-thought,
careful and sensible, making sound
judgement)

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 Ethical legal aspects of
midwifery
ETHICS OF MIDWIFERY
• Ethics are rules or principles that govern right
conduct and distinction between right or wrong.
The Code of Conduct in midwifery
Midwifery Relationships
• Midwives respect a woman's informed right of
choice and promote the woman's acceptance of
responsibility for the outcomes of her choices.

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 Cont…
• Negligence- Medical negligence can be defined as
the commission of an act that a prudent person
would not have done or the omission of a duty that
a prudent person would have fulfilled, resulting in
injury or harm to another person (patient)
• Medical malpractice-Medical malpractice means
bad, wrong, or injudicious treatment of a patient
professionally, which results in injury, unnecessary
suffering, or death. Malpractice and negligence
may occur through omission of a necessary act as
well as commission of an unwise or negligent act
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 Cont…

• Midwives work with women, supporting

their right to participate actively in
decisions about their care, and
empowering women to speak for
themselves on issues affecting the
health of women and their families in
their culture/society.
• Confidentiality - keep information given
in trust by the patient secret.
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 Cont…

• Midwives support and sustain each other in

their professional roles, and actively nurture
their own and others' sense of self-worth.
• Midwives work with other health professionals,
consulting and referring as necessary when the
woman's need for care exceeds the
competencies of the midwife.
• Midwives recognize the human interdependence
within their field of practice and actively seek to
resolve inherent conflicts.
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 Practice of Midwifery

• Midwives provide care for women and

childbearing families with respect for cultural
diversity while also working to eliminate
harmful practices within those same
cultures.
• Midwives encourage realistic expectations of
childbirth by women within their own
society, with the minimum expectation that
no women should be harmed by conception
or childbearing.
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 Cont…

• Midwives use their professional knowledge to

ensure safe birthing practices in all
environments and cultures.
• Midwives respond to the psychological, physical,
emotional and spiritual needs of women seeking
health care, whatever their circumstances.
• Midwives act as effective role models in health
promotion for women throughout their life cycle,
for families and for other health professionals.

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 Cont…

• Midwives actively seek personal,

intellectual and professional growth
throughout their midwifery career,
integrating this growth into their
practice.

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 The Professional
Responsibilities of Midwives
• Midwives hold in confidence client
information in order to protect the right
to privacy, and use judgment in sharing
this information.
• Midwives are responsible for their
decisions and actions, and are
accountable for the related outcomes in
their care of women.

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 Cont…

• Midwives may refuse to participate in

activities for which they hold deep moral
opposition; however, the emphasis on
individual conscience should not deprive
women of essential health services.
• Midwives participate in the development
and implementation of health policies
that promote the health of all women
and childbearing families.
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