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Community Midwifery
Curriculum
Pakistan Nursing Council
Islamabad
Community Midwifery Curriculum
Midwifery Curriculum
Midwives registered with Pakistan Nursing Council
Rationale:
Pakistan has one of the highest maternal mortality ratio in South East Asia.
According to the available statistics over 80% of women deliver at home in
Pakistan. Trained health professionals conduct 5% of these deliveries, rest are
delivered by a female who could be a Dai, a traditional birth attendant, a
family member or a neighbour. Internationally accepted figures state that
85% of all births can be handled or conducted safely by properly trained
midwives. Only 15% of women will develop complications requiring higher
level of professional skills. Most of the countries of the world have lowered
their maternal mortality through wider involvement of the professional
midwives.
Pakistan too has learnt that there is a need for training competent
midwives/skilled birth attendants, who can promote safe motherhood within
the communities and avert maternal death and morbidity. This course of
studies outlines the process of training midwives.
Overview:
This eighteen months course of studies is meant for the training of females as
midwives to practice safe normal delivery. The goal of training this group of
health care providers is to promote maternal and child health services in the
country. In order to achieve this goal, the training will be conducted in
accordance with local traditions, cultural values and beliefs of the community.
Emphasis will be placed on the care of the women during the maternity cycle,
including the care of the newborn.
Health education for healthy life style and prevention of disease will form the
core of the theoretical and practical learning experience of the students. 25%
of the time will be dedicated to theoretical teaching while 75% of the time will
be consumed in supervised and hands-on practical training, both in the
community as well as institutions. Different teaching and training
methodologies will be utilized in the training of the midwives.
After the successful completion of training, the certified midwife will be
expected to perform the duties laid down in her job description. This will
include the proper management of the pregnant women, mothers and infants
under her care. She will be able to identify abnormal conditions and refer
such cases to the appropriate facility/specialist, after providing emergency first
aid care to stabilize the condition.
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.2
Community Midwifery Curriculum
It is hoped that the qualified midwives will make a positive impact on the
maternal health situation in the country and help lower the high maternal and
infant mortality ratios.
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.3
Community Midwifery Curriculum
Philosophy:
We believe that midwifery is an art and science that has developed over
millions of years. Since the first birth of man, midwifery is being practiced in
one form or the other. Therefore, one cannot reinvent the wheel by changing
the content of this time-honored art. However, it is necessary to understand
that the emphasis is on the level of competence of each cadre of practitioner.
Pregnancy, delivery and peurperium are normal physiological processes, which
in most cases requires no intervention but guidance and assistance, to
progress uneventfully, and that the midwife can provide such assistance in an
institution or at home. Midwifery is an art based upon scientific principles,
and that this art can be perfected only by constant and correct practice and
up-to-date knowledge. The midwife can play a significant role in providing
care to the mother and the neonate throughout the maternity cycle.
The midwife’s functions are preventive, promotive and curative and that she
perform these functions within her authorized limits in a hospital, a mother
and neonate health center, a primary health care center or in a home, through
providing direct services, guidance and counseling. The midwife is fully aware
of her professional boundaries as prescribed by the regulatory mechanisms
governing her professional practice and does not cross them to trespass in the
domain of an obstetrician. The midwife is capable of making independent
and sound decisions in connection with giving safe and efficient antenatal,
intranatal and postnatal care to the mother and the neonate, seeking medical
assistance when deviations from the normal are anticipated, suspected or
diagnosed.
The midwife is capable of guiding the couples in matters related to family
planning/spacing of pregnancies and is capable of providing advice and all
contraceptive services except surgical interventions for family limitation. The
midwife has the responsibility towards improving the health standards in
Pakistan through providing maternal and neonate health care services by
participation in PHC programmes and through activities of disease prevention
and promotion of health. The midwife is aware of the fact that learning is a
shared responsibility of the learner and the teacher and unless both the
participants shoulder their responsibilities and obligations, very little success
can be achieved in terms of lasting results and desirable changes of behaviour.
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.4
Community Midwifery Curriculum
The international definition of midwife as defined by International
Council of Midwives (ICM 1999) Geneva, Switzerland:
The midwife; - is a person who, having been regularly admitted to a
midwifery educational programme 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.
She must be able to give the necessary supervision, care and advice to women
during pregnancy, labour and the postpartum period, to conduct deliveries on
her own responsibility and to care for the newborn and the infant. This care
includes preventive measures, the detection of abnormal conditions in mother
and child, the procurement of medical assistance and the execution of
emergency measures in the absence of medical help. She has an important
task in health counseling and education, not only for the women, but also
within the family and the community. The work should involve antenatal
education and preparation for parenthood and extends to certain areas of
gynaecology, family planning and child care. She may practice in hospitals,
clinics, health units, domiciliary conditions or in any other service.
A competent midwife should have the varied skills, some covering those of a
nurse or a doctor even:
Skills and obligations of a midwife:
A midwife must be responsible for her actions and must practice her art
with ethics and caution. Some of her areas of expertise include:
 Promote Health awareness
 Assessment of the client/woman
 Managing the pregnant woman
 Taking care of the woman dependently and independently during
antenatal, natal and postnatal period
 Seeking help from others (referral)
 Caring for the woman as prescribed by the doctor
 Has good communication skills
 Awareness of research and participate in research activities
 Knows how to work in a team
 Knows the law and legal aspects of practicing
 Is aware of ethics
 Assessment and care of neonate
 Communication and counseling
 Practice the ethical law and legal aspects of midwives as prescribed by
PNC
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.5
Community Midwifery Curriculum
Functions of a midwife:
 Diagnosis and management of normal and complications of pregnancy,
labour and puerperium in the at home, birthing station, in urban and
rural settings
 Early detection of abnormalities throughout the maternity cycle, taking
decisions for required action in each individual case and implementing
the decision
 Care of the normal and premature neonate
 Care of asphyxiated and Low Birth Weight babies
 Advice/guidance in the form of health education for healthy habits and
prevention of disease
 Providing general and obstetric first aid in case of emergencies,
and making timely referrals to the next level of EmoC facilities by
developing linkages
 Advice/guidance/assistance and services to the mothers (and couples)
to plan and space their pregnancies
 Ensuring implementation of policies, rules and regulations governing
MCH services in Pakistan
 Performing of administrative and management functions related to her
duties
 Respecting at all times women’s right to life and health, and
contributing towards the attainment of these rights
 Continuing her educational and professional growth by keeping her
knowledge up-to-date and by attending continuing professional
development activities whenever possible
 Participation in activities aimed at improving midwifery education and
practice and conditions of midwife’s services
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.6
Community Midwifery Curriculum
PART I
Objectives and requirements
Goal:
To reduce the high maternal mortality and infant mortality rate in the
country
General objectives:
 To make safe delivery possible for the women in their homes and in the
communities
 To initially work in tandem and eventually replace the TBA, by offering
skilled midwifes to the community
Specific objectives:
After completing the skills training the Midwife will be able to:
 Define her role in provision of care to the woman during her maternity
cycle
 Differentiate the roles of a TBA, LHW, LHV, Midwife, and obstetrician
 Recognize signs of pregnancy
 Identify pregnant women in the community and persuade them to
undergo antenatal registration
 Examine a woman and determine the progress of pregnancy
 Advise the pregnant woman regarding care during pregnancy and to
seek registration at a health facility for antenatal care and immunization
 Manage minor discomforts of pregnancy
 Explain to the mother what to eat and why, during pregnancy and
lactation
 Help pregnant and lactating women to deal with nutritional problems
 Recognize common danger signs during pregnancy that require timely
or immediate referral for medical attention
 Assess risk conditions and manage these according to the level of risk
involved
 Advise women and the family about the possible dangers involved in
home delivery when contraindicated and advise delivery in a
hospital/health facility capable of coping with the complications
 Initiate discussions during the antenatal period and provide guidance
about breast feeding and postponing the next pregnancy
 Advise the mother and the family about collecting and preparing things
for delivery for herself and for the newborn two months before her due
date, including money for emergency
 Determine when a woman is in true labour
 Prepare the environment, material needed for delivery by herself and
by the mother to ensure clean and safe delivery
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.7
Community Midwifery Curriculum
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Recognize that the labour is progressing normally through regular
monitoring and use of a partograph
Provide supportive care to the mother throughout labour and delivery
Manage all stages of labour within her boundary lines to ensure safe
delivery
Recognize, manage as taught, and refer women with any complications
in the first, second or third stage of labour to the appropriate health
facility
Recognize, manage and refer complications arising in the first six hours
after delivery
Recognize, manage and refer complications arising in the first six weeks
after delivery
Recognize presentations other than the vertex and refer the woman to
a hospital
Provide essential care to the neonate
Ensure clean cutting of the cord and provide and instruct the mother to
practice clean cord care
Recognize a baby who is not crying or breathing or breathing poorly
and provide breathing support
Encourage early initiation of breast feeding with colostrum
Assist and support the mother in establishing exclusive breastfeeding
Identify newborn babies requiring special care and refer them to
appropriate health facility
Advise the mother about proper diet, hygiene, rest and mobility during
the postnatal period
Recognize early signs of complications during the postnatal period
Start discussions about family planning, explain options available and
guide the mother to the source of services
Recognize and advise how to manage sexually transmitted diseases
and refer to proper facilities
Advise the mother and the family about basic health messages
Participate in the immunization campaigns
Maintain accurate and up to date records and submit reports as
instructed
Recognize the need for additional knowledge/skills to fulfill her role
and obligations and request her supervisor to arrange in-service
training
Should use the provided protocol
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.8
Community Midwifery Curriculum
Minimum Qualification (Community Midwifery Program)
1.
2.
3.
4.
5.
6.
7.
Admission will only be granted to females having passed matriculation
examination or equivalent with minimum 45% marks. (To be verified at
the time of admission by the SOM)
The medium of instruction will be in English / Urdu
Candidates age should be between 15 to 30 years, relaxable to 35 years
in special cases
All candidates will be required to undergo a medical fitness checkup to
be arranged by the institution
This Program will be of minimum 18 months duration
Midwifery Examinations:
a.
Internal Examination: At the end of 10 weeks, there will be an
internal examination to be arranged by the SOM. Students
unsuccessful will be reexamined after 4 weeks. If unable to clear
the second attempt, the student will be excluded from the
course
b.
Nursing Examination Board: After completion of the course, the
students will appear in the NEB examination.
c.
Fee for examination will be as per NEB policy
d.
Provincial NEB rules will apply to the examination
Passing Marks: The minimum passing marks required to be obtained in
all subjects will be as follow:
a.
Written
50%
b.
Oral
50%
c.
Aggregate 50%
Minimum requirements for the Teaching Hospitals for CMW
a. Number of beds
No hospital shall be allowed to train Midwives unless it has 50 occupied
beds and an admission of at least 1000 midwifery cases in a year. The
distribution of maternity beds shall be as under:
Antenatal beds
08
Lying in beds
30
Labour beds
04
Emergency beds
04
Septic beds
04
TOTAL
50
All institutions recognized for the training of Midwives will be subject to
the rules in respect of periodical inspection, annual returns and
payment of affiliation fees as applicable to training Schools of Nursing
b Strength of staff of maternity unit
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.9
Community Midwifery Curriculum
i.
Medical Staff
There shall be Resident Medical Officer who preferably is an
obstetrician or under special circumstances a Medical Officer with at
least 3 years experience in obstetrics, who should deliver Interactive
lectures.
ii. Nursing Staff for ward
Nursing Sister
3 for 24 hours
Charge Nurse
6 for 24 hours
iii. Nursing Staff for Labour Room
Nursing Sister
2 (one for morning and one for evening)
Charge Nurse
6 for 24 hours
iv. Nursing Staff for operation theatre
Charge Nurses
2 for one operation theatre
Teachers
:-Lectures in obstetrics must be delivered by a registered obstetrician
and Midwifery lectures shall be given by qualified Tutors.
Faculty
 Principal
 Nursing Superintendent
 Midwifery Tutors
 Midwifery Supervisors
 Guest Lecturers
Domiciliary midwifery
Each training institution must arrange to provide domiciliary midwifery
experience to the students under training for 10 weeks. Where this is not
possible for the institution; they must affiliate with the nearest MCH centre or
Public Nursing School
Syllabus and curricula
The following curriculum is prescribed for the training of Midwives. All
trainees will undergo four levels of skills training; observation, assisted
training, performance under supervision and independent performance of
procedures. A minimum number of procedures would be expected of the
trainees:
Observation of normal delivery cases
5
Assisted normal delivery cases
5
Normal delivery cases under supervision 5
Independent normal delivery cases
10
 25 antenatal records in log book as cited above
 25 deliveries in midwifery journal
 Follow-up of the 25 deliveries
 Report in the form of a casebook or project report on a health issue
faced by the community, e.g.:
o collection of data for surveys
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.10
Community Midwifery Curriculum
o report on hygiene and sanitation issues
o Nutritional status of the community etc.
The record must be maintained in the prescribed practical books, duly signed
by the supervisor after each entry and countersigned by the head of the
institution prior to the examination.
Attendance
Each student must have attended a minimum of 85% of Interactive discussions
and 85% practical on job training, supported by a certificate by the head of
the institution, prior to the examination
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.11
Community Midwifery Curriculum
Time distribution of topics for Midwifery curriculum
Summary
Theory Practical Hours
Theory
Practical
Projects/books/reports/demonstrations
Evaluation
TOTAL HOURS
294
1306
96
104
398
1402
1800
Basic nursing care and practices
Topic
Unit 1 basic nursing care
Orientation
General anatomy and physiology
Microbiology
Pharmacology
First Aid
Basic nursing care
Theory Practical Hours
30
20
20
20
70
160
72
30
6
6
10
140
264
72
60
26
26
30
210
424
Midwifery
Topic
Unit 2 Introduction
Introduction to midwifery
Unit 3 Anatomy and physiology
Reproductive System: Female pelvis
Female external genitalia
Male reproductive system
Physiology of reproduction: Fertilization
Fetal skull
Unit 4 Pregnancy
Preparing for pregnancy
Infertility
Physiological changes of pregnancy
Antenatal care
Unit 5 Normal labour
Management of first stage of labour
Physiology and management of second stage of
labour
Physiology and management of third stage of
labour
Unit 6 Puerperium
Management of puerperium
Family planning
Unit 7 Abnormalities of pregnancy, labour and
Theory Practical Hours
30
6
36
12
12
6
20
4
3
3
0
10
6
15
15
6
30
10
6
6
6
6
30
0
30
54
36
6
36
60
12
12
148
148
160
160
12
148
160
6
12
54
54
60
66
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.12
Community Midwifery Curriculum
puerperium
Abnormalities of early pregnancy
Sexually transmissible diseases in pregnancy
Disorders caused by pregnancy
Disorders of pregnancy
Diseases associated with pregnancy
Multiple pregnancy
Prolonged pregnancy and disorders of uterine
action
Malpositions and malpresentations
Obstetric emergencies
Complications of third stage of labour
Unit 8 The newborn
Care of the newborn
Breastfeeding
Unit 9 Community Midwifery and Health Education
Community Midwifery
Health Education
TOTAL
6
6
6
6
6
6
6
24
24
24
24
24
24
24
30
30
30
30
30
30
30
6
6
12
24
24
48
30
30
60
12
6
162
48
174
54
36
12
294
84
54
1306
120
66
1600
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.13
Community Midwifery Curriculum
PART II
Unit 1 Basic Nursing Care
General Anatomy and Physiology
Time: 60 hours (T30+P30)
Objectives
Contents
Suggested
Teaching/Learning
Strategies and Aids
The midwife is expected to
be able to:
(K) Describe the terms of
anatomy and physiology
Definition of anatomy and
physiology
Lectures
(S) Demonstrate using
models and diagrams the
anatomical structures,
their locations and
relations
Characteristics of living matter
Charts, diagrams
(K) Describe cell structure,
types and functions
(K) Name organs of
various systems in the
body
(K) List blood groups and
describe their importance
in midwifery
(S) Perform blood
grouping (ABO and
Rhesus ) using reagents
Cell structure and type
Blood and blood groups
Basic structure and functions of:
Cardiovascular system
Heart
Blood vessels
Circulation
Blood pressure
Pulse
Nervous system
Brain
Spinal cord
Respiratory system
Organs of respiration
Position and function
Digestive system
Structure and function of GIT
Liver
Pancreas
Gall bladder
Process of digestion
Excretory system
Urinary system, kidneys,
ureters, bladder
Urine formation
Endocrine system
Glands and hormones
Reproductive system
Organs of male and female
Structure and functions
Lymphatic system
Structure and functions
Models
Simulators
Laboratory
equipment
Blood grouping
antisera
BP apparatus
Videos
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.14
Community Midwifery Curriculum
Unit 1
Microbiology
Objectives
Contents
Time: 26 hours (T20+P6)
Suggested
Teaching/Learning
Strategies and Aids
The midwife is expected to
be able to:
(K) Define microbiology
and describe its role in
midwifery
Definition of microbiology
Lectures
Interactive discussions
(S) Demonstrates steps to
avoid spread of infection
by various routes
Types of micro organisms
Bacteria
Viruses
Protozoa
Fungi
(K) List the various
organisms that can cause
disease
Infection
Sources
Routes of spread of disease
Videos
Charts
Models
Slides
Immunity
Natural
Acquired
Sexually transmitted infections
HIV/AIDS
HBV and HCV
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.15
Community Midwifery Curriculum
Unit 1
Pharmacology
Objectives
Contents
Time: 26 hours (T20+P6)
Suggested
Teaching/Learning
Strategies and Aids
The midwife is expected to
be able to:
(K) Define pharmacology
and therapeutics
(S) Differentiate between
metric and apothecary
systems
(S) Demonstrate the
various routes of
administration of drugs
(S) Correctly administer an
SC, IM and IV injection
(S) Administer an enema
(K) List the permissible
drugs for midwives
Definition of pharmacology and
therapeutics
Weights and measures of solids
and liquids
Lectures
Demonstration and
return demonstration
on models and
simulators
Routes of administration of drugs
Oral
Laboratory equipment
Inhalation
Injections
Weights and measures
Local applications
(safe disposal of sharps)
Drugs and medicines
Approved drugs for midwives
Mode of action
Complications of drugs
Management of complications
Injections
(K/S) List common
complications of
permitted drugs and
demonstrate their correct
management
(S) Demonstrate the
correct use of
disinfectants and list their
complications
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.16
Community Midwifery Curriculum
Unit 1
First Aid
Objectives
Contents
Time: 36 hours (T12+P24)
Suggested
Teaching/Learning
Strategies and Aids
The midwife is expected to
be able to:
(K) Define First Aid and
describe its concept
(S) List the problems of
bleeding and trauma and
demonstrate the correct
management of such
cases
(S) Identify various types
of wounds on a simulator
and describe the
management of each
(S) Demonstrate correct
Recovery Position of a
casualty
(S) Performs the
immobilization of a
casualty and safe disposal
to a health facility
Concept of First Aid
Lectures
Role of First Aider
Demonstrations
Recovery Position
Advantages
Procedure
Models, dummy
Heimlich maneuver
Videos
Simulation exercises
Immobilization and transfer of
casualty
Wounds
Types
Management
Bleeding
Internal
External
Signs and symptoms of shock
First Aid management of shock
(S) Demonstrate the
correct first aid
management of fractures
of bones
Fractures of bones
First Aid management of
fractures
(S) Demonstrates the
correct management of
shock
First Aid Box
Contents
Care of FA box and drugs
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.17
Community Midwifery Curriculum
Unit 1
Objectives
Fundamentals of nursing care
Time: 210 hours (T70+P140)
Contents
Suggested
Teaching/Learning
Strategies and Aids
The midwife is expected to
be able to:
(K) Define nursing and
purpose of nursing
(S) Demonstrate the
procedure regarding
documentation of patients
(S) Demonstrate the
proper bed making
technique
(S) Give a bath to a patient
(S) Displays how to ensure
oral hygiene of a patient
(S) Displays proper
removal of a bed pan
(S) Perform maneuvers to
prevent bed sores and
demonstrate proper care
of bed sores
(K) Lists causes of bed
sores
(S) Demonstrate proper
filling of hot water bottle
(S) Demonstrate nursing
positions
(S) Administer enema to a
patient correctly
(S) Demonstrate
sterilization procedures
Introduction to nursing
History of nursing
Purpose of nursing
Ethics of nursing
Documentation of patients
Welcome and reception
Procedure of admission
Procedure of transfer
Procedure of discharge
Record keeping
Bed bath procedure
Purpose
Equipment
Principles
Procedure
Bed making
Types
Procedure
Requirement
Oral hygiene
Equipment
Procedure
Care of dentures
Use of bed pan
Requirement
Method of use
Removal of bed pan
Bed sores
Definition
Causes
Treatment
Prevention
Water bottle and ice pack
Equipment
Procedure
Care of equipment
Lectures
Interactive discussion
Demonstration and
return demonstration
Charts and models
Simulators
Patient bed
Linen
Oral hygiene
equipment
Bed pan
Videos
Water bottle
Dummy for positions
Enema can
Thermometer
BP apparatus
Stethoscope
Weighing scale
Tape measure
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.18
Community Midwifery Curriculum
Precautions
(S) Demonstrate
procedure and recording
of patients’ temperature,
pulse and respiration
(S) Demonstrate taking BP
of a patient
(S) Demonstrate proper
collection and handling of
specimens for analysis
(S) Demonstrate proper
non touch technique of
catheterization
(S) Demonstrate obstetric
and gynaecological
nursing procedures
(S) Develop skills in
carrying out various
procedures relating to
mother and baby
Positions in nursing
Recumbent
Semi recumbent
Prone
Upright
Dorsal
Lateral (left and right)
Fowler
Lithotomy
Knee chest
Baby bath tub
Baby doll
Haemoglobinometer
Test tubes
Burner etc.
Enema
Types
Purpose
Solutions
Equipment
After care of patient
After care of equipment
Sterilization
Definition
Purpose
Methods used
Temperature Pulse and
Respiration
Temperature taking
Equipment required
Recording temperature
Counting & recording pulse
Counting & recording
respiration
Blood pressure
Purpose
Equipment
Procedure
Charting
Collection of specimens
Methods of collection
Procedure of dispatch to lab
Urine testing for sugar and
albumin
Catheterization
Purpose
Procedure
Precautions
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.19
Community Midwifery Curriculum
Perenial toilet
Purpose
Procedure
Precautions
Weight, height & baby bath
Maternal height
Checking Hb%
Measuring height and weight of
baby
Procedure of baby bath
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.20
Community Midwifery Curriculum
Unit 2 Introduction
Introduction to midwifery
Objectives
Contents
Time: 36 hours (T30+P6)
Suggested
Teaching/Learning
Strategies and Aids
The midwife is expected to
be able to:
(K) Introduced to the
course, express their
expectations etc.
(K) Become aware of the
Maternal Mortality
situation in Pakistan and
steps to reduce it
(K) Define midwifery and
describe the role, skills
and responsibilities of a
midwife
(K/S) Be oriented with the
workplace
How the course will be
conducted
Expectations and apprehensions
about the course
Introduction to Maternal
Mortality in Pakistan
Safe motherhood initiative
Saving mothers and newborn
lives
Icebreaking
techniques
Lectures with
interactive discussion
OHP transparencies
Handouts
Visit of facilities
Definition of midwifery and
midwife
Introduction to midwifery
Role of a midwife
Ethics and values in practice
Skills and competencies of a
midwife
Responsibilities of a midwife
Orientation of departments and
clinics
OPD
Labour room
Operation theatre
CSSD
Nursery
Indoor wards
Emergency room
Lactation clinic
Children ward
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.21
Community Midwifery Curriculum
Unit 3 Anatomy and physiology
The reproductive system
Female pelvis
Objectives
Contents
Time: 15 hours (T12+P3)
Suggested
Teaching/Learning
Strategies and Aids
The midwife is expected
to be able to:
(S) Demonstrate on a
model, the anatomy and
physiological functions
of the pelvis as related
to delivery
(S) Demonstrate on a
model the pelvic floor, its
muscles, and its function
during childbirth
Pelvis:
Definition of the pelvis
Functions of the pelvis
The pelvic bones and their
functions
The pelvic joints
The pelvic ligaments
The true pelvis
Lecture with interactive
discussion
Charts and diagrams
Bones and models
Demonstration on models
and bones with return
demonstration
Pelvic brim and its
landmarks
The false pelvis
Types of pelvises
Pelvic brim and cavity
Diameters of the pelvis
Pelvic Floor:
Functions of the pelvic floor
Muscles of the pelvic floor
Superficial layer
Deep layer
The perineal body
Structures forming the
perineal body
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.22
Community Midwifery Curriculum
Unit 3
The reproductive system
Female external genitalia
Objectives
Contents
Time: 15 hours (T12+P3)
Suggested
Teaching/Learning
Strategies and Aids
The midwife is expected
to be able to:
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.23
Community Midwifery Curriculum
(S) Demonstrate on a
Vulva
model the anatomy of
Mons pubis
the external genitalia and
Labia majora
its role in childbirth
Labia minora
Fourchette
(S) Demonstrate the
Vestibule
structure, functions and
Uretheral orifice
role of the uterus in
Vaginal orifice
conception, pregnancy
Perineum
and childbirth on a
Vagina
model
Function
Blood supply
(K) Describe the
Nerve supply
importance of fallopian
Lymphatic drainage
tubes with special
Position
reference to conception
Relations
and ectopic pregnancy
Layers
Uterus
(K) Describe the structure
Position
and function of ovaries
Functions
Relations
Supports
Structure
Layers
Blood supply
Fallopian tubes
Functions
Relations
Supports
Structure
Layers
Ovaries
Functions
Ovarian hormones
Control of ovarian
hormones
Relations
Supports
Structure
Layers, cortex, medulla
Lectures and interactive
discussions
Simulators and models
Charts and diagrams
Demonstration on
simulator and return
demonstration
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.24
Community Midwifery Curriculum
Unit 3
The reproductive system
Male reproductive system
Objectives
Contents
Time: 6 hours (T6+P0)
Suggested
Teaching/Learning
Strategies and Aids
The midwife is expected
to be able to:
(S) Demonstrate on a
model the male
reproductive system and
its role in conception
(S) Demonstrate the
proper application of
condom and its safe
removal in respect of
contraception/STD
prevention
The scrotum and its contents
The spermatic cord
The seminal vesicles
The ejaculatory ducts
The prostate gland
Lecture and interactive
discussion
Models
Charts and diagrams
The penis
The male hormones and
sperms
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.25
Community Midwifery Curriculum
Unit 3
Physiology of the reproductive system
Fertilization
Time: 30 hours (T20+P10)
Objectives
Contents
Suggested
Teaching/Learning
Strategies and Aids
The midwife is expected
to be able to:
(K) Describe ovarian
Ovarian cycle
Lecture and interactive
hormonal cycle and the
Functions of the ovary
discussion
role of ovaries in
Development of the ovum
conception
Ovarian hormones
Demonstration and return
Control of the ovarian cycle
demonstration on
(S) Demonstrate on a
simulators
model process of
The menstrual cycle
fertilization
Charts and diagrams
Puberty and the menopause
(S) Show the
developmental stages of
the fetus using
simulators and models
(S+K) Demonstrate and
describe the
development, coverings
and functions of the
placenta using models
and simulators
The gametes
Fertilization of the ovum
Growth of the fertilized ovum
Video “The miracle of life”
Development of the fetus
Fetal organs
Blood
Fetal circulation
Extra uterine adaptation of
circulation
Development of the placenta
Functions of the placenta
Appearance of the placenta
The coverings
Amniotic fluid
Functions, Origin
Volume, Constituents
The umbilical cord
Variations of the placenta and
the cord
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.26
Community Midwifery Curriculum
Unit 3
The fetal skull
Objectives
The midwife is expected
to be able to:
(S) Demonstrate the
bones, sutures and
diameters on the skull,
and describe their
importance during
childbirth
Contents
Bones of the skull
Sutures and fontanels
Landmarks of fetal skull
Diameters of fetal skull
Presentation attitudes of the
fetal skull
Time: 10 hours (T4+P6)
Suggested
Teaching/Learning
Strategies and Aids
Lecture and interactive
discussion
Charts and diagrams
Skull and models
Demonstration and return
demonstration
Moulding
Intracranial membranes and
sinuses
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.27
Community Midwifery Curriculum
Unit 4 Pregnancy
Preparing for pregnancy
Objectives
The midwife is expected
to be able to:
(K) Describe the
reproductive cycle of a
female and the roles of
husband and family in
parenthood
(S) Counsel women in
parent craft,
motherhood, planning
families etc
Contents
Marriage
Parenthood
Pre-pregnancy care
Medical screening
Genetic counseling
Psychosexual counseling
Time: 36 hours (T6+P30)
Suggested
Teaching/Learning
Strategies and Aids
Lecture and interactive
discussion
Food charts and models
Demonstration and return
demonstration using food
models
Diet
(S) Assemble a balanced
diet using food models
Weight
from all four food groups
Exercise
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.28
Community Midwifery Curriculum
Unit 4
Infertility
Objectives
The midwife is expected
to be able to:
(S) Take history of
infertility in couples
(S) Counsel couples on
infertility and propose
adequate steps for
seeking help
Contents
Male causes and Investigations
Female causes and
Investigations
Time: 6 hours (T6+P0)
Suggested
Teaching/Learning
Strategies and Aids
Lecture and interactive
discussion
Demonstration and return
demonstration in
infertility clinic on
patients
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.29
Community Midwifery Curriculum
Unit 4
Objectives
Physiological changes of pregnancy
Time: 36 hours (T6+P30)
Contents
Suggested
Teaching/Learning
Strategies and Aids
The midwife is expected
to be able to:
(K) Describe the changes
in the reproductive
system during pregnancy
(S) Demonstrate the
changes in the body
systems in pregnancy on
a pregnant woman in
ANC/Community
Changes occurring in
Uterus
Cervix
Vagina
Breasts
Cardio vascular system
Blood
Blood pressure
Lecture and interactive
discussion
Charts and diagrams
Demonstration and return
demonstration on
patients in
ANC/community
Respiratory system
GIT
Skeletal system
Maternal weight
Endocrine system
Psychological changes in
pregnancy
Diagnosis of pregnancy
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.30
Community Midwifery Curriculum
Unit 4
Antenatal care
Objectives
Contents
Time: 60 (T6+P54) hours
Suggested
Teaching/Learning
Strategies and Aids
The midwife is expected to be
able to:
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.31
Community Midwifery Curriculum
(K) List the importance and
steps of antenatal care
Aims of antenatal care
Lectures and
interactive discussions
Booking visit
(S) Demonstrate how to take a
history of a pregnant woman
and calculate the EDD from
LMP
(S) Perform a proper antenatal
check up
(S) Perform an examination to
determine the height of
fundus, lie of fetus, presenting
part, engagement, fetal heart
sounds and calculate the
correspondence to calculated
dates
(S) Perform a vaginal
assessment for adequacy of
pelvis for normal vaginal
delivery
Charts and diagrams
Objectives of booking
Antenatal cards
Midwifery history
Factors indicating intensive
antenatal care
Physical examination
Abdominal examination
Fundal height
Lie
Position
Engagement
Fetal heart sounds
Assessment of pelvis
Follow up visits
Investigations
(K) List the investigations for a
pregnant woman and describe
the normal values
(K) List the common
medicines and their doses to
be prescribed during
pregnancy
(S) Communicate to the
patient the schedule for return
visits
Investigations forms
with normal values
Models and
simulators
Demonstration and
return demonstration
on simulators and
actual patients
Skills observation
checklists
(Fill out 50 case
records in log book,
certified by
observer/instructor)
Medications and nutritional
advice
Things to avoid during
pregnancy
Planning place and mode of
delivery
Things to prepare for delivery
(K) List the high risk
conditions in pregnancy and
describe action to be taken in
such cases
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.32
Community Midwifery Curriculum
Unit 5 Normal Labour
Management of the First Stage of Labour
Time: 160 hours (T12+P148)
Objectives
Contents
Suggested
Teaching/Learning
Strategies and Aids
The midwife is expected to be
able to:
(S) Demonstrate the three
Environment
Lecture and interactive
cleans for a safe delivery at
Emotional support
discussion
home
Prevention of infection
Position mobility and
Demonstration and return
(S) Perform the proper
monitoring
demonstration on
management of labour in the
Nutrition
patients in community
community setting
Bladder care
and simulators
Observation of the mother
Observation of the fetus
Video “Preparing for
delivery”
Perception of pain
Physiology of pain
Psychological support
Physical care
Sedatives and analgesics
Inhalation analgesia
Alternative methods of pain
relief
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.33
Community Midwifery Curriculum
Unit 5
Physiology and management of the second stage of labour
Time: 160 hours (T12+P148)
Objectives
Contents
Suggested
Teaching/Learning
Strategies and Aids
The midwife is expected to
be able to:
(S) Demonstrate how to
Physiological changes
Lecture and interactive
monitor the uterine
discussion
Mechanism of normal
contractions and the
labour
progress of labour at home
Charts and diagrams
(S) Fill out properly a
modified partogram (WHO)
monitoring the process of
labour
Midwifery care
Demonstration and return
demonstration on
simulator and patients
Partogram (WHO
modified)
Video “Childbirth”
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.34
Community Midwifery Curriculum
Unit 5
Physiology and management of the third stage of labour
Time: 160 hours (T12+P148)
Objectives
Contents
Suggested
Teaching/Learning
Strategies and Aids
The midwife is expected to
be able to:
(S) Demonstrate the steps
Physiological processes
Lecture and interactive
in the active management
Management of the third
discussion
of third stage
stage of labour
Demonstration and return
Delivery of placenta and the demonstration on
membranes
models, simulators and
patients
Completion of the third
stage
Video “Active
management of third
stage”
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.35
Community Midwifery Curriculum
Unit 6 Puerperium
Management of the puerperium
Objectives
Contents
The midwife is expected
to be able to:
(S) Demonstrate the
Introduction
management of a patient
in the puerperium
Physiology of the puerperium
Psychology of the puerperium
Time: 60 hours (T6+P54)
Suggested
Teaching/Learning
Strategies and Aids
Lecture and interactive
discussions
Demonstration and return
demonstration on
patients
Management of postnatal care
Video on puerperial
sepsis and management
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.36
Community Midwifery Curriculum
Unit 6
Family Planning
Objectives
The midwife is expected
to be able to:
(S) Demonstrate the
application of various
methods of family
planning
Contents
Role of the midwife
Time: 66 hours (T12+P54)
Suggested
Teaching/Learning
Strategies and Aids
Lectures and interactive
discussions
Natural methods
Charts and diagrams
Barrier method
(S) Counsel couples on
birth spacing and family
planning
Intra uterine contraceptive
devices (IUCD)
Hormonal method
Contraceptives, pills,
IUCDs, Injections etc.
Demonstration and return
demonstration on
simulators and patients
Male and female sterilization
Video on family planning
techniques
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.37
Community Midwifery Curriculum
Unit 7 Abnormalities of pregnancy, labour and puerperium
Abnormalities of early pregnancy
Objectives
The midwife is expected
to be able to:
(K) Describe abortion
and its management
(S) Manage a patient
having a miscarriage
Contents
Bleeding in early pregnancy
Causes of vaginal bleeding
Abortion
Ectopic pregnancy
Time: 30 hours (T6+P24)
Suggested
Teaching/Learning
Strategies and Aids
Lecture and interactive
discussions
Demonstration and return
demonstration on
patients
Hydatidiform mole
Video on management of
abortions
Video on management of
ectopic pregnancy and
hydatidiform mole
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.38
Community Midwifery Curriculum
Unit 7
Sexually transmissible infections in pregnancy
Time: 30 hours (T6+P24)
Objectives
Contents
Suggested
Teaching/Learning
Strategies and Aids
The midwife is expected
to be able to:
(K) Describe the common Vaginal infections
Lecture and discussions
sexually transmitted
diseases and their
Abnormal vaginal discharge
Charts and diagrams
presentation
Warts and eruptions
Demonstration and return
(S) Correctly Diagnose
demonstration on
cases of STIs and
Genital sores
patients
propose proper
management
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.39
Community Midwifery Curriculum
Unit 7
Disorders caused by pregnancy
Objectives
The midwife is expected
to be able to:
(S) Manage common
diseases in pregnancy
Contents
Vomiting in pregnancy
Pregnancy induced
hypertension and pre
eclampsia
Time: 30 hours (T6+P24)
Suggested
Teaching/Learning
Strategies and Aids
Lecture and nteractive
discussion
Demonstration and return
demonstration on
patients
Eclampsia
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.40
Community Midwifery Curriculum
Unit 7
Disorders of pregnancy
Objectives
The midwife is expected
to be able to:
(S) Demonstrate proper
management of APH
Contents
Antepartum haemorrhage
Time: 30 hours (T6+P24)
Teaching/Learning
Strategies and Aids
Lecture and interactive
discussions
Placenta praevia
Accidental haemorrhage
Demonstration and return
demonstration on
patients
Blood coagulation failure
Disorders of the amniotic fluid
Video on management of
APH and shock
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.41
Community Midwifery Curriculum
Unit 7
Objectives
Diseases associated with pregnancy
Time: 30 hours (T6+P24)
Contents
Suggested
Teaching/Learning
Strategies and Aids
The midwife is expected
to be able to:
(K) Describe common
diseases associated with
pregnancy and their
effect on the mother and
baby
(S) Diagnose the disease
and provide first aid care
prior to referral
Cardiac disease
Anaemia
Hypertension
Renal problems
Lectures
Demonstration and return
demonstration on
patients
Diabetes mellitus
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.42
Community Midwifery Curriculum
Unit 7
Multiple pregnancy
Objectives
The midwife is expected
to be able to:
(S) Diagnose multiple
pregnancy and
demonstrate its proper
management
Contents
Twin pregnancy
Labour and delivery
Complications of multiple
pregnancy
Time: 30 hours (T6+P24)
Suggested
Teaching/Learning
Strategies and Aids
Interactive discussions
Charts
Diagrams
Demonstration
Return demonstration
Postnatal period
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.43
Community Midwifery Curriculum
Unit 7
Prolonged pregnancy and disorders of uterine action
Time: 30 hours (T6+P24)
Objectives
Contents
Suggested
Teaching/Learning
Strategies and Aids
The midwife is expected
to be able to:
(S) Diagnose cases of
Prolonged pregnancy
Lecture and interactive
prolonged period of
discussion
pregnancy, describe its
Induction of labour
causes and perform its
Demonstration and return
management
Abnormal uterine action
demonstration on
patients
Prolonged labour
Video on prolonged
Obstructed labour
labour and its
management
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.44
Community Midwifery Curriculum
Unit 7
Objectives
Malpositions and malpresentations
Time: 30 hours (T6+P24)
Contents
Suggested
Teaching/Learning
Strategies and Aids
The midwife is expected
to be able to:
(S) Correctly diagnose
presentations other than
vertex and perform their
proper management
Occipito posterior position
Lecture and interactive
discussions
Face presentation
Brow presentation
Demonstration and return
demonstration on
Simulators
Breech presentation
Shoulder presentation
Video on malpresentation
and its management
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.45
Community Midwifery Curriculum
Unit 7
Obstetric emergencies
Objectives
The midwife is expected
to be able to:
(S) Diagnose obstetric
emergencies and
perform their
management
Contents
Cord prolapse
Time: 30 hours (T6+P24)
Suggested
Teaching/Learning
Strategies and Aids
Lecture and interactive
discussion
Amniotic fluid embolism
Rupture of the uterus
Shoulder dystocia
Demonstration and return
demonstration
Video on obstetric
emergencies and their
management
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.46
Community Midwifery Curriculum
Unit 7
Complications of third stage of labour
Time: 60 hours (T12+P48)
Objectives
Contents
Suggested
Teaching/Learning
Strategies and Aids
The midwife is expected
to be able to:
(S) Diagnose and
Postpartum haemorrhage
Lecture and interactive
manage PPH
discussions
Acute inversion of uterus
(S) Demonstrate proper
Demonstration and return
management of a case of Shock
demonstration
hypovolemic shock
Effects of trauma sustained
Video on PPH, acute
(S) Diagnose and
during labour
inversion of uterus and
manage injuries
management of Shock
sustained during labour
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.47
Community Midwifery Curriculum
Unit 8
Newborn Care
Objectives
The midwife is expected
to be able to:
(K/S) Describe and
demonstrate principles
of communication and
counseling of families on
newborn care and is able
to teach and counsel a
Mother and Family about
Newborn Care
(S) Demonstrate
essential aspects of
immediate newborn care
(S) Conduct immediate
assessment of a newborn
(APGAR score) and is
able to do immediate
resuscitation of newborn
if required.
(S) Demonstrate
counseling of mothers
and families on
breastfeeding,
immunization and
promoting infection
prevention practices
(S/K) Name Common
Newborn Problems and
can manage them
Contents
Time: 174 hours (T12+P162)
Suggested
Teaching/Learning
Strategies and Aids
Preparing for birth
Immediate new born care
Postnatal care of newborn
Exclusive breastfeeding
Lactation management
Immunization and minor
problems
Prepare for a Baby’s Birth
Immediate Care at Birth
Newborn Care during the First
Day
Newborn History and Physical
Examination
Brief presentation
Discussions
Role play
Demonstrations and
Return demonstration
Interactive discussions
Checklists
Demonstrations on
manikins
Models and Simulators
Interactive discussions
Videos
Brief presentation
followed by Q&A session
Case studies
Transparencies
Care of a Newborn during the
First 28 Days (cord care and
eye care)
What is Asphyxia?
Preparation for Newborn
Resuscitation
Deciding If the Newborn Needs
Resuscitation
Doing Newborn Resuscitation
Care after Resuscitation
Cleaning Resuscitation
Equipment and Supplies
(S) Demonstrate Care of
Low Birth Weight Babies
and can counsel mothers
Possesses Basic Skills for Care
of the Newborn
(S) Can demonstrate
correct record keeping &
Stabilization and Emergency
Referral of Newborns
Newborn Danger Signs
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.48
Community Midwifery Curriculum
can describe referral
protocols
Problem of the Newborns
(K) Can describe
essentials for Successful
Breastfeeding and can
counsel Mothers for
breastfeeding in problem
situations
Counseling breastfeeding
mothers with TB/ hepatitis and
HIV
(K) Can describe and can
counsel mothers/families
for Maternal and Infant
Immunization Schedules
(K) Can describe
principles of Infection
Prevention and can
manage aseptic
technique in newborn
care
Is familiar with drug list for
newborns and mothers
What is Low Birth Weight?
Care for the Low Birth Weight
Newborn
Skin-to-Skin Kangaroo Mother
Care
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.49
Community Midwifery Curriculum
Unit 8
Breastfeeding
Objectives
Contents
The midwife is expected
to be able to:
(S) Counsel mothers
Breast milk
on the importance of
breast milk for the
Advantages of breast milk
baby
Disadvantages of bottle milk
(S) Show how to start
breast feeding and
Latching of the baby
manage cases of non
compliance
Exclusive breastfeeding
Time: 54 hours (T6+P48)
Suggested
Teaching/Learning
Strategies and Aids
Lectures and interactive
discussions
Video of newborn baby
care
Video on breast feeding
Baby friendly hospitals
initiative
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.50
Community Midwifery Curriculum
Unit 9
Community Midwifery
Objectives
Contents
Time: 120 hours (T36+P84)
Suggested
Teaching/Learning
Strategies and Aids
The midwife is expected
to be able to:
(K) Discuss the basic
Components of
Community
(K) Review the concepts
of reproductive health
and its component and
state the target
indicators of
reproductive health
(S) Demonstrate the
primary health care
concept and its element
in-relation to community
reproductive health
(S) Perform home visiting
and give advice on
reproductive health
issues
(S) Identify reproductive
health problems and
related risk factors at the
level of family and
community
(S) Plan a program for
reproductive health
promotion based on
identified problems
Definition and components of
Community
 Geographical area
 Human resources
 Material resources
 Standards demographic
percentages
Discussion
Definition and components of
reproductive health
 Family planning
 Safe mother hood
 Newborn care
 Prevention and Treatment
of sexually transmitted
diseases
 Adolescent health
 Gender equality
Field Visit
Target Indicators of
reproductive health in
Pregnant and Child Bearing
Age women
 Tetanus Toxoid
immunisation status
 Nutrition status (Anaemia)
 Family planning coverage
 Registration of pregnant
woman at health centre
 Deliveries conducted by
skilled health care
providers
 Postnatal care of mother
and newborn
 Newborn registration for
immunisation & growth
monitoring
Practical Exercises
Video
Scenario base exercises
Interactive lecture
Video Drama
Lecture
Simulative Group
discussion
Role play
Definition and elements of
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.51
Community Midwifery Curriculum
primary health care (PHC)
 Preventing Controlling
Health Problems
 Promotion of Nutrition
 Basic Sanitation and Safe
Water
 Maternal and Child
health/Family Planning.
 Immunisation against
Communicable Diseases
 Prevention and Control of
epidemic diseases and injuries
 Provision of Essential
Drugs
Definition, principles, purpose
and advantages Steps and
Phases of home visiting
Definition and types of Family
structure and functions
Methods for identifying
problems in family and
community
Data analysis and presentation
Prioritization of problem
Plan a program using the step
of planning cycle
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.52
Community Midwifery Curriculum
Unit 9
Health Education, Principles, Methods and Techniques of Teaching
Time: 66 hours (T12+P54)
Objectives
Contents
Suggested
Teaching/Learning
Strategies and Aids
The midwife is expected
to be able to:
Definition, Purpose,
Interactive Lecture
(K) Define Health
Importance, Aims and
Education and
objectives and Characteristics
Video
enumerate its
of successful health education
importance
Role play
Counselling and motivation:
(S) Demonstrate the role
Scenario based exercises
of communication in
Factors influencing on
health education
behaviour and attitude change: Group work
 Customs
(S) Change behaviour of
 Norms, Values, & Believes
the community through
 Superstitions
the process of health
 Economic status
education
 People around you
(S) Deliver effective
health education to the
community
(S) Use Teaching
Learning Aids for
conducting health
education program for
reproductive age group
clients
(S) Identify the settings
for conducting health
education sessions
(S) Develop a health
education plan focusing
on primary, secondary,
and tertiary level of
prevention for
reproductive health
clients
Feedback, Evaluation and
Contribution of HE
 Health promotion
 Disease prevention
 Health Maintenance
Methodologies for HE:
 Face to face
communication
 Lecture/demonstration
 Group discussion
 Question answers
 Role-playing / story telling
 Drama
 Posters / pamphlets etc.
 Flip charts /flannel graphs
 Models
 Black board
 Overhead and slide
projector
 Video (TV/VCR/VCP)
Identifying problem
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.53
Community Midwifery Curriculum
Developing action plan Setting
objectives
Evaluation of achievement of
objectives
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.54
Community Midwifery Curriculum
PART III
List of skills to be imparted to the midwife:



Antenatal care
o History taking
o Counseling
o Blood Pressure and weight
o Checking for anaemia
o Top to toe obstetric/abdominal examination
o Identifying high risk cases
o Checking Hb%, urine for protein and sugar, referral for HBV,
HCV, HIV Blood group and Rh factor
o Giving injections (IM/IV)
o Prescribing Iron, Folic Acid and Calcium supplements
o Giving symptomatic treatment for minor ailments like Tab
Panadol
o Referrals
o Drawing blood samples for tests
o Vaccination
Normal deliveries
o History
o Recognizing true/false labour
o Abdominal and pelvic examination to determine progress of
labour
o Maintaining aseptic environment
o Bladder catheterization
o Setting up IV line using cannulas
o Maintaining and interpreting partogram
o Recognizing signs of fetal distress, stabilize and referral
o Recognizing signs of maternal distress, stabilize and referral
o Providing support to the mother and her family
o Managing normal delivery
o Performing an episiotomy and its repair
o Repair of 1st and 2nd degree perineal tears
o Referral for difficult tears
o Active management of third stage
Management of post partum hameorrhage
o Controlled cord traction
o Checking for completeness of placenta
o Internal and bimanual uterine massage
o Abdominal aortic compression
o Correct use of drugs
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.55
Community Midwifery Curriculum








o Managing shock
o Bedside clotting test
o Immediate repositioning of inverted uterus
Immediate care of newborn and resuscitation
o First assessment of the newborn
o Checking APGAR score at 1, 5 and 10 minutes
o Cleaning the baby’s airways
o Checking baby’s heart rate and breathing
o Cord cutting and care
Postpartum care
o Care of the breast and lactation management
o Care of perineum
o Care of the newborn
o Vaccination of the newborn
Manual removal of retained placenta
Repair of vaginal tears 1st and 2nd degree
Episiotomy and its repair
Recognizing prolonged and obstructed labour using partograms
Digital removal of retained products of conception
Stabilizing and referral of patients having convulsions
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.56
Community Midwifery Curriculum
List of drugs to be taught (allowed for usage by the midwife 3rd National
Workshop May 10, 2003 Islamabad):
Drug Indication of use
Inj Syntocinon  Active management of third stage
 Post partum hameorrhage
Inj Methergine 

Inj Valium (one dose 
and refer)
Inj Magnesium Sulfate 
Cap Ampicillin 
Tab Flagyl 

Tab Methyldopa (one 
dose and refer)
Tab Panadol 
Tab Tramadol 
Active management of third stage
Post partum hameorrhage
Severe pre eclampsia and eclampsia
Impending eclampsia (only loading dose)
Puerperal pyrexia
Severe pelvic infections
Gastro Intestinal Tract infections
Severe hypertension
Relief of pain
Relief of pain
Tab Ferrous Sulfate 
Diet supplement
Tab Folic Acid 
Diet supplement
Ringer’s lactate solution 

Tetanus Toxoid vaccine 
Treatment of shock
Replacement of fluids/blood lost
Prevention of tetanus
Drugs and practices contraindicated in pregnancy
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.57
Community Midwifery Curriculum
Evaluation of the outcome of training
The trainers will take each learning objective and develop three sets of tools to
test the trainees learning.
Tool 1:
Traditional written tests to find out how much the trainee remembers – recall
only. These are short answer tests and should be given frequently, preferably
every week. Each question should relate to the objective of that unit
Tool 2:
An oral examination whereby the trainee is given a case study and then asked
questions to see how they apply their theoretical knowledge to a given
situation
Tool 3:
Using checklists and protocols for reference to find the level of competencies
of the trainee in a given situation. This is an important tool, as it tests the
skills of the trainee.
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.58
Community Midwifery Curriculum
Guidelines for final assessment of competency
Skills for final assessment which may be completed using, models, case studies, role
plays, or clinical simulations (patients should be used whenever possible)
Antenatal period:
 Management of shock
 Management of severe pre eclampsia/eclampsia
 Postabortion care
 Management of fever during pregnancy
Labour and childbirth:
 Twin delivery
 Breech delivery
 Management of prolapsed cord
 Management of shoulder dystocia
 Episiotomy and repair
Postpartum care:
 Management of PPH
 Bimanual compression of uterus
 Compression of abdominal aorta
 Manual removal of placenta
 Inspection and repair of perineal, vaginal and cervical tears
Newborn care:
 Newborn resuscitation
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.59
Community Midwifery Curriculum
Guidelines for final assessment of competency
Skills for final assessment MUST be completed with PATIENTS (learning
competencies may be completed using models, case studies, role plays, or clinical
simulations first)
Pre pregnancy period:
 Educating the women and her family in personal and environmental health
awareness and hygiene
 Care of self, checking for anaemia, nutrition and care of newborn
 Planning and preparing for parenthood
Antenatal period:
 Antenatal history taking and examination
 Antenatal care, including preparation of birth plan
 Counseling of pregnant women about dos and don’ts in pregnancy
 Preparing place for birth and collecting supplies needed
Labour and childbirth:
 Assessment of onset of labour
 Monitoring of labour using partogram
 Care during labour and emotional support of woman
 Clean and safe delivery
 Active management of third stage
 Examination of placenta and birth canal
 Cleaning and safe disposal of human waste
Postpartum care:
 Postnatal history taking
 Postnatal examination
 Postpartum care, especially perennial care
 Breastfeeding support
 Family planning counseling and support
Newborn care:
 Immediate newborn care, cleaning and APGAR score
 Warmth
 Cord care
 Eye care
 Newborn examination
 Newborn immunization
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.60
Community Midwifery Curriculum
Proposed academic calendar
Quarter 1
Week 1
Orientation
Week 2
Orientation
Week 3
General anatomy
and physiology
Week 4
General anatomy
and physiology
Week 5
Week 6
Week 7
Week 8
Microbiology
Microbiology
Pharmacology
Pharmacology
Week 11
Week 12
Week 9
First Aid
Week 10
First Aid
Basic nursing care
Basic nursing care
Week 13
Basic nursing care
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.61
Community Midwifery Curriculum
Quarter 2
Week 1
Basic nursing care
Week 5
Break
Week 9
Fetal skull
Female external
genitalia
Week 2
Basic nursing care
Week 6
Introduction to
midwifery
Week 10
Female external
genitalia
Week 3
Basic nursing care
Week 7
Reproductive
System: Female
pelvis
Week 11
Physiology of
reproduction:
Fertilization
Male reproductive
system
Week 4
Review exam
Week 8
Reproductive
System: Female
pelvis
Week 12
Preparing for
pregnancy
Infertility
Week 13
Physiological
changes of
pregnancy
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.62
Community Midwifery Curriculum
Quarter 3
Week 1
Week 2
Week 3
Week 4
Antenatal care
Antenatal care
Antenatal care
Antenatal care
Hands on training
in ANC
Hands on training
in ANC
Hands on training
in ANC
Hands on training
in ANC
Week 5
Week 6
Week 7
Week 8
Management of
first stage of labour
Management of
first stage of labour
Management of
first stage of labour
Management of
first stage of labour
Hands on training
in LR
Hands on training
in LR
Hands on training
in LR
Hands on training
in LR
Week 9
Week 10
Week 11
Week 12
Physiology and
management of
second stage of
labour
Physiology and
management of
second stage of
labour
Physiology and
management of
second stage of
labour
Physiology and
management of
second stage of
labour
Hands on training
in LR
Hands on training
in LR
Hands on training
in LR
Hands on training
in LR
Week 13
Physiology and
management of
second stage of
labour
Hands on training
in LR
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.63
Community Midwifery Curriculum
Quarter 4
Week 1
Week 2
Week 3
Physiology and
management of
third stage of
labour
Physiology and
management of
third stage of
labour
Physiology and
management of
third stage of
labour
Hands on training
in LR
Hands on training
in LR
Hands on training
in LR
Week 5
Management of
puerperium
Hands on training
in post partum
ward
Week 9
Sexually
transmissible
diseases in
pregnancy
Hands on training
in Gynaecology
clinic
Week 6
Week 7
Family planning
Family planning
Hands on training
in FP clinic
Hands on training
in FP clinic
Week 10
Week 11
Week 4
Management of
puerperium
Hands on training
in post partum
ward
Week 8
Abnormalities of
early pregnancy
Hands on training
in Gynaecology
clinic
Week 12
Disorders caused
by pregnancy
Disorders of
pregnancy
Diseases associated
with pregnancy
Hands on training
in Gynaecology
clinic
Hands on training
in Gynaecology
clinic
Hands on training
in ANC clinic
Week 13
Multiple pregnancy
Hands on training
in ANC clinic
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.64
Community Midwifery Curriculum
Quarter 5
Week 1
Prolonged
pregnancy and
disorders of uterine
action
Week 2
Week 3
Malpositions and
malpresentations
Obstetric
emergencies
Hands on training
in LR
Hands on training
in LR
Hands on training
in LR
Week 5
Complications of
third stage of
labour
Hands on training
in LR
Week 9
Care of the
newborn
Hands on training
in Newborn
Nursery
Week 6
Week 7
Week 4
Complications of
third stage of
labour
Hands on training
in LR
Week 8
Care of the
newborn
Care of the
newborn
Care of the
newborn
Hands on training
in Newborn
Nursery
Hands on training
in Newborn
Nursery
Hands on training
in Newborn
Nursery
Week 10
Week 11
Week 12
Breastfeeding
Breastfeeding
Health Education
Hands on training
in Breast Feeding
Clinic
Hands on training
in Breast Feeding
Clinic
Practical training in
HE classes
Week 13
Health Education
Practical training in
HE classes
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.65
Community Midwifery Curriculum
Quarter 6
Week 1
Week 2
Health Education
Health Education
Practical training in
HE classes
Practical training in
HE classes
Week 5
Week 6
Week 3
Week 4
Community
Midwifery
Community
Midwifery
Home visits and
community work
Home visits and
community work
Week 7
Week 8
Community
Midwifery
Community
Midwifery
Community
Midwifery
Community
Midwifery
Home visits and
community work
Home visits and
community work
Home visits and
community work
Home visits and
community work
Week 11
Preparation leave
Week 12
Preparation leave
Week 9
Week 10
Community
Midwifery
Community
Midwifery
Home visits and
community work
Home visits and
community work
Week 13
Final Assessment
Examinations
Pakistan Nursing Council, Islamabad. (www.pnc.org.pk).
Page No.66