09 Scaling Midwife-Led Care in India

Speakers:- Zuber Sultana & Pothuraju Anitha

Facilitator:- Indriana Widya Puspitasari

Abstract:- Background: Maternal health in India faces challenges of high intervention rates and limited access to respectful, woman-centered care. To address this, the Fernandez Foundation in South India embedded midwifery into its services through the Professional Midwifery Education and Training (PMET) program launched in 2011. A co-located Midwife-Led Unit (MLU) was established, serving as a model for dissemination to training institutes and supporting the setup of MLUs in government facilities across several states in South India. Aim: To evaluate the impact of midwifery-led care on maternal outcomes, birthing practices, and national midwifery capacity building. Methods: A retrospective review of hospital records from 2010-2025 was conducted, analyzing MLU admissions, transfers to obstetric-led units (OLUs), birthing positions, and use of hydrotherapy and waterbirth. Results: Between July 2019 and December 2025, 2,175 women were admitted to MLUs; 1,477 (67.9%) birthed in MLUs, while 698 (32.1%) required transfer to OLUs. Birthing positions reflected autonomy: propped up (1,228), left lateral (189), all fours (35), squatting (18), standing (6), and right lateral (1). Hydrotherapy was used by 930 women and waterbirth by 427. Nationally, the first Midwifery Training Institute trained 30 midwifery educators from six states, strengthening workforce capacity and supporting the establishment of MLUs in government facilities. Conclusion: Midwife-Led Units at Fernandez Hospital demonstrate safe, cost-effective, and respectful maternity care. Embedding midwifery within hospital systems and extending MLUs to government facilities has strengthened maternal health in India, offering a replicable model for optimizing outcomes in low-risk pregnancies and advancing midwifery globally.

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