Name: Shahnaz Shahid
Qualification: MScN, BA, RN, RM
Affiliation:Aga Khan University School of Nursing and Midwifery, Karachi, Pakistan
Designation: Midwifery Programme Coordinator and Senior Instructor

Title of Presentation: Community Midwives Refresher Training: Strengthening Knowledge and Skills



Maternal Mortality Rate (MMR) is a major area of concern all over the world; despite of several interventions, MMR is still very high. Pakistan ranks third highest in the world with estimated number of 276 maternal deaths per 100,000 live births. In Pakistan, 65% of births take place in homes; the proportion of births at home is much higher in rural areas, where risk of death due to obstetric complications remains much higher. Availability of skilled birth attendant including community midwife (CMW) is critical at community level for reducing maternal morbidity and mortality. In spite of, many efforts by maternal neonatal and child health (MNCH) program in producing a number of CMWs throughout Pakistan, the need for their continuous professional education in restoring their midwifery knowledge and skills are significant to make them safe and competent quality care providers. As CMWs are expected to practice independently in their birthing center in the community, hence, refresher training was designed for graduated CMWs in Sindh province of Pakistan to update the midwifery knowledge and skills and provide them basic birthing home management skills to help them run their centers smoothly.

  • To conduct training of graduated CMWs by reviewing normal pregnancy, labor, postnatal and newborn care.
  • To provide birthing home management skills to practice smoothly in their respective communities.


Five week refresher training was conducted in Aga Khan Maternal and Child Care Center, Hyderabad, Sindh. Training comprised of five modules including antenatal, intranatal, postnatal and newborn care and management of childbirth complications. A total of 42 CMWs were identified and selected from 11 districts of Sindh Province by MNCH program coordinator. These 42 participants were divided into three groups comprising of 14 members in each group. Pre and post-assessment of CMWs theoretical knowledge and skills was done by using the Steven Harvey tool. The tool was pilot tested on four participants before using.


Findings from pre-assessment revealed that most of the CMWs lacked basic competencies and infection prevention and control practices to provide quality maternity care to women. Hence, throughout the training essential midwifery competencies were practiced along with theoretical content review. The post-assessment showed an increase in CMWs knowledge and skills, and they shared their thoughts about being more competent and confident.

Conclusion/ Recommendations

Training was a significant effort made to enhance CMWs development, as it was first of its kind in the country. Through this training CMWs were able to review the important midwifery concepts and skills. The most effective part of the training as verbalized by participants was the hands on practice opportunity in primary and secondary health care setups. Participants recommended internship in the community with a mentor after their graduation and inclusion of birthing home management skills in the curriculum.