PURPOSE:
In 2018, the Government of India launched the Nurse Practitioners in Midwifery (NPM) program to develop a professional midwifery workforce delivering respectful, evidence-based, women-centric care. In this case study of the NPM program in Karnataka, Aastrika shares valuable insights on introducing ICM-defined midwives into settings with no prior experience of midwifery and into heavily medicalised institutions.

DISCUSSION:
Historically, ‘midwife’ in India has been vaguely used to describe traditional birth attendants (TBAs) as well as various cadres of nurses. The NPM program is the first effort to build, educate, and regulate a cadre of professionals who meet the ICM’s definition of a midwife: educated as per the ICM Essential Competencies, recognized and licensed to be called midwives, with a clear scope of practice.

EVIDENCE WHERE RELEVANT:
Karnataka now has 29 graduated midwifery faculty, 69 midwives currently in training, and 5 clinical practice sites. More students and hospitals are in the pipeline. Early program results show significant success, such as episiotomy rates reducing from over 80% to 19%. A major roadblock has been resistance and scepticism from obstetricians and nurses. While sensitization workshops and hands-on demonstrations helped, encouraging doctors to directly observe midwives was the most impactful. Seeing is believing: midwives have inspired doctors to reduce episiotomies and increase ambulation even in obstetrician-led wards. Initial hesitance among families was addressed through midwifery-led antenatal care, childbirth education, and testimonials. The program's success is such that pregnant women now actively seek out NPMs. To ensure clarity and professional recognition, Aastrika consistently uses the terms "professional midwife" and "NPM," distinguishing these NPM graduates with ICM competencies from nurses and TBAs. A successful coalition-based advocacy process has ensured that India now has a Scope of Practice for NPMs and an accreditation pathway.

KEY MESSAGE:
This case study from Karnataka describes successful strategies to overcome obstacles to introducing midwives into a new setting. Poster session 3 (Group B)