BACKGROUND:
Andhra Pradesh (AP) registers over 8.2 lakh births annually but ranks third in cesarean section rates (42.4%, NFHS-5), reflecting growing over-medicalization and overstretched tertiary services. In response, the state government introduced midwifery as a solution to promote respectful, physiologic birth. AP became the first Indian state to issue a Government Order (GO Ms. No. 205) for operationalizing midwifery services with structured guidelines and certification mechanisms. Despite quality training, midwives were facing challenges in applying competencies independently, risking skill attrition. A structured mentoring mechanism was needed to hand-hold and integrate into the healthcare system.

OBJECTIVES:
To strengthen the competencies and confidence of newly trained Nurse Practitioners in Midwifery (NPMs) through a blended mentoring model combining virtual and physical modalities and ensure their professional integration across 13 high-delivery public facilities.

METHODS:
Five state midwifery educators, trained at Fernandez National Midwifery Training Institute, trained 60 NPMs (30 each at State Midwifery Training Institutes, Guntur and Tirupati) over 18 months on ICM competencies. Almost a year after deployment, a dual-mode mentoring program—virtual (Jun–Oct 2024) and physical (Oct–Dec 2024), the first of its kind hand-holding mentoring mechanism in the country for midwives—was implemented in collaboration with the Fernandez Foundation and UNICEF. Evaluation involved pre/post knowledge tests, skill observations, case reviews, and facility audits.

RESULTS:
Knowledge scores improved from 59% to 78% during virtual mentoring. Physical visits reinforced clinical skills, documentation, and problem-solving. NPMs independently conducted 42% of normal births across 13 facilities, including 11,178 women supported in alternate birthing positions. 60.5% of births attended by midwives required no episiotomy, versus 19% for doctors/nurses.

CONCLUSIONS:
AP’s government-led, educator-driven model demonstrates how dual-mode mentorship can effectively build a competent midwifery workforce embedded within the public health system.

KEY MESSAGE:
With structured education, policy backing, and blended mentoring, AP’s initiative presents a scalable model for midwifery reform globally—transforming maternal care through respectful, evidence-based practices. Education - competency development 1 (including three-minute presentation competition)