Role of Auxiliary Nurse Midwife (ANM)
Auxiliary Nurse Midwives serve as frontline maternal and child health providers in primary healthcare settings, particularly in rural and underserved areas, where they monitor uncomplicated pregnancies, support women through labor, conduct deliveries, perform basic clinical procedures, and escalate high-risk cases to physicians. 1, 2
Core Clinical Responsibilities
ANMs function as the primary maternal and child health workforce at the community and facility level, with specific duties including:
- Monitoring uncomplicated pregnant women throughout the antenatal period, identifying those requiring higher-level medical intervention 1
- Supporting women through labor and conducting normal deliveries independently in primary care settings 1, 3
- Performing essential clinical procedures including venepuncture, IV cannulation, and documentation of patient progress 1
- Providing medical abortion services at sub-health post levels in rural settings, with studies demonstrating safe and effective provision by ANMs with minimal complications requiring referral 3
- Delivering promotive, preventive, curative, and rehabilitative healthcare services for maternal, neonatal, and child health 4
Patient Triage and Escalation
A critical function of ANMs involves identifying patients requiring higher-level care and escalating appropriately to the medical team for assessment and management 1. This ensures continuity of care while allowing physicians to focus on complex cases, similar to how midwives function in obstetric settings globally 1.
Workforce Context and Challenges
The ANM role has evolved significantly with expanded responsibilities over time:
- ANMs carry substantial burden of executing health services in rural India's healthcare delivery system, working alongside ASHA workers and Anganwadi workers as frontline community health workers 5, 4
- Performance is governed by multiple factors including inadequate training and supervision, weak regulatory enforcement leading to poor standardization of training quality, insufficient clinical support in workplaces, and challenges in accountability mechanisms 5
- Expanded scope of work has added numerous responsibilities beyond the original maternal-child health focus, often without corresponding increases in training or support 5
Training and Capacity Building
Effective skill development requires:
- Complementary mix of directed and self-directed learning approaches for building essential maternal and newborn health skills, including maternal and newborn resuscitation and eclampsia management 2
- Regular skill-building exercises through innovative approaches should be prioritized given the significant responsibility resting on ANMs in transforming healthcare delivery systems 2
- Clinical skills improvement is particularly notable in ANMs with less work experience, though knowledge retention requires ongoing reinforcement 2
Quality of Care Outcomes
When properly trained and supported:
- ANMs provide improved continuity of care for patients, particularly in settings where physician availability is limited 1
- Medical abortion services by ANMs demonstrated no complications requiring referral to higher-level facilities except one incomplete abortion in a study of 307 women, with nearly all women satisfied with services 3
- Community health volunteers working with ANMs significantly increased knowledge of abortion services, pregnancy testing (584 women), and appropriate referrals (114 women) in rural Nepal 3
Critical Pitfalls to Avoid
- Focusing solely on technical tasks without addressing systemic factors (regulatory enforcement, supervision quality, accountability mechanisms) is insufficient to achieve ANMs' full potential 5
- Inadequate clinical support and problem-solving supervision limits effectiveness, as current supervisory approaches focus primarily on comparing reports against expected outputs rather than clinical mentorship 5
- Insufficient training relative to expanded responsibilities creates gaps in competency that compromise patient safety and quality of care 5