Staff nurses (nurse-midwives) in India are expected to provide normal birth services in health facilities under the maternal health strategy of the National Rural Health Mission. Under the integrated nursing and midwifery programme in India, every nurse graduate has some midwifery education which may not be adequate for this role.

To assess confidence of students in four domains of midwifery skills of the International Confederation of Midwives,just before graduation, namely antepartum, intrapartum, postpartum and newborn care. The study further compares confidence levels of students from the diploma and bachelor programmes.

Self-reported confidence data was obtained from 633 final year students from diploma and bachelor's programmes in one district, from 25 randomly selected schools and colleges of nursing. An explorative factor analyses using principal component analysis (PCA) for the four competency domains was done.Relationship between type of program and self-assessed confidence unadjusted and adjusted logistic regression models were performed.

Sixty five per cent students did not meet the national registration requirements ofnumber of assisted and independent births. Except for managing high risk pregnancies the students were confident in other antepartum skills. More than 40% of all students expressed low confidence in most of the intrapartum skills. Students expressed low confidence for first level care for postpartum complications and some basic skills such as assessing involution, and healing of lacerations. Except for newborn complications, the students expressed confidence in most basic newborn care skills. Students in the diploma program were significantly more confident in all skill areas with 2-7 times higher odds for self-assessed high confidence.

Students graduating from the diploma and bachelor's programme do not feel confident in fulfilling their role of normal births as expected under the national strategy on maternal health. They need more hands on clinical experience especially for intra partum care, and for recognition and initiating life saving measures for complications.