Midwifery Education Standards Research Articles

Establishing a Europe-wide foundation for high quality midwifery education: The role of the European Midwives Association (EMA)

A cornerstone of European policy involves freedom of movement of individuals between member countries, which applies equally to those who use and provide maternity care. To promote and support safe, high quality maternity care, minimum standards for midwifery education and practice have been published, including Directives EEC/80/154 and EEC/80/155 which support the recognition of professional qualifications. These Directives established a minimum standard for midwifery education, including the duration and content of theoretical and practical education. Annex V of the Directives established a framework of professional activities to define and guide the scope of midwifery practice in EU member countries. The Directives were updated in 2013, with the European Midwives Association (EMA) an important partner in this process.While the degree of implementation of the Directives at individual country level varies, EMA has an ongoing role in ensuring, promoting and advancing high quality midwifery education and practice throughout the EU.

Development of a context specific accreditation assessment tool for affirming quality midwifery education in Bangladesh

Objectiveusing the International Confederation of Midwives (ICM) Global Standards for Midwifery Education as a conceptual framework, the aim of this study was to explore and describe important ‘must haves’ for inclusion in a context-specific accreditation assessment tool in Bangladesh. DesignA questionnaire study was conducted using a Likert rating scale and 111 closed-response single items on adherence to accreditation-related statements, ending with an open-ended question. The ICM Global Standards guided data collection, deductive content analysis and description of the quantitative results. Settingtwenty-five public institutes/colleges (out of 38 in Bangladesh), covering seven out of eight geographical divisions in the country. Participantsone hundred and twenty-three nursing educators teaching the 3-year diploma midwifery education programme. Findingsthis study provides insight into the development of a context-specific accreditation assessment tool for Bangladesh. Important components to be included in this accreditation tool are presented under the following categories and domains: ‘organization and administration’, ‘midwifery faculty’, ‘student body’, ‘curriculum content’, ‘resources, facilities and services’ and ‘assessment strategies’. The identified components were a prerequisite to ensure that midwifery students achieve the intended learning outcomes of the midwifery curriculum, and hence contribute to a strong midwifery workforce. The components further ensure well-prepared teachers and a standardized curriculum supported at policy level to enable effective deployment of professional midwives in the existing health system. Key conclusionsas part of developing an accreditation assessment tool, it is imperative to build ownership and capacity when translating the ICM Global Standards for Midwifery Education into the national context. Implications for practicethis initiative can be used as lessons learned from Bangladesh to develop a context-specific accreditation assessment tool in line with national priorities, supporting the development of national policies.

United States Model Midwifery Legislation and Regulation: Development of a Consensus Document.

Midwifery is defined and regulated across all 50 United States. However, states' regulations vary markedly, creating confusion for policy makers and consumers, and can limit services to women. In 2011, the International Confederation of Midwives released Global Standards for Midwifery Education, Regulation, and Association, providing guidance for international midwifery for the first time. US organizations representing midwifery education, regulation, and professional associations (US MERA) agreed to work together on common goals. The purpose of this modified Delphi study, conducted by US MERA, was to develop a consensus document on principles of model US midwifery legislation and regulation. Expert panelists (N = 51) across maternal and child health care professions and consumer groups participated over several iterative rounds. The final document establishes guiding principles for US midwifery regulation, including regulatory authority, education, qualifications, regulation, registration and licensure, standards of practice and conduct, complaints, and third-party payment for services. As more US states recognize and license midwives of all credentials and in every practice setting, we can envision a time when equity, informed choice, safety, and seamless access to quality midwifery care will be the right of every birthing family.

Developing a work/study programme for midwifery education in East Africa

Backgroundthere is extensive evidence to show that skilled midwifery care is crucial in reducing maternal deaths; however, in East Africa, the midwifery profession has been subsumed within the nursing role. This paper highlights issues in the preparation of skilled midwives in three East African countries, specifically, Uganda, Kenya and Tanzania and provides a case study description of a flexible work/study programme designed to develop skilled midwives to meet internationally regarded ICM competency standards in midwifery education and practice. The modela flexible, competency-based Bachelor's of Science in Midwifery programme (BScM) has been developed based on fifteen years' experience of running a Bachelor of Science in nursing programme. The new BSCM programme allows licensed diploma midwives the opportunity to study for two days a week towards a bachelor's degree in midwifery, whilst continuing to work and support their families. The model also provides education at degree level thus providing a sound platform for ongoing development of a cadre of midwifery leaders. Conclusionthe BScM education model for working midwives builds on the success of the BScN work/study model in developing strong leadership, clinical and critical thinking competencies. The newly developed midwifery programme provides a pathway by which to increase the availability of skilled East African midwives educated to the Global Standards for Midwifery Education.

Beyond Brexit: Cross-border collaborations in pre-registration midwifery education

In June 2016, the UK voted to leave the European Union (EU), which will have wide ranging social, legal and constitutional implications. Although the International Confederation of Midwives has established international standards for midwifery education, education and practice are regulated through an EU directive that includes the recognition of professional qualifications that is necessary for midwives to practise anywhere within the EU. While there is uncertainty around the future political landscape post-Brexit, it is important that pre-existing professional links are protected and strengthened, providing a platform for international collaboration for professional discourse, dissemination of research findings and sharing of best practice. At the University of Northampton, this is happening through partnership with The Florence Network, which connects nurses and midwives.

The development of a global Midwifery Education Accreditation Programme

ABSTRACTBackground: Many countries are responding to the global shortage of midwives by increasing the student intake to their midwifery schools. At the same time, attention must be paid to the quality of education being provided, so that quality of midwifery care can be assured. Methods of assuring quality of education include accreditation schemes, but capacity to implement such schemes is weak in many countries.Objective: This paper describes the process of developing and pilot testing the International Confederation of Midwives’ Midwifery Education Accreditation Programme (ICM MEAP), based on global standards for midwifery education, and discusses the potential contribution it can make to building capacity and improving quality of care for mothers and their newborns.Methods: A review of relevant global, regional and national standards and tools informed the development of a set of assessment criteria (which was validated during an international consultation exercise) and a process for applying these criteria to midwifery schools. The process was pilot tested in two countries: Comoros and Trinidad and Tobago.Results: The assessment criteria and accreditation process were found to be appropriate in both country contexts, but both were refined after the pilot to make them more user-friendly.Conclusion: The ICM MEAP has the potential to contribute to improving health outcomes for women and newborns by building institutional capacity for the provision of high-quality midwifery education and thus improved quality of midwifery care, via improved accountability for the quality of midwifery education.

Exploring global recognition of quality midwifery education: Vision or fiction?

Midwifery education is the foundation for preparing competent midwives to provide a high standard of safe, evidence-based care for women and their newborns. Global competencies and standards for midwifery education have been defined as benchmarks for establishing quality midwifery education and practice worldwide. However, wide variations in type and nature of midwifery education programs exist. To explore and discuss the opportunities and challenges of a global quality assurance process as a strategy to promote quality midwifery education. Accreditation and recognition as two examples of quality assurance processes in education are discussed. A global recognition process, with its opportunities and challenges, is explored from the perspective of four illustrative case studies from Ireland, Kosovo, Latin America and Bangladesh. The discussion highlights that the establishment of a global recognition process may assist in promoting quality of midwifery education programs world-wide, but cannot take the place of formal national accreditation. In addition, a recognition process will not be feasible for many institutions without additional resources, such as financial support or competent evaluators. In order to achieve quality midwifery education through a global recognition process the authors present 5 Essential Challenges for Quality Midwifery Education. Quality midwifery education is vital for establishing a competent workforce, and improving maternal and newborn health. Defining a global recognition process could be instrumental in moving toward this goal, but dealing with the identified challenges will be essential.

Committee Opinion No 697 Summary: Planned Home Birth.

In the United States, approximately 35,000 births (0.9%) per year occur in the home. Approximately one fourth of these births are unplanned or unattended. Although the American College of Obstetricians and Gynecologists believes that hospitals and accredited birth centers are the safest settings for birth, each woman has the right to make a medically informed decision about delivery. Importantly, women should be informed that several factors are critical to reducing perinatal mortality rates and achieving favorable home birth outcomes. These factors include the appropriate selection of candidates for home birth; the availability of a certified nurse-midwife, certified midwife or midwife whose education and licensure meet International Confederation of Midwives' Global Standards for Midwifery Education, or physician practicing obstetrics within an integrated and regulated health system; ready access to consultation; and access to safe and timely transport to nearby hospitals. The Committee on Obstetric Practice considers fetal malpresentation, multiple gestation, or prior cesarean delivery to be an absolute contraindication to planned home birth.

Committee Opinion No. 697: Planned Home Birth.

In the United States, approximately 35,000 births (0.9%) per year occur in the home. Approximately one fourth of these births are unplanned or unattended. Although the American College of Obstetricians and Gynecologists believes that hospitals and accredited birth centers are the safest settings for birth, each woman has the right to make a medically informed decision about delivery. Importantly, women should be informed that several factors are critical to reducing perinatal mortality rates and achieving favorable home birth outcomes. These factors include the appropriate selection of candidates for home birth; the availability of a certified nurse-midwife, certified midwife or midwife whose education and licensure meet International Confederation of Midwives' Global Standards for Midwifery Education, or physician practicing obstetrics within an integrated and regulated health system; ready access to consultation; and access to safe and timely transport to nearby hospitals. The Committee on Obstetric Practice considers fetal malpresentation, multiple gestation, or prior cesarean delivery to be an absolute contraindication to planned home birth.

Collective action for the development of national standards for midwifery education in Australia.

This article describes a sequence of events that led to the development of national standards for the accreditation of Australian midwifery education programmes for initial registration. This process occurred within a climate of polarised opinions about the value of the introduction of three-year degree programmes for midwives who are not nurses (known as the BMid in Australia) and concerns about the invisibility of midwifery within nursing regulation, education, policy and nomenclature. Concerted efforts to develop standards to inform the introduction of BMid programmes through a process of collective action are described. This involved arguing successfully for the positioning of midwifery as a separate profession from nursing, with a need for its own discreet regulation.

Any action? Reflections on the Australian Midwifery Action Project.

In 1997 a group of midwifery academics, researchers and practitioners met to discuss issues of concern related to the midwifery profession in Australia. It became clear from this discussion that midwifery in Australia was lagging behind similarly developed countries and that urgent action was required. From this meeting, a plan was developed to seek funding for a major national study into midwifery education and practice standards and as such, the Australian Midwifery Action Project (AMAP) was born. This discussion paper presents an overview of a number of midwifery education and regulation changes within the framework of the recommendations from the Australian Midwifery Action Project. A key question arising from this discussion is whether our current midwifery education and regulation standards provide a fit-for-purpose workforce that ensures all women and their families receive best practice midwifery care. Over the past 20 years the Midwifery profession in Australia has undergone significant changes and developments and these changes have had, and continue to have, significant impact on midwifery education and therefore on the quality of midwifery practice in Australia. Many changes have been implemented in the nearly 20 years since AMAP was first conceived. However, many of the issues that provided the impetus for a project such as AMAP remain and are still to be resolved. The midwifery profession continues to be subsumed with nursing, it is not possible to gain accurate midwifery workforce data and, despite the development of national standards for midwifery education, wide variations in courses still exist across Australia.

Committee Opinion No. 669 Summary: Planned Home Birth.

In the United States, approximately 35,000 births (0.9%) per year occur in the home. Approximately one fourth of these births are unplanned or unattended. Although the American College of Obstetricians and Gynecologists believes that hospitals and accredited birth centers are the safest settings for birth, each woman has the right to make a medically informed decision about delivery. Importantly, women should be informed that several factors are critical to reducing perinatal mortality rates and achieving favorable home birth outcomes. These factors include the appropriate selection of candidates for home birth; the availability of a certified nurse-midwife, certified midwife or midwife whose education and licensure meet International Confederation of Midwives' Global Standards for Midwifery Education, or physician practicing obstetrics within an integrated and regulated health system; ready access to consultation; and access to safe and timely transport to nearby hospitals. The Committee on Obstetric Practice considers fetal malpresentation, multiple gestation, or prior cesarean delivery to be an absolute contraindication to planned home birth.

Committee Opinion No. 669: Planned Home Birth.

In the United States, approximately 35,000 births (0.9%) per year occur in the home. Approximately one fourth of these births are unplanned or unattended. Although the American College of Obstetricians and Gynecologists believes that hospitals and accredited birth centers are the safest settings for birth, each woman has the right to make a medically informed decision about delivery. Importantly, women should be informed that several factors are critical to reducing perinatal mortality rates and achieving favorable home birth outcomes. These factors include the appropriate selection of candidates for home birth; the availability of a certified nurse-midwife, certified midwife or midwife whose education and licensure meet International Confederation of Midwives' Global Standards for Midwifery Education, or physician practicing obstetrics within an integrated and regulated health system; ready access to consultation; and access to safe and timely transport to nearby hospitals. The Committee on Obstetric Practice considers fetal malpresentation, multiple gestation, or prior cesarean delivery to be an absolute contraindication to planned home birth.

The first competency-based higher education programme for midwives in the South Asian region – Pakistan

Midwives in Pakistan and the South Asian region who complete a diploma program face many challenges for career growth and development. The absence of higher education in professional midwifery in the region has contributed to general non-acceptance and invisibility of midwifery. In response to the interest, Aga Khan University (AKU) developed bachelors program in midwifery based on the Global Standards for Midwifery Education developed by the International Confederation of Midwives (ICM) with the vision to equip midwives to provide full-scope practice, develop confidence to practice midwifery independently, become clinical leaders and contribute to the future of midwifery. The final curriculum had a balance of theory and clinical practice in order to develop a high level of clinical competence that would meet the ICM standards and guidelines. The two year bachelors program is currently in progress. The first cohort of 21 midwives graduated in 2014 and a second cohort was enrolled in 2015. There is a planning for a future graduate program in midwifery to prepare individuals for leadership roles in practice, teaching, maternal–child health provision and policy making through a master’s degree in midwifery.

Inter-professional Perinatal Simulation training: A valuable educational model to improve competencies amongst student midwives in Brussels, Belgium

Simulation training is a powerful and evidence-based teaching method for students and healthcare professionals. The described educational model of Inter-professional Perinatal Simulation training is the result of a collaborative project with the Erasmus University College Brussels, the Medical School of the Vrije Universiteit Brussel (VUB) and the University Hospital Brussels. This model enhances student midwives to acquire competencies in all fields of midwifery according to national and European legislation and to the International Confederation of Midwives Global Standards for Midwifery Education. In our educational program, simulation training enhanced the achievement of decision-making and inter-professional communication competences.

Women's experiences of having a Bachelor of Midwifery student provide continuity of care.

The Australian national midwifery education standards require students to complete a number of continuity of care (COC) experiences. There is increasing evidence outlining the value of this experience to the student, but there is limited research examining women's experiences of having a COC midwifery student. This study aimed to investigates the woman's experiences. A retrospective descriptive cohort design was used. A paper-based survey was posted to all women cared for by a midwifery student in 2013 (n=698). Descriptive statistics were used to explore the proportion, mean score, standard deviation and range of the variables. Construct validity of the Satisfaction and Respect Scales was tested using exploratory factor analysis. Free text responses were analysed using latent content analysis. One-third of women returned a completed survey (n=237/698, 34%). There was a significant positive correlation (p<0.05) between the number of AN/PN visits a midwifery student attended and women's levels of satisfaction. Women were very satisfied with having a student midwife provide continuity. The qualitative data provided additional insight demonstrating that most women had a positive relationship with the midwifery student that enhanced their childbearing experience. The women in this study valued continuity of midwifery care and were able to form meaningful relationships with their midwifery student. Programs leading to registration as a midwife should privilege continuity of care experiences. Not only does this benefit women but provides the future midwifery workforce with a clear understanding of models that best meet women's individual and the benefits of working in these models.

Practitioner and Practice Characteristics of Certified Professional Midwives in the United States: Results of the 2011 North American Registry of Midwives Survey.

No data describing certified professional midwives (CPMs) currently exist in the literature, although CPMs attend the majority of home births in the United States. This study addresses this gap by assessing the demographics, education levels, routes to certification, and practice characteristics of currently practicing CPMs. Data were collected from a survey of CPMs conducted by the North American Registry of Midwives (NARM) between July and October 2011. In order to assess generalization to the entire population of practicing CPMs, we also completed a nonresponse bias analysis. We examined midwives' demographic, education, certification, and practice characteristics using descriptive and nonparametric, bivariable statistics. More than 90% of the 568 respondents attended at least some college, and 47.1% hold a bachelor's degree or greater. CPMs spent a median of 3 years (interquartile range, 2-5 years) in training before attending births as a primary midwife. However, 38.9% of currently practicing CPMs had less than 3 years of training. Regarding pathways to certification, 48.5% utilized the portfolio evaluation process (PEP); 36.9% graduated from a Midwifery Education and Accreditation Council (MEAC)-accredited school; 14.5% were already licensed by a state as a direct-entry midwife; and 0.7% were already a certified nurse-midwife or certified midwife, although many CPMs reported a blended education pathway. One-fifth (21%) of respondents identified as midwives of color. Whereas nearly one-third (31.8%) of CPM respondents reported that 95% or more of their clients were white, 5.2% serve populations that are 90% or more nonwhite. CPMs of color are significantly more likely to serve clients of color (P < .001). Training and nonmidwifery education levels of most CPMs practicing in the United States align with the Global Standards for Midwifery Education established by the International Confederation of Midwives, although there are still clear areas for improvement.

Personal costs of the continuity of care experiences

Introduction: Midwifery education standards in Australia require students to undertake Continuity of Care Experiences (COCE). The COCE afford an ongoing relationship between a midwifery student and a woman for student learning, from initial contact in the early antenatal period, through pregnancy, birth and postnatal period.When exploring student learning in the COCE, we found incidental findings of significant personal cost to students undertaking COCE. Aim: To identify andmeasure these personals costs involved for students participating in the COCE. Methods: A mixed method study was undertaken over a 12 month period. A total of 72 midwifery students across all three years of Bachelor of Midwifery programs at two universities participated through an online survey, and diary records of their time, costs and personal concerns for each individual COCE they participated in across one year. Two focus groups were held at the conclusion of the 12 months of diary collection to discuss the findings and gain a deeper insight into the student experience. Results: Of particular interest is the personal time taken to complete the COCE and the financial costs including travelling and parking to health services, and childcare. Significant non-clinical time of travelling and being with women for extended periods in clinic waiting to see the healthcare practitioners will be detailed. Furthermore, personal safety issues, concerns about their professional relationships with staff and the impact of the COCE on their personal/private relationships will be presented. Conclusion: When developing educational interventions it is important to consider the impact on all stakeholders, including the student experience. These findings of the true costs of the COCE for students may influence the expectations placed on students and the support provided by both education and health service providers.

Exploration of the implementation of the obese obstetric woman policy

Introduction: Midwifery education standards in Australia require students to undertake Continuity of Care Experiences (COCE). The COCE afford an ongoing relationship between a midwifery student and a woman for student learning, from initial contact in the early antenatal period, through pregnancy, birth and postnatal period.When exploring student learning in the COCE, we found incidental findings of significant personal cost to students undertaking COCE. Aim: To identify andmeasure these personals costs involved for students participating in the COCE. Methods: A mixed method study was undertaken over a 12 month period. A total of 72 midwifery students across all three years of Bachelor of Midwifery programs at two universities participated through an online survey, and diary records of their time, costs and personal concerns for each individual COCE they participated in across one year. Two focus groups were held at the conclusion of the 12 months of diary collection to discuss the findings and gain a deeper insight into the student experience. Results: Of particular interest is the personal time taken to complete the COCE and the financial costs including travelling and parking to health services, and childcare. Significant non-clinical time of travelling and being with women for extended periods in clinic waiting to see the healthcare practitioners will be detailed. Furthermore, personal safety issues, concerns about their professional relationships with staff and the impact of the COCE on their personal/private relationships will be presented. Conclusion: When developing educational interventions it is important to consider the impact on all stakeholders, including the student experience. These findings of the true costs of the COCE for students may influence the expectations placed on students and the support provided by both education and health service providers.

The 2012 American College of Nurse‐Midwives Core Competencies for Basic Midwifery Practice: History and Revision

The American College of Nurse-Midwives (ACNM) Core Competencies for Basic Midwifery Practice, approved in 2012, (hereafter referred to as Core Competencies) outline the knowledge, skills, and abilities that can be expected of new certified nurse-midwives (CNMs) and certified midwives (CMs). The Core Competencies are standards for midwifery education, and the document is an important guide for midwifery practice and policy. As a part of the 2012 revision, the Basic Competency Section of the ACNM Division of Education reviewed a variety of national and international documents to ensure that the basic education of CNMs/CMs is consistent with the practice of midwives in the United States and internationally. Few substantive changes were made to the document, but several areas were adjusted and clarified. New graduates continue to be prepared by midwifery education programs to provide safe, evidence-based midwifery care to women across the lifespan, well newborns up to 28 days, and sexual partners of women diagnosed with sexually transmitted infections.