Joyce Beebe Thompson

The International Confederation of Midwives' study of essential competencies of midwifery practice.

OBJECTIVE To delineate the knowledge, skills, and behaviours that would characterise the domain of competencies of the midwife who is educated according to the international definition of the profession. DESIGN Phase I: a qualitative Delphi study; Phase II: a descriptive survey research process. PARTICIPANTS A stratified random sample of member organisations of the International Confederation of Midwives (ICM) and regulatory representatives from these same countries. FINDINGS A list of basic (essential) and additional competencies for midwives who have been educated in keeping with the ICM/WHO/FIGO international definition of the midwife was developed through an interative Delphi process, and then affirmed, using a survey research method. The final list includes 214 individual task statements within six domains of midwifery practice. IMPLICATIONS FOR PRACTICE This list of competencies can serve as a basis for educational curriculum design, as a guideline for regulatory policy development, as a reference document for individual practitioners in an assessment of their initial and continued competency and by the ICM and its member associations as a resource for advocating for the role of midwifery within health-care systems world-wide.

The International Confederation of Midwives Essential Competencies for Basic Midwifery Practice. An update study: 2009–2010

OBJECTIVE a 2-year study was conducted to update the core competencies for basic midwifery practice, first delineated by the International Confederation of Midwives in 2002. A competency domain related to abortion-related care services was newly developed. DESIGN a modified Delphi survey process was conducted in two phases: a pilot item affirmation study, and a global field survey. SETTING a global survey conducted in 90 countries. PARTICIPANTS midwifery educators or clinicians associated with midwifery education schools and programmes located in any of the ICM member association countries. Additional participants represented the fields of nursing, medicine, and midwifery regulatory authorities. A total of 232 individuals from 63 member association and five non-member countries responded to one or both of the surveys. The achieved sample represented 42% of member association countries, which was less than the 51% target. However, the sample was proportionally representative of ICMs nine global regions. MEASUREMENTS survey respondents expressed an opinion whether to retain or to delete any of 255 statements of midwifery knowledge, skill, or professional behaviour. They also indicated whether the item should be a basic (core) item of midwifery knowledge or skill that would be included as mandatory content in a programme of midwifery pre-service education, or whether the item could be added to the fund of knowledge or acquired as an additional skill by those who would need or wish to include the item within the scope of their clinical practice. FINDINGS a majority consensus of .85 was required to accept the item without further deliberation. An expert panel made final decisions in all instances where consensus was not achieved. The panel also amended the wording of selected items, or added new items based on feedback received from survey respondents. The final document contains 268 items organised within seven competency domains.

Quality considerations in midwifery pre-service education: Exemplars from Africa

OBJECTIVE This paper uses comparisons and contrasts identified during an assessment of pre-service education for midwives in three countries in sub-Saharan Africa. The purpose of the paper is to stimulate discussion about issues that must be carefully considered in the context of midwifery educational programming and the expansion of the midwifery workforce. DESIGN AND SETTING A mixed qualitative and quantitative participatory assessment was conducted in Ethiopia, Ghana and Malawi, in the context of a final review of outcomes of a USAID-funded global project (ACCESS). Quantitative surveys were distributed. Individual and focus group interviews were conducted. PARTICIPANTS Participants included key informants at donor, government and policy-making levels, representatives of collaborating and supporting agencies, midwives and students in education programmes, and midwives in clinical practice. FINDINGS Information is presented concerning the challenges encountered by those responsible for midwifery pre-service education related to issues in programming including: pathways to midwifery, student recruitment and admission, midwifery curricula, preparation of faculty to engage in academic teaching and clinical mentorship, modes of curriculum dissemination and teaching/learning strategies, programme accreditation, qualifications for entry-into practice and the assessment of continued competence. KEY CONCLUSIONS Quality issues must be carefully considered when designing and implementing midwifery pre-service education programmes, and planning for the integration of new graduates into the health workforce. These issues, such as the availability of qualified tutors and clinical teachers, and measures for the implementation of competency-based teaching and learner-assessment strategies, are particularly relevant in countries that experience health manpower shortages. IMPLICATIONS FOR PRACTICE This review highlights important strategic choices that can be made to enhance the quality of pre-service midwifery education. The deployment, appropriate utilisation and increased number of highly qualified midwifery graduates can improve the quality of maternal and newborn health-care service, and reduce maternal and newborn mortality.

The International Confederation of Midwives: Global Standards for Midwifery Education (2010) with companion guidelines.

OBJECTIVE a 2-year study was conducted to develop Global Standards for Midwifery Education in keeping with core documents of the International Confederation of Midwives. Elements of the standards were based on evidence available in the published and unpublished literature. Companion Guidelines to assist in implementing the standards were also developed. DESIGN a modified Delphi survey process was conducted in two rounds following item validation by a panel of midwifery education experts. SETTING a global survey conducted in 88 countries. PARTICIPANTS midwifery educators and clinicians associated with midwifery education located in any of the ICM member association countries. Additional participants included an Expert Midwifery Resource Group, other Key Stakeholders, midwifery regulators and policy makers. A total of 241 individuals from 46 ICM member association countries and ten non-member countries responded to one or both of the survey rounds. MEASUREMENTS survey respondents expressed an opinion on whether to retain or to delete any of the proposed components of the standards. Version one had 109 proposed components and version two had 111 items for consideration. FINDINGS a majority consensus of .80 was required to accept an item without further deliberation. The Education Standards Task Force (expert panel) made final decisions in the four instances where this level of consensus was not reached, retaining all four items. The panel also amended the wording of selected items or added new items based on feedback received from survey respondents. The final document contains 10 Preface items, 35 glossary terms, and 37 discrete standards with 27 sub-sections.

Competence and Competency: Core Concepts for International Midwifery Practice

The global health community has implemented several initiatives over the past in the interest of accelerating country-by-country progress toward the Millennium Development Goal of improving maternal health. Skilled attendance at every birth has been recognized as an essential component of approaches for reducing maternal and perinatal morbidity and mortality. Midwives have been acknowledged as a preferred cadre of skilled birth attendant. The International Confederation of Midwives (ICM) speaks for the global community of fully qualified (professional) midwives. The ICM document entitled Essential Competencies for Basic Midwifery Practice is a core policy statement that defines the domains and scope of practice for those individuals who meet the international definition of midwife. This article explores the meaning of competence and competency as core concepts for the midwifery profession. An understanding of the meaning of these terms can help midwives speaking individually at the clinical practice level and midwifery associations speaking at the policy level to articulate more clearly the distinction of fully qualified midwives within the skilled birth attendant and sexual and reproductive health workforce. Competence and competency are fundamental to the domains of midwifery education, legislation, and regulation, and to the deployment and retention of professional midwives.

Ethics in Nursing: The Caring Relationship, 3rd ed

By Verena Tschudin. Edinburgh: Butterworth Heinemann imprint of Elsevier Science Limited, 2003. 218 pages. Paperback.

International Policies for Achieving Safe Motherhood: Women's Lives in the Balance

Every minute of every day somewhere in the world one woman dies during pregnancy or childbirth and eight newborns die, which is a great loss to families and to societies. Nearly two decades of global efforts to promote safe motherhood and newborn health have led to several conclusions as to why these unnecessary deaths of women and newborns continue, especially in the developing world. Healthy women are needed for healthy newborns and families, yet attention to the health of women, especially during childbearing, has received minimal or no attention at country and lo cal levels where policies seem to ignore the value of the girl–child, women and newborns. One of the most important interventions proven to promote safe or healthy pregnancy for women and their newborns is the availability of skilled care—the combination of an accredited health professional with midwifery skills working in an well-equipped environment at the community level, supported by the political will needed to save the lives of mothers and babies. Yet skilled care is missing from nearly half of the worlds women. This article describes the reasons for the continuing high rates of maternal and newborn deaths, key lessons learned about how to prevent such deaths based on the best available evidence, and the need for evidence-based policies directed at achieving safe motherhood for each woman who becomes pregnant and for her newborn.

Global workshops in midwifery competency-based educational methodologies: lessons learned

The Lancet Series on Midwifery and The State of the World’s Midwifery 2014 called on countries to expand the midwifery workforce as a key strategy to improve the health of women and newborns and lower maternal and newborn morbidity and mortality. Well-prepared midwife teachers and preceptors are required to prepare midwives to provide competent, high quality care for women and childbearing families. This article describes the design of competency-based education (CBE) capacity development workshops building on the International Confederation of Midwives’ (ICM) essential competencies and education standards, led by eight English-, Spanish-, and French-speaking CBE Master Educators (MEs). Common content and processes used in three English, one Spanish, and one French workshop are briefly described, noting the influence of participants’ backgrounds, location, and teacher preferences in modifications to common content. As of December 2016, 30 CBE Master Teachers and 22 CBE Teachers have attended a CBE capacity development workshop and, in turn, have provided CBE continuing education (CE) sessions for more than 300 midwife teachers and preceptors in over 20 countries in the Caribbean, Latin America, and Anglophone and Francophone Africa. Lessons learned are shared along with suggestions for next steps in assessment and evaluation of the use of CBE in midwifery education programs.

International Confederation of Midwives core documents: their added value for US midwifery associations.

Concurrently, the ICM, the global leadership organization for midwives, developed and adopted 2 new core documents (global standards for midwifery education and regulation)2, 3 and updated 2 core documents (essential competencies and the definition of the midwife).4, 5 These landmark documents provide the framework for educating and regulating professional midwives. Together these documents provide the standards and guidelines for countries to develop, evaluate, upgrade, and strengthen the midwifery workforce. This commentary was prepared at the request of the president of the American College of Nurse-Midwives (ACNM) to inform ACNM members about the relevance of these materials for certified nurse-midwives/certified midwives (CNMs/CMs) and, by extension, for other members of the US midwifery workforce. The ICM documents can serve as the central core that unifies the structure, process, and intended outcomes of midwifery education and practice in the United States. Reference to the education standards and essential competencies in an interorganizational dialogue can also facilitate communication between the professional associations, accreditation organizations, and educational policymaking bodies that define the scope of practice of the professional (fully-qualified) midwife within the country. The regulation standards can be used as a reference to promote full-scope, autonomous midwifery practice.

Young Midwifery Leaders Programs: Capacity Building for the Future

This article describes the program components, program outcomes and challenges of two iterations of a leadership development program that was intended to contribute not only to individual capacity building but also to succession planning within midwifery professional associations. The young midwifery leaders programs were similarly designed, using self-study modules that focused on essential leadership knowledge and skills, and a mentor–mentee relationship to provide guidance and support to selected midwives early in their professional careers. The International Confederation of Midwives (ICM) implemented a 3-year leadership program conducted from 2004 to 2007 for five mentee participants. A collaborative United Nations Population Fund (UNFPA)/ICM team in Latin America designed and implemented an 18-month program with 12 mentees that began in 2013. Examples of leadership outcomes in policy and education include assumption of elected offices in midwifery associations, integration of evidence-based topical content into an established midwifery education program, and development of a new preservice education program in a rural zone of a large country. The vision for the future is to expand this program globally while simultaneously adapting the program content and strategies to reflect the leadership needs of the regional context in which it is implemented.