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Qualified Midwives for Quality Maternal-Newborn Care April 24, 2013 4th ICM Regional Conference in the Americas Joyce Beebe Thompson, DrPH, CNM, FAAN, FACNM Emeritus Professor Co-Chair, ICM Task Force on Education Standards Technical Advisor, UNFPA-LACRO

Women Are Key to the Health & Development of Any Nation • • • •

Healthy women lead to healthy children Healthy women promote healthy families Healthy families lead to healthy nations Women’s reproductive role is both societymaintaining & society-enhancing! • Healthy women are essential to reach health MDGs

What do Women Want? • • • • • • •

“Listen to me – don’t assume you know what I need” “Respect me as a person – treat me well” “Look at me before you look at my health record” “Help me understand what is happening to me” “Encourage me to make my own decisions” “Love what you do – be passionate” “Know what you are doing - competency” Taken in part from Listen to Women, ACNM, 1993.

Midwifery Model of Care Based on trust, mutual respect, and evidence-based practice: • Protects, supports women’s reproductive rights • Respects ethnic & cultural diversity • Builds self-confidence , listens to & empowers women • Facilitates informed decision-making • Promotes & protects women’s wellness • Primary concern for safety • Enhances the health of newborns • Advocates for non-intervention in normal childbirth • Uses technology appropriately & timely referral ICM. The Philosophy and Model of Midwifery Care. 2008

Midwifery: A Profession in Demand • Important human resource for meeting Millennium Development Goals – MDG 3: empower women – MDG 4: child health – MDG 5: maternal health

• Additional 334,000 new midwives needed immediately to assist countries in meeting MDG 5 World Health Report (2006). Working Together for Health

Lancet – Maternal Survival 2006 “where an option still exists [for a professional attendant – midwife or doctor], the evidence is strongly in favor of midwives as the main providers.” Campbell & Graham (2006), p.32


Midwives are key to the health of women • Caring & competent midwives contribute to the health of women and newborns. • Need more midwives! • Quailty midwives require educational standards, competency-based learning, practice standards and support for ongoing lifelong learning.

Midwives Save Lives! • • • • •

Prepared in all essential midwifery competencies Maintain competence in practice at all times Use best evidence in practice Work with team to advocate for quality care for all Advocate for safe environments for care – essential equipment and pharmacologic agents – transport for timely referrals

• Trusted member of the community – Live, work in and understand the community

How to Meet Need • UNFPA strategies for strengthening midwifery • Political will of Governments to invest in fully qualified midwives, not cheaper workers • Strengthening & expanding education of fully qualified midwives


Fully Qualified Midwives “Persons educated and trained to competency in all the ICM basic or core competencies, legally recognized to practice full scope midwifery, and who maintain competency over time.� ICM Education Standards 2010

Preparation of Qualified Midwives • Formal education process

• Based on ICM global standards & competencies

• Adapted to country needs

Formal Education Process Requires Well designed, logical curriculum plan Qualified teachers eager to teach Qualified students eager to learn Safe environments for learning & practice Sufficient resources available for learning Teaching & learning strategies that promote learning Valid & reliable assessment methods External validation of graduate competency

Why Global Education Standards? • Many individuals use ‘title’ midwife – – – – –

Education level varies Quality of midwifery care varies Scope of practice varies Practice competencies vary Regulatory bodies confused

• Standards set minimal, uniform reference point for the required level of performance of a professional midwife • Why use? Define quality indicators for successful program

Organization of ICM Education Standards I.

Organization and administration (6)


Midwifery faculty (8 plus 10 subparts)


Student body (7 plus 8 subparts)


Curriculum (6 plus 4 subparts)


Resources, facilities & services (5)


Assessment strategies (5 plus 5 subparts)

Step 1: Prepare • Review ICM core documents o o o o

International definition of midwife, code of ethics Essential competencies for basic midwifery practice Global standards for midwifery education & regulation Other education resource materials

• Review country documents o o o o

Country health & human resource plans Legal recognition of health professionals in MCH Standards of practice for maternal-infant care Deployment strategies of health professionals

ICM Essential Competencies

Seven Competency Domains [Knowledge, Skills & Behaviors] 1. Social, epidemiologic and cultural context of maternal-newborn care 2. Pre-pregnancy care & family planning 3. Care during pregnancy 4. Care during labor & birth 5. Care for women during postpartum period 6. Postnatal care of the newborn 7. Abortion-related care

Basic Emergency Obstetric and Neonatal Care Competencies include each of the “signal functions” for provision of BEmONC, with essential interventions for initial management of hemorrhage: – Administration of parenteral antibiotics, uterotonic drugs and anticonvulsants – Bimanual uterine compression – Manual removal of placenta – Removal of retained products of conception (MVA) – Performance of vacuum delivery – Performance of basic neonatal resuscitation

Midwives do save lives!

Remember The essential competencies do not define what the midwife should do in a particular clinical situation (when) – that is why critical thinking and clinical reasoning are essential.

Essential focus of teaching & competency demonstration!

Step 1: Continued • Identify unique needs childbearing women in your country – – – –

Status of women in society Socioeconomic & legal conditions Geographic challenges Major causes of maternal & neonatal deaths

• Add to ICM essential competencies what is needed to address country-specific needs (task analysis)

Step 2: Assess Need • Review human resource plan for country • Need enabling regulation for midwifery practice • Identify current providers of childbearing services & geographic distribution • Assess the quality of current childbearing services • Determine stakeholders supportive of midwives • Evaluate resources available for midwifery education • Secure appropriate technical assistance as needed • Plan for sustainability of education program

Step 3: Design Program • Establish teaching team – Prepare qualified midwife teachers if needed – Involve teaching expertise of others; eg., OB/GYN, public health officials, nutritionists, specialist nurses

• Work with experienced midwife educator to: – – – – –

Design the curriculum Content map each competency & related KSBs Assign content to instructional units/modules/courses Assign teacher to each content unit Agree teaching, learning & assessment strategies

ICM Global Standards for Midwifery Education (2010) • Framework for curriculum design • Framework for evaluation of quality of the program • Establish key markers for quality education • Define qualifications of teachers, students – Competent midwifery clinicians – Formal preparation for teaching – Post-secondary education

Quality Indicators in Standards (examples) • Midwifery leadership of programme – Standard I.4 Midwifery faculty self-governing – Standard I.5 Head of program qualified midwife teacher

• Minimum length of midwifery programmes – 3 years direct entry – 18 months post-nursing

Quality Indicators (con’t) • Competency-based teaching & learning strategies requiring active student participation • Minimum content of curriculum beginning with ICM Essential Competencies • Minimum 50% in supervised midwifery practice • Appropriate criteria for learning resources/practice facilities • Ongoing evaluation required: students, teachers, curriculum, program

Step 3: Continued • Recruit/prepare qualified midwife teachers • Agree admission requirements • Recruit qualified students • Prepare clinical sites & other resources • Determine recognition of graduates

Step 4: Implement Program • Admit qualified students in keeping with available resources, including clinical learning sites & teachers • Encourage frequent teacher & student feedback on successes & challenges • Promote active learning among students • Monitor progress of learning, intervene as needed • Monitor clinical learning & progression of competency • Make needed changes without affecting current students

Competency-based Education Teaching, learning and assessment activities that are sufficient to: • enable students to acquire • and demonstrate • a predetermined set of competencies • as the outcome of learning.

Step Five: Evaluate Program • • • • • • • •

Successes & challenges Quality of teaching Quality of students Quality of clinical learning sites Competency of graduates Graduates’ ability to practice midwifery Placement of graduates in areas of greatest need Community acceptance of midwives

Companion Guidelines Answer two key questions: 1. How can one implement each of the education standards for a quality midwifery programme? 2. How will one know whether the midwifery programme meets the ICM Standards (evidence)?

Long Term Evaluation • Midwives maintain currency in practice – Ongoing education updates – Reasonable workload – Avoid isolation

• Maternal & newborn deaths reduced given enabling environments for care – Baseline surveys before introducing midwives – Periodic surveys of indicators of maternal/neonatal health

• Continued evidence of community acceptance

Preparation of Midwives for Quality Care: Attitudes & Behaviors • Help students understand how to listen to women • Offer opportunities to learn to combine wants with needs for care • Require competency in practice within the framework of the Midwifery Model of Care • Require practice according to accepted standards • Encourage commitment to life-long learning • Support integration of heart, mind, and hands in working with childbearing women and families

Selected Quality Indicators for Care • • • • • • • • •

Respectful at all times Introduces self, makes eye contact Maintains privacy & confidentiality Solicits concerns & questions Involves woman in decisions Includes support persons Provides information, counseling Promotes bonding, exclusive breast feeding Maintains clean hands and equipment

Quality Care is Care Used • Women want to be treated as persons • Women want to trust their caregivers

• Women will not seek care if treated poorly

Formula for Success Competent Midwives Providing Quality Childbearing Care = Dynamic Partnership for Healthy Women and Newborns

Together we can change the world! Better health care for women and childbearing families with professional midwives. Thank you.

Preparing qualified midwives for quality care 2013  
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