Chapter 1. Introduction
Both the frameworks and the model will be referred to throughout the book. The focus of this book is learning the skills relevant for midwifery practice. Although there will be reference to anatomy and physiology the reader will be directed to look in depth at the relevant systems of the body depending on the skill described.
The role of the midwife
Whether you are new to midwifery practice or in the process of updating your skills and knowledge it is important that you are fully aware of the remit of being a midwife. Many agencies contribute to the description of the midwife’s position and together provide a comprehensive portfolio of the skills and attributes, knowledge and sphere of this complex role. The role of the midwife is however more than the sum of its constituent parts and many aspects of it evade measurement. For example, how can the intuition, emotional intelligence and sensitivity required for the development of a trusting relationship between a woman and her midwife be captured and formally assessed? Nevertheless, many aspects of the midwife’s role have been identified and form the basis for professional guidance relating to educational programmes and subsequent clinical practice.
European Midwifery Directive
Midwives who work in the European Union (EU) must be able to fulfil the activities of a midwife as laid down in the European Union Second Midwifery Directive 80/155/EEC Article 4 and presented in the Midwives rules and standards (NMC 2004a); see Box 1.1.
Box 1.1
Activities of a midwife (NMC 2004a:36–37)
■ To provide sound family planning information and advice
■ To diagnose pregnancies and monitor normal pregnancies; to carry out examinations necessary for the monitoring of the development of normal pregnancies
■ To prescribe or advise on the examinations necessary for the earliest possible detection of pregnancies at risk
■ To provide a programme of parenthood preparation and complete preparation for childbirth, including advice on hygiene and nutrition
■ To care for and assist the mother during labour and to monitor the condition of the fetus in utero by the appropriate clinical and technical means
■ To conduct spontaneous deliveries including where required an episiotomy and in urgent cases, a breech delivery
■ To recognize the warning signs of abnormality in the mother or infant which necessitate referral to a doctor and to assist the latter where appropriate; to take the necessary emergency measures in the doctor’s absence, in particular the manual removal of the placenta, possibly followed by a manual examination of the uterus
■ To examine and care for the newborn infant; to take all initiatives which are necessary in case of need and to carry out where necessary immediate resuscitation
■ To care for and monitor the progress of the mother in the postnatal period and to give all necessary advice to the mother on infant care to enable her to ensure the optimal progress of the newborn infant
■ To carry out treatment prescribed by a doctor
■ To maintain all necessary records.
EU Second Midwifery Directive 80/155/EEC Article 4
Nursing and Midwifery Council
Midwives who work in the United Kingdom (UK) must be registered with the Nursing and Midwifery Council (NMC). The NMC is an organisation instituted by Parliament under the Nursing and Midwifery Order 2001 to protect the public by ensuring high standards of care are provided by nurses and midwives to their clients. To do this the NMC maintains a register of qualified nurses, midwives and specialist community public health nurses and set standards for practice and conduct. The NMC publishes standards regarding many aspects of professional practice and these are regularly reviewed. There are two that pertain specifically to midwifery: Standards of proficiency for pre-registration midwifery education (NMC 2004b) and the Midwives rules and standards, and many more that are generic to all registrants. Firstly, we will consider the Standards of proficiency for pre-registration midwifery education.
Standards of proficiency for pre-registration midwifery education
In addition to fulfilling the EU activities of a midwife, midwives in the UK must also demonstrate competence in the standards of proficiency for pre-registration midwifery education. These are the skills and practices that midwives should be competent to fulfil at the point of registration without direct supervision. They are presented in the NMC booklet Standards of proficiency for pre-registration midwifery education (NMC 2004b: 36–47) and form the basis for the assessment strategy for many pre-registration midwifery programmes. There are 29 midwifery proficiencies and they are described under four domains:
■ Effective midwifery practice
■ Professional and ethical practice
■ Developing the individual midwife and others
■ Achieving quality care through evaluation and research.
Each proficiency comprises a number of descriptors, for example, the proficiency ‘communicate effectively’ incorporates the descriptors, listening to women, enabling women to make their own choices, encouraging them to think through their feelings and should be demonstrated throughout the childbirth continuum of pregnancy to the postnatal period. A circular from the NMC identifies essential skills students should have learnt by different stages of their programmes (NMC 2007). Reference will be made to the midwifery proficiencies throughout this book to enable students and midwives to understand how they apply to clinical practice.
Midwives rules and standards
These are presented in the NMC booklet Midwives rules and standards (2004a) along with additional guidance on how they can be interpreted. They are the backbone of accountable midwifery practice in the UK and should be a well-thumbed resource in all midwives’ personal profiles. The contents of Midwives rules and standards are summarized in Box 1.2.
Box 1.2
Midwives rules and standards (NMC 2004a)
| Rule | Summary of content |
|---|---|
| 1 | How the rules should be cited and when they came into force |
| 2 | Interpretation of the rules: this section provides guidance on the meaning of some of the terms used throughout the rules, for example, what is meant by ‘postnatal period’ |
| 3 | Notification of intention to practise (NIP): how often and in what circumstances midwives should inform their local supervising authority (LSA) that they intend to practise midwifery in that locality |
| 4 | Notifications by local supervising authority: the people to whom and dates by which midwives should inform their intentions to practise above |
| 5 | Suspension from practice by a local supervising authority: the circumstances under and methods by which a midwife may be suspended from practice |
| 6 | Responsibility and sphere of practice: this section clearly outlines the role of the midwife |
| 7 | Administration of medicines: the responsibilities and guidance for a midwife in the administration of medicines |
| 8 | Clinical trials: the circumstances under which a midwife my participate in research trials |
| 9 | Records: the instructions and standards for record keeping |
| 10 | Inspection of premises and equipment: the rule governing the monitoring of equipment, premises and records by the local supervising authority |
| 11 | Eligibility for appointment as a supervisor of midwives: the rules governing the selection and training of supervisors of midwives |
| 12 | The supervision of midwives: instruction for the role of supervision |
| 13 | The local supervising authority midwifery officer: the role of the midwifery officer responsible for supervision in the locality |
| 14 | Exercise by a local supervising authority of its functions: the role of the LSA in supervision of the practice of the midwifery officer |
| 15 | Publication of local supervising authority procedures: the responsibilities of the LSA in giving information on those who have responsibility and dealing with complaints about processes and practices |
| 16 | Annual report : the responsibilities of the mechanisms of reporting by the LSA. |
Definition of the midwife
(Adopted by the International Confederation of Midwives Council 2005)
‘A midwife is a person who, having been regularly admitted to a midwifery educational programme, duly recognized in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practise midwifery.
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