International Confederation of Midwives

1. International Confederation of Midwives Essential Competencies for Basic Midwifery Practice 2011 Update

2. Importance and Impact of the Essential Competencies • ICM competency statements were endorsed and adopted by WHO/FIGO/ICN/ICM as essential competencies for Skilled Birth Attendants “an accredited health professional - such as midwife, doctor, or nurse - who has been educated & trained to proficiency in the skills needed to manage normal pregnancies, childbirth, & the immediate postnatal period, and in the identification, management, or referral of complications in women & newborns.”

3. ICM Definition of Midwife • A midwife is a person who, having been regularly admitted to a midwifery educational program, 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 practice midwifery.

4. ICM Definition of a MidwifeAdditional elements • Responsible, accountable and autonomous professional • Works in partnership with women • Provides support, care and advice during pregnancy, labor and postpartum period • prevention • detection of complications • emergency care • Conducts births • Provides care for newborn and infant • Provides sexual and reproductive health education/counseling • Works in various practice settings

5. Essential Competencies - History • Impetus for development generated by Safe Motherhood Initiative • Six year developmental process • Phase 1: (1996 – 1999) outline of the competencies Led by Dr. Joyce Thompson • Phase 2: (2000 – 2002) global field study Led by Dr. Judith Fullerton

6. Purpose and Applications • Basic competencies • “Core” for education and practice • A requirement for all midwives to meet the international definition of midwife • Additional competencies • Expanded scope of practice to increase access to women’s reproductive health care services • Additional skills sets in lower-resource settings where certain skills could make the difference in maternal or neonatal outcomes (eg. basic emergency obstetric and neonatal care - BEmONC)

7. Rationale for Update • “Best practice” for task analysis • methodology emphasizes a reconsideration of findings in (approximately) 7-year cycles • Task analysis for “best practice” • Emerging evidence in the published literature may suggest the importance of amending the designation of certain skills from “additional” to “basic” • New position and policy statements have been promulgated that may translate into practice standards (e.g., AMTSL) • Consider midwifery community requests for additional competencies

8. Core Definitionsfor Education and Practice • Ability: The quality of being able to perform; a natural or acquired skill or talent • Attitude: A person’s views (values and beliefs) about a thing, process or person that often leads to positive or negative reaction • Behavior: A person’s way of relating or responding to the actions of others or to an environmental stimulus • Competence: The combination of knowledge, psychomotor, communication and decision-making skills that enable an individual to perform a specific task to a defined level of proficiency. • Competency (midwifery): A combination of knowledge, professional behavior and specific skills that are demonstrated at a defined level of proficiency in the context of midwifery education and practice. • Knowledge: A fund of information that enables an individual to have confident understanding of a subject with the ability to use it for a specific purpose • Skill: Ability learned through education and training or acquired by experience, to perform specific actions or tasks to a specified level of measurable performance • Task: A specific component of a larger body of work

9. Work Plan and Timeline • 2009: • Agreement with WHO and ICM to work collaboratively in updating of Essential Competencies document • Establishment of a global Study Advisory Committee and Task Force (2009) • Human Subjects Research approval • Exhaustive review of the literature → new or revised statements → draft document • Translation into French and Spanish; iterative reviews to accommodate global linguistic usage

10. SAC/Task Force Membership Taskforce Members: • Professional disciplines • Midwives (14) • Physicians (2) • Organizational affiliates • WHO (2) • External member (1) • One member from each of 4 ICM Regions • One representative from ICM Education and Regulation Task Forces • One representative from ICM Research Standing Committee Three languages: English, French, Spanish

11. Work Plan and Timeline • Survey Round 1:(November 2009 – January 2010) • Content validation study • Incorporation of findings into working documents • Demographic form • Survey tool • 7 competency domains • 255 items • Field survey (May 1, 2010 – June 15, 2010)

12. Sampling Frame and Sample Size • One to six midwifery education programs in each of ICM’s 87 member countries • each survey to be completed by up to 6 respondents • to reflect diversity of pathways to midwifery education • 35 midwifery regulators from 4 regions of the ICM • to reflect diversity of midwifery regulations • Minimum response • 51% of member countries • 3 countries per region

13. Data Analysis Plan • “Keep or delete” and “basic or additional” cut-points • set arbitrarily at 0.80 • based on statistical trends from validation survey • Any item below the cut-point will be presented to ICM Council • Council members will be provided with relevant evidence-based literature on each item/topic

14. Dissemination • Document is anticipated for dissemination no later than Fall 2011 • Will replace current document • Document will be used by • Governments • UN agencies, NGOs • Member Associations • Educational institutions • Regulators • Clinicians This updated Essential Competencies for Basic Midwifery Practice document will provide ongoing guidance in the education and regulation of the global midwifery workforce.