Elsevier

Midwifery

Volume 76, September 2019, Pages 8-20
Midwifery

Informing the development midwifery standards for practice: A literature review for policy development

https://doi.org/10.1016/j.midw.2019.05.007Get rights and content

Highlights

  • Addresses the gap in evidence to guide the development of midwifery standards for practice.

  • Identifies concepts central to both clinical and non-clinical midwifery practise.

  • Highlights interchangeable terms that have markedly different origins.

  • Presents contemporary midwifery identity, legitimacy and practice as autonomous, woman-centered and focussed on continuity of care, yet often confronted by constraints on being able to work to the full scope of practice.

Abstract

Aim

To critically appraise and synthesise the literature regarding the role and scope of midwifery practice, specifically to inform the evidence based development of standards for practice for all midwives in Australia.

Design

A structured scoping review of the literature

Data sources

CINAHL Complete, MEDLINE Complete and Cochrane Libraries databases, online and grey literature databases

Review methods

Comprehensive searches of databases used key words and controlled vocabulary for each database to search for publications 2006–2016. Studies were not restricted by research method.

Findings

There is no substantive body of literature on midwifery competency standards or standards for practice. From 1648 papers screened, twenty-eight papers were identified to inform this review. Eight studies including systematic reviews were annotated with three research papers further assessed as having direct application to this review. To inform the development of Midwife standards for practice, the comprehensive role of the midwife across multiple settings was seen to include: woman centred and primary health care; safe supportive and collaborative practice; clinical knowledge and skills with interpersonal and cultural competence.

Key conclusions

Midwifery practice is not restricted to the provision of direct clinical care and extends to any role where the midwife uses midwifery skills and knowledge. This practice includes working in clinical and non-clinical relationships with the woman and other clients as well as working in management, administration, education, research, advisory, regulatory, and policy development roles.

Implications for practice

This review articulates the definition, role and scope of midwifery practice to inform the development of contemporary standards for practice for the Australian midwife.

Introduction

The midwife plays a vital role in the provision of maternity and newborn, sexual and reproductive health services. The criteria and processes arising from legislation to control practice, identify who can hold the title ‘midwife’ and practise midwifery are important mechanisms that reflect the social mandate of health practitioners for accountability for the quality of health care (International Confederation of Midwives 2017, United Nations Population Fund (UNFPA) 2014). In Australia, the Health Practitioner Regulation National Law, as in force in each state and territory (the National Law) protects the title ‘midwife’. Midwifery is one of 16 health professions regulated by the National Law under the National Registration and Accreditation Scheme (NRAS). A midwife is a regulated health practitioner who holds registration as a midwife with the Nursing and Midwifery Board of Australia (NMBA).

The role, scope and practice of midwives in Australia are regulated at individual, occupational, professional and statutory levels by various authorities, organisations, standards, guidelines, values, and ethics. Practice standards generally need to reflect midwifery regulation and the midwife's role in maternity services so that there is a direct link between the healthcare statutes, the midwifery body of knowledge and contemporary practice.

With a focus on public protection, including the needs and safety of the woman and her baby, the NMBA regulates midwives by developing standards, codes and guidelines which provide midwives, students of midwifery, midwife employers and the public with the professional framework for midwifery practice. Standards for practice set out the practice expectations and assist the NMBA in its regulatory role to assess competence, determine eligibility for registration (Australian Health Practitioner Regulation Agency, 2016) and assist the midwife and others in communicating what can be expected of practice.

The first National competency standards for the midwife were developed in 2006 by the Australian Nursing and Midwifery Council (ANMC) working with the then state and territory nursing and midwifery regulatory authorities (Homer et al., 2007). In 2010, as part of the NRAS and establishment of the NMBA, these standards were adopted and owned by the NMBA as part of the regulation of midwives in Australia. Notwithstanding some rebranding changes that occurred in 2013, the content and intent of the National competency standards for the midwife has remained unchanged for the last decade.

This paper describes a targeted, scoping literature review, designed to inform the initial research activity in a review of the National competency standards for the midwife adopted by the NMBA in 2010, and the development of NMBA Midwife standards for practice.

Section snippets

Design

A structured scoping review was conducted of guiding evidence from national and international published literature related to the regulation of midwives and midwifery practice. Additional relevant articles were identified from the reference lists of relevant articles. In addition, grey literature was sourced though website searches.

Literature search

Journal articles were included if they were published: between 1/1/2006–31/12/2016, the period of time since publication of the National competency standards for the

Findings

There was little available research into the regulation of midwives, beyond the determination of definitions of midwife roles and scopes. Findings or conclusions from much of this literature were not readily transferable to the regulation and standards for practice for midwives in Australia. Common to journal publications, the papers reviewed often lacked detailed reviews of the literature (Walsh and Downe, 2006), though all reference lists were checked for other relevant sources.

The PRISMA

Definitions of a midwife

All of the international midwifery standards and guidelines reviewed for this report and the current midwife standards in Australia, showed some level of integration of the International Confederation of Midwives’ (ICM) definition of a Midwife, including the scope of practice (American College of Nurse-Midwives 2011, Australian College of Midwives 2016, Canadian Midwifery Regulators Council 2008, International Confederation of Midwives 2011, International Confederation of Midwives 2013a,

Midwifery roles and scope of practice

The ICM broadly defines the of scope for midwives as ‘those activities which midwives are educated, competent and authorised to perform’ (International Confederation of Midwives, 2011, p. 12). The NMBA reworked this ICM definition as ‘the professional role and services that an individual health practitioner is educated and competent to perform’ (Nursing and Midwifery Board of Australia, 2016a p.3), and provide further detail in their standards, codes of conduct and ethics, and guidelines

Discussion

There has been little research into midwifery standards for practice. There is however, a consolidating body of evidence that informs policy and services where midwifery contributes to safe and quality maternity outcomes for women and their infants. This literature shows many concepts and terms used interchangeably across definitions, scopes, standards and competencies. Some of these concepts and terms are based in values and philosophies while others reference episodes or events. Some concepts

Recommendations for policy development

Practice standards generally need to reflect midwifery regulation and the midwife's role in maternity services so that there is a direct link between the healthcare statutes, the midwifery body of knowledge and contemporary practice. To inform the development of standards for the practice of all midwives the following concepts were identified as significant: woman-centred care; safety and quality; collaborative practice; primary health care; interpersonal competence, cultural safety; and

Conclusion

There is an established body of research that midwifery contributes to safe and quality maternity outcomes for a mother and her infant, yet there is a paucity of evidence into midwifery standards of practice. This review of the literature has provided valuable guidance for the development of the NMBA Midwife standards for practice (Nursing and Midwifery Board of Australia, 2018).

This scoping review has demonstrated the challenges presented by concepts and terms used interchangeably across

Ethical approval

Ethics approval was obtained from Deakin University (HREC 2016:216).

Funding source

The study was funded by the Australian Health Practitioner Regulation Agency (APHRA) RM31757. The funding body had no role in the design and conduct of the study; data collection, data management, data analysis, and interpretation of the data; preparation, review. AHPRA received reports of data collection and analysis, and approved the submission of this manuscript.

Clinical trial

Not applicable.

Declaration of Competing Interest

The authors declare they have no conflicts of interest.

Acknowledgements

The authors acknowledge with gratitude the research assistance provided by librarians Louise Sher at Deakin University and Elizabeth Reale at the Australian Nursing and Midwifery Federation and project assistance provided by Jenny Saal.

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