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Objective To explore how the International Confederation of Midwives Global Standards for Midwifery Education are currently used and their influence, if any, on the development of education programs globally. Secondarily, to identify current challenges to midwifery education. Design Cross-sectional exploratory descriptive qualitative study using focus groups and one-on-one interviews to collect data about knowledge of and use of the Education Standards and participants perceived current challenges to midwifery education. Interviews conducted in English, Spanish, and French. Setting and Participants Midwife educators, education directors, or regulators attending one of four national/international conferences or one-on-one interviews in person or via internet. Thematic analysis was employed using the Framework approach for data analysis. Findings There were 11 focus groups and 19 individual interviews involving 145 midwives from 61 countries. There was a general awareness of the Education Standards amongst the participants although knowledge about the specifics of the document was lacking. The Standards were mainly used as a reference and greater use was made when developing new educational programs. The Standards identified as most difficult to meet included: organization and administration of the program, ensuring that teachers were formally prepared as teachers, meeting targets for teacher to student ratios and that 50% of educational time took place in the clinical setting. Universally endorsed challenges to midwifery education were: 1) inability to accommodate the increase in curricular content without compromising prior content or lengthening programs; 2) insufficient resources including lack of classroom and clinical teachers; 3) medicalization of childbirth and health system changes limiting student exposure to the midwifery care model; 4) role conflict and competition for clinical experience with other health professionals. Key Conclusions The Education Standards need to be more widely disseminated and implemented. Stronger collaborations with clinical settings and government systems are required to solve the current challenges to midwifery education. Implication of Practice Well-educated midwives can provide the majority of maternal and neonatal care, however it will require an investment in strengthening midwifery programs globally for this goal to be achieved.

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.

Background many articles published in the decade since promulgation of the Millennium Development Goals have acknowledged the distinct advantages to maternal and newborn health outcomes that can be achieved as a result of expanding access to skilled birth attendant (including midwifery) services. However, these advantages are often predicated on the assumption that the midwifery workforce shares a common definition and identity. Regrettably, a clear delineation of midwifery competencies is rarely addressed. A core set of midwifery competencies is essential to providing the high quality services that lead to the desirable health outcomes described in that body of research. Attribution of improved outcomes to access to midwifery cannot be made without a common understanding of a defined set of services provided to standard by the midwifery workforce across the inter-conceptional and childbearing time frame. The International Confederation of Midwives (ICM) has developed a clear list of competencies that delineate the domains of practice for the fully qualified, professional midwife. These domains frame the educational outcomes that must be conveyed within competency-based education programmes. Purpose this article explores the concept of competency-based education for midwives; first exploring the concept of competency itself, then providing examples of what is already known about competency-based approaches to curriculum design, teacher preparation, teacher support and assessment of student learning. These concepts are linked to the ICM competencies as the unifying construct for education of individuals who share a common definition and identity as midwives.

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.

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 ICM's 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.

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 ...

Summary Objective: to present the evidence for inclusion of selected midwifery tasks (skills) as essential practice competencies for midwives throughout the world. The tasks addressed are those presented to the International Confederation of Midwives (ICM) Council of Delegates in 2002 for discussion and adoption, based on the fact that during field-testing, notable variance was encountered. Key conclusions and implications for practice: evidence-based practice should be characterised by the use of best practices derived from rigorous research, combined with and balanced by client perspectives and the expert judgement based on the critical thinking of the clinician. Much of midwifery practice is considered an art based on common sense, tradition, and woman-centred approaches to caring, as most of the women who seek midwifery care are healthy and require a health-promotion model of care that may not easily lend itself to examination by scientists or clinicians. However, when intervention is indicated to save the lives of mother, baby, or both, those interventions must be based on the best available evidence from a variety of sources leading to the most effective choices for action. The ICM Essential Competencies for Midwifery Practice (2002) are based on evidence derived from a variety of quantitative and qualitative methodologies. Expert clinical consensus may serve as to the best form of evidence at certain points in the evolution of knowledge. Every midwife needs to understand where the gaps exist in supporting traditional practices that have yet to be fully examined in a scientific manner. In summary, a multi-matrix or triangulated approach may be most appropriate to the delineation of evidence underpinning best midwifery practice.

The LancetSeries 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.

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.

Healthy, prosperous nations require healthy women and newborns. Young girls and women in resource-poor nations suffer the greatest ill-health consequences from low status, denial of basic human rights, and poverty. Poverty and poor health result in poor economic development. The Millennium Development Goals call for immediate efforts to reduce poverty, improve health, especially of girls and women, and foster development in the world's poorest nations.

Summary Objective to present recently developed guidelines by the International Confederation of Midwives (ICM) to guide the ethical conduct of research by midwives across international and culturally diverse communities. To illustrate the complexities of conducting collaborative research across diverse communities, a case study is provided highlighting unequal power balances, legal, ethical and cultural constraints. Background the research guidelines are structured using a human rights framework. The document was developed with input and consideration by the ICM Research Standing Committee and comments of 35 delegates who participated in a workshop to evaluate the guidelines from the perspectives of frontline midwifery clinicians, leaders and researchers. It is intended to serve as a blueprint for midwives aiming to enter into a collaborative research partnership with ethnic and culturally diverse groups. Conclusions although the document was developed with the international midwifery community in mind, it will guide any researcher seeking to conduct research in the best interest of women, their newborn babies, their families, and their wider communities.

This article presents a rights-based model for midwifery care of women and childbearing families. Salient features include discussion of the influence of values on how women are viewed within cultures and societies, universal ethical principles applicable to health care services, and human rights based on the view of women as persons rather than as objects or chattel. Examples of the health impact on women of persistent violation of basic human rights are used to support the need for using a human rights framework for midwifery care--a model supported by codes of ethics, the midwifery philosophy of care, and standards of 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.

Objective A train-the-trainer intervention was evaluated in which village leaders in Malawi, Africa, taught other villagers how to improve their health. Design Health knowledge and reported health practices were compared before and after the educational intervention in 15 villages in Chimutu, Malawi, Africa. Setting Surveys were completed by trained data gatherers in the village setting. Patients/Participants All men and women of childbearing age who were present in the village when data collection occurred were asked to participate. There were 187 participants in the preintervention survey and 175 participants in the postintervention survey. Intervention Seventy-six village women were trained, using low literacy techniques, to provide content on health promotion and risk reduction in pregnancy. Over 20,000 persons have received at least one health teaching session from the village trainers. Results The intervention resulted in reported changes in prenatal and postpartum care and in more births occurring in the hospital or clinic. Some positive nutritional changes were reported, although few changes in beliefs about use of herbal medicines or about the use of witchcraft were reported. Conclusions A train-the-trainer approach is a sustainable intervention that appears to have positive benefits on the health of village women living in Malawi, Africa.

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

Clinical teaching is a vital component of any practice discipline and comprises almost two-thirds of the teaching time for any nurse-midwifery educator. Yet, clinical educators (academic or preceptor) often have had little or no preparation for their important role in preparing the nurse-midwives of the future. It has often been assumed that good clinicians make good teachers, but this assumption has left both teachers and students frustrated, or worse, afraid to pursue any further teaching or learning. This article is a synthesis of ideas and practical experience related to teaching and learning in the clinical setting, specifically based on knowledge of how adults learn, what constitutes knowledge, and how learning principles can guide the clinical teacher in her or his teaching efforts.

This text reviews theoretical bases for bioethics including definitions of morals, ethics, metaethics, bioethics and the role of health care professionals. Theory includes discussion of philosphical ethical systems, such as utilitarianism, denotology and natural law, and moral theology and religion as source and reason for ethics. The natural law theory of moral development is described in terms of Jean Piaget, Lawrence Kohlberg, James Rest, Carol Gilligan and others. One way to understand this is to see people as moral beings. This includes nurses and other health care professionals who make bioethical decisions. The bioethical decision model has 10 steps based on critical inquiry and reasoned analysis. The model does not provide ready-made answers, but serves as a guide to the process. The text includes a chapter on each of the 10 steps.