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© 2017 This article describes a sequence of events that led to the development of national standards for the accreditation of Australian midwifery education programmes for initial registration. This process occurred within a climate of polarised opinions about the value of the introduction of three-year degree programmes for midwives who are not nurses (known as the BMid in Australia) and concerns about the invisibility of midwifery within nursing regulation, education, policy and nomenclature. Concerted efforts to develop standards to inform the introduction of BMid programmes through a process of collective action are described. This involved arguing successfully for the positioning of midwifery as a separate profession from nursing, with a need for its own discreet regulation.

© 2015 Australian College of Midwives. Background: Papua New Guinea has some of the poorest health outcomes in the Asia-Pacific region. Maternal mortality is unacceptably high and there is a severe midwifery shortage requiring a quadrupling of the workforce. Aim: This paper outlines the findings of an evaluation of the Maternal Child Health Initiative (MCHI) (2012-2013) to determine key factors contributing to maternal health workforce strengthening. Method: A descriptive mixed methods study was undertaken. Data were gathered through interviews, focus group discussions and surveys with clinicians, midwifery students and staff from nursing and midwifery schools and National Department of Health staff. Documentation from stakeholder meetings and regular site reports were reviewed. Each data set was analysed separately and meta-inferences were drawn across all data. Findings: Learning opportunities were found to have increased for midwifery educators and improvements were described in midwifery educators teaching capacity and student clinical education experience. There was an increase in the number of midwifery graduates and improvements were noted in the working environment and skills of clinical staff. Education challenges were described including the lack of clinical preceptoring and limited continuing education for clinical educators. Participants recommended increasing clinical education hours and extending the length of the midwifery program. Ongoing efforts to accredit the midwifery curricula and regulate midwifery graduates were noted. Conclusion: The MCHI has contributed to strengthening the midwifery workforce nationally. However, scaling-up and sustaining these achievements requires leadership and funding commitments from the midwifery schools and government alongside the accreditation of midwifery curricula and regulation of new graduates.

Research question: What are the experiences of midwives working in midwifery-led models of care in NSW who undertake the credentialling process? Background: In 2005, the NSW Health Department issued a directive requiring midwives who worked in midwifery-led models of care to undergo a process known as credentialling. Credentialling involved a four-step process: self-assessment, face-to-face panel review of midwifery practice, assessment of emergency management skills and discussion of a case study from practice. Method: A descriptive exploratory study examined the experiences of the midwives who undertook the credentialling process in NSW. Data were collected through in-depth, semi-structured interviews with 12 midwives who had experienced credentialling and analysed using descriptive and thematic analysis. Findings: The themes were preparing for credentialling; doing credentialling; achieving credentialling; valuing credentialling; and, improving credentialling. Initially, the midwives were self-focused in their understanding and impressions of the value of credentialling. There were a number of contentions including seeing credentialling as another 'hoop to jump through' or a need to 'tick the box' and not as a framework for practice. Some viewed it as a necessary move to increase professionalism and facilitate practice review. Others felt they were being unfairly targeted as not all midwives were expected to undertake it. The midwives were cognisant of the need for a process that encouraged responsibility for ongoing professional development and continuing competence and believed the process would be useful in promoting deeper reflection on practice. Implications for practice: Credentialling was recognised as being valuable for all midwives to undertake as it encourages both a review of, and reflection on, practice. The process has further developed into Midwifery Practice Review (MPR) and is administered by the national professional association for midwifery. © 2011 Australian College of Midwives.

There is growing interest in the application of citizen participation within all areas of public sector service development, where it is increasingly promoted as a significant strand of post-neoliberal policy concerned with re-imagining citizenship and more participatory forms of citizen/consumer engagement. The application of such a perspective within health services, via co-production, has both beneficial, but also problematic implications for the organisation of such services, for professional practice and education. Given the disappointing results in increasing consumer involvement in health services via 'choice' and 'voice' participation strategies, the question of how the more challenging approach of co-production will fare needs to be addressed. The article discusses the possibilities and challenges of system-wide co-production for health. It identifies the discourse and practice contours of co-production, differentiating co-production from other health consumer-led approaches. Finally, it identifies issues critically related to the successful implementation of co-production where additional theorisation and research are required. © 2009 National Council of the Institute of Public Administration Australia.

Conducted as the first phase of the Improving Patient Outcomes Project, a structured literature review aimed to determine an evidence base for the development of a midwifery-led antenatal model of care. In particular, evidence was sought for those elements of antenatal care that were proven effective and were valued by women. There is good quality evidence that women are satisfied with receiving antenatal care from midwives and that antenatal visit schedules can be made more flexible. The literature provided practical assistance in defining maternity outcome measures but was not able to provide a strong evidence base for all aspects of antenatal care. This paper reports on a systematic approach to reviewing literature in which the intuitive and practical experience of expert reviewers and clinicians contributes to assessing the overall quality of currently available research evidence. This combined approach ensures a judicious and sensitive application of available evidence to the development of safe and appropriate models of care.

This research gives a voice to midwives in identifying the barriers and current problems in the organisation of maternity care in Australia. Using a critical feminist research approach, data was collected from a cross section of midwives nationally. Through standard qualitative research methods, themes were identified that enabled analysis of significant issues affecting the current status of midwifery. The system of maternity care was identified as being dominated by medicine, not evidence based and restricting of women's choices, with midwifery autonomy not recognised or supported. The invisibility of midwifery within the community was identified as a significant barrier which, in conjunction with the occupational imperialism of obstetrics, ensures ongoing strategic control of maternity services and a denial of the rights of consumers to access midwifery care.

Objective To test whether a new community-based model of continuity of care provided by midwives and obstetricians improved maternal clinical outcomes, in particular a reduced caesarean section rate. Design Randomised controlled trial. Setting A public teaching hospital in metropolitan Sydney, Australia. Sample 1089 women randomised to either the community-based model ( n =550) or standard hospital-based care ( n =539) prior to their first antenatal booking visit at an Australian metropolitan public hospital. Main outcome measures Data were collected on onset and outcomes of labour, antenatal, intrapartum and postnatal complications, antenatal admissions to hospital and neonatal mortality and morbidity. Results There was a significant difference in the caesarean section rate between the groups, 13.3% (73/550) in the community-based group and 17.8% in the control group (96/539). This difference was maintained after controlling for known contributing factors to caesarean section (OR=0.6, 95% CI 0.4–0.9, P =0.02). There were no other significant differences in the events during labour and birth. Eighty babies (14.5%) from the community-based group and 102 (18.9%) from the control group were admitted to the special care nursery, but this difference was not significant (OR 0.75, 95% CI 0.5-1.1, P =0.12). Eight infants died during the perinatal period (four from each group), for an overall perinatal mortality rate of 7.3 per 1000 births. Conclusion Community-based continuity of maternity care provided by midwives and obstetricians resulted in a significantly reduced caesarean section rate. There were no other differences in clinical outcomes.

Globally, the impact that regulated, competent midwives make to positive maternal and infant health outcomes is seen as central in efforts to accelerate progress towards the achievement of Millennium Development Goals 4 and 5. Skilled, empowered midwives earn respect from women and communities by providing competent, culturally sensitive care, but they do more than just contribute to safer childbirth. Midwives, especially those working in developing countries, are essential to ensuring access to contraception, reducing malaria and mother-to-child transmission of HIV, eradicating obstetric fistula and preventing deaths from unsafe abortions. In addition, midwives are central to addressing gender-based violence and the upholding of human rights in their communities. It is clear that ‘the world needs midwives, now more than ever’ (ICM, 2013) and yet in most countries around the world, the recruitment of sufficient number of midwives remains grossly short of identified need. Increasing the number of midwifery student places, midwifery tutors and well-equipped classrooms alone will not, however, be enough to address current critical shortages. Significantly, retention and motivational strategies also have to be high on the list of strategies within global midwifery workforce priorities. Many midwives are working in difficult, unsafe, isolated, poorly equipped environments where there are daily challenges to be overcome. Over time, this disempowers and demoralises them and impacts on their capacity to stay in their roles. This undermines global efforts to increase access to midwifery care. There is therefore an imperative for governments and funding agencies to put in place strategies to ensure that midwives are more enabled, better supported and importantly, retained over the long term.

Objective: to explore collaborative approaches undertaken to build midwifery education, regulation and professional association in low income countries and identify evidence of strategies that may be useful to scale-up midwifery to achieve MDG 5. Design: an integrative review involving a mapping exercise and a narrative synthesis of the literature was undertaken. The search included peer reviewed research and discursive literature published between 2002 and 2012. Findings: fifteen papers were found that related to this topic: 10 discursive papers and five research studies. Collaborative approaches to build midwifery capacity come mainly from Africa and involve partnerships between low income countries and between low and high income countries. Most collaborations focus on building capacity across more than one area and arose through opportunistic and strategic means. A number of factors were found to be integral to maintaining collaborations including the establishment of clear processes for communication, leadership and appropriate membership, effective management, mutual respect, learning and an understanding of the context. Collaborative action can result in effective clinical and research skill building, the development of tailored education programmes and the establishment of structures and systems to enhance the midwifery workforce and ultimately, improve maternal and child health. Key conclusions: between country collaborations are one component to building midwifery workforce capacity in order to improve maternal health outcomes. Implications for practice: the findings provide insights into how collaboration can be established and maintained and how the contribution collaboration makes to capacity building can be evaluated. © 2013 Elsevier Ltd.

Background: An appropriately educated and competent workforce is crucial to an effective health care system. The National Health Workforce Taskforce (now Health Workforce Australia) and the Maternity Services Inter-Jurisdictional Committee funded a project to develop Core Competencies and Educational Framework for Primary Maternity Services in Australia. These competencies recognise the interdisciplinary nature of maternity care in Australia where care is provided by general practitioners, obstetricians and midwives as well as other professionals. Participants: Key stakeholders from professional organisations and providers of services related to maternity care and consumers of services. Methods: A national consensus approach was undertaken using consultation processes with a Steering Committee, a wider Reference Group and public consultation. Findings: A national Core Competencies and Educational Framework for Primary Maternity Services in Australia was developed through an iterative process with a range of key stakeholders. There are a number of strategies that may assist in the integration of these into primary maternity service provider professional groups' education and practice. Conclusions: The Core Competencies and Educational Framework are based on an interprofessional approach to learning and primary maternity service practice. They have sought to value professional expertise and stimulate awareness and respect for the roles of all primary maternity service providers. The competencies and framework described in this paper are now a critical component of Australian maternity services as they are included in actions in the newly released National Maternity Services Plan and thus have relevance for all providers of Australian maternity services. © 2011 Australian College of Midwives.

Objective: To undertake a systematic review of the literature to determine whether Asian ethnicity is an independent risk factor for severe perineal trauma in childbirth. Method: Ovid Medline, CINAHL, and Cochrane databases published in English were used to identify appropriate research articles from 2000 to 2010, using relevant terms in a variety of combinations. All articles included in this systematic review were assessed using the Critical Appraisal Skills Programme (CASP) 'making sense of evidence' tools. Findings: Asian ethnicity does not appear to be a risk factor for severe perineal trauma for women living in Asia. In contrast, studies conducted in some Western countries have identified Asian ethnicity as a risk factor for severe perineal trauma. It is unknown why (in some situations) Asian women are more vulnerable to this birth complication. The lack of an international standard definition for the term Asian further undermines clarification of this issue. Nevertheless, there is an urgent need to explore why Asian women are reported to be significantly at risk for severe perineal trauma in some Western countries. Conclusion: Current research on this topic is confusing and conflicting. Further research is urgently required to explore why Asian women are at risk for severe perineal trauma in some birth settings. © 2011 Australian College of Midwives.

Background Graduates from a new, 3-year Bachelor of Midwifery program joined those educated through the 1 year, postgraduate route (for those already qualified as nurses) for the first time in New South Wales (NSW) Australia in 2007. Many hospitals offer transition support programs for new graduates during their first year of practice though there is little evidence available to inform these programs. Objectives To establish the new midwife's confidence in working to the 14 “National Competency Standards for the Midwife” 1 and the International Confederation of Midwives (ICM) Definition of a Midwife and to explore whether the new midwife's confidence changed over the new graduate year. In particular the study set out to determine whether there were any differences in the confidence of new graduates from undergraduate or postgraduate programs. Design Pre and post survey with comparisons longitudinally and within undergraduate and postgraduate cohorts. Settings Three Area Health Services in Sydney and surrounding areas, Australia. Participants A convenience sample of all new graduate midwives employed in the three Area Health Services in the early months of 2008. Methods New graduate midwives rated their level of confidence (1–10) in working to the 14 National Competency Standards for the Midwife and the ICM Definition of a Midwife during their first weeks of employment and after the completion of their first year of practice. Results Midwives prepared through the undergraduate and postgraduate routes commenced their first year of practice with similar levels of confidence. The confidence of these midwives increased modestly over the first year of practice. Those from postgraduate programs were significantly more confident than those from undergraduate programs on four competencies after the first year of practice. Participant's self reported confidence in working to the ICM Definition of a Midwife was low. Conclusions Our profession and community need strong, confident midwives and it is in all our interests to look to ways we can best achieve this. While the findings of this study should be treated with caution, this study suggests that there is room for improvement in the way we support newly graduated midwives to build their confidence over their first year of practice. Further research is needed to identify the needs of newly graduated midwives and how best we can support them to develop as strong and confident practitioners through their first year of practice.

Objective: to develop and validate national competency standards for midwives in Australia. This study was part of a commissioned national research project to articulate the scope of practice of Australian midwives and to develop national competency standards to assist midwives to deliver safe and competent midwifery care. Design: a multi-method, staged approach was used to collect data through a literature review, workshop consultations, interviews, surveys and written submissions in order to develop national competency standards for Australian midwives. Subsequently, direct observation of practice in a range of settings ensured validation of the competencies. Setting: maternity-care settings in each state and territory in Australia. Participants: midwives, other health professionals and consumers of midwifery care. Findings: The national competency standards for the midwife were developed through research and consultation before being validated in practice. Key conclusions: the national competency standards are currently being implemented into education, regulation and practice in Australia. These will be minimum competency standards required of all midwives who seek authority to practise as a midwife in Australia. It is expected that all midwives will demonstrate that they are able to meet the competency standards relevant to the position they hold. Implications for practice: the competency standards establish a national standard for midwives and reinforce responsibility and accountability in the provision of quality midwifery care through safe and effective practice. In addition, individual midwives may use the competency standards as the basis of their ongoing professional development plans. © 2006 Elsevier Ltd. All rights reserved.

INTRODUCTION: Telecommunication infrastructure is being rolled out across Australia with little knowledge about the uptake by health professionals in remote areas. Computer mediated communication has the potential to offer educational support to remote practitioners; however, the viability of this is uncertain. The aim of this research was to establish and evaluate an internet-based resource library targeting the needs of remote area maternity service providers. METHODS: A participatory action research (PAR) approach was used to involve remote area maternity service providers in the Northern Territory of Australia. The evaluation of the resource library included its performance on reach, agency affiliation and richness, factors identified to affect the sustainability and utility of such a resource. An additional component of the evaluation framework documented the facilitators of and barriers to using an information technology strategy to reduce the isolation of remote area maternity service providers. RESULTS: Overall, the evaluation of the resource library was very positive. Feedback from the PAR team described the resource as contemporary, useful and relevant. Practitioners in leadership and education positions identified the resource library as a valuable tool that enabled them to access professional knowledge, which could then be distributed to any remote-based practitioners, who experienced difficulties with access themselves. The evaluation found that logistical issues were a major problem for potential users. Hardware inadequacies, access difficulties, unfamiliarity with computers, and a lack of management support for nursing and midwifery staff to utilise the resource, were all identified barriers. Remote-area practitioners highlighted education, training and 24 hour support as key priorities. CONCLUSIONS: Results from this research clearly showed the potential of web-based resources to offer educational support through access to clinical guidelines, reports and research, thus reducing the isolation of the remote practitioner. However, it highlighted the need for clear strategic direction at policy level, whereby all stakeholders unite to synchronise the rollout of information technology infrastructure with the necessary education, training and support as an integral component.

Summary Objective to research the role of midwives in Australia from the perspectives of women and midwives. This study was part of a commissioned national research project to articulate the scope of practice of Australian midwives and to develop national competency standards to assist midwives to deliver safe and competent midwifery care. Design a multi-method approach with qualitative data collected from surveys with women and interviews with midwives. Setting participants represented each state and territory in Australia. Participants midwives who were randomly selected by the regulatory authorities across the country and women who were consumers of midwifery care and involved in maternity activism. Key conclusions midwives and women identified a series of key elements that were required of a midwife. These included: being woman centred; providing safe and supportive care; and working in collaboration with others when necessary. These findings were consistent with much of the international literature. Implications for practice a number of barriers to achieving the full role of the midwife were identified. These included a lack of opportunity to practice across the full spectrum of maternity care, the invisibility of midwifery in regulation and practice, the domination of medicine, workforce shortages, the institutional system of maternity care, and the lack of a clear image of what midwifery is within the wider community. These barriers must be addressed if midwives in Australia are to be able to function according to the full potential of their role.

Objective:This study evaluated women's perceptions of a new community-based model of continuity of antenatal care, the St George Outreach Maternity Project (STOMP). The model was established in an attempt to address some of the ongoing concerns and criticisms regarding antenatal care in Australia: lack of continuity of care and caregiver; prolonged waiting times; and inaccessible clinics. Methods:A randomised controlled trial was conducted with 1,089 women (550 in the experimental group and 539 in the control group). The experimental group (the STOMP group) received antenatal care from small teams of midwives and an obstetrician in community-based settings. Data were collected using a questionnaire administered at 36 weeks' gestation, with a response rate of 75%. Results:Women in the STOMP group reported waiting significantly less time for antenatal visits with easier access to care. STOMP group women also reported a higher perceived ‘quality’ of antenatal care compared with the control group. STOMP group women saw slightly more midwives and fewer doctors than control group women did. Conclusion and implications:This model of care has implications for the planning and provision of antenatal services within the Australian public health system, which is increasingly moving towards a community-based emphasis. Antenatal care is a service that can be successfully transferred into community-based settings with benefits for women.

We write in response to a letter from the Chair of the Nursing Board of Northern Territory that was published in Issue 25 number 3 of the AHR, in respect to our paper on midwifery regulation that was published in Issue 24 number 4. The Chair of the Nursing Board raised three matters, and we will cover them in turn.

This paper, which is based on the preliminary findings of the Australian Midwifery Action Project (AMAP), outlinesthe issues around the midwifery labour force and education in Australia. One of the most alarming features is thelack of comprehensive data on midwives. Where data is available it demonstrates the shortage of midwives and thelack of consistency in educational programs for midwives within states and nationally. It is difficult to form a nationalpicture with published sources of data because there are differences in definition and a lack of relevant information.Strategies for educational reform are discussed in relation to improving the supply and preparation of midwives.