ACDM
California College of Midwives
Jan 2003 Principles of Mother-Friendly Childbearing Services Part 6 ~ Generally Accepted Practices for Community-based Midwifery Practice
Competencies of California Licensed Midwives -- ~ Adapted from the practice guidelines of the College of Midwives, British Columbia, Canada
(consistent with but not limited to those identified in the LMPA)
The central challenge for California midwifery programs are to develop educational processes which promotes the acquisition of essential midwifery knowledge and skills while embracing the philosophy of midwifery care. The midwife, as a primary health care professional, must be able to provide responsive holistic care and advice to women and their families during the childbearing experience.
The midwifery education program needs to foster the development of sound practical skills based on and reinforced through clinical experience. Participants should be prepared to assume roles in education, health promotion, and counseling related to childbearing and transition to parenthood. Programs should provide opportunities to develop and use clinical judgment, critical thinking, communication, collaboration and research skills necessary to provide family-centered care in all birth locations, ideally providing experience in both domiciliary and institutional settings. Training programs should also help participants develop a sensitivity toward women's and children's health issues related to childbearing from a global perspective.
GENERAL COMPETENCIES
Professionally-licensed Midwives have the knowledge and skills necessary to:
1. provide responsive holistic care and advice to the woman and her family before and during pregnancy, labor, birth and the postpartum;
2. provide care which responds to client diversity;
3. provide education, health promotion and counseling related to childbearing, transition to parenthood and family planning for the woman, her family and the community;
4. facilitate informed decision-making;
5. assist the woman and her family in planning for an appropriate place of birth;
6. provide care in a variety of settings including hospitals, clinics, health units, community health centers, birth centers or homes;
7. promote normal parturition -- spontaneous labor and physiological birth;
8. conduct births and care for the newborn on their own responsibility;
9. identify risk factors before and during pregnancy, during labor, birth and the postpartum period and take appropriate action;
10. order, perform and interpret results of screening and diagnostic tests consistent with the California LMPA;
11. identify abnormal conditions, recommend and initiate appropriate treatment and make referrals, as required;
12. provide objective information regarding the risks and benefits of and alternatives to obstetrical treatments and interventions;
13. use technology appropriately;
14. administer drugs and substances consistent with the California LMPA;
15. establish and maintain comprehensive, relevant and confidential records;
16. use basic life support and other emergency measures when necessary;
17. interpret research findings and apply them to midwifery practice;
18. practice in an ethical manner.
SPECIFIC COMPETENCIES
I. Antepartum Care
A. Midwives have knowledge of:
1. the importance and functions of pre-pregnancy counseling;
2. general anatomy and physiology;
3. anatomy and physiology of the reproductive systems;
4. physical, emotional, sexual and social changes associated with pregnancy;
5. physical, emotional, sexual and social factors likely to influence pregnancy outcome;
6. selected aspects of genetics, embryology and fetal development;
7. nutritional requirements during pre-conception and pregnancy;
8. the physiology and management of common discomforts during pregnancy;
9. methods for diagnosing pregnancy, establishing due date, assessing gestational age and assessing the progress of pregnancy;
10. screening and diagnostic tests used during pregnancy;
11. uses and interactions of any drugs and substances that may be used during pregnancy;
12. complementary therapies which may be used during pregnancy;
13. environmental, occupational, genetic, biological and pharmacological hazards to the woman and the fetus;
14. causes, recognition, treatment and management of abnormalities and variations of normal which may occur during pregnancy;
15. sexually transmitted diseases, vaginal infections and their impact on pregnancy.
B. Midwives have the ability to:
1. obtain a comprehensive health history;
2. perform a complete physical examination;
3. confirm pregnancy;
4. assess general nutritional status and provide or recommend appropriate counseling;
5. manage common discomforts associated with pregnancy;
6. assess fetal well-being;
7. assess for sign and symptoms of abnormal conditions;
8. obtain the necessary specimens to determine the presence of sexually transmitted diseases, vaginal infections and cytological changes;
9. perform venipuncture and finger puncture;
10. provide information and resources to the woman and her family regarding newborn behavior, developmental needs, nutrition, feeding and care;
11. provide information and resources to the woman on the benefits and practice of breastfeeding;
12. administer drugs and substances consistent with the California LMPA;
13. use or recommend appropriate complementary therapies.
II. Intrapartum Care
A. Midwives have knowledge of:
1. the process of parturition, including the mechanisms of normal labor and birth its variations;
2. fetal and maternal anatomy as relevant to assessing fetal position and the progress of labor;
3. indicators of maternal and fetal well-being;
4. requirements for a safe birthing environment;
5. comfort and support measures during labor and birth;
6. holistic approaches to facilitate labor and birth;
7. fetal heart rate patterns;
9. significance of ruptured membranes and methods of reducing risk of infection;
10. abnormalities of labor and birth and emergent conditions that may require immediate intervention by the midwife;
11. prevention, assessment and management of exhaustion and dehydration during labor;
12. techniques to protect the perineum, avoid episiotomy and minimize lacerations;
13. indications and procedure for episiotomy;
14. indications and procedure for repair of lacerations or episiotomy;
15. care during the 3rd stage of labor;
16. prevention and treatment of hemorrhage;
17. drugs and complementary therapies which may be used during the intrapartum period;
18. obstetrical interventions used to assist labor;
19. obstetrical interventions used in emergency care;
20. neonatal resuscitation (including intubation if successful completion of a recognized neonatal advanced life support program providing appropriate hands-on experience).
B. Midwives have the ability to:
1. provide the emotional and physical support to the laboring woman and her support people.
2. assess the onset and progress of labor and take appropriate actions according to:
(i) frequency, duration and intensity of uterine contractions;
(ii) fetal station, position, presentation, attitude and degree of molding;
(iii) condition of the cervix;
3. recognize abnormal labor patterns and identify the probable cause(s);
4. assess fetal heart tones by intermittent auscultation and electronic means, including ability to discern long-time FHT variability and record on a graph;
8. aseptic technique;
5. determine the status of fetal membranes and perform amniotomy;
6. assess amniotic fluid;
7. recognize factors which could impede labor progress;
8. recognize a full bladder and catheterize;
9. assess the need for relief of pain and intervene using non-pharmacological and
pharmacological measures as required;
10. give injections, insert an intravenous catheter and administer intravenous fluids and medications;
11. protect the perineum, avoid unnecessary episiotomy and minimize lacerations;
12. perform an episiotomy when medically emergent circumstances require;
13. assist and support the spontaneous vaginal birth of the baby and placenta;
14. recognize signs of placental separation;
15. collect cord blood;
16. examine the placenta, membranes and cord;
17. examine the perineal and vulval areas for lacerations, hematomas and abrasions and repair lacerations or episiotomy;
18. recognize and manage postpartum hemorrhage, including the manual removal of a retained placenta in emergent circumstances when transport is unavailable or ill-advised
19. recognize signs of maternal shock, initiate treatment and perform ongoing assessment;
20. perform immediate newborn assessment and care;
21. perform neonatal resuscitation;
22. encourage and assist with the initiation of breastfeeding.
III. Postpartum Care of the Woman
A. Midwives have knowledge of:
1. anatomy and physiology of the woman during the postpartum period;
2. postpartum discomforts and their management;
3. methods to assess and manage postpartum complications;
4. emotional, psychosocial and sexual aspects of the postpartum period and early parenting;
5. nutritional requirements of the woman during the postpartum period;
6. methods of birth control and family planning and their risks and benefits.
B. Midwives have the ability to:
1. assess the health and monitor the progress of the woman in the postpartum period;
2. assist the mother to establish and maintain breastfeeding;
3. provide information and resources to the woman and her family regarding self-care, normal postpartum progress and signs and symptoms of common postpartum complications;
4. manage postpartum complications;
5. counsel the woman and her family in the choice and use of contraceptive methods;
6. fit diaphragms and cervical caps.
IV. Care of the Newborn and Young Infant
A. Midwives have knowledge of:
1. anatomy and physiology of the newborn;
2. methods of newborn assessment and gestational age assessment;
3. nutritional needs of the newborn and properties of breast milk and breast milk substitutes;
4. methods of infant feeding;
5. newborn screening methods and diagnostic testing;
6. growth, development and developmental needs of the newborn;
7. signs and symptoms of abnormal conditions in the newborn;
8. prophylactic medications commonly given to the newborn;
9. effects of drugs on the newborn;
10. safety needs of the newborn;
11. issues related to circumcision.
B. Midwives have the ability to:
1. perform a newborn assessment and provide care at birth;
2. perform a comprehensive newborn exam;
3. administer medications to the newborn;
4. perform a heel puncture to obtain samples;
5. assess the ongoing well-being and development of the newborn in early infancy and make appropriate referrals as necessary;
6. provide information and resources to the woman and her family regarding newborn growth, development, behavior, nutrition, feeding and care;
7. provide information to parents regarding immunizations.
V. Breastfeeding
A. Midwives have knowledge of:
1. anatomy and physiology of lactation;
2. health benefits of breastfeeding;
3. the normal breastfeeding process and necessary conditions and factors for its success;
4. emotional, social and psychological aspects of breastfeeding;
5. the influence of environmental, occupational, biological and pharmacological factors on breastfeeding;
6. stimulation and suppression of lactation;
7. management of common breastfeeding problems.
B. Midwives have the ability to:
1. assist the woman to initiate and maintain breastfeeding;
2. use assistive devices and complementary therapies to support breastfeeding;
3. identify special, unusual or abnormal maternal or infant situations and develop an appropriate plan of action.
VI. Education and Counseling
A. Midwives have knowledge of :
1. principles and processes of informed decision-making;
2. principles of adult education, communication and counseling;
3. theoretical approaches to prenatal and parenting education;
4. family theory;
5. grief and loss;
6. available community resources;
7. cultural influences on childbearing and child rearing;
8. the impact of life experiences on childbearing;
9. the role of midwives as preceptors for learners;
10. principles of mentoring.
B. Midwives have the ability to:
1. provide objective information about care alternatives to facilitate informed decision making;
2. communicate effectively with the woman, her family, and their support people;
3. identify and respond to the woman and her family's educational and counseling needs;
4. assist the woman and her family in planning and preparing for the birth experience and early parenting;
5. assess the emotional status of the woman;
6. provide prenatal and parenting education;
7. respond sensitively to cultural differences in providing care to the woman and her family;
8. work with and in groups;
9. support and evaluate student learning.
VII. Sexuality
A. Midwives have knowledge of :
1. physiological and psychosocial aspects of human sexuality;
2. physiological and psychosocial aspects of human fertility;
3. human sexuality during the childbearing cycle;
4. infertility and its implications for midwifery care;
5. counseling and resources for unexpected pregnancies.
B. Midwives have the ability to:
1. inform and advise the woman and her family on issues of human sexuality and make referrals where appropriate.
VIII. Collaboration with Other Caregivers
A. Midwives have knowledge of:
1. the role and responsibilities of other health care providers and their standards of practice;
2. the process of team-building and engaging in professional partnerships.
B. Midwives have the ability to:
1. communicate effectively with other caregivers, facilitating referral, consultation and collaboration when appropriate.
IX. Professional, Legal and other Cornerstones of the Profession
A. Midwives have knowledge of:
1. current issues in midwifery at local, state, national and international levels;
2. the structures and processes of the health care system;
3. key historical developments in health care as they relate to midwifery;
4. selected health policies in the state, national and international context;
5. the process of policy analysis and policy development;
6. the politics of health care as it relates to women's health;
7. the history, philosophy and nature of the midwifery profession;
8. the structure and function of professional midwifery organizations;
9. legislation and regulations governing midwifery in California;
10. legal aspects of midwifery practice including, but not limited to, duties and responsibilities of the midwife, privacy and freedom of information, informed consent and informed choice and recording and reporting;
11. the College of Midwives Code of Ethics and ethical frameworks guiding midwifery practice;
12. frameworks and methods for assessing evidence for practice;
13. entrepreneurial frameworks and midwifery practice management.
Adapted from the British Columbia, Canada's Competencies of Registered Midwives as documented on January 27, 1997
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