Fundamentals of Midwifery: A Textbook for Students (5 page)

The European Commission, which represents the interests of the Union as a whole.Together, these three institutions produce the new policies and laws that apply throughout the EU. In principle, the Commission proposes new laws, and the Parliament and Council adopt them. The Commission and the member countries then implement them, and the Commission ensures that the laws are properly applied and implemented.
EU directives
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purpose of the EU is to facilitate the freedom of movement of people, goods and services. In the case of seven professions who have to be registered to practice (doctors, nurses, dentists, midwives, veterinarians, opticians and architects); specific sectarian directives were developed as the EU recognised that the purpose of the registration is first and foremost the protection of the public. To ensure the protection of the public throughout the EU, directives were developed so that a minimum standard of education and practice could be identified. Midwifery education and practice are determined by the Directive 2005/36/EC of the European Parliament and of the Council (2005). This Directive has just been amended on 20 November 2013 to ensure greater efficiency and transparency with the recognition of professional qualifications and has placed value on the use of a European Professional Card (Directive 2013/55/EU, 2013).The NMC set standards for education and practice and give guidance to professionals. The latest standards for pre-registration midwifery education (NMC 2009) are guided by the inter- national definition of a midwife and the requirements of the European Union Directive Recogni- tion of Professional Qualifications 2005/36/EC Article 40 (training of midwives) and amendments to the EU Directive as stated above. These directives stipulate the experience that students must demonstrate before registering as a qualified midwife and are listed in Box 1.2.All member states that adopt this directive must ensure that midwives are at least entitled to take up and pursue the following activities listed in Box 1.3.The NMC insist that education programmes prepare students to practise safely and effectively so that, on registration, they can assume full responsibility and accountability to undertake the
Box 1.2 The European Union Article 40 (training of midwives) of Directive 2005/36/EU

Advising of pregnant women, involving at least 100 antenatal examinations.

Supervision and care of at least 40 women in labour. (The student should personally carry outat least 40 deliveries; where this number cannot be reached owing to the lack of availablewomen in labour, it may be reduced to a minimum of 30, provided that the student participates actively in 20 further deliveries.)

Active participation with breech deliveries. (Where this is not possible because of lack of breechdeliveries, practice may be in a simulated situation.)

Performance of episiotomy and initiation into suturing. Initiation shall include theoretical instruction and clinical practice. The practice of suturing includes suturing of the wound follow- ing an episiotomy and a simple perineal laceration. (This may be in a simulated situation ifabsolutely necessary.)

Supervision and care of 40 women at risk in pregnancy, or labour or postnatal period.

Supervision and care (including examination) of at least 100 postnatal women and healthynewborn infants.

Observation and care of the newborn requiring special care including those born pre-term, post-term, underweight or ill.

Care of women with pathological conditions in the fields of gynaecology and obstetrics.

Initiation into care in the field of medicine and surgery. Initiation shall include theoreticalinstruction and clinical practice.(NMC 2009)
Box 1.3 Article 42 of Directive 2005/36/EU5

To provide sound family planning information and advice.

To diagnose pregnancies and monitor normal pregnancies; to carry out examinations necessaryfor the monitoring of the development of normal pregnancies.

To prescribe or advise on the examinations necessary for the earliest possible diagnosis of preg- nancies at risk.

To provide a programme of parenthood preparation and a complete preparation for childbirthincluding advice on hygiene and nutrition

To care for and assist the mother during labour and to monitor the condition of the fetus in utero by the appropriate clinical and technical means.

To conduct spontaneous deliveries including where required an episiotomy and, in urgent cases,a breech delivery.

To recognise the warning signs of abnormality in the mother or infant which necessitate referral to a doctor and to assist the latter where appropriate; to take the necessary emergency meas- ures in the doctor’s absence, in particular the manual removal of the placenta, possibly followedby a manual examination of the uterus.

To examine and care for the newborn infant; to take all initiatives which are necessary in case of need and to carry out where necessary immediate resuscitation.

To care for and monitor the progress of the mother in the postnatal period and to give all neces-sary advice to the mother on infant care to enable her to ensure the optimum progress of thenewborn infant.

To carry out treatment prescribed by a doctor.

To maintain all necessary records.(NMC 2009)activities of a midwife as directed by the EU Directive. To meet this in the UK, the NMC expect students, at the end of their midwifery programme to demonstrate competence in the following tasks, listed in Box 1.4:
Box 1.4 Students must demonstrate competence in:

Sound, evidence-based knowledge of facilitating the physiology of childbirth and the newborn, and be competent in applying this in practice.

A knowledge of psychological, social, emotional and spiritual factors that may positively oradversely influence normal physiology, and be competent in applying this in practice.

Appropriate interpersonal skills (as identified in the Essential Skills Cluster – Communication) to support women and their families.

Skills in managing obstetric and neonatal emergencies, underpinned by appropriateknowledge.(
Continued
)

Being autonomous practitioners and lead carers to women experiencing normal childbirth and being able to support women throughout their pregnancy, labour, birth and postnatal period, in all settings including midwife-led units, birthing centres and the home.

Being able to undertake critical decision-making to support appropriate referral of either thewoman or baby to other health professionals or agencies when there is recognition of normalprocesses being adversely affected and compromised.(NMC 2009)6‌‌
The International Confederation of Midwives
In view of the Global Midwifery agenda, the International Confederation of Midwives (ICM) isactive and current. The use of global standards, competencies, tools and guidelines ensures that midwives in all countries have effective education, regulation and strong associations. The ICM has developed various interrelated ICM Core Documents, which guide Midwives Associations and their Governments to review and improve on the education and regulation of midwives and midwifery, and enable countries to review their midwifery curricula for the production and retention of a quality midwifery workforce.The ICM supports, represents and works to strengthen professional associations of midwives throughout the world. There are currently 108 national Midwives Associations, representing 95 countries across every continent. This includes the Royal College of Midwives in the UK, which is the UK’s only professional organisation and trade union led by midwives for midwives. The ICM is organised into four regions: Africa, the Americas, Asia Pacific and Europe. Together these associations represent more than 300,000 midwives globally. Its first recorded meeting was in 1919 in Belgium after World War I.
ICM Scope of Practice
. . . The midwife is recognised as a responsible and accountable professional who works in part- nership with women to give the necessary support, care and advice during pregnancy, labour andthepostpartumperiod, to conductbirthsonthemidwife’sownresponsibilityandtoprovide care for the newbornandtheinfant. This care includes preventative measures, the promotionof normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency measures.
The midwife has an important task in health counselling and education, not only for the woman, but also within the family and the community. This work should involve antenatal education and preparation for parenthood and may extend to women’s health, sexual or reproductive health and child care.
A midwife may practise in any setting including the home, community, hospitals, clinics or health units . . .
(Revised and adopted by ICM Council June 15, 2011. Due for review 2017)
Key midwifery concepts
(See Box 1.5.)
The European Midwives Association (EMA)
is a non-profit and non-governmental organisa- tion of midwives, representing midwifery organisations and associations from the member states of the European Union (EU), members of the Council of Europe, the European Economic Area (EEA) and EU applicant countries.
Box 1.5 Key midwifery concepts that define7the unique role of midwives