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INTERNATIONAL CONFEDERATION OF MIDWIVES

Regulation Taskforce: Global Standards for Midwifery Regulation
Survey Form – June 2010
BACKGROUND
The ICM is developing global standards for midwifery regulation. Draft one is attached to this questionnaire. ICM seeks your feedback on the draft standards.
INSTRUCTIONS

Please read draft one of the regulation standards (attached to this document) and then complete the following survey and return by 10 July to Sally Pairman. Email response to sallyp@op.ac.nz or post to Sally Pairman, School of Midwifery, Otago Polytechnic, Private Bag 1910, Dunedin, NEW ZEALAND.


Please type responses directly into document if possible. Note that text box will automatically expand if you need more space. If a written response is easier please use extra sheets of paper as required. We are happy to receive written responses by mail or as a scanned email attachment.
Thank you very much for your assistance in this project.
Sally Pairman

Project Manager.



INFORMATION ABOUT RESPONDENT (please complete as fully as possible)


Name & title of respondent



Organisation represented by respondent




Brief description of organisation



Postal contact address



Email contact address



Date of response




Regulation Standard

Please place an X in the column to indicate your opinion about whether this standard should be retained or changed.

Your comments about each standard or your suggestions for re-wording (of the standard NOT the explanation) can be entered in this column. Please place an X in the box to indicate the intention of your response. You can provide BOTH a comment and a suggestion for rewording, if you wish to do so.

The text box will expand to accommodate

the length of your response.

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STANDARDS

1. Model of regulation

1.1 Regulation is midwifery specific
Explanation: Midwifery requires specific legislation to support autonomous midwifery practice and for the midwifery profession to be recognised as an autonomous profession.

Midwifery-specific legislation protects the health of mothers and babies by ensuring safe and competent midwifery practice.

Midwifery is not a specialty of nursing in the ICM’s model of regulation. Therefore the title ‘nurse-midwife’ is not considered in these standards. A midwifery-specific regulatory authority cannot regulate the nurse part of the ‘nurse-midwife’ title. Nor can a nursing regulatory authority regulate the midwife part of the ‘nurse-midwife’ title.







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1.2 Regulation should be at a national level
Explanation: Where possible regulation should be at a national level. However, if this is not possible there must be a mechanism for collaboration and communication between the midwifery regulatory authorities.







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2 Protection of Title

2.1 Only those authorised under relevant legislation may use the title ‘midwife’
Explanation: Mothers and their families receiving care from a midwife have a right to know that they are being cared for by a legally qualified practitioner. A legally qualified practitioner is individually responsible and accountable for her actions and is required to adhere to professional codes and standards.

Reserving the title ‘midwife’ for legally qualified midwives identifies legally qualified midwives from others who provide aspects of maternity care.

Legislative protection of the title enables the regulatory authority to prosecute someone who breaches the legislation by holding themselves out to be a midwife when they are not on the register of midwives.








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3 Governance

3.1 The legislation sets a transparent process for nomination, selection and appointment to the regulatory authority and identifies terms of appointment.
Explanation: ICM recommends a combination of appointment and election for all members of the midwifery regulatory authority because there is no evidence for any specific model of selection of members for regulatory authorities.







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3.2 The majority of members of the regulatory authority are midwives.
Explanation: Midwife members should be appointed or elected from nominees put forward by the midwifery profession. The midwife members need to reflect the diversity of midwifery practice in the country and have credibility within the profession.







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3.3 There must be provision for public representatives
Explanation: Public members of the midwifery regulatory authority should be appointed or elected from nominees put forward by consumer-based organizations rather than individual self-nomination. Public members without support from a wider consumer-based organisation can be marginalised by the professional members of the regulatory authority and their ability to provide a public perspective can be undermined.

In jurisdictions where there are indigenous peoples provision should be made to include their perspectives.

Members should demonstrate experience and expertise against pre-determined selection criteria such as broad experience in the midwifery profession; business and finance expertise; education expertise and legal expertise.







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3.4 The legislation should set out the governance structures of the regulatory authority.
Explanation: The regulatory authority has systems and processes in place to specify roles and responsibilities of board or council members; powers of the council; appointment of chairperson.

The regulatory authority determines the processes by which it carries out its functions under the legislation.







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3.5 The chairperson of the midwifery regulatory authority must be a midwife.
Explanation: The regulatory authority has systems and processes in place to specify roles and responsibilities of board or council members; powers of the council; appointment of chairperson.

The regulatory authority determines the processes by which it carries out its functions under the legislation.







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3.6 The regulatory authority is funded by the profession
Explanation: Payment of a fee is a professional responsibility that entitles midwives to obtain a license to practice if that midwife meets the required standards. Fees paid by midwives provide politically independent funding of the regulatory authority. In countries where the midwifery workforce is small or poorly paid some government support may be required. Government funding has the potential to limit the autonomy of the regulatory authority.








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3.7 The regulatory authority works in collaboration with the midwifery professional organisation.
Explanation: The regulatory authority needs to work in partnership1 with other midwifery organizations that also have a role in public safety and standard setting such as the midwifery association.

Collaboration with other regulatory authorities, both nationally and internationally, promotes understanding of the role of regulation and more consistent standards globally.

The regulatory authority’s processes should be based on principles of collaboration and consultation.







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3.8 The regulatory authority works in collaboration with other regulatory authorities.
Explanation: The regulatory authority needs to work in partnership2 with other midwifery organizations that also have a role in public safety and standard setting such as the midwifery association.

Collaboration with other regulatory authorities, both nationally and internationally, promotes understanding of the role of regulation and more consistent standards globally.

The regulatory authority’s processes should be based on principles of collaboration and consultation.







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4 Functions

4.1 Scope of Practice

4.1.1 The regulatory authority defines the scope of practice of the midwife that is consistent with the ICM definition and scope of practice of a midwife.
Explanation: The midwifery profession determines its own scope of practice rather than employers, government, other health professions, the private health sector or other commercial interests.

The primary focus of the midwifery profession is the provision of normal childbirth and maternity care. Midwives are required to demonstrate all ICM competencies regardless of setting whether it be tertiary/acute hospitals or home and community-based services/birthing centres.

The scope of practice must include prescribing rights and access to laboratory/screening services all of which are essential aspects of autonomous midwifery practice. Midwives also need to have admitting privileges, consultation and referral rights as well as access to back up emergency care for women in their case load in order to meet their scope of practice requirements.

To ensure that midwives can practice in their full scope associated non-midwifery legislation may need to be amended to give midwives the necessary practice authorities. For example, other legislation that controls the prescription of narcotics/medicines or access to laboratory/diagnostic services.








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4.2 Pre-registration education

4.2.1 The regulatory authority sets the standards for pre-registration midwifery education that are consistent with the ICM education standards.
Explanation: The midwifery profession defines the standards for education and competence required for registration. The ICM definition and scope of practice of a midwife, core competencies and standards for registration provide the framework for pre-registration midwifery education programmes. Midwives will be educated to the qualification/standard/level required for midwifery registration through the pre-registration midwifery programme.

The regulatory authority utilises a transparent process of consultation with the wider profession, maternity consumers and other stakeholders In setting standards for pre-registration midwifery education.









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4.2.2 The regulatory authority approves pre-registration midwifery education programmes leading to the qualification prescribed for registration.
Explanation: The regulatory authority establishes the processes to approve programmes and accredit education providers in order to ensure that the programmes and graduates meet the approved education and registration standards.








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4.2.3 The regulatory authority approves and accredits the education providers.
Explanation: The regulatory authority establishes the processes to approve programmes and accredit education providers in order to ensure that the programmes and graduates meet the approved education and registration standards.








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4.2.4 The regulatory authority audits pre-registration midwifery education programmes and providers.
Explanation: The regulatory authority establishes the processes for ongoing monitoring and audit mechanisms of pre-registration midwifery education programmes and providers in order to ensure that appropriate standards for education are maintained.







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4.3 Registration

4.3.1 The legislation sets the criteria for registration.
Explanation: To enter the register of midwives applicants must meet the competencies for entry to the register (refer ICM competencies); have successfully completed the approved pre-registration midwifery education programme to the required standard; meet standards of fitness for practice including being of good character (screen for criminal record), being able to communicate effectively in the professional midwifery role and having no health issues that could negatively impact on practice.







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4.3.2 The regulatory authority develops standards and processes for registration
Explanation: To enter the register of midwives applicants must meet the competencies for entry to the register (refer ICM competencies); have successfully completed the approved pre-registration midwifery education programme to the required standard; meet standards of fitness for practice including being of good character (screen for criminal record), being able to communicate effectively in the professional midwifery role and having no health issues that could negatively impact on practice.








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4.3.3 The regulatory authority develops processes for assessing equivalence of applicants for entry to the register from other countries.
Explanation: Registrants from other countries must meet the same registration requirements as local registrants. The assessment process should be comprehensive including original qualifications and post-registration experience, competency assessment and a certificate of good standing from other regulatory authorities with whom the midwife is registered. Assessment methods may include examinations and clinical assessment of competence.

Midwives from other countries who meet registration standards should be required to complete an adaptation programme to orientate to local society and culture, health system, maternity system and midwifery profession. Midwives can hold provisional registration until these requirements are met.

Regulatory authorities should cooperate and collaborate to facilitate international mobility of midwives without compromising midwifery standards or public safety.









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4.3.4 The regulatory authority maintains a public register of midwives.
Explanation: The regulatory authority demonstrates public accountability and transparency of its registration processes. Women and their families have a right to know that their midwife is registered and has no conditions on her practice.









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4.3.5 Mechanisms exist for a range of registration status.
Explanation: Legislation should include categories of registration such as provisional, temporary, conditional, suspended and full registration. The regulatory authority develops policy and processes to communicate the registration status of each registered midwife.









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4.3.6 The regulatory authority establishes pathways leading to registration for midwives from other countries who do not meet registration requirements.
Explanation: Where midwives from other countries do not meet the registration standards a range of options can be considered including examination, education programmes, clinical assessment.









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4.3.7 The regulatory authority collects data about midwives and their practice to contribute to workforce planning and research.
Explanation: The regulatory authority has a role in workforce planning. Information collected can inform pre-registration and post-registration education requirement and inform government about workforce needs and strategies.

The regulatory authority is an appropriate body to provide a national overview of the midwifery workforce for planning purposes.

Regulatory authorities may be the appropriate body to manage workforce deployment to prevent over or under supply of midwifery workforce numbers. It is an issue of public safety to ensure access to midwives for all women regardless of location.








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4.4 Continuing Competence

4.4.1 The regulatory authority implements a mechanism through which midwives demonstrate their continuing competence to practise.
Explanation: Midwifery competence involves lifelong learning and the demonstration of continuing competence for licensure.

Eligibility to continue to hold licence to practice is dependent upon the individual midwife’s ability to demonstrate continuing competence.

Assessment and demonstration of continuing competence is facilitated by a recertification or relicensing policy and process that includes such things as continuing education, minimum practice requirements, competence review (assessment) and professional activities.







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4.4.2 The legislation sets out separate requirements for entry to the register and relicensing on a regular basis.
Explanation: A requirement for regular relicensing separates the registration process for the application to practise process. Historically in many countries relicensing required only the payment of a fee. Internationally there is an increasing requirement for demonstration of ongoing competence as a requirement for relicensure of health professionals. This is achieved through the issuing of a practising certificate on a regular basis to those who meet the requirements for ongoing competence.








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