Friday, January 21, 2011

Eligible Midwives

Notation on the Register of Midwives as an 'eligible midwife' enables that midwife to apply to Medicare for a provider number, thereby providing rebate from the Australian government's Medicare program on certain midwifery services. Eligible midwives will also be able to prescribe certain scheduled medicines, after completion of an approved course of study, and after State and Territory laws have been amended to allow midwives to prescribe.

The national Nursing and Midwifery Board of Australia's (NMBA) Guidelines and Assessment Framework for Registration Satandard for Eligible Midwives and Registration Standard for Endorsement for Scheduled Medicines for Eligible Midwives (pictured above) is available for downloading as a .pdf document at the Codes and Guidelines section of the NMBA website.

The Requirements are as follows (copied without editing from the Guidelines document)
To be entitled to be identified as an eligible midwife, a midwife must be able to demonstrate, at a minimum, all the following:
(a) current general registration as a midwife in Australia with no restrictions on practice
(b) midwifery experience that constitutes the equivalent of three years’ full-time post initial registration as a midwife
(c) current competence to provide pregnancy, labour, birth and postnatal care to women and their infants
(d) successful completion of an approved professional practice review program for midwives working across the continuum of midwifery care
(e) 20 additional hours per year of continuing professional development relating to the continuum of midwifery care
(f) formal undertaking to complete within 18 months of recognition as an eligible midwife, or the successful completion of
(i) an accredited and approved program of study determined by the Board to develop midwives’ knowledge and skills in prescribing, or
(ii) a program that is substantially equivalent to such an approved program of study, as determined by the Board.

In order to demonstrate part (c) current competence ..., the Board has noted that more than one reference may be required to ensure that all aspects of the midwife's performance and scope of practice are addressed. In an undated statement from the Board, titled 'Professional Practice Reference/s to support an application for notation as an Eligible Midwife to the Nursing and Midwifery Board of Australia', two options for references are given. The referees suggested are a 'Midwife Manager', an obstetrician, or (unspecified) member of the multidisciplinary team.

The referee is required to provide their own professional registration and employment details, and:
"In addition the referee must note their professional relationship with the applicant midwife, including the time period of that professional relationship.

"The following aspects of the midwife’s performance and detail of the scope of midwifery practice are required to support the application.

"The referee should address the applicant midwife’s performance in relation to the four competency domains as described in the ANMC National Competency Standards for the Midwife 2006.

"The referee needs to address how the applicant midwife is qualified to provide pregnancy, labour, birth and post natal care to women and their infants; including the capacity to provide associated services, and order diagnostic investigations; appropriate to the eligible midwife’s scope of practice. This includes whether the applicant midwife has the skills, knowledge and attitudes expected of a midwife to work within the midwifery scope of practice which includes giving:

"the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant. This care includes preventative measures, the promotion of 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

"(excerpt from International Definition of the Midwife, adopted by the International Confederation of Midwives Council meeting, 19th July, 2005, Brisbane, Australia)."

The midwife applying for notation, in the mind of the author of this requirement, would appear to be a person who is currently in the employ of a hospital, and who wants to launch out into private practice. That midwife, who has possibly been employed in a caseload program within the hospital, would ask the midwife manager to write a reference, being careful to state all the important points noted above. The midwife would perhaps also ask an obstetrician who works at the hospital to attest to her/his competence to recognise abnormalities and complications, and to refer and collaborate appropriately. Perhaps also a paediatrician would be kind enough to give a reference, covering the midwife's practice as regards newborn care. A lactation consultant could write a reference with regards to breastfeeding.

A midwife in private practice who has not worked in a hospital unit for some time would not be known by either the midwife manager, the obstetrician, the paediatrician, or the lactation consultant. If that midwife asked one of these members of the hospital's multi-disciplinary team to write a reference confirming the midwife's competence across the full scope of midwifery practice, as defined by ICM (2005), it is likely that any such person would, at the best, be able to confirm that only a small fragment of the midwife's practice appears to be good. It is possible that some members of the multidisciplinary team would be reluctant to put their professional reputations on the line in the way required, for a variety of reasons. Competition for business may be considered.

A privately practising midwife's professional practice review, however, gives clear evidence of the midwife's caseload, a summary of outcomes, examples of referral and transfer of care, and reflective accounts outlining the way in which the midwife acted to fulfil her/his duty of care as described in the Definition (ICM 2005) and in Australian codes and competency standards - all without any potential conflict of interest such as is obvious in the previous example.

The Board's processes should be workable, and should not disadvantage any group within those who are expected to apply for notation as eligible midwives.

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